Such an inflammation is the result of phlegmonous processes in the neighboring cellular tissue. The symptoms are much more marked than in case of inflammation of a retention cyst, seeing that the pain extends to the ischia, the pubes, and the thighs, torments the patient and results in constitutional disturbance. The inflammation which has invaded the surrounding cellular tissue, the intralobular tissue, and the individual lobules, rapidly becomes purulent, and the labium increases greatly in size, I have seen it the size of a goose-egg, and this is accompanied by pain and tension in the neighborhood. After a certain period there occurs rupture, and usually on the inner side, the mucous membrane, where the gland lies nearest the surface. The discharge ordinarily con sists of foul, discolored pus, which is mixed with the secretion and in consequence is thick. In case of more than one abscess there are a num ber of rupture sites with separate fistulous tracts communicating one with another. After cure, hence, there are a number of cicatricial de pressions.
Seeing that occasionally condylomata develop from the base of the tumor, and it is very difficult to treat them effectively, the question arises as to whether gonorrhoea does not play a part in these affections. Re currence is very frequent, even as is the case with other lobular glands, the mamma; for instance. The result is that patients who object to ex cision are subject to having an abscess every four weeks.
The diagnosis is not difficult and need only be made from ordinary abscesses of the labia majora. ElEematoma is to be differentiated by its bluish color and the absence of pain, and hernia by the tympanitic percus sion note.
The treatment is at the outset an antiphlogistic one, and as soon as an abscess forms it is to be freely laid open and its cavity packed with iodoform gauze. Simple incision will only exceptionally suffice, in case of the existence of only one cavity, for instance; but where there exist a number of small abscesses even the iodoform packing may not answer. In case of recurrence the entire gland must be out out. We have had a case of the kind: A young widow, who at her last confinement had been very ill, came to me with abscesses in both the labia. She had not had painful micturition, but during her last pregnancy had suffered from a profuse discharge accompanied by great burning of the external genitals. A year afterwards the abscesses appeared. The first and largest was on the left labium. It was incised and very foul pus let out. When the cyst refilled excision was advised, but she refused. There were numer ous recurrent attacks, and she married again. She became pregnant, and every four weeks an abscess formed and ruptured, first on one labium and then on the other. About the seventh month of gestation, she finally insisted on an operation for radical cure, even at the risk of inducing premature labor. The operation was performed, but union by first in tention did not occur. The pregnancy was not interrupted. Since then I have on two occasions extirpated the glands with good results. In neither instance was anything definite in regard to etiology obtained.