1. Defect And Excess Of Formation

Complete absence of the uterus must be considered as extremely rare; in most cases in which the uterus was found deficient in the dead or living subject, rudiments of a uterine organ of different forms were discovered.1

The most common case of arrest, which is generally considered as absence of the uterus, is that in which the fold of the peritoneum, which is destined for the reception of the internal sexual organs, contains, on one or both sides, posteriorly to the bladder, one or two small, flattened, solid masses, or larger hollow bodies, with a cavity of the size of a pea or a lentil, which is lined with mucous membrane. They are to be viewed as rudiments of the uterine horns, and the Fallopian tubes bear an exact relation to their development. These may either be totally deficient, or terminate in the vicinity of the uterus in the peritoneum as blind ducts, or they may communicate with the uterus with or without an open passage.

1 Oestr. Jahrb. xvii. 1.

This formation of the uterus, and especially the existence of two lateral, hollow, elongated and rounded uterine rudiments, each of which is connected with a corresponding Fallopian tube and ovary, constitutes what Mayer terms the uterus bipartitus. From each of the uterine rudiments a flattened, round cord of uterine tissue ascends within the fold of the peritoneum, and the two from each side coalesce. The place of the uterus is occupied by cellular tissue, in which a few uterine fibres, derived from the just-mentioned cord, may be traced; it presents the general outline of a uterus, and, reaching downwards, rests upon the arch of a short vaginal cul-de-sac. The external sexual organs and the mammary glands, as well as the general sexual character of the individual, attain a normal development.

If we pursue the progress of these uterine rudiments we find a development on one or both sides; representing in the former case, a uterine half, or a uterus unicornis; in the latter, a two-horned uterus, or uterus bicornis, varying in degree; this is what is falsely called the double uterus, uterus duplex. These, and the following uterine formations which depend upon fissure, offer considerable interest.

The one-horned uterus may be always demonstrated to be a uterine half, developed from a rudimentary uterine horn, or the unsymmetrical half of a uterus bicornis, either of the right or the left side. It is a cylindrical or fusiform body, that is curved towards the corresponding side, and from the superior portion of which a tube passes to the ovary. The following are the proofs of its resulting from an arrest of development; it presents:

Firstly

A vertical diameter, which generally resembles that of a normal uterus;

Secondly

A diminution of the transverse diameter;

Thirdly

A small (virginal) fundus, with a preponderating thickness of the long and spacious cervix (foetal state);

Fourthly

The arch in which this uterus is deflected from the meridian is variously curved;

Fifthly

The cervix, as it descends, corresponds more and more to the axis of the body, and its vaginal portion entirely coincides with it. In the virginal uterus the latter is always small, and the vagina narrow;

Sixthly

In the os tincae the palmae plicatae approach closer to the convex margin of the uterus;

Seventhly

The broad ligament on the side of the deficient uterine half is in some cases remarkably large; it at least presents sufficient room for the absent symmetrical half of the uterus.

The Fallopian tube of the defective side shows various relations; if there is no indication of a uterine horn it is almost always absent, and the broad ligament generally forms a slightly fringed prolongation at the point corresponding to the free end of the tube. Occasionally it is even absent when there is a rudimentary uterine horn, and it presents the relations described at p. 206. In rare cases we find a total absence of one half of the uterus, whilst the corresponding tube terminates blindly in the convex margin of the one-horned uterus above its cervix.

The ovary of the defective side is, with rare exceptions, present even when the Fallopian tube is wanting.

We are the more induced to extract the following remarkable case from the essay cited elsewhere (Vol. III.) as an instance of the transition from the uterus bipartitus to the uterus bicornis, as the case of pregnancy in a uterine rudiment (one-half of the uterus bipartitus), which we shall have occasion to quote at a future period, will thus be rendered more intelligible.

The internal sexual organs of a tailor's wife, aet. 34, who died in the lunatic asylum on the 24th of September, 1830, had always menstruated scantily, and bore no children, present the following relations. The uterus has a conical shape, is two inches and three lines in length, presents a curve to the left, has tolerably thick parietes, and is acuminated above; the fimbriated extremity of the Fallopian tube is agglutinated to its ovary. On the right side there is a very large ligamentum latum, within which, at a distance of two inches from the uterus just described, and on a level with its superior portion, there is a body of the size of a hazel-nut, consisting of uterine tissue, and presenting a cavity of the size of a lentil, into which a tube an inch and a half long, and of a sigmoid serpentine form, opens. Posteriorly this uterine rudiment sends off a carneous prolongation, representing the ovarian ligament, anteriorly it gives off a round ligament. On its inner side it is prolonged in the direction of its axis, i. e. obliquely downwards, as a solid band of uterine substance, which impinges upon the convex right margin of the left uterus one inch above its external orifice. Both ovaries are small and contracted, the cervix is small, the vagina narrow, and its arch infundi-buliform.