A CASE OF DOUBLE UTERUS AND VAGINA.
BY S. W. KELLEY, M. D., CLEVELAND, O.
Miss H. E., aged 20, American of Irish parentage: dark brunette, short in stature but apparently quite handsomely formed, and ruddy with health. She has never been sick in her life. Has menstruated normally since her fifteenth year, though scantily during the past year. She feared she had been injured a few days previously by the overturning of a chair upon which she was standing, as she had since felt pain and uneasiness in the lower pelvic and pubic region, for which she sought advice.
Upon examination I found no injury worthy of record, but the malformation here described. Cases of this anomaly have been recorded from time to time, being always of interest to the teratologist, occasionally requiring attention on account of interference with the marital relation or parturition, and being referred to in every discussion on superfœtation.
The external genitalia are well developed. No hymen, nor any remains of one. I have no reason to doubt her virginity. An inch within the introitus vaginæ the finger met a narrowing into which only its tip would pass. Searching to the left another smaller opening was discovered, the two being separated by a strong membrane. Returning to the right or larger passage, was able by careful dilatation for ten or fifteen minutes to insert three-fourths of the length of the index finger and encounter another narrowing, which being patiently overcome, the first joint of the finger found more room and examined uterine cervix and the external os, which is linear antero posteriorly. The neck projects about half an inch into the vagina. The lips are thin, of normal density. Withdrawing the finger and finding the smaller opening, could succeed in penetrating only about an inch. Observed a third, smallest opening in the left vaginal wall, between the ostium vaginæ and the second opening described.
The patient would consent to no interference that could possibly cause even temporary disability for daily housework and care of an invalid mother, but agreed to return daily for a few days. After dilating without anæsthesia fifteen to twenty minutes daily for four days, could pass two fingers or a Fergusson speculum one and one-eighth inches into the right passage, and could pass one finger readily, or speculum seven-eighths of an inch in diameter into the left passage. The septum between the two passages is placed antero posteriorly. It is about an eighth of an inch thick, and has the appearance of any other portion of the vaginal wall. It begins an inch within the introitus, and extends to the uterus, making a right and left vagina of normal length. The third, smallest passage, admits a sound and extends upward an inch in the left lateral vaginal wall and ends in a blind extremity.
The right vagina discloses an uterine os three-eighths inch in length antero posteriorly, the anterior end of the slit inclined toward the median line. The sound passes readily a distance of one and three-eighths inches, entering in a direction upward and inward half that length, and then turning upward and outward. The sound moves freely in the cavity, and the lining membrane evidently contains folds. Secretion of the cervix free.
On the left side the os uteri is smaller, the opening not exceeding a quarter inch, the length being laterally. The lips are in a pouting shape, the anterior, especially, having quite a fold above it. The sound enters freely nearly an inch in a direction upward, outward and slightly backward; lining membrane apparently folded. Very little secretion. By introducing two fingers of the left hand, palm upward, the index into the right vagina and the second finger into the left, the two uterine mouths can be examined simultaneously, and this gives a very vivid impression of the condition. As to the shape of the whole uterus very little can be determined by bimanual examination, the vaginal walls being so tense and abdominal thick. By the rectum the uterus can be felt flat and wide, but no bi-lobing is apparent.
The young lady could not be persuaded to permit an examination during menstruation to determine whether the flow took place on both sides.