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haracters in the sexual ducts。 There was ectopia vesicae and prolapse of the intestine at the umbilicus； the right kidney was elongated； the right vas deferens opened into the ureter。 There was persistence in a separate condition of the two Mullerian ducts which opened externally inferiorly； and there were two ducts near the openings which represented anal pouches。 Both testicles were in the abdomen。 Ord describes a man in whom one of the Mullerian ducts was persistent。
Anomalies of the Bladder。Blanchard； Blasius； Haller； Nebel； and Rhodius mention cases in which the bladder has been found absent and we have already mentioned some cases； but the instances in which the bladder has been duplex are much more frequent。 Bourienne； Oberteuffer； Ruysch； Bartholinus； Morgagni； and Franck speak of vesical duplication。 There is a description of a man who had two bladders； each receiving a ureter。 Bussiere describes a triple bladder； and Scibelli of Naples mentions an instance in a subject who died at fifty…seven with symptoms of retention of urine。 In the illustration； B represents the normal bladder； A and C the supplementary bladders； with D and E their respective points of entrance into B。 As will be noticed； the ureters terminate in the supplementary bladders。 Fantoni and Malgetti cite instances of quintuple bladders。
The Ephemerides speaks of a case of coalition of the bladder with the os pubis and another case of coalition with the omentum。 Prochaska mentions vesical fusion with the uterus； and we have already described union with the rectum and intestine。
Exstrophy of the bladder is not rare； and is often associated with hypospadias； epispadias； and other malformations of the genitourinary tract。 It consists of a deficiency of the abdominal wall in the hypogastric region； in which is seen the denuded bladder。 It is remedied by many different and ingenious plastic operations。
In an occasional instance in which there is occlusion at the umbilicus and again at the neck of the bladder this organ becomes so distended as to produce a most curious deformity in the fetus。 Figure 143 shows such a case。
The Heart。Absence of the heart has never been recorded in human beings except in the case of monsters； as； for example； the omphalosites； although there was a case reported and firmly believed by the ancient authors；a Roman soldier in whom Telasius said he could discover no vestige of a heart。
The absence of one ventricle has been recorded。 Schenck has seen the left ventricle deficient； and the Ephemerides； Behr； and Kerckring speak of a single ventricle only in the heart。 Riolan mentions a heart in which both ventricles were absent。 Jurgens reported in Berlin； February 1； 1882； an autopsy on a child who had lived some days after birth； in which the left ventricle of the heart was found completely absent。 Playfair showed the heart of a child which had lived nine months in which one ventricle was absent。 In King's College Hospital in London there is a heart of a boy of thirteen in which the cavities consist of a single ventricle and a single auricle。
Duplication of the heart； notwithstanding the number of cases reported； has been admitted with the greatest reserve by Geoffroy…Saint…Hilaire and by a number of authors。 Among the celebrated anatomists who describe duplex heart are Littre； Meckel； Collomb； Panum； Behr； Paullini； Rhodins； Winslow； and Zacutus Lusitanus。
The Ephemerides cites an instance of triple heart； and Johnston has seen a triple heart in a goose。
The phenomenon of 〃blue…disease；〃 or congenital cyanosis； is due to the patency of the foremen ovale； which； instead of closing at birth； persists sometimes to adult life。
Perhaps the most unique collection of congenital malformations of the heart from persons who have reached the age of puberty was to be seen in London in 1895。 In this collection there was an adult heart in which the foremen ovale remained open until the age of thirty…seven； there were but two pulmonary valves； there was another heart showing a large patent foramen ovale from a man of forty…six； and there was a septum ventriculorum of an adult heart from a woman of sixty…three； who died of carcinoma of the breast； in which the foremen ovale was still open and would admit the fore…finger。 This woman had shown no symptoms of the malformation。 There were also hearts in which the interventricular septum was deficient； the ductus arteriosus patent； or some valvular malformation present。 All these persons had reached puberty。
Displacements of the heart are quite numerous。 Deschamps of Laval made an autopsy on an old soldier which justified the expression； 〃He had a heart in his belly。〃 This organ was found in the left lumbar region； it had； with its vessels； traversed an anomalous opening in the diaphragm。 Franck observed in the Hospital of Colmar a woman with the heart in the epigastric region。 Ramel and Vetter speak of the heart under the diaphragm。
Inversion of the heart is quite frequent； and we often find reports of cases of this anomaly。 Fournier describes a soldier of thirty years； of middle height； well proportioned and healthy； who was killed in a duel by receiving a wound in the abdomen； postmortem； the heart was found in the position of the right lung； the two lungs were joined and occupied the left chest。
The anomalies of the vascular system are so numerous that we shall dismiss them with a slight mention。 Malacarne in Torino in 1784 described a double aorta； and Hommelius mentions an analogous case。 The following case is quite an interesting anatomic anomaly： A woman since infancy had difficulty in swallowing； which was augmented at the epoch of menstruation and after exercise； bleeding relieved her momentarily； but the difficulty always returned。 At last deglutition became impossible and the patient died of malnutrition。 A necropsy revealed the presence of the subclavicular artery passing between the tracheal artery and the esophagus； compressing this latter tube and opposing the passage of food。
Anomalies of the Breasts。The first of the anomalies of the generative apparatus to be discussed； although not distinctly belonging under this head； will be those of the mammae。
Amazia； or complete absence of the breast； is seldom seen。 Pilcher describes an individual who passed for a female； but who was really a male； in whom the breasts were absolutely wanting。 Foerster； Froriep； and Ried cite instances associated with thoracic malformation。 Greenhow reports a case in which the mammae were absent； although there were depressed rudimentary nipples and areolae。 There were no ovaries and the uterus was congenitally imperfect。
There was a negress spoken of in 1842 in whom the right breast was missing； and there are cases of but one breast； mentioned by King； Paull； and others。 Scanzoni has observed absence of the left mamma with absence of the left ovary。
Micromazia is not so rare； and is generally seen in females with associate genital troubles。 Excessive development of the mammae； generally being a pathologic phenomenon； will be mentioned in another chapter。 However； among some of the indigenous negroes the female breasts are naturally very large and pendulous。 This is