TERATOLOGY. 



951 



with the genital organs, just as in the cases 

 of imperforate anus just mentioned (Meckel, 

 Burns), or with an open anus, as in the cases 

 of Zhryliam, Oliver, and Bonnet ; this condi- 

 tion approaches the nearest to the natural state, 



Fig. 602. 



Hypogastnc region of a Child, which lived twenty-two 

 days, with vesica inversa, fyc. 



a, a, congenital umbilical hernia ; b, umbilical cord ; 

 c, c, the separated halves of the vesica urinaria, 

 with the urethral orifices ; d, anus ; e, e, penis epi- 

 spadiacus ; /. frenulum ; g, cutaneous appendage 

 to the closed anus. 



if the urinary bladder is complete (Martin) ; 

 2. The rectum may be separate, while the uri- 

 nary bladder remains fissured and fused with 

 the genital organs (Meckel, Gross); 3. The 

 fissured urinary bladder may be separated from 

 the anus, without taking up the ureters, which 

 then open themselves into the rectum (Meckel, 

 Oberteuffer). In some cases the outlets of 

 these three apparatus are found not on a flat 

 surface, but in a cavity. The cloaca, existing 

 previously on the surface of the body, is then 

 removed from it and folded in, so as to form 

 a cavity. 



In another degree of malformation the cavity 

 is formed, and the uropoietic and generative 

 organs are completely separated from each 

 other ; but the rectum, being a distinct organ, 

 is nevertheless in connection with one of the 

 said parts, by means of a sort of canal. In 

 the female sex this communication is found 

 between the rectum and vagina (fistula ani 

 vaginalis congcnita) ; in the male sex between 

 the rectum and urinary bladder (fistula ani 

 vesicalis congenita). The transition towards 

 the natural state is nearest when the rectum 

 opens into the urethra j to this condition, 

 when it is complicated with an imperforate 

 anus, Papendorp has given the name of atresia 

 ani urethralis. 



b. Congenital fissure of the urinary bladder. 

 Without a cloaca, and "with a perforate anus, 

 the interior surface of the posterior part of 

 the bladder may lie exposed on the hypogas- 

 tric region (prolapsus, inversio, fiss'w 



It then forms a red, spongy tumor, situated 

 somewhat above the separated pubic bones, 

 and involving the umbilicus, so as to give 

 the appearance of a deficiency of the um- 

 bilical cicatrix. In male children the ori- 

 fices of the vasa deferentia are to be found 

 on the inferior part of the tumor. The ure- 

 thral orifices are papillary eminences on the 

 naked internal surface of the bladder. The 

 urine drops continually out of them, but may 

 sometimes be seen to issue in a small stream. 

 The pubic bones are widely apart, sometimes 

 with an interspace of four inches. They have 

 no intermediate cartilage, but are merely 

 united together by a ligament, without form- 

 ing a synchondrosis. The consequence of 

 this is a very peculiar reeling in the walk of 

 the malformed subject, and a great disposition 

 to inguinal hernia, due to the absence of suf- 

 ficient support at the interior surface of the 

 body. The penis is fissured on its superior 

 surface (epispadias}. The testes are, even in 

 adults, very small, and often retained in the 

 abdomen or in the inguinal canals. The 

 seminal vesicles, the prostate and the vasa 

 deferentia, offer various deviations. In the 

 female sex the labia majora and minora are 

 separated and without a commissure at their 

 upper part. The vagina is often closed or 

 very narrow. The anus is more protruded 

 than in the natural condition. 



Sometimes the penis is epispadiac, with 

 a well-formed urinary bladder. In such a 

 case, Bonn found, nevertheless, the pubic 

 bones apart, but united by a ligamentous 

 texture. Although the continual dropping of 

 the urine is a very annoying disturbance, 

 which I contrived to remove by the means 

 illustrated in figs. 603 and 604 , and although 

 the generative organs are very incomplete, 

 this malformation is not dangerous to life, 

 which in several cases has been remarkably 

 protracted. 



Fig. 603. 



Hypogastnc Region of a living Child, with vesica 



inversa. 



a, internal surface of the urinary bladder ; b, um- 

 bilical cicatrix ; c, c, urethral orifices ; d, epispa- 

 diac penis ; f, e, scrotum. 



3 P 4 



