ETIOLOGY AND SYSTEMATIC A.CCOUNT OF THE OPMENTAL ANOMALIES OF THE UTERUS.
Nevertheless they had been fairly studied at the beginning of this century; and it is not quite proper to say that we knew but little about them before the appearance of A. Kussmaul's epoch-making book. Thus in Fr. L. Meissner's text-book on Female Diseases (1842) the vari ous forms of malformation are classified and their mode of origin de scribed. Almost at the same time appeared W. H. Busch's great work upon the Sexual Life of the Female (Vol. III., 1841), where is to be found a fairly sufficient description of the single anomalies from a clinical stand point. The pathologists also had done good work in this direction. Roki tansky had given an exact description of the various forms, and Forster had classified them in a very satisfactory manner. Naturally both these re garded the subject from a morphological standpoint, and a genetic classi fication could hardly be expected in the condition that embryology was then in. It was not until 1830 that Joh. Miiller's investigations eluci dated the history of uterine development, and permitted a proper explana tion of the maladies in question to be given.
It was reserved for A. Kussmaul, however, to give an exhaustive de scription of uterine malformations, to refer their origin to interferences with the ordinary processes of development, and to classify them accord ingly. This he did in his book " On the Absence, Flexion and Duplica tion of the Uterus," in 1859. Since his time the literature of this branch of gynecology has swollen considerably; and we may especially mention the researches of L. Furst, V. Hoist, and Le Fort. Nevertheless all that they have done is based upon Bussmaul's work.
L. Ffirst deserves special credit for his efforts to fix the time at which the various malformations occur.
But although we can now decide the time and place at which the vari ous developmental faults arise, we are yet rather in the dark as to their determining cause. Nevertheless there are certain grounds for very probable hypotheees. It is to be doubted whether anatomical investigation will suffice to elucidate the etiological relationships of these conditions.
Perhaps by means of experiments, such as those to which we owe no in considerable light on teratology, there may in the future be more light thrown upon the subject.
But even if we do not know the ultimate cause of these faults of de velopment, we have yet sufficient data to form some conception as to how these uterine malformations arise. The process varies in different cases.
1. The approximation and union of the two lateral organs which form the uterus may be interfered with. This union, as we have seen, begins below and extends upwards. In accordance with the time at which the interference with coalescence takes place, will be the amount of the organ in which each half is separately developed. When this interference has once taken place, the damage is irreparable, a return to the normal de velopment is no longer possible.
2. A second factor is the disappearance of the vaginal septum formed by the union of the two median walls. Interference with this process gives us a uterus with double cavity, and since the atrophy is progressive from below upward, the division of the cavity of the womb may be com plete, or it may be more or less imperfect.
3. The interference may cause nutritive disturbance in the original genital structures. Pressure from without, or inflammation, may cause changes in the shape and structure of the parts affected. If it occur early, before fusion of the lateral parts has occurred, it may affect one half only, the other side going on to develop normally. Or the interfer ence may affect the single or yet double uterus along a horizontal plane, and the parts above and below may be quite normal. The amount of disturbance may entail complete destruction without any trace being left; or it may fall short of that. In this latter case, since the uterus is a hol low and not a solid organ, the lumen of the canal may easily be destroyed. Then are formed those important anomalies known as atresias.