THE MAMMARY GLANDS. 2027 



Variations. The glands of the two sides often vary in size and may be asymmetrically 

 placed. The ducts may be doubled and the lobules so separated that the usual gland-mass is 

 replaced by isolated divisions. The glands are sometimes seemingly wanting on one or 

 both sides. 



PRACTICAL CONSIDERATIONS : THE EXTERNAL GENITALS. 



Owing to the protected position of the vulva it is rarely wounded except from 

 tears in childbirth. When lesions from external violence do occur, they are usually 

 the result of falls astride hard objects, of kicks, of blows, or of wounds inflicted by 

 horned cattle. Because of the laxity of the tissues and the free blood-supply in the 

 labia majora large hsematomata may collect, especially if the bulbus vestibuli is 

 opened. Again, because of the free blood-supply and loose tissue in this region, 

 plastic operations are commonly very successful. The hemorrhage is free, but ordi- 

 narily stops spontaneously unless the erectile tissue of the clitoris or its continuations 

 backward, the bulbus vestibuli, is wounded. 



The lymphatics and veins of the vulva pass to the groin, thus explaining the en- 

 largement of the vulva in lymphatic obstructions in the inguinal nodes, such as 

 elephantiasis, and in venous stasis in the same region, as in milk leg. The clitoris 

 is especially involved in elephantiasis, either alone or as part of a general enlarge- 

 ment. The absorbents of the vagina pass to the pelvis. About the orifice of the 

 vagina is a zone in which the two sets intercommunicate. 



Cysts of the vulva are commonly due to retention of secretion within the glands 

 of Bartholin. They occupy the posterior third on each side of the vaginal orifice, and 

 project more from the mucous than from the cutaneous surface. These glands are 

 often the seat of abscess, almost, if not always, the result of gonorrheal infection. The 

 female urethra, running downward and forward so that it is nearest to the vaginal 

 wall in its upper portion is much shorter, much less curved, relatively much wider, 

 and as it is not surrounded at any point by structures of such density much more 

 dilatable than the male urethra. In consequence of its shortness, its width, the direc- 

 tion of its course, and the limitation of its function to serving as a passage for urine, 

 it is, as compared with the male urethra, infected less frequently, and its inflammation 

 is associated with less severe symptoms, yields more readily to treatment, and gives 

 rise to fewer complications and sequelae, stricture, for example, being very rare. 



As a result of its dilatability it may be used as a channel for digital exploration 

 of the bladder, or for the extraction of vesical calculi or pedunculated tumors, if 

 small, or of foreign bodies. The dilatation should be accomplished very slowly 

 under an aneesthetic and is then rarely followed by persistent paralysis. The imper- 

 fect development of the triangular (subpubic) ligament in the female and of the 

 muscular wall of the urethra the emptying of the canal being so facilitated by its 

 direction, width, and shortness explains the relative ease and safety of extreme 

 dilatation. 



A small red vascular tumor, called a ^lrethral caruncle, is sometimes found pro- 

 truding, usually from the posterior wall of the female urethra. It is extremely sensi- 

 tive, giving rise to much pain on pressure, movement, or urination. 



The vaginal process of peritoneum accompanying the round ligament, already 

 spoken of, may reach as far as the labium majus, and may give rise to a congenital 

 hernia or hydrocele in that part. Owing commonly to the presence of vaginal dis- 

 charge, the vulvar region is frequently the seat of venereal warts. Because of the 

 warmth, moisture, and friction to which syphilitic papules are exposed in these parts, 

 condylomata and mucous patches are common and well marked. One of the most 

 frequent seats of chancre in women is about the fourchette and anus, because the 

 infected discharges of the vagina tend to run over and lodge on these structures. 



THE MAMMARY GLANDS. 



Although morphologically considered they are modified cutaneous glands and 

 developed in both sexes, the functional importance of the mammary glands (mammae) 

 in the female entitles them to be reckoned as organs accessory to the reproductive 

 apparatus. Each mamma, or breast, consists of a group of twenty or more individual 



