=Incision of an abscess of Bartholin’s gland.= Abscesses arise by infection passing into the gland along the ducts, and are a very frequent accompaniment of gonorrhœa. The orifice of the duct can usually be seen red and prominent, and may exude pus if pressure be made over the abscess-sac. Sometimes the abscess bursts and spontaneous recovery may follow, but it is very liable to recur, for infection lurks among the smaller ducts and is carried to a fresh part of the gland, and the process may continue until the whole gland has been thus destroyed.
=Operation.= The abscess must be freely incised and all pockets and septa broken down. It is stuffed with iodoform gauze, which is changed daily, and the cavity is allowed to granulate up from the bottom. If the abscess recurs, or if it consists only of a small collection of pus surrounded by brawny œdema, the whole gland should be excised.
OPERATIONS FOR ATRESIA OF THE HYMEN AND THE VAGINA
Occlusion of the hymen is the commonest form observed. The vagina becomes slowly distended with blood, forming an elastic pelvic swelling (hæmato-colpos) upon which the uterus is, so to speak, perched. Later in the course of the disease, this organ itself (hæmato-metra) and the Fallopian tubes (hæmato-salpinx) may become affected similarly.
=Indications.= In atresia of the hymen symptoms only commence after puberty; there is then congenital amenorrhœa with periodic pelvic pain and gradual formation of a pelvic swelling. On inspection the hymen is distended and the blood-tumour above it gives a bluish tint to its surface.
=Operation.= After administration of an anæsthetic, careful palpation of the tubes should be made _per rectum_: if they are distended it is better to open the abdomen, ligature and remove them; if not, the hymen should be incised by means of a crucial opening and the characteristic tarry fluid allowed to escape: no hypogastric pressure should be used.
Irrigation and packing with gauze may be resorted to as after-treatment, but are considered unnecessary by a large number of operators.
Atresia of the vagina may be congenital or acquired. In the latter case the condition results from contraction of adhesions developed from damage done during labour; or it may follow acute septic vaginitis, the introduction of acids or irritating materials to produce abortion, or as a sequel to typhoid fever.