THE DOUBLE UTERUS.
It was formerly supposed that this abnormality only occurred in non viable monstrosities, especially when the lower part of the a'bdomen of the fcetus is chiefly affected. But though most pronounced in these, it also occurs in other cases. It occurs most often with fissure of the blad der, atresia ani, and the presence of a cloaca. The two halves of the or gan then form pillar-like laterally curved bodies, the pointed ends of which are continuous with the normal or rudimentary tubes. At their lower extremities they sometimes end in distinctly separable vaginte, which open into the bladder, into the cloaca, or, more rarely, into the rectum. But more frequently the uteri end directly, without vaginte, in these cavities. The uteri may be solid, and then they belong rather to the uterus rudimentarius bipartitus than here, but in most cases they are The two halves are usually widely separated, and between them lie urachus, bladder, and rectum. Often there is a distinct reeto-vesical liga ment.
Until recently this anomaly hal; not been seen in adults; and Ilayr hofer yet believes that it only occurs as part of a series of malformations which render life impossible. But we now know that some cases which were formerly supposed to be examples of the higher grades of uterus bicornis really belong here. If the drawings are correct, it is a question whether the repeatedly reproduced cases of Cassan and of Eisenmann are not really cases of double uterus. And a number of cases and specimens have now been shown to be cases of uterus didelphys. C. L. Heppner's case is usually classed the first of these.
Instead of the vagina there was a quadrangular, thick, solid, musenlo fibrous plate, 1.9 inch broad, and about .5 inch thick, which was continu ous at its upper border with the rounded uterine columns. These were solid, 2.6 inches long, running upwards and backwards, and forming at their upper extremities club-shaped protrusions half an inch in size. A body and a cervix may be distinguished in each cornu. Neither is hollow. Tubes in general normal. Ovaries show scars, distinct menstrual corpora lutes, and a few Graafian follicles.
Now it is at once apparent that this is a case of rudimentary uterus or uterus bipartitus, and not one of uterus didelphys.
A case of A. 011ivier's was decided by post-mortem examination.
The patient was forty-two years old, and had been married since her twenty-fifth year; confined four times normally, at the ninth month, after having had three eclamptic attacks. She felt sick during the puer perium, and died three months later, the diagnosis being cirrhosis of the liver.
The autopsy revealed two uteri, widely separated by intestinal coils. 'The right organ was like that of a multiparous woman, and larger than the left, which was virgin in size. The left portio vag. was plump, and the edges of the orificium uteri externum were irregular and everted; the right portio was virginal.
The adnexa were normal. From the external border of each fundus proceeded one lig. rotundum, oue tube, and one lig. latum.
The vagina was completely divided by a median wall, which ended anteriorly in a triangular fold which projected beyond the level of the external genitals a little.
Here the division was not only complete throughout the entire tract, but the uteri themselves were widely separated. 011ivier mentions a case of Bonnet's, who had observed the same condition of things in a woman twenty-five years old.
But clinical examination also has in recent times proved the existence of uterus didelphys in the adult. A whole series of such cases has been recorded, although some of them were undoubtedly cases of well-developed uterus bicornis.
Perhaps the most marked of the recent cases is that of J. Heitzmann: A girl twenty-three years old bad been long treated in vain for a blen orrhoic discharge. A careful examination showed a fleshy vaginal septum two lines thick, extending from the point of meeting of the middle and lower third to the fornix, and dividing the organ into two unequal but fully developed halves. The sound showed the left uterus to be two in ches and the right one 1.8 inches long; and, while the sounds were in situ, it'was easily perceived that the lower parts of the colli were united, but that the upper parts of the bodies were movable and widely separated. The two vaginal portions were one inch, and the two funduses, 2 to 2.4 inches apart. One tube and one ovary were apparent on each side. The girl had menstruated since her fifteenth year, normally.