The nature of malformations of the rectum and urogenital passages.

  • Jones, F. Wood (Frederic Wood), 1879-1954.
Date:
1904
Catalogue details

Licence: In copyright

Credit: The nature of malformations of the rectum and urogenital passages. 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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    It is customary to describe and picture the fetal vagina as an open tube having very much the characters of the vagina of the adult—that is to say, it is a canal separated by a septum in front from another canal. This idea of a wide open vagina, formed by the growth of a discrete septum, is the cause of the failure of embryology to explain the most common abnormalities, and is also the cause of ascribing to infantile fevers and septic conditions of childhood the pro- duction of abnormalities, which really admit of simple and clinically useful explanation by a study of the development of the part. The vagina is for a great part of fetal life a solid rod, and not an open canal at all. The Mullerian opening into the urogenital sinus becomes early lost, and its com- munication with the exterior is only made again late in fetal life. The whole subject of the development of the vagina is ex- ceedingly complex, and it would be better to reserve for some future time any discussion as to the precise morphological elements that take part in its strange growth. The develop- mental process involved is, however, clear: Early in the history of the embryo the Mullerian ducts open into the uro- genital sinus at its upper part; late in its history they open at the hind end by the vagina, and for a considerable interval they have no opening at all—the old one being lost and the new one not yet formed. No septal division is employed in this change, but as the hind gut, when its cloacal opening is lost, re-establishes communication with the exterior by a new downgrowth, so the Mullerian ducts, when their cloacal opening becomes obliterated, tunnel a new passage to the hind end. The active agents in this strange growth are two epithelial masses that have been described by Berry Hart as the Wolffian bulbs, but to give this name to them is to give a definite idea as to their origin, and this seems to be by no means clear. The active migration of the Mullerian opening is not an unparalleled fact in the animal kingdom, as Dr. Arthur Keith has pointed out to me; for James Hill has shown that in peramele the median vagina is formed at delivery by an active rupture of the Mullerian ducts into the urogenital sinus. The actual significance of this extraordinary process does not, however, concern us here; but the fact that the vagina is formed as a solid structure, that becomes canalized only late in development, is of extreme practical importance. Without going further into the development of the vagina, it will be seen that such statements as “ congenital atresia in the sense of a vitium primae formationis does not occur. The embryological development of the vagina furnishes no explanation to transverse vaginal septa” (Henrotin and Harris), are not correct when the development of the vagina is rightly understood. The active downgrowth of the vagina will now serve to explain the varied levels at which, in imperforate rectum, the cloacal opening of the hind gut is found, and it will also serve to explain why—as is the usual case—it is a larger opening than is the persistent cloacal opening of the hind gut in the male. One word may here be said as to the development of the hymen. The vagina is an active downgrowth like the post-