PATHOLOGY OF THE BLADDER AND URETER. 377 



and also for an interesting skiagram of the pelvis, showing a 

 markedly cleft condition at the pubes. So far as I am aware, 

 this is the first skiagram of this condition taken (figs. 37, 38, 

 and 39). 



In considering this matter, I purpose taking up the following 

 points : — 



1. The anatomy of extroversion of the Uadder and of allied con- 



ditions in the same region. 



2. The origin of the bladder and the anatomical relations of the 



cloacal membrane. 



3. The nature of extroversion of the bladder and allied condi- 



tions in the same region. 



1. The anatomy of extroversion of the bladder and of allied 

 conditions in tlie same region. 



In the mesial abdomino-vulvar region, from navel down and 

 back to anterior margin of perineal body, we may have a fissure 

 varying in depth and extent from a mere cutaneous cicatrix, 

 or a dehiscence of the abdominal walls laying bare the anterior 

 aspect of the bladder, to one where the posterior wall of the 

 bladder and urethral walls are exposed and the pelvis cleft 

 anteriorly ; while between these extremes we may have varying 

 amounts of epispadias and bladder exstrophy. As is often the 

 case in malformations, others of a dissimilar nature may be 

 present. 



The most marked form of the lesion is that known as extro- 

 version of the bladder, often associated with epispadias and cleft 

 pelvis, and it is this I wish specially to consider at present. 



I shall describe therefore (1) an ordinary case of extroversion 

 in an adult woman; (2) one in a neivly-born female child; (3) 

 one in a newly-born male child. 



(1) Extroversion of the bladder in an adult ivoman. 



Klein's case, which I summarise, is interesting, as the patient 

 became pregnant and bore a healthy child. 



The navel was not present in this case, the bladder was extro- 

 verted — i.e., its posterior aspect was exposed in the region of 

 the space between the pubic ends. The exposed bladder surface 



