DISEASES OF THE BARTHOLINIAN OR COWPER'S GLANDS.
Huguier called these glands the vulvo•vaginal. As a rule Cowper's glands in the female have the size and the shape of a bean (about .7 of an inch long.) They lie with their long axis coincident with that of the labia majors, and are deep-seated. In thin women they may be felt in the lower part of the labia majors by grasping this part between the thumb and the fore-finger. The gland is about three quarters of an inch from the surface of the labium majus, and we must incise to this depth, in order to expose it. Generally, it is composed of one or more lobes, which extend into the muscular substance. These lobes are cov ered by the same cylinder epithelium as is its analogue in the male (Henle). The ducts of the glands converge towards the apex into the common duct, which is about three quarters of an inch long, and from .039 to .08 of an inch in width. The glands are surrounded by the muscular bundles of the bulbo-cavernosus which cover its external surface entirely, and only in part its inner surface (Henle). The duct admits the passage of a fine hypodermic needle point. It extends from the upper border of the gland at right angles to it, against the labium minus, is covered by the muscular fibres of the constrictor cunni, and opens in the vestibule in front of the hymen, about one inch from the mid-line. In women who have borne children, and where only the carunculfe myrtiformes remain, the opening of the duct is very easy to find, since it ordinarily lies to the outside of such a caruncle.
The glands secrete a grayish white slimy mucus, and this is the fluid which moistens the genitals during copulation, and since the gland is surrounded by the fibres of the bulbo cavernosus, is probable that ejacu lation is caused by the contraction of this muscle. In these mints these glands are again analogous to Cowper's glands, and Rot to the prostate of the male.
Disease of these glands is very frequent, and we believe that gonor rhoea is by far the most frequent cause.
Inflammation and Occlusion of the Duct. —The cause of occlusion is the same as holds for other ducts in the body. Any inflammation in the neighborhood of the duct and extension into it, leads to swelling of the mucous membrane and occlusion. As the result of vulvitis in particular, the gonorrhoeal form of condylomata, which spread over the opening of the duct, there occurs swelling of the mucous membrane, and narrowing and obliteration of the duct. The tumors reach the size of a goose to a hen's egg, although they are not necessarily painful. They only interfere in sitting, standing, walking, and in copulation, and may from mechani cal irritation become painful. Long retention leads necessarily to disten sion of the canals of the glands, but there is also present a widening of the duct itself, whereby the secretion may flow out. The distension is, of
course, the source of discomfort, and the emptying gives great relief, but the occlusion of the duct speedily occurs again.
We have already given it as our opinion, that some inflammatory pro cess must precede the development of these affections, that they cannot, in a word, occur as the result of some pure mechanical cause. It so hap pens that the inflammatory process is localized and then the duct is little affected or greatly so. Through extension of the inflammatory process the secretion becomes more or less purulent, and through partial occlu sion of the duct or through its obliteration, there results a retention cyst of the Bartholinian gland. As a rule inflammation of the duct is the re sult of extension of gonorrhoeal catarrh, and the hypersecretion may be due to a catarrh. Often cases of intractable and recurrent gonorrhoea is dependent on this duct, where the incarcerated secretion acts as a focus of regeneration of the gonorrhoeal virus, and thus leads to recurrent at tacks. This affection is seen at its best in prostitutes and kept women. From Breton's researches it has been proved that a gonorrhoea of long duration generally has its principal seat in this duct, and that from here the germ emanates. Zeiss] is of the opinion that the disease remains in this duct long after the cure of a vaginal and a vulvar catarrh, and that the physician who is not aware of this fact may fall into decided error. The treatment, hence, must be directed toward preventing this retention, and therefore the causal factor of recurrence. The best means to this end is the injection of the duct with a solution of nitric acid through a small canula, the thickness of a Pravatz syringe. If the duct is not per meable to the syringe, puncture is of no utility, since the artificially made canal closes soon afterwards and retention of secretion again occurs. Far preferable to these injections is slitting of the duct with a small protected bistouri, such as ophthalmologists use for incision of the lachrymal duct. I have often done this with the best results. Through the small incision the cyst and its duct are packed with iodoform gauze. Much pressure on the cyst from within outward should be avoided, lest it rupture and its contents become extravasated into the surrounding cellular tissue. The mouth of the duct is best found by pulling the labium apart with one hand, and then with the other hand or with dressing forceps pulling the remains of the hymen inwards towards the median line. Above the duct of Bartholin's gland lie two small mouths of mucous glands, which belong to the superficial mucous membrane, and these may lead to error.