THE TWO-HORNED UTERUS.
The amount of division apparent externally varies greatly. In the highest degree of the deformity, the bodies are entirely divided, and seem to be only placed in apposition; and the common cervix has a deep fur row upon both its anterior and posterior surface. In lesser degrees the cervix appears single, but is exceptionally broad; and in a still less de gree the division of the uterine body is marked externally only by a fur row in the broadened fundus, forming the important form of the malady known as uterus arcuatus. In the very least marked degree the fundus, instead of being arched, is flat; and the division is apparent only inter nally. Thus we get the triangular or anvil-shaped womb; uterus trian gularis or incudiformis.
AS a rule, the left horn is turned anteriorly. and the right horn more to the rear. This twisting of the organ upon its longitudinal axis is what is seen in the normal womb also, and is probably due to the presence of the rectum.
As a rule there exists a partition wall inside the uterus. The uterus and cervix may be completely divided into two separate compartments (uterus bicornis septus), and the dividing membrane may partly or wholly involve the vagina. also. In other cases the body of the womb only is partitioned, and the cervix is single (uterus bicomis unicollis). Or the partition wall may only partly divide the uterine cavity itself, while the two cornua are completely separated (uterus bicornis unicorporeus). Or again, the partition of the uterine body may be only indicated by a promi nent ridge upon the posterior uterine wall.
The two halves of the womb are rarely equally developed; one is usu ally larger than the other. Transition forms, between the complete uterus bicornis with both halves fully developed and the uterus unicornis with rudimentary cornu, are frequently observed.
The ligamentous band, so frequently found between the posterior vesi cal and anterior rectal wall, and tntversing the furrow between the two uterine cornua, the ligamentum recto-vesicale, is of importance both in relation to the origin of the anomaly and in connection with pregnancy.
As regards neighboring organs, the tubes and ovaries are usually nor mal, but the vagina often participates in the duplexity. The vagina may be double; and one vagina will then usually be found to be less developed) narrower, or blind at its upper or lower end. Often the dividing mem brane does not extend down to the introitus, or the two vaginw may com municate with one another by orifices in the partition.
The external genitals and breasts are usually normal.
The atresias which may affect one half of a uterus bicornis, and which may be at the cervix or at the os extemum, are of great importance. If the vagina participates in the reduplication, the division may extend even down to the hymeneal region. The less developed side is almost always closed.
It is interesting to note that the symptoms of duplexity sometimes extend to the rest of the body; the transverse diameter of the pelvis is increased, and the face and thorax is broadened. The general female character of the entire organism is, however, in no way affected.
The sexual functions are, however, disturbed. Menstruation is irreg ular. When the partition is complete, it does not always occur simulta neously from both cavities; or the two halves may alternately functionate. If other menstrual disturbances are present, they are usually referable to other causes.
When one half becomes pregnant, menstruation usually ceases en tirely, but there are cases in which the menses appear regularly from one half, while the other half is in a gravid condition. The following care fully reported case of Francis Henderson is interesting in this connection; Henderson watched this patient for seventeen years, and his observa tions are, therefore, thoroughly reliable. The patient was thirty-nine years old, had menstruated from her sixteenth year regnlarly every three weeks for eight days, until six weeks previous to the birth of her first child, which occurred one year after her marriage in 1866. This birth, and the other five were normal. All the children were nursed by her; and the menses were absent during lactation.