ANOMALIES OF FORMATION AND POSITION Fissure of the urethra and clitoris has been observed in females corresponding to epispadias in the male.
Defective opening of the urethra has been observed in various locations, as for instance in the intestines, or into the vagina.
The urethra may be partially or entirely missing, and then the blad der opens directly into the vagina.
If a fissure exists in the vaginal urethra we speak of it as a hypo spadias. Bitner and Mosenthal designate as hypospadias the opening of the urethra upon the vestibule as a blind sulcus, while the true vagi nal urethra opens upon the anterior wall of the vagina either immedi ately behind the hymen or further back.
It speaks for the rarity of hypospadias in the female sex that Hofmokl in 104,416 children did not once find this deformity in girls, while lic found 13 instances in boys.
Among the atresias of the external genitals are to be mentioned: Complete atresia of the anus and vulva, and atresia of the anus and vagina. The atresia of the vulva may consist simply in an epithelial adhesion of the opposing surfaces of the labia majora and minora, or in a solid union of the parts. The res:ult of atresia of the hymen in the
newborn is the retention of mucus, in girls after puberty a Inematocolpos.
Congenital cysts of the hymen, described by Ziegenspeck, are also due to defects of development.
Among the deformities of the ovaries are to be mentioned: defective formation and accessory glands. Defects of formation of the uterus and vagina are due to the manner in which the Mfillerian ducts become united into a single structure.
Where the development of the uterus and tubes is defective there is free mobility of these organs, and a disposition to hernia of the ovary, which occurs not very rarely. Prolapse of the uterus which is seen in nen- born children, is also to be referred to congenital anomalies. The diagnosis of congenital anomalies, according to Zuppinger, is very difficult, and must be made with great care, particularly if an operation is contemplated.