f 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 o