Displacements of the kidney anteriorly are very rare.
The ureters have been found multiple; Griffon reports the history of a male subject in whom the ureter on the left side was double throughout its whole length; there were two vesical orifices on the left side one above the other; and Morestin, in the same journal, mentions ureters double on both sides in a female subject. Molinetti speaks of six ureters in one person. Littre in 1705 described a case of coalition of the ureters. Allen describes an elongated kidney with two ureters. Coeyne mentions duplication of the ureters on both sides. Lediberder reports a case in which the ureter had double origin. Tyson cites an instance of four ureters in an infant. Penrose mentions the absence of the upper two-thirds of the left ureter, with a small cystic kidney, and there are parallel cases on record.
The ureters sometimes have anomalous terminations either in the rectum, vagina, or directly in the urethra. This latter disposition is realized normally in a number of animals and causes the incessant flow of urine, resulting in a serious inconvenience. Flajani speaks of the termination of the ureters in the pelvis; Nebel has seen them appear just beneath the umbilicus; and Lieutaud describes a man who died at thirty-five, from another cause, whose ureters, as large as intestines, terminated in the urethral canal, causing him to urinate frequently; the bladder was absent. In the early part of this century there was a young girl examined in New York whose ureters emptied into a reddish carnosity on the mons veneris. The urine dribbled continuously, and if the child cried or made any exertion it came in jets. The genital organs participated but little in the deformity, and with the exception that the umbilicus was low and the anus more anterior than natural, the child was well formed and its health good. Colzi reports a case in which the left ureter opened externally at the left side of the hymen a little below the normal meatus urinarius. There is a case described of a man who evidently suffered from a patent urachus, as the urine passed in jets as if controlled by a sphincter from his umbilicus. Littre mentions a patent urachus in a boy of eighteen. Congenital dilatation of the ureters is occasionally seen in the new-born. Shattuck describes a male fetus showing reptilian characters 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, Aand 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.
