The fluid contents were exactly like those found in dermoid cysts, al though neither hair nor teeth were present. The wall of the cyst was covered with pavement epithelium. After emptying the cyst the finger could be passed above the pelvic inlet and could feel the upper end of the ovary. The cyst quickly shrunk. There is no statement in regard to the texture of the cyst.
The reasons for the belief in the development of vaginal cysts from remnants of Gartner's duct are their deep seat more to one side, and their mucous covering with an epithelial layer, which from the method of devel opment of the epithelium need not necessarily be simply cylindrical. Not much e,an be said in regard to difference in structure between cysts from Maller's and from Wolff's ducts. Presumably the cysts from Mailer's ducts should show greater development of the papillEe of the mucous membrane. The only valuable differential diagnostic point is the fact that cysts from Wolff's ducts may extend above the fornix vagintv into the broad liagment up to the neighborhood of the ovary, and this can never happen in case of those from Mfiller's ducts. The difficulty in differentiation is, however, still great, and we must await further obser vations.
As regards the origin of the vaginal cysts from the vaginal glands (von Preusen), although exceptional, it has been proved by a number of ob servers. C. Huge determined this in a case of hEematocolpos internally to the hymen; Hiickel and Heitzmann have observed e,ases exactly like von Preusen's. These cysts may be recognized by their structure, that . is to say, as C. Huge has shown, they are regularly lined with cylinder epithelium, and are better explained on the assumption that they are re tention cysts of the glands, thau in any other way.
Winckel's suggestion that these cysts result from obstruction of the mucous follicles of the vagina, or the belief that they are due to dilated lymph vessels (Klebs), cannot be excluded; the present results of exami nation, however, do not point to such conclusions.
More readily explainable are the cystic tumors which partially develop from the peri-vaginal connective tissue, and the contents of which are at times hemorrhagic, at times pale, watery or slimy. The first are the result of trauma—hematoma after a fall, after labor (Sanson, Winckel); the latter, as Verneuil has shown, result from the collection of serum in the loose cellular tissue between the rectum and vagina, the cause of which is re laxation of the vaginal wall from traction or pressure. When there is
collection of much fluid, there is cystic projection toward the vagina, that is to say, a hygroma recto-vaginale.
Although the anatomical examination 'of cysts of the vagina prove that they are of varied origin, this is still more apparent from the clinical findings. Cystic tumors growing down towards the vagina from neigh boring organs or tissue cannot sometimes be differentiated from those which arise from the vagina. Miami has recorded an instance of such a tumor with atheromatous and dermoid-like contents; Paul has reported a peculiar case where a cystic tumor pushing down the posterior vaginal wall proved an obstacle to labor; and after the mucous membrane had yielded longitudinally, a black body, the size of a man's fist, project,ed, the contents of which was a black fluid in which were pale gray, shiny bodies the size of a bean. That he wits not dealing, as in Sucro's case, with a tear in the posterior vaginal fond x, with prolapse of an ovarian cyst, is proved by the thinness (tf the walls of the tear in the vaginal covering of the tumor, and by the fact that the puerperium was undisturbed.
Although no anatomical examination was made, still this cyst of Paul's was probably an echinococcus-eyst. Latterly, Schatz, in a valuable paper on echinococci of the genitals and the pelvis in the female, has collected a number of such cysts, in part lying between the vagina and bladder (Hill, Eldridge), and in part between the rectum and vagina, in which number Paul's is included (Park, Blot, Paul, Schatz, Sibille). Possi bly the crypts near the orifice of the urethra, which are occasionally long ducts, may be converted into retention cysts. Von Preusen has reported an instance Where a gland of the urethra developed into a cyst the size of a walnut and was prominent in the vagina. Belfield noted the presence of considerable bending and flexion in the course of Morgagni's lacunw of the posterior urethral wall, and considered this a favomble cause for the development of retention cysts in the female.