and likely to prove fatal. Women are sometimes hurt in this way, with sharp-pointed splinters or sticks, when sitting or falling; and I think that these copious bleedings are more commonly derived from laceration of the bulbs, or of the pars intermedia, than from wounding of parts behind the symphysis; for, although there be blood vessels within, these outside ones are not only the most exposed, but they furnish the most copious outpourings, and these cases require to be understood in order to be well managed. If I should have a case of the kind to treat, I would make a tamponade for the purpose, causing the vulva to bulge more outwards, or to be as convex as possible, and then I would lay upon the ramus of the pubis and on the face of the symphysis, masses or trusses of scraped lint or raw cotton, which I should confine by a closely drawn T bandage. I have no doubt that such a dressing would suffice instantly to control the most desperate hemorrhage from a broken bulb or a lacerated pars intermedia. I shall not detain the Student to speak of other causes that might give rise to severe bleeding, in these tissues, it is enough to have called his attention to the general facts in which he will find not only the indications of his practice, but my apology for introducing in this work a topic so unacceptable.

I refer the curious in such matters to my American 2d edition of Colombat on Diseases of Females, pages 84 and 85, where numerous citations may be found. At page 85 is the case reported by me, with a drawing of a very singular disorder of this organ.

Duverney's Glands. In the year 1846, Dr. P. C. Huguier, of Paris, read before the National Acad. of Med., a paper on the diseases of the secretory apparatus of the external genitalia in women. This paper is contained in the 15th vol. Mem. Roy. Acad. Med., 4to., Paris, 1850, and extends from p. 427 to p. 844, with four plates, having numerous drawings.

Dr. Huguier divides the secretory organs of the genitalia into two great classes, vid. the sebaceous and piliferous follicles and the muciparous organs. The muciparous organs are of two sorts, some of them being isolated mucous follicles, found here and there about the orifice of the vagina, or agminated, and gathered into patches; and the others massed together and enveloped in a common covering, and all connected with a single excretory duct. These latter compose two glands to which M. H. applies the title of vulvo-vaginal glands. This gland, which, according to the author, was known to Plazzoni, Duverney, Bartholin, Garengeot, Haller, &c., appears to have eluded the attention of modern teachers, and wholly escaped the researches of authors. It is a conglomerate gland, situated just within the vaginal

orifice, near the lower end of a nympha about one centimetre above the upper face of the hymen, behind the inner face of the ascending ramus of the ischium. In size it is as large as an apricot kernel. It resembles the lachrymal gland more than any other organ. It may be ovoidal, amygdaloid, reniform, triangular, semilunar in shape, or it may even be a plaque of glandules like the glands of Peyer.

The excretory duct of this vulvo-vaginal gland, or Duverney's gland, runs in a direction oblique from below upwards, from behind forwards, and from without inwards. The duct is generally about seven or eight lines, and sometimes eleven or twelve lines long; leaving the outer edge or margin of the gland by several distinct tubes which soon combine into a single duct, and discharges the secretion at the vulva, just behind the hymen or myrtiform caruncle, and never in front of either. A reddish disk or areola surrounds the orifice which cannot be readily found except by pulling the labia outwards and downwards, whereupon one discovers the aperture in the bottom of a small dimple-one on each side of the orifice.

Duverney's gland is the feminine analogue of Cowper's gland in the male, and like other glands is liable to become diseased: when indurated and enlarged it would feel like a hard encysted tumor, which can be extirpated by the surgeon, as the operation has been done by Mr. Huguier.

Like the parotid gland, the gland of Duverney is subject to obstructions of the excretory duct, and the disorder in such case is very like the salivary tumor met with in the stenonian duct. If the excretory tube is an inch in length, and if any cause occurs that closes its outer orifice, atresia of the canal must be the consequence, and the mucous secretion from the gland collecting in the tube causes it to swell or expand and assume at last a globular shape. If examined by the touch, it presents the appearance of a fluctuating abscess or cyst. Such a distended tube must eventually, and indeed soon inflame, and its mucous surface becomes a pyogenic one, so that the tube becomes filled with true pus commingled with juice of the gland. To open this tumor with a lancet seems to be the indication, especially as the surrounding tissues have also become inflamed and very painful; but, this ought not to be done, if it be possible to avoid it, because the discharge of such a sac will not cure the sac which fills again and again, as is so commonly observed to occur by physicians familiar with the disorder.

Taught by the fine memoir of Dr. Huguier, I have adopted his method, and cured the cases by forcing the collected excretions out

through the orifice. I cured one in this way in June, 1856, as I have cured others before it.

By passing one finger into the orifice, and then with the thumb applied outside of the labium, one may, with very gentle and slowly augmented pressure, compel the collected fluid to advance along the obstructed canal to its orifice, whence the whole of the pus and mucus spouts out in a jet or stream until the sac is completely collapsed and emptied. On doing this, the pain is removed, except the excessive distension may have caused a sort of phlegmonous hardness and painfulness to affect the texture of the labium, and even that soon disappears after the cause is properly removed, as above. My advice, then, to the Student is to suspect Duverney's gland or its excretory duct in all those cases in which he shall be complained to of great pain, soreness, hardness, and swelling of the labium. No one need question that common abscess may exist in a labium, and require to be healed as such, but the fact is that most of the complaints of this kind that occur in practice should be suspected as somehow concerned with Duverney's gland.

OF THE VAGINA.

