PATHOLOGY OF THE BLADDER AND UEETEK. 387 



month, and if the ureteric communication with it continues, we 

 thus get the apparent lower ureteric end at the outer edge of 

 the urethral orifice— e.^., at the hymeneal edge. The ureter may 

 also open into the bladder, or it may not. 



In von Massari's case the course of the lower part of the 

 alleged ureter is exactly that of a persistent Wolffian duct. 



Amand Eouth has come to the same opinion in regard to 

 the Wolffian duct alone — viz., that it may persist " to the vesti- 

 bulnm vulvai" (p. 167). 



Explanation (2), that the whole tube, with its low aperture, 

 is ureteric, is of course possible, but is unlikely. It would in 

 such a case not be the usual malformation, a permanent tempo- 

 rary stage as in view (1), but an inexplicable abnormality. 



The following is a resume of the points bearing on view (1) : — 



1. The Wolffian ducts persist normally in the lower third 

 of the vagina at the third and a half month of fcetal life, and 

 develop the hymen at their lower ends. 



2. The Wolffian ducts between the epoophoron (parovarium) 

 and hymen usually atrophy in the adult. 



3. The Wolffian duct may alone persist and end near the 

 hymen (Amand Routh). 



4. If it persist, have a patent lower opening, and the original 

 communication between it and the ureter remain, we get the 

 anomaly of apparent low implantation of the ureter explained. 



DESCRIPTION OF PLATE XXXVII. 



Fig. 37. Extroversio vesicse : Champney's case, reduced by J from 

 drawing by G. T. Gwilliam (original drawing in St Bartholomew's 

 museum). N, navel ; B, extroverted bladder ; Urt, ureter, natural 

 size ; left shows amount of dilatability ; V, two openings into vagina ; 

 F, blind fossa, entirely posterior to vagina ; X', left nympha ; Z, 

 labium majus ; P, perineum ; R, rectum prolapsed. 



Fig. 38. Extroversio vesicae in boy, case of Professor MacEwan, 

 Dundee ; the penis drawn down to show epispadias ; B, extroversio 

 vesicae. 



Fig. 39. Diagram of skiagram to show cleft pelvis of above case ; 

 dotted line shows soft parts. 



