PREGNANCY IN A RUDIMENTARY HORN OF THE UTERUS.
This forms the connecting link between intrauterine and extra uterine pregnancy. Rokitansky thought that he had described the only case of this variety in 1842, and ten years later Scanzoni thought that he had described the second case, but Kussmaul, in his classical treatise, stated that many cases that had been described as tubal pregnancy were in reality pregnancy in the neighboring rudimentary horn.
The cases of Pfeffinger and Fritze 1779, of Friedemann and Czihak 1824, Jiirg and Guntz 1831, Dreier 1835, Ingleby 1834, Heifelder 1835, were considered to be pregnancy of the Fallopian tube. Further cases were described by Rokitansky in 1842, (which was at that time considered to be pregnancy in the Fallopian tube, but Rokitansky declared it, in his pathological anatomy, to be pregnancy in a rudimentary horn of the uterus,) by Scanzoni 1854, (who at first considered it to be pregnancy in the Fallopian tube until he was shown his error by Virchow,) Base 1852, Ramsbotham 1832. Two cases seem to have been correctly observed at a still earlier date, one by Dionis 1681, and the other by Camestrini 1788, to which may be added a later case by Luschka, 1863. Sanger has col lected all of the cases up to 1884, and with the later cases of Chiari 1876, C. Ruge 1878, Maschka 1882, and his own, he finds twenty-nine cases, so that with one described in Fig. 14 there are altogether thirty cases of this variety of disease. Twenty-three ended in rupture during the first six months, three resulted in calcareous formations. In four cases laparotomy was performed.
The differentiation of interstitial pregnancy and development in a rudimentary horn is often very difficult on the cadaver, since in both varieties the round ligament, which ought to differentiate between the two, lies outwards. According to Virchow great difficulty is frequently experienced in the explanation of a case as to whether it is pregnancy in a slightly developed accessory horn of a liicornate uterus or " graviditas interstitialis herniosa," in which case one has to bear in mind the loca tion of the interstitial part of the tube and the part of the uterus to which the lateral ligament is attached.
These pathologico-anatomical observations ought to prove to the prac titioner that the diagnosis of this variety of extra-uterine pregnancy may be impossible.
I received a very good preparation to illustrate this variety through the kindness of Prof. Hofmann; but unfortunately could learn very little of its history; although the rudimentary horn had no opening into the vagina, impregnation had taken place, very likely by wandering of the spermatozoa. A marked corpus luteum could not be found on the cut surface of the ovar The cases are very rare where an extra-uterine ovum develops in a hernial sac. In one of Widerstein-Genth's ,reported cases, a four months' fcetus was taken from an inguinal hernia that previously con tained an ovary.
Changes in the Uterus in Extra-Uterine Pregnancy.
It is an old observation that the walls of the uterus are developed as in normal pregnancy. Friedlander, Kundrat and Engelmann have studied the development of the mucous membrane of the uterus during normal pregnancy; Ercolani and Langhaus the development of the uterus and its mucous membrane during extra-uterine pregnancy, and found the processes to be entirely analogous. Langhaus found on examining a uterus, the right tube of which contained a six weeks' ovum, that it was 3.8 inches long, two inches of which was body one inch thick, from the uterine attachment of one tube to the other 2.4 inches; in the cervix a tough plug of mucus was found. The changes in the uterine mucous membrane were the same as in the uterus in normal pregnancy at the fourteenth week, which Langhaus also examined.
In both cases it was found that swelling of the mucous membrane of the uterus took place, with extensive ce'l proliferation in the superficial part of the stroma, while in the deeper portion of the same the glands were markedly developed, giving a soft feel. Taking into consideration the stroma and glands, three layers can be distinguished in the mucosa; an upper compact, the original decidua; a middle spongy layer, rich in glands; and a deeper compact in which blind ends of the glands can be found. The layers were as markedly defined as in a normal case; the spongy layer was fully developed only in the middle of the anterior and posterior walls of the corpus uteri; in the remaining portions the glands were slightly developed, as were the middle and deep layers.