Adenoma vaginae diffusum (adenomatosis vaginae), with a critical discussion of present views of vaginal and hymeneal development / by D. Berry Hart.

  • Hart, D. Berry (David Berry), 1851-1920.
Date:
1911
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Licence: In copyright

Credit: Adenoma vaginae diffusum (adenomatosis vaginae), with a critical discussion of present views of vaginal and hymeneal development / by D. Berry Hart. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    4 D. Berry Hart that at this early stage—sixth-seventh week—the septum between the Mullerian ducts has disappeared. The Mullerian duct is lined at this time with a low columnar epithelium. At a certain level of the urinogenital sinus corresponding to a point in the adult vagina an inch or so above the hymen there is a distinct projection on the posterior wall of the duet—the eminence of Muller. Here the Mullerian duets end blindly. Below the eminence of Muller the Wolffian ducts open one on each side (Fig. 1). The urino- genital sinus is relatively long at this period, and indeed has been described erroneously as the future vagina. At this stage, then, the Mullerian duet, which will form part of the future vagina, has a single lumen, is lined with columnar epithelium, has no lower aperture, and no hymen is present. In earlier sections the ducts are double. The next distinct stage of development known to me is at the fourteenth week, and this is an important period, as it is at this period of foetal development that the hymen develops. I have examined two specimens at this time, and, so far as I know, no other similar specimens have been described, even by observers who have strong views opposed to mine on the nature of the development of the hymen. Specimens at this period are best cut in the form of a central mesial slab in sagittal central section, as the paraffin blocks are somewhat large, and this direction gives a useful view of the whole tract. In such a section one can see from above down—(1) The uterus with a lumen and beginning formation of glands; (2) the lower end of the cervical canal blocked with epithelium ; (3) the vagina solid with cells, and with a line of clear space between them and the connective-tissue wall of the duct; (4) at the lower end, a remark- able condition, viz. a development of two bulbs of epithelium with cells exactly like the squamous epithelium of the adidt vagina, and into one of these I traced the Wolffian duct. From these bulbs —the Wolffian bulbs—the squamous epithelium spreads up into the Mullerian duct, blocks it, absorbs its epithelium, maps out the future fornices, solid also, and passes a short distance into the cervical canal. Outside tlae bulbs, and higher up, the epithelial streams from each bulb communicate before entering the Mullerian ducts, and one can still see the Wolffian duet lying by the side of the vagina as would be expected (Figs. 2, 3, 4, 5). Thus, at or about the fourteenth week of foetal life two lateral bulbs develop at the lower ends of the Wolffian ducts at a level a little below the eminence of Muller, where these open into the