As we have seen, the non-impregnated womb can only be recognized at the beginning of pregnancy; the motility of the organs being such that the gravid womb soon lies over and displaces the unimpregnated organ, so that it cannot be felt. The pointed shape of the fundus also seems to give us but little help, especially in multiparte, and we have seen that tbe same is the case in the uterus unioornis. But so long as the presenting part has not entered the pelvic canal, and the cervix has not been distended, the two separate vaginal portions should enable us to make the diagnosis. At birth itself the cervix of the non-impregnated uterus will not change its shape; while in the uterus bicornis and bilocu laris, the os externum of the empty half, following the dilatation of the entire cervix, will be transformed into a wide, crescent-shaped pocket. I consider this sign so characteristic that I think that all the older recorded eases in which the second os, though it opened at delivery, yet did not change its shape, are cases of double uterus.
Benicke's case shows that bi-manu'al examination is quite sufficient to effect a diagnosis of double uterus after delivery, and during the.puer perium.
We possess as yet no observations which will enable us to decide as to the possibility of diagnosis when both portions are pregnant, or in labor.
As to the treatment of the anomaly, that is neither possible nor ne. cessary. Any trouble from retained fluid or any difficulty arising during childbirth is to be treated exactly as in the case of marked uterus bicor nis. If the vagina is involved, it may be necessary to take means to faci litate copulation, as in the case of Tauffer which Derner has reported: Patient twenty-seven years old, healthy in childhood; menstruated at fourteen years, regularly, profusely, always with backache. Married ten
years; six months ago was informed that the dribbling of urine after coitus was due to urethral cohabitation. Examination at that time showed that the two hidden vaginal introiti would just admit a catheter. They were dilated, first with a three-bladed dilatator, then for two to three days with Weiss's rectal speculum. The patient was then advised to let coitus be attempted by the proper channel. She soon conceived, but aborted at the fourth to fifth month. Since then has had pains in the left hypochondrium, and much discharge.
Status Prassens.—Mons fat; labia thin; clitoris normal. At place of urethral opening a nut-sized, reddish, cock's-comb-like tumor, the mucous membrane covering which has been transformed into an epider mis-like covering. (It is the detached lower wall of the urethra.) When this tumor is replaced we have a picture very like that of atresia hymen alis. We can see the two vaginal entrances, the left broader, the right just large enough to admit a finger.
Digital examination of left vagina shows a normal portio with broad orifice, and a goose-egg-size, anteflexed, tender uterine body, on the pos terior wall of which is a sub-serous tumor. Right vagina shows portio with lentil-sized orifice, and a movable, non-sensitive, anteflexed uterus the size of a hen's egg.
The urethra will admit the index finger. There is slight resistance at the sphincter, and the broad furrow between the two urethne can be distinctly felt. Per rectum a membranous structure half an inch broad can be felt uniting the two cervices. Ovaries hyperresthetic.
The vaginal septum is wedge-shaped; broad and muscular at the in troitus, it becomes thin as paper higher up. Chronic vaginitis. No vesi cal incontinence.