952 



TERATOLOGY. 



Fig. 604. 



The same Region armed with an Apparatus for the 

 reception and evacuation of Urine. 



c. Ectopia vesiccE urinarice. The smallest 

 degree of deformity is when the urinary blad- 

 der remains intact, but lies in an opening in 

 the wall of the hypogastric region. It is ecto- 

 pia vesicee urinarice, of which a representation 

 is given in fig. 605. ; and for more details I 

 refer to my " Tabulae ad illustrandum embryo- 

 genesin,'' etc., Tab. xxx. 



Fix. 605. 



Hypogastric Region of a Child, which lived six years, 

 with ectopia i-esiccc urinarice. 



a, part of the bladder lying on the surface of the ab- 

 domen ; b, umbilical cicatrix ; c, penis ; d, d, pre- 

 puce ; Ji, urethral orifice ; f, scrotum ; g, g, testes, 

 lying at the inguinal region. 



d. Inversio veslcce unlnnrite. Prolapsus vc- 

 SICCB unnaricE inverse. If the urachns re- 

 mains open after birth, the urinary bladder 

 may be expelled, and thereby inverted through 

 it. R. Froriep(C////wg. Kupfertafeln, Heft 67. 

 Taf. cccxl.) has given an example of this 

 malformation. It ought to be distinguished 

 from the inversion of the bladder through the 

 urethra, which is possible even in adult women 

 (Voigtel). 



If we take a general survey of all these cases 

 'of non-closure of the hypogastric region, it 



is evident that they are intimately connected 

 with one another. 



The cloacal disposition is the highest, the 

 ectopia of the urinary bladder the lowest, de- 

 gree of malformation, and therefore the latter 

 is a distinct transition towards the natural con- 

 dition. The inversion of the urinary bladder 

 observed by Froriep has, as to its origin, no 

 direct relation to the other forms. It is but an 

 accidental effect of the remaining open of the 

 urachus, through which the bladder chanced 

 to become inverted, and the urine flowed away 

 through the urethra if the child was held up- 

 right. From the gradual transition of one form 

 into the other, I conclude that the origin of 

 this malformation cannot well be attributed to 

 a mechanical cause, as Duncan and Bonn 

 have asserted nearly at the same time. They 

 both consider it the effect of a preternatural 

 accumulation of urine, causing a violent dis- 

 tension, and later a rupture of the bladder, of 

 the urethra, of the hypogastric region, and 

 of the pubic articulation. This theory had 

 already, in the year 1816, a very strong oppo- 

 nent in my father (Verh. d. l e kl. van het 

 Koninkl. Nederl. Instit. D. II. B. 88). His 

 chief arguments against it, to which I add 

 my own, are : 



1 . That, if the urinary bladder bursts, as may 

 happen in adults, the urine will be evacuated 

 into the abdominal cavity, without fissuring the 

 anterior wall. 2. That it is improbable that 

 in some cases such an accumulation should 

 fissure the whole apparatus, and in others re- 

 strict its effect to the corpora cavernosa, 

 penis, and the urethra, as may be seen in 

 simple epispadias (W. Vrolik, Bosson, Sals- 

 mann, Morgagni, and Oberteuffer). 3. That 

 by an observation of Baillie is proved, that in 

 fissure of the urinary bladder the posterior part 

 of the urethra may remain intact and closed, 

 while the corpora cavernosa are fissured at 

 the anterior part of the penis. 4. That I have 

 often found in the foetus atresia urethra com- 

 plicated with an unusual expansion of the 

 urinary bladder and of the ureters, but with- 

 out the least sign of bursting or of producing 

 the malformation in question. 5. Thafcectopiq 

 of the urinary bladder demonstrates that the 

 anterior wall of the abdomen may be open, the 

 urinary bladder remaining intact ; or the sup- 

 posed effect may exist, when the cause is 

 absent. From all these and other remarks 

 and observations I conclude that the origin 

 of this malformation is not to be found in a 

 mechanical cause, neither internal nor external 

 (Roose). I am much more inclined to ascribe 

 all its different forms to arrest of develope- 

 ment. My chief grounds for this opinion are 

 the frequent coexistence of: 1. The want 

 of artcrio: hypogastricas (G. Vrolik) ; 2. Ab- 

 normal condition of the kidneys and the ure- 

 ters (Pinel, Cooper, Isenflamm) ; 3. Fis- 

 sured dorsal vertebra (Littre, Revolat, Delfin, 

 G. Vrolik) ; and many other malformations, as 

 labium leporinum (Dupuytren, Meckel), con- 

 fluent toes (Saxtorph). The only question 

 which remains is, what is the cause of this 

 imperfect developement ? As to the cloacal 



