During the first gravidity the menses were more abundant than usual; during the second there was an almost constant bloody flux, which be came profuse at the slightest exertion; and the patient wa.s very anaemic when she bore a child in 1868. The menses appeared three times during the first gravidity, the fourth, fifth, and sixth gravidities and deliveries were entirely normal.
After weaning the sixth child she menstruated regularly until June, 1879. Then the menses were absent twice, and the patient believed her self pregnant Thereupon there. ensued a continuous moderate hemor rhage until December of the same year. At that time Henderson believed abortion to be unavoidable, and dilated with laminaria. One inch above the os externum he found a septum, which divided the womb into two cavities. The left cavity, one inch long, was entirely empty; and from the right cavity, 3i inches long, only a small amount of white, fibrous matter could be scraped out. After this the uterus returned to its nor mal size. Henderson himself inspected all the matters that were brought away, and there were no fcetal remnants. He, therefore, thought that there probably was an extra-uterine pregnancy. Menstruation thereupon set in as before until gravidity again began, and the seventh birth occurred in October, 1882. Henderson did not have an opportunity to decide which part contained the ovum, but one month post partum the left portion was found by the examining physician to be the most developed.
Bilateral atresia of the uterus bicornis has not yet been observed. Most often the right half is occluded, and hematometra occurs in it as in the rudimentary uterine cornu. There are some cases, however, where years may pass after puberty, without the first symptoms of blood stasis setting in. And the growth of the tumor may be so slow that it may finally only reach very moderate dimensions. This irregularity is due to the fact that the entire development of the individual is delayed, or the closed cornu is only in a rudimentary condition.
Hematosalpinx not infrequently appears early; and it is liable to rup tare earlier than is the dilated half of the uterus. Adhesion of the womb to the abdominal wall from peritonitis, and external rupture of the sac has also been observed.
Perforation into the patent uterus or into the vagina is much more favorable, and definite cure may occur from the fistula remaining open.
But not infrequently the catarrh of the patent canal spreads to the former closed cavity, in which there is frequently some blood stagnating, and suppuration sets in. If the opening now closes we again have a tumor (pyometra lateralis). And besides this, suppuration may occur from unknown causes in a sac filled with blood or mucus. The sac may break again into the sound half, or the pus may be evacuated through the tubes into the abdominal cavity.
Lobonowski has recorded a case in which mucus collected in the im perforate half. Here there can be no menstrual flux, but only a condi tion of hypersecretion of the mucous membrane. These tumors do not become very large.
Menstruation gives us peculiar symptoms when one half of a bicorned uterus is imperforate and distended. Menses are present, and yet the symptoms of hematometra, dysmenorrhcea, pressure and peritonitis are present also. Perforation of the dilated cornu or tube into the abdominal cavity or genital canal may also occur. When pyometra sets in, fever and pain are present; and perforation means peritonitis or prolonged suppura tion of the sac.
Sexual desire is unaffected. The possibility of coitus depends upon the condition of the vagina, a,s to whether the malformation extends so far, and the development of both canals. Usually they are of unequal diameter, and the wider one only is used; and if this wider one is blind, as sometimes occurs, coitus may be impeded, and conception prevented. Duplexity of the uterus alone never causes sterility; either half of the organ may become gravid. Defective development of the organ does not interfere more often with the pregnancy than is the case with the simple organ. The fcetus is usually carried to term, the muscular structure of the gravid half being almost as great as that of the single organ. The non-impregnated uterus usually participates in the pregnancy, hyperpla sia of its walls, and formation of a decidua taking place. The only rare exception to this is when the second horn approaches a rudimentary cornu in its development. It is but little enlarged by the pregnancy, and, lying posteriorly, is lost in the abdomen. Only when the child has been born does it become prominent. If the uterus unicornis is also unieor porens, both cornua will be dilated, that in which the buttocks lie directed upwards being largest, whilst the smaller ()Grim may contain the pla centa. The more perfect the division, the more independent do the two uteri seem to be. Both cornua contract at the same time otter parlum in the uterus bicornis unicorporeus; and when the two cornua are entirely divided we observe contractions and dilatations of the cervix in the un. impregnated halt In some cases, however, the latter takes no part in the birth. The independence may be so great, that when either half contains a fcetus, the contractions at birth may occur now in one and now in the other horn; and it may happen that the two fcetuses are extruded at periods far apart. Gonterman has described an interesting, and, I think, reliable case, in which pregnancy occurred alternately in either horn.