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No. 1 .
ATRESIA OF THE VAGINA.
By R. S. Hill, M. D., Gynecologist to the Hill Infirmary, Counsellor of
the Alabama State Medical Association and Fellow of the Southern Surgical and Gynecological Association, Montgomery, Ala. .
Atresia of the vagina may be congenital or acquired. The former is rare and the latter is comparatively frequent. We will first consider the congenital variety, which, of course, represents a local failure in development. To properly comprehend this form of atresia it is necessary that we recall the development and structure of the vagina.
Strictly speaking this canal is formed, in common with the uterus and Fallopian tubes, by the Mullerian ducts. The upper thirds of these ducts diverge and form the Fallopian tubes. the lower two thirds converge, and eventually, by blending or fusing make a common canal, wbich is later divided into two parts by the growth of a constriction or ring near its middlethe primitive cervix uteri. The portion above the ring de. velops into the uterus, while that below forms the vagina. When completely developed the walls of the vagina are composed, commencing from within, of a mucous membrane, lined with flat epithelium; a muscular layer, consisting internally of circular and externally of longitudinal fibres; and a layer of loosely woven fibrous tissue, containing fat in its meshes. The lower ends of the Mullerian ducts in the early period of their existence are closed. During its antenatal development the vagina opens into a space known as the uro-genital sinus. This sinus is formed, in common with the urethra and bladder, by, according to some investigators, the allantois or, according to others, the cloaca; and in some animals, as the marsupials,