The influence of these tumors is, of course, not the same in every case. This depends on various circumstanc,es and complications. Their seat is a matter of some importance. Tumors which are polypoid or sub-mu cous, protruding into the cavity, seldom permit conception to take place. The entrance of the spermatozoa is thus prevented, or the state of the uterine mucous membrane is such that the impregnated ovum can not further develop. Hemorrhages and discharges point to an unnatural condition of the mucous membrane. If the tumor is sub-peritoneal, then conception is more apt to take place, although here on account of the resulting dislocation of the tubes and ovaries, and on account of the in flammatory processes which may be excited in the peritoneal cavity, con ception may be prevented in other ways. If the tumor is intramural, then it may, by compression of the cavity, the twisting of the tubes, etc., prevent the union between the semen and ovum.
The statistics of Leopold lileyer are of interest in this connection. In six eases the cervix was long the seat of the new growth, in two essen tially so; in twenty-five other cases five were essentially sub-peritoneal, fourteen probably interstitial; in six the location of the tumor could net be exactly det,ermined. There were five sub-mucous tumors, three fibrous polypi. According t,o these statistics the location has less effect on productiveness than it is the custom to think. The number of tumors also seems to have an influence, for many seated in the walls and surrounding the uterine cavity render conception very unlikely. The size of the tumor is also of importance. The larger the tumor the less likely is conception to occur, and although there are cases in which the reverse may be true, yet we cannot depend on the pregnancy going to full term, and then mar riage remains childless, not because of sterility, but mther as a result of rePeated miscarriages. The chances of conception, however, are not always dependent on the size of the tumor, for not infrequently at the very out • set they seem to be detrimental to conception taking place. Thus I know of a number of women who, although married for two decades, yet have never conceived, and in whom only during the last ten years could I discover evidences of a fibromyoma, and that of a moderato size only. These are the cases which could be claimed as evidence that fibro myoma resulted from sterility, and not the reverse, a view which very often finds expression. Aside from the fact, however, that no reason can
be given why the non-activity of the generative process should cause the growth of fibromyomata, it is also true that many unmarried old women are affected with similar tumors. The supposition seems much more natural to me that the fi rBt beginning of the new growth was present at the time of marriage, that it prevented conception, but gave rise to no other symptoms, and that only through the slow development, which is characteristic of these tumors, were symptoms produced which caused. the patient to seek medical advice.
The malignant new growths of the uterus (carcinomata, sarcomata) prevent conception, since they either begin in the mucous membrane, or soon involve and disturb it. Owing to the rapidity of their course. the severity' of the suffering, and the bad prognosis, the sterility does not call for treatment.
Diseases of the Vagina.—The physiological function of the vagina (the reception of the male organ, and of the semen which it ejaculates) may be disturbed in many ways. At the outset we must mention con genital malformations. The congenital lack of development of the vagina is in some cases so marked, that not even the lower part is patent for cohabitation, and in such a case the urethra is frequently widely dilated through attempts at coition. Not unusually this lack of development is attended with a corresponding anomaly of the internal organs of genera tion. So that a priori conception is impossible even after remedying the atresia. In other cases the malformation is confined to the vagina alone, at times there being partial occlusion, and again the canal is closed by a membrane, there resulting hematocolpos and hematometra. If this affection is rectified by making a canal, then conception can take place. This may occur in other ways, as where in a deep-seated atresia the vagina communicates with the rectum, and the semen enters in this way and reaches the upper part of the genital tract, and by the same route the child is delivered. Such cases are extremely rare. The best known case is that of Louis, which a hundred years ago deeply interested theologians, and called forth a bull from Pope Benedict XIV., allowing coitus to take place in this person's case by the rectum. Where atresia exists impreg nation may also occur through the urethra, when the vaginal eau& opens into the urinary canal, as was noted by C. Braun. A similar muse has recently been reported by Th. Wyder.