These several deviations from the normal form of the uterus will more or less in fluence the manner of performance of all its functions.
The acts of menstruation and insenzination are those perhaps which are the least dis turbed. Regarding this former function, wherever the ovaries are perfect and a chan nel exists for the menstrual fluid, as, for in stance, in the one-horned uterus, the external escape will occur as usual ; but in the case of atresia of the vagina, and in those examples of a hollow rudimental uterus, the menstrual blood collects, and distending the closed sac forms there a hmmatometra.* Where the parts representing the uterus are entirely solid, the menstrual inolimen may not be thereby hindered, but the escape of blood can only take place, if at all, from some unsuitable situation producing the so-called menses devii, or vicarious menstruation.
Regarding the influence of these malforma tions upon insemination and a resulting im pregnation, much of necessity depends upon the condition of the vagina; for this canal may be in so rudimental a state as not to admit of intromission. The canal leading to the ovary also may be either open or closed. In the case of the rudimental tube attached to one side of a single developed cornu, the passage may open into the cervix of the de veloped half, and thus a channel for the se minal fluid will be established in connexion with an ovary that may be normally formed, and thus impregnation and gestation, even in an undeveloped cornu, is possible.* Greater difficulties and considerable danger indeed to life arise, during the progress of gestation, in the higher deformities of this class. Pregnancy in a rudimental horn would probably be attended by rupture and fatal hwmorrhage at an early period, as happened in Rokitansky's case quoted in the last note, and as usually occur also in the not dissimilar example of ordinary tubal gestation. But even in the case of pregnancy occurring in the developed horn of a uterus unicornis, the undeveloped half will exercise a marked in fluence upon the progress of gestation, by impeding the due expansion of the developed side; while the supply of blood usually fur nished in pregnancy being here provided by only. one set of vessels, the course of the pregnancy will probably suffer in a corre sponding degree.
In the cases of the uterus bicornis and bilocularis, either horn, or either uterine half, may become separately or alternately the seat of gestation, or pregnancy may proceed simul taneously in both. There is even reason to suppose that twins have been developed in one half, and also that superfietation has obtained in such a condition of parts.
In those cases where the vagina is parti tioned into two canals impregnation may take place more frequently or even exclusively on one side, in consequence of the one channel or half being more favourably formed for in tromission than the other.
Regarding the influence which these ano malies may have over the last office of the uterus, viz. parturition,it is only necessary to observe that in both the uterus bicornis and bilocularis the organ will be deprived of the advantageous use of the fundus, which so ma terially aids expulsion in a normally formed uterus, while in the case of the uterus uni cornis and bicornis, where the impregnated half usually forms an acute, or even nearly a right angle with the axis of the body, the effect, as Rokitansky has shown *, will be, that during the act of parturition the axis of the impregnated half meeting with the vaginal axis in an obtuse angle, the direction of the uterine force and of the expulsion of the fcetus will cross the axis of the pelvis, and fall upon the pelvic parietes that lie opposite to the vertex of the pregnant half of the womb, and thus the act of parturition will be rendered correspondingly difficult in such cases.
2nd Class. Defective development after birth. The pre-pubertal uterus. — The or dinary age of puberty may have arrived and the organ retaining the form and size which passed, and yet no corresponding enlargement or growth of the uterus may have taken place; characterise it in infancy or childhood. Such may be the condition of the entire internal organs, as in the accompanying example (fig. 465.) of the undeveloped uterus from a female aged 19, who had never menstruated. In these cases, the body generally exhibits a corresponding feebleness of growth, and the sexual attributes are little, if at all, dis played.