384 DR D. BERRY HART. 



seemed to be the lower ureteric opening ending not in the 

 bladder but on the vestibule near the uretliral or hymeneal 

 edge, and on one side usually. The cause of this apparent low 

 implantation has been disputed, the ditficulty being to settle 

 whether the part below the bladder is ureteric or part of a 

 persistent Wolffian duct. I purpose in considering this question 

 to summarise briefly some of the most recently recorded cases, 

 and to discuss the opposing views. 



Baker in 1878 narrated an interesting case where incontinence 

 of urine was due to a minute opening two lines below and to 

 the left of the lower angle of the meatus urinarius. When 

 this was laid open, a tube, apparently the ureter, was found. 

 This was dissected out from the anterior vaginal wall, cut off 

 at a proper level and successfully sutured into the bladder. 



He also quotes similar cases in the practice of Dr J. B. S. 

 Jackson of Boston, and of Dr Emmet of New York. 



Dr Davenport of Boston recorded in 1890 a case almost 

 identical with the above, but in the vagina was noted a 

 ridge on the anterior wall which could be traced from below 

 and to the right of the cervix down to within an inch behind 

 the meatus. At the edge of the urethral orifice and below it 

 there was a heart-shaped papilla, with a small aperture from 

 which urine issued. 



The ridge above mentioned was now cut across at its lower 

 end, the tube dissected out and turned into the bladder with 

 ultimate success. 



A very important case is that of von Massari. The patient 

 was a four-year-old girl, and had been operated on for atresia ani 

 vaginalis. Afterwards incontinence of urine was complained of, 

 although it had of course previously existed, and no satisfactory 

 explanation could be found for it. The child died from sepsis 

 after a second operation for the preternatural anus, and on 

 sedio an interesting condition was found. The kidneys were 

 fused, and the left part markedly atrophied. The right ureter 

 opened normally in the bladder, but the left passed at the neck 

 of the bladder to the left side of the anterior vaginal wall and 

 ended at the vestibule by a minute opening in a fold of the 

 prepuce. The vagina was double, with a small communication 

 between the two halves at the top, as one often finds. 



