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A CASE OF 
ABSENCE OF THE BLADDER. 
BY \ 
JOHN T. WINTER, M.J)., 
Washington, I). C. 
[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Yol. XXII., No. 4, 1889.] 
NEW YORK : 
WILLIAM WOOD & CO., PUBLISHERS, 
56 & 58 Lafayette Place. 
1889. ABSENCE OF BLADDER - WINTER. 
Lindner, Eddy 4 Clause, Ljth. N. Y. A CASE OF 
ABSENCE OF THE BLADDER. 
BY 
JOHN T. WINTER, M.D., 
Washington, D. C. 
[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Yol. XXII., No. 4, 1889.] 
NEW YORK : 
WILLIAM WOOD & CO., PUBLISHERS, 
56 & 58 Lafayette Place. 
1889. [Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Yol. XXII., No. 4, 1889.] 
A CASE OF ABSENCE OF THE BLADDER.1 
BY 
JOHN T. WINTER. M.D., 
Washington, D. C. 
(With colored Plate.) 
This child, Mamie F., now eight years old, is the offspring of 
a healthy mother and a whiskey-soaked father. She wras always 
well as an infant, but it was remarked even then that she was 
constantly wet. No attention was ever given to the parts until 
the child was nearly two years old, when, in consequence of an 
almost constant bearing-down pain, causing prolapsus of the 
rectum, an examination was made, and then for the first time 
the malformation was discovered. 
The meatus urinarius, vestibule, and labia minora are entirely 
absent. The labia majora are imperfectly formed, consisting 
simply of little folds of skin, about an inch long; about an inch 
and a half apart posteriorly, and about two inches apart ante- 
riorly. 
The ureters discharge externally, just inside of the anterior 
edge of these little folds of skin, nearly two inches apart. 
The pubis is considerably depressed, and has a soft feel, as if 
it might be cartilaginous. 
During the first examination, six years ago, a tumor was 
found protruding partly, during a pain, through this imperfectly 
formed vulva, which would be drawn into the vagina again as 
the pain would wear off. After several weeks of this kind of 
suffering, the tumor, about as large as a hulled walnut, was 
1 Case exhibited before the Washington Obstetrical and Gynecological So- 
ciety, April 6th, 1888. 3 
WINTEK : A CASE OF ABSENCE OF THE BLADDEK. 
found to remain extruded all the time, and the bearing-down 
pain to be almost continuous. The tumor was removed, and as 
the paternal grandmother had just died of uterine cancer, it was 
submitted to microscopic examination, and was at first reported 
to be cancer, but was afterwards thought to be composed of 
bladder epithelium. 
After the removal of the tumor, the bearing-down pain ceased, 
and the rectum was prolapsed only when the child would 
strain hard at stool. This improved condition lasted for about 
one year, when it was found that the tumor had returned, with 
the bearing-down pain, prolapsus of rectum, etc. In making 
an examination at this time, now five years ago, I pushed the 
tumor back into the vagina, carrying it up the whole length of 
my finger, and was surprised to find that the bearing-down pain 
was entirely relieved. I have seen but little of this child for the 
last five years, but am informed that, although she occasionally 
has the bearing-down pain, the tumor has not returned. 
There is now, as there always has been, a constant dribbling 
of urine, and an almost constant inflammation of the parts. 
The external orifices of the ureters can be seen quite plainly 
in the accompanying colored plate.