ABNORMAL PLICATION OF THE CERVICAL CAVITY.
This is a peculiar developmental defect of the cervix, in which in stead of the norn-ial arbor vital, a broad thick fold projects into the lumen of the c,anal, giving the impression of a second vaginal portion filling the cavity of the cervix. (See accompanying illustration.) I have bad occa sion to see a case of the kind.
In a girl twenty years old, with normal external genitals and vagina, the uterus could be felt to be slightly retroflexed through the wall of the posterior vaginal vault; and a soft fleshy mass could be felt in the cervical cavity in the same way. After the cervix had been dilated with a lami naria tent, a structure was found inside so like a dilated portio vaginalis, that there seemed to be a second cervix. Evidently here was a repetition of the vaginal portion higher up in the cervical canal.
A microscopic examination of a part excised during life showed that it contained all the elements of the cervix in proper order, muscle bundles, connective tissue, glands, and epithelium. And there were no signs of chronic nutritive disturbances, no granulation tissue.
The deformity is rare, arid has not yet been described. I will add a few observations which my predecessor Breisky has noted in the clinical records at Berne.
A woman, forty years old; one child eight years before; vaginal por tion relaxed, thin, .6 of an inch long, os and cervical canal admit two fingers. In the region of the internal os is a prominent, circularly attached tumor projecting into the cervical canal. Its surface is rough, and there is a small opening in its middle, into which the tip of the finger can be passed. After dilating this with laminaria, we found the mucous mem
brane covering the ring perfectly smooth, and the internal os open to the finger tip. Uterus 3.6 inches long, 2.8 inches of it being above the patho logical orifice.
In both cases menstruation appeared early, and was profuse; and both women sought assistance for the hemorrhage.
It is bard to decide as to the etiology of this undoubted developmental fault. We may note that it is very like the form which occurs normally in the sheep.
It is also of practical importance, apparently causing the same pro fuse hemorrhages as do polypoid growths, to be relieved by ablation of the fold. It may also disturb delivery. Thus E. Bidder reports as fol lows: In a primipara twenty-six years old, the cervix was funnel-shaped. Its canal was divided 'by a semilunar-shaped fold nearer the internal os, into an upper and a lower pocket. Neither the bag of waters nor the head could dilate this fold. Chills and fever set in; two incisions were made in the fold and the cervix, and the forceps applied. The patient had fever from the third to fifth day from colpitis and endometritis colli. The cervical fold seemed to be entirely destroyed, and did not form again.
The hemorrhage will necessitate an examination of the inner uterine surface. We will find a perforated ring in the cervical canal, which on closer examination will be found to be exactly like a second cervix.
A speedy ablation of the membrane is indicated. During labor, in cisions, such as Bidder made, will remove the obstacle.