Having now given some account of the external organs of generation, I have to speak of the vagina, which, as it is, according to the French terminology, a vulvo-uterine canal, is partly an external and partly an internal organ of generation.

Previously, however, to passing on to the study of the inward structures, I wish to recall attention to the admirable wood-cut by Baxter (Fig. 18), which is reduced one-half from Kolrausch's plate. I much regretted the necessity of making this reduction, which was not to be avoided, on account of the size of my page.

I cannot think that the modern literature of obstetrics anywhere contains a more admirable and instructive anatomical drawing than the one from which I have taken this reduced copy. It is from the Zur Anatomie und Physiologie der Beckenorgane, by D. O. Kolrausch, Leipzig, 1855, 4to., pp. 64. This drawing is from a preparation of the parts of a maiden who, at the age of 24 years, committed suicide by hanging while menstruating. The subject having been dissected, and the specimen reduced to the form seen in the figure, it was placed in a vessel containing alcohol, through which every part of the surface to be examined could be clearly seen, as in our picture. When thus carefully placed in the transparent alcohol, a glass plate was laid over

the vase as a cover, through which every line, fibre, or form could be seen. About two feet high, above the middle of the preparation, was secured a diopter, through which the artist was to look when copying the specimen. A pen dipped in printers' ink softened with oil of turpentine, was used by the artist, who, looking through his diopter, two feet above the preparation, could see through, and draw or copy upon the glass with his pen, every one of these different lines and points, which being finished, the drawing was transferred from the glass to paper, and then engraved. Such is Dr. Kolrausch's history of this beautiful plate, which is of inestimable value to the student of midwifery, as imparting to him an absolute correct ideal of the relative magnitudes, forms, and places of the parts within the pelvis.

A line drawn from the promontory of the sacrum to the top of the pubis represents the place of the plane of the strait, which shuts down beneath it all the pelvic viscera, except that the bladder, when filled with urine to the degree represented, does jut upwards into the belly, as is known to be the case. It may even be distended, so as to rise as high as the navel. I shall have frequently occasion to refer to this plate, as I now do in proceeding to speak of the vagina.

The Vagina is a mucous tube that serves as the excretory duct of the uterus. Not only the menstrual products but the mucus and the other fluids separated from the uterus find their exit through this canal, which is formed on a plan that admits of an expansion sufficiently great to give passage to the foetus at term. Being liable to most enormous changes of dimensions, the vagina could not be composed of fibrous tissue, but, as I above said, it is a mucous canal or tube, whose basement texture is a laminated areolar tissue, containing numerous glandules and follicles which yield a sort of slimy liquor that lubricates the whole. Numerous blood vessels, absorbents and nerves, together with a few muscular fibres scantily dispersed, impart to it its peculiar life qualifications, which appear to me to be passive rather than active, having but little influence upon the general economy, a circumstance in which it greatly differs from the uterus, and some other portions of the reproductive system, very slight affections of which are known to develop the most considerable disturbance of the animal economy, whereas even grave disorders of the vagina do not seem to awaken a decided constitutional irritation.

The lower or outer extremity of the vagina, its introitus, is sur rounded with a sphinctorian muscle that enjoys a community of life and activity with the sphincter of the rectum, and might be considered as a sort of appendix to or prolongation of the great sphinctorial

muscle: by its contractions it keeps the ostium of the vagina strictly closed.

In women who have not had children, the anterior and posterior walls of the vagina generally rest in contact. Hence the transverse diameter of the tube is much greater than its antero-posterior diameter. This contact of surfaces, however, does not exist in emaciated women, or in those who have very little stercoraceous matter left in the rectum. I believe that in most women who have what is called a scaphoid abdomen, the walls of the vagina become orbicular, or balloon-shaped. In these cases while the ostium is tightly closed, a man's fist might lie inside of the canal without touching the walls. I have found the vagina balloon-shaped, in this way, in many different women, both young and old.

The above remark is worthy of the student's consideration, inasmuch as it sets forth the important truth that the upper or uterine extremity of the vagina is excessively yielding or distensible, while the vulvar extremity of it is firmer and more resisting. The clinical application of the doctrine is found in the use of the tampon. Many doctors seem to me to think they have made a tamponade if they but insert a sponge as big as an egg into the vagina, a thing they would not do if they but knew how distensible is the uterine portion of it. To insert such a sponge into the vagina that shall readily assume the shape of a balloon as large as a child's head, is simply a foolish thing; a tampon should be large enough to fill the balloon.

The vagina is two inches and a half long; in the general, it ought to be about three inches long, but not one woman in a thousand has it so long, and not one in ten thousand of those who are mothers.

I was much surprised to find that Dr. Tyler Smith, in his "Course of Lectures on the Theory and Practice of Obstetrics," Lancet, No. 2, vol. i. p. 30, 1856, should think that the "anterior wall of the vagina is about four inches long, the posterior being five or six inches in length." That author must have allowed his pen to slide in making such a statement, for the distance from the crown of the arch to the lower end of the fourth segment of the sacrum is but little more than four inches, even in the dried pelvis. Therefore the author has made a mistake, for there is not room enough in the cavity for so long a vagina, and a womb of two and three-quarter inches. Such a womb would lift its fundus more than four inches above the plane of the strait, which it never does when it is in the normal state, and in pregnancy not until the fifth month.

The authors speak of the anterior and the posterior column of the vagina, and there is some reason to say so, because the substance of