uterus during infantile life. When the first evolution in the process of development-i. e., the union or coalescence of Müller's ducts

FIG. 30.-Uterus unicornis from a young child, posterior aspect (Pole): 6, right Fallopian tube; c, left Fallopian tube exceptionally present; dd, ovaries; e, bladder (Courty).

is arrested, and each duct grows by itself, the result is the uterus bipartis (Fig. 33).

The uterus duplex is formed by the coalescence of the ducts, with arrest of absorption of the central wall. The development goes on, so that in time the whole organ is larger than the normal uterus, but it is divided into two by the central wall (Fig. 29). Uterus unicornis is produced by a complete arrest of development of one of the ducts at the part which should form one half of the body and fundus of the uterus (Fig. 30). The uterus bicornis occurs as the result of non-union of that part of the ducts which forms the

FIG. 31.-Uterus bicornis unicollis (Winckel).

body and fundus (Fig. 31). The uterus bifundalis unicollis is formed by the same error of development as that which produces the uterus bicornis and double uterus with the following difference: In the

uterus bifundalis (Fig. 32) the horns, though not united, are well developed and present outlines more nearly like the normal body of the uterus and the septum

formed by the union of the ducts at the part which forms the cervix. In this it differs from the uterus duplex (Fig. 33). Entire absence of the uterus is perhaps unknown, unless in monstrosities in whom the lower part of the trunk is wanting. Rudimentary uterus is seen occasionally. As most frequently found,

there is a very small cervix slightly, if at all, invaginated, and in place of the body of the uterus one or two small solid masses are

FIG. 33.-Uterus duplex (Cruveilhier). Left walls developed in consequence of pregnancy. found from a quarter to half an inch in thickness and about the same in length.

The effect of these malformations as manifested during func

tional life is quite remarkable. In some there is not the slightest deviation from health in the function of the sexual organs. In others the results are very disastrous. This practically gives two classes of malformations according to the effect they have upon the health and usefulness of the subject. In the one class the malformation does not materially affect the function of the uterus, while in the other, the functional action is always imperfect-sometimes impossible. The cases of simple deformity, in which there are sufficient development and growth of one or both elements of the uterus to make the organ functionally competent, have no ill effect upon the general usefulness and welfare of the individual. The following case will illustrate this:

Double Uterus and Vagina.-A married lady, thirty-two years of age, who had borne three children and nursed them, called upon me for advice regarding a leucorrhoea which had troubled her since the birth of her last child. Her general health had always been excellent. Upon making a digital examination, I found the vagina normal and also the cervix, excepting that one side of the cervix was closely united to the vaginal wall throughout its entire length. On the left side of the vagina high up I found a hard mass which was also noticed on making bimanual exploration. The first impression was that she had suffered from a pelvic cellulitis, and that the mass on the left side was the remains of its products. This idea was given up at once on finding that the patient gave no history of any pelvic inflammation. I then suspected that

there might be a fibroid in the left side of the uterus, which, by extending the entire length of the cervix, had pushed the vaginal wall before it. A speculum examination revealed a catarrh of the cervical canal. The uterus had the usual appearance of one that had borne children, and the cervix was normal in shape and position, except for the peculiar relations of the cervix and vagina on the left side, which were noticed during the examination with the touch. Just within the labium minus on the left side, a peculiar fold of the vaginal wall was noticed running transversely. On raising this fold with the point of the sound it was found to be a septum, and there was also discovered another vagina to the left of it. Using a smaller Sims's speculum to distend this vagina, I found the other cervix which had all the characteristics pertaining to a nullipara. The passage of a sound showed that the canal of the uterus on the left side was not quite so long as the one on the right. It was then clearly evident that the patient had a double uterus and vagina, and that the right uterus had borne three children, while

the left uterus was a virgin one. She was attended in her confinements by three different physicians, none of whom made any reference to this malformation, and it is fair to suppose that none of them discovered it.

This case is of interest as showing the fact that some of the malformations do not in any way affect the function of the uterus nor the general health of the subject.

When there is malformation, and the growth of the uterus falls so far short of the normal type that functional activity is impossible, the results are often very unfortunate. The nature of this class of cases bears such close resemblance to those in which there is arrest of secondary development at puberty, that they may be considered together in the following chapter.

CHAPTER III.

ARREST OF DEVELOPMENT, AND ENTIRE ABSENCE OF FUNCTIONAL ACTIVITY-ARREST OF DEVELOPMENT AND GROWTH IN THE LATER STAGES OF EVOLUTION, AND THE CONSEQUENT IMPERFECTION OF FUNCTION.

IF absence of the uterus or a rudimentary state of its development is associated with absence or a rudimentary state of the ovaries, there is no tendency to functional action, and the individual may not suffer in consequence. She simply remains an imperfect and undeveloped being. But when the ovaries are present and functionally active, there is generally a tendency to menstruate; and this tendency, unrelieved by a menstrual flow, is often attended with great derangement of the general health and much suffering.

The first evidence of this malformation from arrest of development that comes to the notice of the physician is derangement of the menstrual function in some form, or its non-appearance at the proper age. On this account it will be well to discuss in a general way the nature and characteristics of menstruation before giving the history of its derangements, which arise from lesions of structure resulting from imperfections of development and growth.

Menstruation has been the subject of so many speculations regarding its physiology, that it would be unprofitable to enumerate them. Suffice it for our present purpose to state that when the uterus attains its normal development in a healthy subject it becomes possessed of all the requisites necessary to the development of an ovum ; but when impregnation does not follow, the mucous membrane of the cavity of the body of the uterus undergoes degeneration, either wholly or in part, and is exfoliated in a granular state. This degeneration and exfoliation, according to some observers, involve the whole membrane down to the muscular walls, while others claim that they only affect the epithelial layer. Be this as it may, there appears to be a general agreement among the authorities of the present time that degeneration and exfoliation occur to an extent sufficient