On the inner side of the Wolffian body, and in their immediate vicinity or rather connection, the sexual glands appear testicles if male, ovaries if female; at first perfectly alike in both. About the eighth week the gland broadens if a testicle, lengthens if an ovary. At the tenth week, the characteristic tubuli of the testicle and follicles of De Graaf of the ovary render a distinction for the first time possible. Coincident with the appearance of these glands there is developed a second canal, the so-called canal of Miller, or the sexual canal, which likewise empties into the lower end of the bladder.

These points in embryology have been brought forward to show the connection between the rectum, the bladder, and the genital system at an early period of development. It is seen that all excretory ducts open into the bladder, the rectum as well.

Before any conclusions are drawn, the most frequent anomalies of the organs mentioned will be hastily mentioned.

The anomaly of a single kidney, according to Cruveilhier, is one of the most frequent of the animal economy. Almost always the two are connected by their small extremities across the vertebral column, with the concave border upwards. The position of the kidney is an important indication as to the character of the anomaly.*

"When one kidney only is present, it is important to distinguish between the unsymmetrical and the solitary kidney. The former is represented by a right or left kidney, which is normal in regard to position and conformation, and occasionally rather enlarged, its fellow being deficient. The solitary kidney is the result of a fusion of the two organs, and therefore offers the characters peculiar to this arrangement in a greater or less degree. The lowest degree of fusion is seen in the horse

The fact of a normal arterial course decides also in favor of the fused or horse-shoe kidney.* The existence of two ureters is additional proof. †

The ureters may present the following anomalies : They may terminate in a cul-de-sac in the vicinity of the bladder; one may be perfect, the other rudimentary; in this case the rudimentary portion has always been found at the bladder. In the case under discussion, the rudimentary ureter floated free, being developed at the kidney. So far as your committee is able to ascertain, this condition is unique.

"Dilatation of the bladder is seen under various forms. It may be uniform and general, and in solitary cases attains such an extent that the bladder is represented by a fluctuating paralyzed sac, with relatively thickened parietes, filling the entire pelvis and hypogastric region. It is caused by accumulation of urine, consequent upon insensibility and paralysis of the bladder, but more par

shoe kidney; the two kidneys are united at their inferior portions by a flat ribbonlike, or rounded bridge of tissue, which crosses the vertebral column. In the higher degrees the two lateral portions approach one another more and more, until they reach the highest degree, in which a single disk-like kidney lying in the median line and provided with a double or single calyx, represents complete fusion. The more intimate this union is, the more the hilus of the kidney is directed forwards, so that whereas, in the lowest degree, it is indicated by an evidently increased, development of the posterior labium of the hilus, the hilus of the solitary kidney occupies the anterior surface. The more considerable the fusion is, the more the kidneys descend along the vertebral column, and the solitary kidney is commonly situated at the promontory, or even at the concavity of the sacrum. In exceptional cases only, the solitary kidney is placed, like the unsymmetrical kidney, at the side of the vertebral column," etc. (Rokitansky, Path. Anat., vol. ii., p. 145.)

*"Man wird leicht entscheiden Können, ob eine abnorme Nierenlage angeboren oder erworben ist da sichim letzeren Falle der Ursprung der Nierenartieren normal im ersteren abnorm verhalten wird." (Hyrtl, Anatomie des Menschen, s. 675.) + Cruveilhier, Anatomie Descriptive, p. 531.

"Pourvus chacun d'un urètre," etc.

ticularly by mechanical obstacles in the neck of the bladder and in the urethra; in the last case especially, that extreme degree is developed which is always accompanied by hypertrophy of the parietes. . . . Dilatation occasionally affects in a greater or less degree certain portions, or predominates in certain directions; thus we find lateral expansions at the fundus vesicæ, and saccular indentations produced by the pressure of calculi at or posterior to the triangle of Lieutaud.

"An important variety of partial vesical dilatation is presented to us in the hernial dilatation, or acquired diverticulum of the bladder. It is always developed in a bladder the muscular coat of which is hypertrophied, and this hypertrophy, being accompanied by increased irritability of the bladder, affords an evident and intelligent explanation for the predisposition. The vesical mucous membrane insinuates itself between the fissures left by the rounded or hypertrophied fleshy columns, is gradually forced through them, and forms saccular appendages to the bladder, which increase by degrees, and attain a size varying from that of a walnut or hen's egg to that of a fist or a human head. Their cavity at first communicates with the bladder by means of an elongated rhomboidal opening, and the more they increase, the more the latter, being enlarged at the same time, is converted into a round sphincter. These diverticula occur principally at the lateral portions and near the vertex of the bladder; they are also found at the posterior surface, and may frequently be seen at all these points at once. .. Its parietes are formed of the mucous membrane of the bladder, which, under certain self-evident circum

stances, is invested by the peritoneum. Sometimes a few muscular fibres traverse the diverticulum, which circumstance may cause it to be viewed as congenital.

The contraction is at times partial, and may then give rise to a permanent contraction of the bladder at one or even at several points. The bilocular vesica, noticed by ancient anatomists, probably took their origin in a morbid contraction of this nature." (Rokitansky, loc. cit., pp. 169-70.)

The urethra may be defective, as in the well-known hypo- and epispadiasis; it may be wholly absent when the bladder or entire uropoietic system is wanting, or when vesical fissure or ectrophy exists; it may at any time become solid by obliteration of its cavity; but we are unable to find an instance of its entire absence when both bladder and kidneys exist.

manner.

The urachus has been found distended and patulous even to some distance down the cord. Infants and adults have voided urine through the umbilicus in this In these cases there was always obliteration of the urethra.* (A still rarer anomaly, and one not to be confounded with the abiding patency of the urachus, is the persistence of the omphalo-mesenteric or vitello-intestinal duct, so that fæces escape per umbilicum. Such a case presented at Wiederhofer's clinic for children's diseases, Vienna, Feb. 14, 1869, when a draw

* Calcareous concretions have been found in the urachus. A remarkable case is mentioned by Cruveilhier: "Boyer is said to have dissected the bladder of a man 26 years of age, whose urachus formed a canal of a foot and a half long, and contained twelve urinary calculi, etc." (Arenulæ in uracho.) Cruveilhier, loc. cit., p. 555.

ing of a case of persistent urachus, presented the previous session, since dead, was also exhibited.)

The rectum, as is well known, may terminate in a blind sac at the anus (atresia ani), or at any distance above (atresia recti). It may open into any of the urinary or genital passages (cloaca). The position of the genital organs often gives an important indication as to the situation of the rectal extremity. When the rectum terminates high in the pelvis, the genital organs occupy the middle or posterior portion of, instead of lying anterior to, the perineum.

In the development of the genital organs in this case, it is observed that there are traces only of those of earliest and latest formation-ovaries, tubes, and clitoris, all intervening structures being absent. It is an anomaly of such exceeding rarity for the uterus to be entirely absent when both ovaries and tubes are present, that another explanation is sought. It is an explanation which may elucidate all the existent conditions, and which it is hoped is a fair deduction from the anatomical features of the case as well from known pathological laws. It would point to the distended bladder as the cause of the check in the development and the transposition and obliteration of certain viscera. The bladder became distended because it possessed no outlet. It collected the whole amount of urine discharged. It arose in the abdominal cavity before the uterus was normally formed and checked its development. Insinuating itself between the ovaries and the sexual tubes, it de ployed them upon its sides, arresting their growth, just as ascites in an adult female atrophies the ovaries. It