680 



UTERUS AND ITS APPENDAGES. 



alescence of the two halves approaches to the 

 external orifice, the more obtuse will be the 

 angle at which their junction takes place, and 

 the more extensive will be the fissure (fig. 

 461.). On the other hand the higher the 

 point of union, the more acute will be their 

 angle. 



This becomes obvious in the lesser degrees 

 of deformity represented in figsAQZ. and 463. 

 In j%. 462., although the commissure is placed 

 at a higher point than mfig. 461., so as to be 

 much further removed from the external os, 

 there is still a considerable separation of the 

 two cornua, and their direction is still mainly 

 horizontal ; but in fig. 463., where a more per- 

 fect coalescence of the two halves has taken 



Fig. 463. 



The cornua more completely united externally, and the 

 two halves becoming more nearly parallel, (Ad 

 Nat.) 



The body is still divided by an internal septum 

 which descends from the commissure as far as the 

 commencement of the cervix, where it ends in a thin 

 falciform edge. 



place, and, consequently, where the com- 

 missure approaches nearer to the points of 

 attachment of the Fallopian tubes and round 

 ligaments, the angle has become so much 

 smaller, that the two halves begin to lie nearly 

 parallel with one another, and the horns, or 

 ununited portions, exhibit only a slight di- 

 vergence. 



In this, as well as in the following group of 

 malformations, there often proceeds from the 

 commissure an internal septum which descends 

 to a variable depth, and exercises a correspond- 

 ing influence upon the separation of the 

 two halves. In cases where the commissure 

 representing the funclus lies very low, there 

 may be no septum, and a single cervix con- 

 ducts into two uterine halves which lie right 

 and left of it. In cases where the fundus 

 is higher, if the septum extends downwards 

 only in a slight degree, as in jigs. 462. and 

 464., the cervix is still common to both sides 

 of the uterus. Where the septum begins to 

 divide the cervix, as in./zg. 463., the separation 

 of the two uterine halves is more complete, 

 but there is still a common os externum, 

 leading to the two canals. The highest de- 

 gree of division, and consequently lowest type 

 of structure, is that in which the septum ex- 

 tends not only through the cervix, but even 



to the extremity of the vagina, dividing the 

 latter, fig. 461., together with the hymen in 

 the virgin state, so that there are two com- 

 plete canals leading to corresponding uterine 

 halves. 



Group IV. In this group the external 

 form of the uterus differs but little from the 

 normal character. The breadth of the organ, 

 especially between the points of entrance of 

 the Fallopian tubes, is usually greater, and the 

 fundus, though arched, is more shallow than 

 usual. Here also a slight notch, extending into 

 a shallow furrow, running along the posterior 

 uterine wall, may indicate the seat of that in- 

 ternal vertical septum which more or less 

 completely divides the uterine cavity into two 

 halves, and constitutes the uterus bilocularis 

 (fig. 464.). 



Fig. 464. 



The body of the uterus showing only a slight indenta- 

 tion externally. (After JBusch.~) 



An internal septum c, divides it into two loculi, 

 a and b. The cervix, d, is single. 



The extent of this septum, and conse- 

 quently the more or less perfect formation 

 of two separate loculi, exhibits the same 

 varieties as in the former group. The par- 

 tition may stop short at the cervix, or ex- 

 tend in rare cases completely through that 

 canal, and even divide the vagina. Where the 

 septum is rudimental, and extends only to the 

 cervix, the lower free border is usually thin 

 and falciform (fig. 463.), having its concavity 

 directed forwards, the lower extremity being 

 that which is connected with the posterior 

 uterine wall. 



These several deviations from the normal 

 form of the uterus will more or less in- 

 fluence the manner of performance of all its 

 functions. 



The acts of menstruation and insemination 

 are those perhaps which are the least dis- 

 turbed. Regarding this former function, 

 wherever the ovaries are perfect and a chan- 

 nel exists for the menstrual fluid, as, for in- 

 stance, in the one-horned uterus, the external 

 escape will occur as usual ; but in the case of 

 atresia of the vagina, and in those examples 

 of a hollow rudimental uterus, the menstrual 

 blood collects, and distending the closed sac 

 forms there a haematometra.* Where the 

 parts representing the uterus are entirely solid, 



* See p. 697. 



