prominence was incised vertically, from a point below the urinary meatus to the fourchette, and three pints of black, tarry fluid were evacuated. The hypogastric enlargement at once subsided. The vagina remained more or less fixedly dilated, its mucous membrane was markedly hypertrophied, and presented an uneven rough surface. The cervix was almost obliterated and the uterine cavity formed a common canal with that of the vagina. The cavity was irrigated with a bichloride solution, I to 5000, and then packed with iodoform gauze. The gauze was removed on the third day, the parts irrigated and repacked. After the lapse of a week the packing was discontinued. Patient made an uninterrupted recovery.

Upon examining the parts two weeks later it was found that the tissues at the site of the incision had contracted, leaving an opening a caliber barely sufficient to admit three fingers. The vagina above this cicatricial ring was elastic and pliable and normally distensible. The uterine cervix was well defined and the organ generally firmly contracted, but somewhat limited in mobility. The narrowed vaginal entrance was now enlarged by incising the lateral remains of the hymen and suture of the cut edges to prevent reunion. The final result was perfect. A crucial, instead of a vertical section of the obstructing membrane, originally, would have obviated the necessity of a second operation.

Case II-Mrs. M., aged 25. Married two years; never pregnant. Puberty at 14; menses irregular, intervals of from one to three months elapsing between periods; flow four and five days, profuse, clotted and painful. Three months after marriage bleeding became more or less continuous with repeated attacks of excessive flooding. Patient is of a large frame, poorly nourished and presents every evidence of pronounced anæmia. Examination disclosed a well formed, roomy pelvis, and normally developed external genitals. Upon separating the labii, instead of bordering a single introitus the retracted remains of the hymen surrounded two openings, separated by a median vertical septum that divided the vaginal structures into two distinct compartments of equal capacity. The septum was exceptionally well developed, its free border measuring no less than one-fourth of an inch in thickness, while its exposed surfaces presented well-marked rugæ. In structure it was identical with that of which it constituted a part in the formation of the two musculo-membranous canals. It was limp and elastic, easily displaced, and in its tubular capacity was compensatory in function in that one canal became narrowed under the stress of a mechanical distention of its fellow. Close to either side of the septum where it

merged with, and entered into the formation of the vaginal vaults were two irregularly rounded, eroded and dimpled elevations. The dimples proved to be separated, cervical openings and the coincident introduction of a sound through each revealed the presence of a wellformed partition that extended to a point within a short distance of a

common uterine fundus. The uterus was somewhat hypertrophied, and the discharge from the cervical openings indicated a hæmorrhagic and catarrhal condition of its lining membrane.

Operation November 19, 1899, assisted by the family physician, Dr. Elmer H. Rogers. Ether anæsthesia. The lateral vaginal walls were drawn to either side by wide-bladed retractors, thus rendering the intervening septum tense. Owing to the thickness and vascularity

of the septum it was divided with a straight scissors by making longitudinal sections of about an inch at a time followed by immediate suture and closure of the corresponding cut edges anteriorly and posteriorly, with chromisized catgut, and so on until by successive steps the entire membrane was severed and a single vaginal canal formed throughout. Upon reaching the vaginal vault traction upon the distal sutures readily brought the partitioned cervix into view and was thus held in a fixed position for treatment. Both cervical canals were dilated until the narrow blades of a scissors could be introduced to divide the thickened lower segment of the septum. This done, its remaining portion was ruptured by the introduction of graduated bougies up to No. 41 of the French scale. The uterine cavity was next curetted and irrigated and then packed with iodoform gauze. The packing was removed from both vagina and uterus on the fifth day, followed by placing a strip of gauze between the sutured edges in the vagina every third day for a period of two weeks. The patient made an uneventful recovery. The writer saw her last four weeks ago (more than five months after operation). She now menstruates regularly at intervals of four weeks, the flow being painless and continuing from four to five days. The vagina is normal in size, possesses the property of equable distensibility, and aside from presenting two slightly elevated median longitudinal ridges, anteriorly and posteriorly, nothing remains to indicate the presence of the previous anomaly. The uterus is freely movable, the vaginal cervix is small and eliptical in outline, and presents a single opening leading to a common uterine canal. The patient has gained nineteen pounds in weight, and presents every indication of robust health.

The special interesting features of this case were: The well-formed fleshy and lax vaginal septum and its median position. Two other cases have come under the writer's observation, but in each the septum, though dense and resisting, was without rugous elevations and comparatively thin, and so situated as to form vaginal canals of markedly unequal dimensions. Recent literature upon this subject tends to prove the extreme rarity of well-developed symmetrical duplicity of the vaginal structure. The etiology of these conditions is well understood. A comprehensive exposition of the pathological significance of genital malformations in the female is given by Dr. Brooks H. Wells in the March number of the American Journal of Obstetrics.

