JAMA. 1917;LXIX(25):2079-2081. doi:10.1001/jama.1917.02590520001001.
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Exstrophy of the bladder is a rare congenital malformation; it is reported by Neudörfer1 as occurring once in 50,000 births. The anomaly is probably occasioned by variations of the salts in the amniotic fluid surrounding the embryo. It is one of the most serious of malformations, as approximately one half of those suffering from it die during the first ten years of life, and the great majority are dead before they are 40. The condition is very distressing from the tenderness and the difficulty of protecting the protruding bladder, the constantly dribbling urine requiring much absorptive dressing or an equally foul smelling receptacle which leads such persons to shun society. Associated defects are epispadias in the male, an absence of the anterior pubic bone in all cases, and an apparent absence of the umbilicus, which becomes the upper margin of the mucocutaneous juncture, the urachus being absent. In the


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