Lawrence recommends the stereoscope for detecting binocular vision, and places in a covered stereoscope a picture each side of which is different, and yet such as to make a single picture when both sides are seen. A clock dial, for example, with figures in one side only or figures with complemental colors, such that with both eyes the object would appear differently colored from what it would when seen with either eye separately. The distance apart of two objects held up in front of both eyes can be readily told by the patient if he sees with both eyes, no matter how the objects are held with relation to each other. But if there is vision with one eye only, the patient can tell the distant apart with accuracy only when the objects are both held at the same distance from the eye, but not when one is held considerably in front of the other.
One who sees with one eye only always thinks he is nearer to the object than he really is when reaching out for that object. It is always more difficult for him to pour from a pitcher into a cup or glass if held a little distance below it, hence the blind in one eye usually place the nose of the pitcher in contact with the glass before pouring. The old parlor trick of placing two pins in the wall and putting a cent on them and directing the patient to stand across the room and then walk over to the cent and knock it off with the outstretched finger without hitting the pins, may be made use of as a test in simulated blindness, for with one eye the patient always falls short of the mark the first time the experiment is tried. The most simple method of detecting simulated blindness in one eye is by noticing the movement of the pupil under the influence of light. If an eye is blind, the light has little or no effect upon it when the other eye is closed. The pupil is usually dilated. It may be well to mention here that atropine dilatation is generally wider than that due to amaurosis, and also that a cone of light from a strong convex glass thrown upon the sound eye will contract the pupil of the blind eye if the dilatation is not due to atropine. Simulated blindness in both eyes is not likely to be seen, and then the condition of the pupil is of great value in detecting it, and is one of the best guides in connection with the ophthalmoscopic observation.
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.