The sequela3 of atresia, which depend upon the accumulation of secre tion above the place, seldom appear before puberty; hence the majority of cases have been observed in adults.
Nevertheless, dilatation above the atresia may occur in young children and in the newborn, and may provoke an investigation. G. Veit men tions an observation of Godefroy,' where, in a child two months old, there was such an accumulation of mucus behind an imperforate hymen, that it caused difficulty in the evacuation of urine and fEeces.1 I have myself seen dilatation from retention of the vagina and the collum uteri in specimens showing atresia in newborn girls. I also saw later, in two new born females, a very thin membrane closing the lower portion of the vagina, close behind a well-formed hymen. Through the dilated hy menal membrane the colorless, transparent, and shining septum was seen to project in an arched form as soon as the children cried. When the tension was relaxed the little finger could be passed into the opening of the hymen, and the fact be ascertained that the septum was entirely distinct from it.. The bladder-like, cherry-sized tumor, which during the first two days projected through the vulva when the child cried, c,aused the parents great anxiety; but the tumor disappeared without a trace upon the third day, with the evacuation of a large amount of thick, milky mucus, containing much desquamated vaginal epithelium. The thin, transparent nature of these membranes, and their sudden disappearance when once they are ruptured by abdominal pressure, render it probable that there were only adhesions of folds of the mucous membrane behind the hymen. Since then I have encountered a case of a firmer septum retro-hymenale of this nature, in a virgin fifty-four years old, suffering from sarcoma uteri.' Perhaps some cases of so-called double hymen be long to this little-noticed form of atresia.
I have but once met with true atresia hymenalis in a newborn girl. The child was well developed, measured 20.3 inches, and weighed 118 ounces. Its genitals were otherwise perfectly normal. The hymen was formed by a closed membrane, the posterior portion of which was bellied forwards as a pea-sized, yellowish-white bladder. The walls of this blad
der were continuous with the surface of the hymen, and the margins were covered with vascular twigs. On opening it a copious thick, mucoid secretion appeared, which showed under the microscope masses of well preserved pavement epithelial cells. (Table No. I.) After completed sexual development, the consequences of vaginal atresia depend naturally upon whether a regular menstrual hemorrhage oc curs or not. Thus exceptionally vaginal occlusion, or atresia of one canal in a divided vagina, inay exist in cases where maladies accompanied by amen orrhcea are present, and no retention of blood above the atresia occurs. Mucus rarely c,auses trouble in adults. (Bryk.)' As a rule, the blood accumulation causes the usual sequelm of the molina menstrualia, and the development of hmmatokolpos and hcema tometra. The troubles depend partly upon the height at which the atresia is seated, and partly upon the amount of menstrual blood which has been poured out. Occasionally, after three months' menstruation, with deep-seated atresias, we may be able to detect considerable stagna tion tumors; while in other cases the accumulations may be very small after the molimena have lasted for yeara In every deep-seated atresia the vaginal tube dilated with blood will form a large part of the retention-tumor. As G. Veit remarks, it may occasionally, even before dilating the uterus, cause such difficulties in urination and defecation, as to lead the patient to consult a physician.' When uterine dilatation occurs, it is chiefly the cervical portion which is affected, and which, with the vagina, contains the great mass of the blood. The vag,inal dilatation may be so great in every direction, that its upper end projects above the lesser pelvis, while its lower end (when there is hymenal atresia) presses the labia and perineum outwards; it occupies the greater part of the pelvic cavity, and compresses and displaces both bladder and rectum.