ATROPHY OF THE UTERITS.
These re mains vary in size and shape, according to the extent and grade of the injury, and the stage of development at which it makes itself felt. Be sides this, the rudimentary structures do increase in size after the injuri ous influence has commenced to act.
In the highest grade of the deformity, which approaches complete defect of the uterus, and is often mistaken for it. the organ may be only indicated by a thickening of the posterior vesical wall. This is well seen in Veit's case. Or the badly developed broad ligaments themselves may be thickened in places by uterine elements, connective tissue and smooth muscular fibres. This was seen in the case of Langenbeck, of which we give a sketch.
In other cases the rudiment is more fully formed and appears as a smooth band, continuous above with the tubes, and below with the round ligaments. Nega has described such a case.
The ovaries were very large and long, but no Graafian vesicles could be found. The vagina was replaced by connective tissue. The labia were strongly developed, the clitoris one inch long, the pubis well provided with hair, and the mons with fat. The pelvis was masculine, though the outlet was very wide. The person was strongly built and fat, and the bosom firm. Nothing could be ascertained as regards menstruation.
In other cases there are two independent, solid, vertically placed bodies in the broad ligaments, forming the uterus bipartitus. Sometimes they meet and unite, and then we have tlie uterus rudimentarius bicornis.
In still more fully developed cases, the median piece ends in the blind vagina, and the cornua project above. This lower segment may increase in size, and more or less approach a cervix in shape; and the whole struc ture will then still more closely resemble a solid uterus bicornis. But in all these eases the structure is almost or entirely solid. Like the normal organ, they are composed of connective tissue and smooth muscular fibres. Although usually found in connection with other and more serious de fects, this deformity does occur in viable individuals. The vagina and external genitals, and the tubes and ovaries, are usually the same as when • there is complete absence of the uterus.
This anomaly occurs at a time when the rudiments of both halves of the organ have been formed, but when fusion hu.s not yet occurred. It usually involves the entire median segment of the Mfillerian ducts, but it may wholly or partially involve only the lower and upper segments (vaginal or tubal). According to the intensity of the nutritive disturbance, a larger
or smaller mass of the rudimentary structure is destroyed.
As we have seen above, it makes no difference as regards the sexual function and sexual maturity whether the uterus is entirely absent or only rudimentary. The ovaries, usually present, are not infrequently normal; and the general system and that part of the genital system that is not interfered with do not suffer in their development at all. The in dividual remains a woman; the habitus, bones, limbs, physiognomy, and voice are female. So also is the psychic development. And so also are the pelvis, the breasts, and the external genitals.
As regards the sexual functions, there is in most cases no trace of periodic ovulation. Only in a very few instances is there a bloody flux from the remains of the internal genitals and the rudimentary vagina. But these hemorrhages are scanty and irregular, and it is doubtful whether they are menstrual in their character. They may be partly traumatic, and due to violent cohabitation when the vagina is rudimen tary; this occurs in animals, and. especially in cows under like circum stances. Vicarious hemorrhages, which with perfect ovaries we would expect more often, are extremely rare, though they have been observed from nose and rectum. Inflammatory products near the ovaries, and re mains of hemorrhages in the abdominal and tubal cavities point to ovarian activity; but they are extremely rare. So also are the so-called men strual molimina. We do in fact think that molimina point to function sting ovaries and 'ripening Graafian follicles, but whether their absence entitles us to assume the existence of an ovarian defect, our present ana tomical knowledge will not enable us to decide. • There is no dispute in the vast majority of these cases as to the incli nation for the other sex. Most of these womon over twenty years of age were married, many of them happily. Almost all of them, whether mar ried or not, showed distinct traces in the external genitals of the energetic attempts at cohabitation, to be more fully considered below; the pain of which would hardly have been suffered had it not been compensated by powerful voluptuous feelings.