4. But the obstacle to development may appear so early that it pre vents the foundations of uterine structure being laid. One half only niay be formed, or one segment of both sides may be wanting. In this manner also atresias may be formed, and every vestige even of a rudimentary struc ture be absent.
I hold that developmental faults of the uterus can only occur in these ways; but I admit that several of the above processes may be jointly con cerned.
But when affected in one or more of these ways, the uterine rudiments may still increase in size, even though the normal form has been entirely lost. Thus a partitioned uterus may be as large as the regular cne, and the weight of the two halves of a divided uterus may be greater than that of the single organ. And in the rudimentary uterus of an adult, the mass of tissue may exceed that of an infantile womb.
In classifying the various uterine malformations, I shall follow in all essentials the scheme of L. Fiirst, which is based upon Kussmaul's work.
I shall make only a few changes, the reasons for which I shall give below, and I shall omit the confusing sub-classification. For the sake of com pleteness, also, I shall make a few additions, and alter the nomenclature a little.
This would be my classification: I. Complete absence of the uterus: Defectus uteri.
II. Atrophy of the uterus: Uterus rudimentarius.
III. Absence and atrophy of the uterine neck: Defectus cervicis uteri et cervix uteri rudimentaria.
IV. The one-horned uterus: Uterus unicornis.
V. The one-horned uterus with atrophied second horn: Uterus unicornis cum cornu rudimentario.
VI. The two-horned uterus: Uterus bicornis VII. The two-chambered uterus: Uterus bilocularis.
VIII. The double uterus: Viii. The double uterus: Uterus didelphys.
IX. Faulty development of the uterus: Hypoplasia uteri.
In addition there are a number of less important uterine anomalies which cannot be easily classified under these heads.
A good deal of confusion has recently been caused by the excessive in troduction of sub-divisions into this classification. A little further ex planation may, therefore, be in order.
By uterus duplex I do not mean the two-horned uterus, but use the term collectively, to designate all forms of reduplication of the organ.
For the two-chambered uterus Kussmaul uses the term uterus septus. I prefer Rokitansky's old term of uterus bilocularis, as more distinc tive, since septus reminds one of " septum,' which is found also in the uterus bicornis. I use the word septus to designate the partition, and speak of a uterus bicornis septus when there is a septum continued down wards from the point of division of the cornua.
I call the completely divided uterus, uterus didelphys, as a shorter and better term than uterus duplex separatus. I reserve the term uterus inpartitus for the two divided and solid halves of the uterus rudimenta rins. I do not follow the customary division of under-developed uteri into uterus fcetalis, infantilis, membranaceous, and small womb; sinr:e I re gard them as mere anatomical varieties, and I call the whole group of un developed uteri hypoplasia uteri.