. Atlas and epitome of gynecology . opening is high up inthe vagina, retention is im-possible despite the strictestcleanliness. If the openingis small or the intestine isbent at an acute angle, in-flammatory and obstructivesymptoms may manifestthemselves. The same istrue, mutatis mutandis, ofatresia ani vestibularis () and anus perinea absence of peri-neum may also be observedfrom failure of fusion ofthe lateral eminences. Incontinence of urine exists withthe more marked degrees of hypospadias, and especiallywith epispadias. (Figs. 4and 5.) Diagnosis.—Persistentnonappearance
. Atlas and epitome of gynecology . opening is high up inthe vagina, retention is im-possible despite the strictestcleanliness. If the openingis small or the intestine isbent at an acute angle, in-flammatory and obstructivesymptoms may manifestthemselves. The same istrue, mutatis mutandis, ofatresia ani vestibularis () and anus perinea absence of peri-neum may also be observedfrom failure of fusion ofthe lateral eminences. Incontinence of urine exists withthe more marked degrees of hypospadias, and especiallywith epispadias. (Figs. 4and 5.) Diagnosis.—Persistentnonappearance of themenses always demands anocular inspection of theparts. AY hen vaginal orhymenal atresia exists, thebluish prot r udi n g m e m-brane is seen, while cervi-cal atresia renders the pas-sage of the uterine soundimpossible. Should theclosure be at the internal os, the cervix alone is patulous ;if at the external os, it is impervious. In unilateralatresia of duplicate genitalia one side will not permit theintroduction of a Fig. 16.—Further descent ofthe urogenital septum, therebyshortening the sinus nroueni talis 28 ANOMALIES OF FORMATION. Palpation completes the diagnosis. The finger is in-troduced into the rectum, and a firm elastic tumor is feltanteriorly, above which the uterus is recognized as a smallhard body. If the distention is more marked, the uterusassumes an hour-glass shape, in consequence of the resist-ance of the internal os. The tubes should be sought for,exercising great care and gentleness. (Figs. 7 to 11.) Cord-like atresia of the vagina is recognized by bi-manual palpation through the rectum. (Plate 19, Fig. 2.)
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