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.
[Illustration]
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.