378 DR D. BERRY HART. 



measured 5 cm. x 3-5 cm., and from the ureters urine passed in 

 occasional jets. Below this the posterior urethral wall was 

 exposed, 5 cm, broad by 1 cm. long. 



The vaginal entrance was transverse, with the anterior vaginal 

 wall projecting. The labia majora and minora were separated 

 above and below ; the clitoris was absent, but may have been 

 represented by traces at the upper ends of the nymphse. The 

 pelvis was split at the symphysis, the ends being 9-5-10 cm. 

 apart. 



This is a fairly typical case in an adult woman who passed 

 through a normal pregnancy and an almost normal labour. 



Klein gives a table of seven labours with this anomaly, but 

 probably some have not been recorded. 



In almost all the cases the perineum gave trouble requiring 

 incision, and forceps had to be applied to the head. 



I do not consider the question of the split pelvis. It is 

 important to note, however, that fascia unites the separated ends 

 in most instances. In cases of this anomaly not surviving birth, 

 or dying soon after, the lesions are often associated with others 

 not necessarily depending on the extroversion. 



Champneys has published a very ably recorded case with some 

 special points of interest, in an infant which died a month after 

 birth. It was a female child, and had extroversion of the bladder, 

 no navel nor urethra, and prolapsus recti was present. The 

 special feature was that two openings lay below the ureteric 

 ones, and these, on post-mortem, were found to open into the 

 vagina. Uterus and ovaries were present. Champneys describes 

 these two openings as jVIiillerian, but I think they can be more 

 accurately held to be the lower ends of the Wolffian ducts. In 

 the paper on the morphology of the human urinogenital tract, 

 already alluded to (see the preceding paper), I attempted to 

 shew that the hymen was derived from the Wolffian ducts, 

 and that the upper two- thirds of the vagina alone were Milller- 

 ian, the lower third being made up of blended urinogenital sinus 

 and Wolffian ducts. In Champneys' case we have the urino- 

 genital sinus cleft in front, and the ducts exposed as they lie in 

 that sinus about the second month of intrauterine life. The 

 opinion Champneys adopts — viz., that they are Miillerian — was 

 the only one possiljle at the time his paper was written (fig. 37). 



