COMPLETE ABSENCE OF THE .UTERITS.
The difficulties of an exact examination in these cases explain why they are so often mistaken for complete de fectus. Even a post-morlem examination is not above cavil; the rudi ments of a bi-lobed uterus have been taken for the tubes, and Kiwisch himself has mistaken the hollow rudimentary uterus for the vagina.
He had diagnosed complete absence of the uterus in a woman eighty one years old. But the vagina consisted of two parts, a lower one, one inch long and blind, and an upper one, beginning as a pointed tube one inch above this, and measuring three inches. It was compressed antero posteriorly and ended also in a blind sac, which was curved upon itself. The vascular bundles which took the place of the round ligament ran into the upper end of the so-called vagina. But an insertion of the round ligaments anywhere save in the uterine cornua or the tissues that replace it, is opposed entirely to the whole course of uterine development. If the uterus were absent, they would be lost in the mass of connective tissue which replaced it. (Bussmaul.) Or there may be hermaphroditism; the vesico-rectal space is empty, and the testicles, still in the abdomen, are mistaken for the ovaries. Steglehner had such a case.
He performed an autopsy on the body of a very well-known woman, of slender and graceful person, twenty-three years old. The vulva was well developed, though scanty in hair; the nymphEe aud clitoris were small, and the vagina WAS very narrow. Stegleimer was astounded to find neither uterus, oviducts, nor ovaries; and lie was about to content himself with the diagnosis " Virgo sine utero,'' etc., especially as the vulva was present, and she was said to have menstruated with fair regularity, when he accidentally saw something like the vas deferens ascending to the ingainal canal, and, on careful examination, discovned a testicle and epididymis.
Other anomalies are almost always present with complete absence of the uterus. Absent or rudimentary and solid tubes, atiophy or absence of the testicles, are almost always found. The vagina is nearly always involved. It may be absent or be a blind sac. The external genitals may
be normal, or small and undeveloped.
If there are no tubes, then there will be no broad ligament, and the peritoneum, as in the male, passes directly from bladder to rectum. If the tubes are present, the broad ligaments appear as two lateral folds con taining them, and uniting in the depth of the pelvis in a half-moon shape.
As a rule complete absence of the uterus and adnexa is only found in the above-mentioned monstrosities; in adults normal or atrophied tubes and ovaries are found. In these latter cases the external genitals are tumidly normal, the pelvis wide, the breasts well developed, the form and character decidedly female.
The malformation occurs during the first period: the Milllerian ducts were either not formed, or they have been completely destroyed. Both rudiments have been affected in their entirety.
The physiological importance of the anomaly, is that of the rudimen tary uterus, and so are the symptoms and. diagnosis. They may well be considered together below.
The best of the older recorded cases seems to me to be that of Quain, although the examination of the specimen does not seem to have been carried out with the requisite care.
An mimic person, thirty-three years old, of female form, had had epistaxis fairly regularly every month, especially for the last two years. She would have married a man had not certain external circumstances interfered. She bad undergone the ordinary changes of puberty, her breasts were well developed, and her pelvis had the female diameter. The vagina was a blind sac into which only the first phalanx of the index finger could be passed. No trace of uterus, ovaries, or tubes could be found. The peritoneum stretched directly from bladder to rectum, unless we should regard the half-moon-shaped fold at the blind end of the vagina for the rudiment of the os. The distance from the ostium urethrm to the end of the blind sac was one inch. High up on the posterior vaginal wall was a small and apparently glandular body, perhaps au ovary. Ex ternal genitals were normal.
Of course there is no treatment for these anomalies.