POLYURIA IN PREGNANCY.*

BY WILMER KRUSEN, M.D., PHILADELPHIA.

Obstetricians are unanimous in the opinion that careful attention should be given to the renal function in pregnant women. The urine should be examined once or twice a month, or oftener if indications are present, to ascertain the physical, chemical and microscopical qualities, and to detect any alterations of its quantity and quality. Many cases of eclampsia may be averted, or their severity modified by such a procedure. To be forewarned is to be forearmed in the treatment of these complications due to renal lesion,' or disturbed renal function. Normally, the urine in pregnancy is increased in quantity, becomes more watery and has a lessened specific gravity. This is probably due to the hydræmic condition which exists, and to the increased functional activity of a somewhat enlarged kidney attributable to an increased blood supply and the increased arterial tension. Greater frequency of urination, due to pressure upon the bladder by the rapidly enlarging uterus, may be mistaken for a polyuric condition; but the amount passed daily is easily ascertained by repeated daily measurements of all urine excreted. When the amount of urine becomes excessive, the patient suffers exceedingly from great thirst and from loss of rest occasioned by the frequent evacuation of urine.

The excessive polyuria of pregnancy is evidently rare as the literature on the subject is extremely meagre. J. Mathews Duncan (Tr. Edin. Obstet. Society, Vol. III., Page 363) reports a case of polyuria occurring in a multipara, aged 25 years, who suffered from polyuria during the seventh month of pregnancy. She had premature labor and the child lived but five hours. In this instance the urine contained no albumen, no sugar, and the highest amount passed was 320 ounces in twenty-four hours. B. C. Hirst (Text Book of Obstetrics, 1898, p. 231) has had a woman under his care who passed 220 ounces of urine per day. In the following case, as the patient was the wife of a physician, a thoroughly accurate and intelligent study of the abnormality could be satisfactorily made.

The patient, Mrs. X., aged 31 years, had had the ordinary diseases of childhood, scarlatina at four years, followed by some obscure kidney * Read before the Philadelphia Obstetrical Society, May 3, 1900.

trouble until 12 years of age. Menstruation began during the twelfth year. In 1896 had an attack of enteric fever. The first child (female) was born April 1, 1898; at that labor there was a large amount of liquor amnii, and she had suffered considerably from edema of the lower extremities during the latter months of the pregnancy. She became pregnant a second time in April, 1899. The uterus was much larger than usual during the last few months of gestation, and although twin pregnancy was suspected a positive diagnosis was not made. The polyuria became noticeable during the last two months, and the excessive thirst and frequent desire for urination caused the patient much discomfort. Urinary examinations and measurements were made as follows:

January 2, 1900, 224 ounces of urine voided during 24 hours. Sp. Gr. 1001; no albumen; no sugar.

January 5, 234 ounces (Ward's report). Reaction, faintly acid; S. G. 1005; urea, 0.3 per cent., or 319 grs. in 24 hours. Albumen, none; sugar, none. Microscopical Ex. A few small uric crystals, amorphous urates, and large squamous epithelial cells slightly granular.

January 6th. By much self-denial in abstaining from drinking as much water as she desired, only 178 ounces were passed. There was much swelling of the extremities and face with considerable pain in the limbs and left groin.

January 7th. 82 oz. Great thirst, edema less marked.

January 8th. 108 oz. Swelling increased. Complained of itching and stinging sensation of the legs.

January 9th. 185 ounces.

January 10th. 160 ounces. More swelling of the forearms, hands and lower extremities.

January 12th. 215 ounces (Ward's report). Reaction, acid. Sp. Gr. 1004; urates, 0.2 per cent., or 196 grs. Albumen, none; sugar, none. Micro. Ex. A few very small uric acid crystals, amorphous urates, normal and granular, squamous epithelial cells. No casts.

January 13th. 182 ounces.

January 14. 166 ounces. A hot bath was given at II p. m. and ten minutes later labor pains began, and at 2:30 a. m., January 15th, the patient gave birth to two boys weighing 6% and 71⁄2 pounds respectively. The labor was normal, both fœtuses presented by the cephalic extremity; a very large amount of amniotic fluid was present. The subsequent convalescence was uneventful; the swelling, thirst and polyuria gradually subsiding, the patient made an excellent recovery. In this case the twin pregnancy caused unusual distention and marked pressure