Catarrh of the Cervical cervical catarrh is justly considered as a not infrequent cause of sterility. Its importance is the greater inasmuch as, like endometritis corporis uteri, it is an important complication of other anatomical lesions that cause sterility. But it may even obstruct conception when it appears singly. Even by a great hy pertrophy of the mucous membrane brought about by a swelling of the plicm palmatie, by hyperplasia of the glandular elements, and above all by a cystic degeneration of the mucous follicles, a canal that is already narrow may be so plugged that it is rather difficult for a sound to pene trate. While under ordinary circumstances the sound finds difficulty only at the two ostia, passing very easily through the canal itself, in the cases mentioned it meets with a uniform resistance, much harder to overcome. The band here receives the impression as if the sound was passing through a soft but strongly compressed mass. When oven in the normal condi tion, the phew palmate are not very favorable for the advance of the sper matozoa, as we have seen in the physiological part of this work, this must be still more so in catarrh, when the projections tightly fit into one another. The obstacle, however, is greater when the walls of the cer vix itself t,ake part in the hypertrophy, whether they project into the lumen in the form of large knobs or folds, or whether they considerably compress the canal proper as a stiff mass; such is the case when at the same time a chronic metritis has attacked chiefly the cervical part. The obstacle is increased still more when polypoid excrescences arise upon the hypertrophied mucous membrane. If several are present, and unless they are soon protruded through the external os into the vagina, they may considerably increase the plugging of the already narrow canal.
The chances of conception are much more unfavorable in nulliparas than in women who have already conceived. Here the os externum, which has been too narrow from the start, or has only been made so by the mttarrh and its consequences, prevents the secretions from flowing out. Not only the glassy, semi-fluid, tough mucus, that is produced by the mucous follicles in large quantities, collects in the cavity, but there is often added to it the secretion of the uterine cavity proper. As this mass is produced more rapidly than it is voided through the narrow os exter num, it not only closes but dilates the canal which, in turn, by its resist ance, exerts a strong pressure against the tough mass of mucus, and there by may render the advance of the sperms impossible. There have been cases in which a single removal of the mucous plug has led to conception.
But this collection of the secretion is not always the essential factor in the condition of sterility, as is seen by the fact that sterility is frequent enough in cases of wide os, in women who have borne children, in whom, therefore, the secretion can flow off. Evidence in favor of this is espe cially given by those cases of pronounced ectropium of the lips of the os uteri, for the cure of which Emmet has recommended the restoration of the cervical cavity by operation. Sterility here is not rare. In these cases the chemical condition of the cervical secretion also seems to have an unfavorable influence upon the sperma. We have already heard that
tbe normal scanty secretion of the cervical cavity is slightly alkaline; ac cording to the numerous, careful investigations as to the effect of chemi. cal substances upon spermatozoa, it would, therefore, be a very favorable fluid for the preservation and onward movement of the latter; but when the production of mucus is copious, as occurs in catarrhs, the reaction of the secretion is strongly alkaline. During preznancy, when there is a high degree of hypersecretion, as is well understood, those large, lumpy masses of mucus that come from the cervical cavity, were, according to numerous examinations made in the clinic of this place, also always found to have a strongly alkaline reaction. But since concentrated alkaline solutions greatly depress the motility of the sperma, the abnormal cervical secretion seems also to be able to prevent conception in a chemical way, by weakening or killing the spermatozoa. Perhaps the commingling of the abnormal secretion of the uterine cavity may also contribute to the effect.
Finally re must call attention to the fact that a profuse uterine secre tion may simply wash away the sperma. Although this seems plausible, we must remember that in animals, when they are in heat, the fluid is poured out of the cervix in quantities by no means small, and that in them it does not at all obstruct the advance of the sperma.
It is a known fact that catarrhs of long duration cause a relaxation and softening of the walls of the uterus, (first stage of chronic metritis); hereby the uterus loses its stiffness and the body of the uterus easily be comes flexed. By this flexion, which may sometimes be extreme, a ate nosis of the internal os is superadded as a further obstacle to conception.
It is not possible to make a reliable statement in regard to the fre quency of cervical catarrh as an obstacle to conception. This affection occurs so often, and is so common a companion to other genital affections, that it is very difficult for physicians to distinguish accurately the cases in which endometritis colli chronica is the cause of the sterility from the others. I therefore desist, as in all genital catarrhs, from giving any doubtful statistics.
Neoplasms of the Cervix Uteri.—All neoplasms that may occur at the cervix uteri may under certain circumstances render conception more or less difficult. In speaking of catarrh of the cervix, we have already be come acquainted with the mucus polypi that arise from it. These may, regardless of the endometritis cervicalis that caused them, by their num ber and size produce a plugging of the cervical cavity, or may stop it up by filling the most narrow part of the canal at the external or internal os. These formations have been demonstrated upon the cadaver as causes of sterility by several authors, especially by O. Achtermann. A similar obstruction is formed by the fibrous polypi that start from the walls of the cervix. They extend the cervical cavity, so that the walls surround the tumor more tightly, and thereby the lumen of the cavity is dimin ished. Though in such cases the co-existing hyperwmia and softening of the walls of the cervix causes the latter to be less tense, yet the very fact that the cervix is diseased, would alone suffice in rendering concep tion difficult.