the cervix, and may then give rise to decided symptoms. The condition is due to imperfect development of the external os. In the well-formed woman there is, at the external os, a sharp line of demarcation between the squamous epithelium of the vaginal aspect and the cylindrical epithelium of the cervical canal. In the congenital erosion the epithelium of the canal extends beyond the limits of the external os, and meets the squamous epithelium at a lower level than normal.

Such congenital erosions usually give rise to no trouble, though perhaps they predispose the woman to cervical catarrh as a result of exposure of the mucous membrane. In extreme cases, however, in which the cylindrical epithelium of the cervical canal persists over the greater part of the vaginal cervix, and in which the glandular elements of the canal are found on the vaginal aspect, a distinct pathological condition arises. The symptoms of this condition resemble closely those of laceration of the cervix with ectropion. There is backache, a feeling of weight in the pelvis, and perhaps some ovarian pain. In addition, the woman complains of a leucorrhea presenting the characteristics of the cervical mucus. Decided nervous and digestive disturbances may be present.

If this condition of congenital ectropion exists along with a laceration of the cervix, the diagnosis. becomes very difficult. If, however, we can exclude the possibility of a former conception, we may by careful study determine the real nature of the case.

Fig. 111 represents the appearance of the cervix in a case of

marked congenital erosion in a virtuous single woman twenty years of age. It will be observed that the appear

ance resembles somewhat that seen in a bilateral laceration of the cervix with eversion. The following are the points of difference:

In laceration

There is a history of previous pregnancy.

The presenting face of the cervix is oval, with the long axis antero-posterior.

The angles of laceration may be determined, by sight or touch, either as more or less well-marked depressions or as hard plugs in case they are filled up by scartissue. The mucous membrane of the cervical canal may be made out as a strip on the anterior and posterior lips, from which there extends laterally a more or less wellmarked erosion.

The vaginal cervix is not of the general mushroom shape seen in the figure.

If microscopic examination of the cervix be made, racemose glands will be found discharging only on the mucous membrane of the cervical canal-not all over the vaginal aspect.

In the congenital ectropion—

There may be no history of pregnancy.

The presenting face of the cervix is approximately

circular.

There is no angle of laceration determined by sight or touch.

The erosion may extend evenly around the external os, and there is no one strip that corresponds to the exposed mucous membrane of the cervical canal.

The vaginal cervix is mushroom-shaped, with a decided stalk.

Microscopic examination reveals racemose glands discharging over the greater part of the vaginal cervix, to the sides of the external os, as well as in front of and behind it.

The ultimate test of this condition is the discovery of the glands discharging on the vaginal aspect of a cervix in which the mucous membrane of the cervical canal had not been exposed by laceration.

The treatment of congenital erosion of the cervix, when it is so marked as to produce distinct symptoms, is amputation of the cervix.

Congenital Split of the Cervix.-There is sometimes found a congenital split of the cervix, closely resembling a unilateral or bilateral laceration following labor or miscarriage. The recognition of this fact is of great medico-legal importance. One of the most positive signs of a former conception is a laceration of the cervix., In some cases, however, a condition resembling such a laceration may exist from birth. Marked lateral split of the cervix has been discovered in the new-born infant, and several cases have been observed in which this condition has been found in adults of undoubted virginity. It is possible that this condition may become pathological. Cervical catarrh might be produced from exposure of the mucous membrane of the cervical canal. The lesion, however, is not of nearly such serious moment as a laceration after miscarriage or labor, for the last injury occurs in a uterus which must undergo involution, and the chief symptoms of laceration of the cervix are usually those incident to arrested involution.

CHAPTER XV.

CERVICAL POLYPI; HYPERTROPHIC

ELONGATION

OF THE CERVIX; CHANCRE OF THE CERVIX;
TUBERCULOSIS OF THE CERVIX.

Cervical Polypi.-Polypoid tumors are found growing from the mucous membrane of the cervical canal, projecting into the canal or protruding from the external OS. The mucous polypus is the most usual form, and is caused by cystic degeneration of the Nabothian glands of the cervical mucous membrane. Sometimes such polypi protrude from the ostium vaginæ. Less often a papillary or warty growth is found on the mucous. membrane of the cervical canal, in the neighborhood of the external os. There is usually present dilatation of the external os and cervical canal. The symptoms of cervical polypi are not characteristic. Inflammation of the cervical mucous membrane and cervical catarrh may result. There may be slight, and rarely profuse, bleeding from the external os. The bleeding may follow efforts at straining, sexual connection, long standing, or exercise. Occurring at the time of the menopause or later, this symptom would excite the suspicion of beginning cancer of the cervix.

Pediculated polypi should be twisted or cut away. Bleeding is usually very slight. The sessile growths, like the papillomata, should be excised, the incision being carried well below the base of the tumor into the healthy tissue of the cervix. The wound may then be closed with an interrupted suture. In every case of such tumor a careful microscopical examination should be made to determine its benign or malignant character. Hypertrophic Elongation of the Vaginal Cervix.

-In this condition there is a marked increase in the length of the vaginal portion of the cervix uteri, though the thickness of the cervix may be but little, if any, greater than normal. The vaginal cervix may be so long that the external os may lie outside the ostium vaginæ.

The condition is a true hypertrophic growth, the cause of which is unknown. It is probably congenital, as it is found in the virgin.

The diagnosis between elongation of the vaginal cervix and the various forms of prolapse of the uterus and the