CONGENITAL CON DITIONS.
Numerical changes.—Absence.—Among the single organs of the body, one degree of nu merical diminution only is possible, namely, their absence. Such an anomaly, if we except true cases of monstrosity, should be extremely rare, and indeed it is so; for as all unique portions of the organization are called upon to perform functions, to which they are more or less exclusively devoted, it is rarely that any other can supply their place, and in conse quence, when the organ is wanting, the func tion is also wanting.
There are upon record a certain number of instances of absence of the urinary bladder; in some of these cases the ureters have been found to terminate directly in the urethra, in others they have been inserted into the rectum, in others they have communicated with the vagina. Of the first species we have the fol lowing examples : Lieutaud * mentions the case of a man, aged thirty-five, in whom the ureters, the capacity of which was much aug mented, terminated immediately below the pubis near the orifice of the urethra. Binnin ger* describes the case of Abraham Clef, in whom there was no urinary bladder, and the Ureters opened upon the urethra. A stylet, introduced into the urethra, passed alternately into the one arid the other ureter ; the ureters were afterwards separated from the kidneys, and the stylet, introduced in the opposite di rection, met with no obstacle to its passage into the urethra.
Of the second species we have, in the se venth volume of the Philosophical Trans actions, the history, given by Richardson, of a lad residing in Yorkshire, who lived to the age of seventeen, without ever having passed urine through the urethra, and who had still enjoyed good health. The only inconvenience he suf fered was a consequence of the passage of the urine into the rectum, by which a troublesome diarrhoea was kept up. Campert speaks of five similar cases, one of which was that of a female. Klein I also speaks of a case. In the Nov. Acta Acad. Nat. cur. ann. i. obs. 38, there is another in which " ureter in rectum intestinum insertus fait." And in the IIist. de l'Acad. ann. 1752, n. 4, there is one de scribed under the head : " Uretra in intestinum patens."
Of the third species, cases are cited by Haller* and by Schrader.- In these cases there was no other malformation. In the foregoing enumeration we have purposely avoided the introduction of cases of general monstrosity in which the urinary bladder was absent.
are upon record a certain number of cases in which two or more urinary bladders are said to have existed. Of these some appear to me to have been cases in which the plurality was maintained merely because the organ was divided into compartments, either as a consequence of arrested develop ment or of the formation of pouches, by the protrusion, or hernia of the mucous membrane of the organ. The following case related by Blasius belongs, I apprehend, to the former species. A person died phthisical, having a " double bladder." When the external sur face was examined, it appeared to be an unique organ, but upon being opened a membranous septum was discovered, by which the organ was divided into two distinct cavities. The narrator adds, that by dissection he separated the one from the other, so that the longitudinal septum was formed by the parietes of the two bladders, which were in contact, and had become united the one to the other. There is a case of a similar nature described by Brom field; and many more are recorded by Mor gagni and others.
We know of no instance in the human sub ject, with the exception of that related by Molinetti,j in which a plurality of urinary blad ders distinct from each other existed. In this case there does not appear to have been any thing abnormal in the organisation except in so far as concerned the urinary organs. " A woman had five urinary bladders, as many kidneys, and six ureters, two of which were inserted into a bladder which was much larger than the others ! ! the remaining four ureters terminated in as many small bladders, which poured their urine by particular canals into the larger bladder." Another but less carefully described case of the same kind is mentioned by Fantoni, in his Anat. Corp. Hum. diss. 7; and in the Acta Physico-Medica Academice Cmsarem Nat. Curios. vol. i. obs.