DEFICIENT DEVELOPMENT OF THE UTERUS.
These forms simply represent the various stages at which the womb has ceased to develop.
Uterus fcetalis is but rarely found. As in the new-born child, the organ is small, and its longitudinal axis is only one-half or two-thirds the size of the normal womli. It is anvil-shaped; the cervix is dispropor tionately large, and the body is small and seems to be merely an appendix to the neck. Often it is bent forwards, so that the small relaxed body rests upon the anterior surface of the thick cervix. The internal os is indis tinct; and the plicm palmatit are continued into the cavity of the uterine body.
In other cases the uterus is as small as in the fcetus, but the body is larger than the cervix, and the walls of the organ are very thin. This form has usually been called congenital atrophy; Virchow and S. v. Forster designate it congenital hypoplasia; Puesch (sails it utkrus pube scent. If the walls are very thin indeed, we have the uterus membrana WIL In other cases the uterus is normal in shape, but is too small. The longitudinal axis is 1.6 to 2 inches; the walls are very thin, and the cer vix is indicated by a barely peroeptible groove. This form is called uterus infantalis by some, but it had better be designated by the term congeni tal smallness of the uterus.
But all these three abnormalities are only types of a series of forms of deficient uterine development, which is best called hypoplasia uteri. Many transition forms between the above types have been recorded; and there are similar transition types downwards to the rudimentary, and upwards to the normal womb. One such interesting case has been re corded by Duplay.
He found a small uterus, cervix eighteen lines long, body only half an inch long and sixteen lines broad. At first sight the womb appeared to be all neck. The body was solid, but the cervix had a narrow cavity one and a half inches long, blind above, and opening below into the vagina by a narrow orifice. The walls of the cavity were united to one another by delicate threads; and the inner surface of the canal was of a yellow color, such as is seen in old apoplectic foci. The oviducts were solid
fibrous cords.
As to the transition stages to the normal size, many of the cases of anteflexio uteri met at puberty, are cases where the organ is too small and its walls are too thin. We cannot, therefore, make too sharp a distinc tion. But if the cervix is. larger than the corpus uteri; if the longitudi nal axis is less than two inches; and if the walls are thin and membranous, I would include the organ in this category. One or all of these factors may be present. If they all are, we have the well-marked uterus fcetalis; while mere thinness of the walls forms the least degree of the anomaly.
The deficient development may apply to the uterus alone; the rest of the genitals and the entire body being normally developed. But in most cases there are irregularities in the sexual or other organs, which are more or less closely related to the uterine anomaly. The tubes are rarely affected, but the ovaries often are. Absence, rudimentary condition, non-presence or defective development of the Graafian follicles, have been found as regards the ovaries, in connection with hypoplasia uteri.
The vagina is usually normal; abnormal narrowness and shortness is uncommon; and the same is true of the external genitals and the breasts.
The pelvis is sometimes small and childlike, and sometimes masculine, but it may be quite natural. The entire body may vary from dwarf size to the natural stature.
The rule is that the less the degree of the anomaly, the less are the associated changes. But there are exceptions. With the highest grades of hypoplasia the ovaries may be normal, and the bodily structure large and vigorous. • The causes of hypoplasia uteri can only come into action when the organ has been completely formed, in the last months of pregnancy, and after the twenty-fourth week. But the uterus attains its fully developed form late, and injurious influences affecting the organ after birth, during childhood, or even at puberty, may cause the deformity. It cannot, therefore, be called purely Congenital.