Neuronia. —Only two instances of neuromata have been recorded. In Simpson's case there were sub-cutaneous painful nodules near the meatus urinarius.
Kennedy describes small sensitive nodules, often only to be detected by a magnifying glass, which he calls " sensitive papillae and warts." They are found on the nymph and in the vestibule, and result after delivery from imperfectly healed ulcerations. According to him they are hyper trophic granulations which were not fully organized and were not covered with normal epithelium. He advises their removal with the scissors.
Cysts.—Aside from those of the glands of Bartholin, cysts form in the labia the origin and cause of which is unknown. They may be retention cysts. The ducts of Gartner open into the urogenital sinus, and these might develop into cysts. An instance of this kind has been recorded by Hoen ing, although here the cyst extended between the walls of the vagina—how far is not stated. The cysts forming in Gartner's ducts are not in the labia but next to the vagina, and the contents, usually a clear fluid, may be seen through the walls. In case of cysts of the vulva this is not possible. Kocks has recently claimed that the extremity of Gartner's duct, which remains patent in certain mammals, the cow for instance, is very con stantly found in the human female as a blind short cul-de-sac near the meatus urethrae. The position of cysts of the labia majora, however, makes it questionable as to whether they may be formed out of Giirtner's canals.
Cysts of the vulva develop occasionally superficially, sometimes in the deeper parts, and may occupy and distend the entire labium. They are found in variable sizes, from that of a pea to that of a child's head. It often happens that there exists only one cyst in the labitun, and the lar ger the cyst the greater the probability of the existence of a single one. When two or more cysts are present near one another the tumor in its en tirety is apt to be small. As a rule the cysts are unilocular, while in case of cysts of the Bartholinian glands they are apt to be multilocular, although in Werth's case the cyst was unilocular. The contents are usually serous, sometimes clear, and again cloudy. At times it is slimy or colored a choco late brown, which certainly leads to the supposition that such cysts are related to the glands of Bartholin. Certain authors have recorded in
stances of fatty degeneration of the contents and of dermoid cysts. The walls of the cyst are of varying thickness. The inner surface is, as a rule, smooth and covered with laminated epithelium, the external surface being in close connection with the surrounding cellular tissue. When these cysts develop downward so as to distend the labia, they may, as in recorded instances, dissect upwards towards the pelvic cavity or between the vagina and urethra. Such cases suggest naturally that the cysts were from Gartner's canals.
Research must prove as to whether glob's belief is correct or not, that is as to whether a portion of the cyst develops from encapsulation of blood extravasations, and a portion from ectases of the lymph-vessels. The last supposition would seem to hold analogically from what happens in other parts of the body, for example, on the neck of the new-born child. Werth states as the etiology in his case that an anomalous conglomeration of the epithelium leads to glandular formation, and that through secretion and pressure the cystlet developed.
The symptoms. so long as the cyst is small, are practically nil.. When larger it interferes with function even as do other growths on the geni tals. Disease only in reality is present when the cyst becomes inflamed. There appear fever, pain, and practical inability to walk or to work. The contents become purulent and offensive. If spontaneous rupture occurs there is only palliation of the symptoms, since thus entire empty ing of the cyst is not possible, and it refills with recurrence of the same symptoms.
The diagnosis is never difficult, because where fluctuation is not ob tainable the tumor may be punctured with the hypodermic needle. Operative means are necessary for cure. Waiting for spontaneous rup ture or attempts to cure by incision, are not at all harmful, but the strict curative method is extirpation of the cyst. To cause obliteration of the cyst it may be packed with cotton dipped in iodine. Extirpation is diffi cult according to the size and extent of the cyst and its union with the cellular tissue.