394 



BLADDER, ABNORMAL ANATOMY. 



Certain portions of the parietes of the organ 

 are in such cases unprovided with the muscular 

 fibre necessary to enable them to offer the 

 usual resistance, and a similar effect is pro- 

 duced to that which I have already described, 

 the mechanism being somewhat different. 



These sacs may attain great size, even supe- 

 rior to that of the bladder itself; commonly 

 the point by which communication with the 

 bladder is maintained is only a narrow neck, 

 and in consequence of this circumstance the 

 organ has occasionally been described as dou- 

 ble, triple, and so on. It is always easy to 

 determine whether it be really so or not, first, 

 by examining the parietes of each, and, 

 secondly, by ascertaining the points at which 

 the ureters are implanted. In the first case we 

 shall find only one of these compartments 

 invested by a muscular tunic : in the second 

 an ureter has never yet been known to pene- 

 trate directly the adventitious cavity. 



There is scarcely any point of the surface of 

 the bladder in which such a state may not be 

 produced, but there are certain regions where 

 the affection is much more frequently met with 

 than others. They are most commonly formed 

 at the lateral parts, or at the summit, near 

 the insertion of the urachus. Occasionally 

 many of these sacculi are found in the same 

 bladder.* 



A species of sacculi or appendices may, 

 however, be produced by an extension, at a 

 given point, of the whole of the vesical tunics; 

 and even these may be a consequence of re- 

 tention of urine, but more frequently of the 

 sojourn of a stone, which forms a cell. 

 Some examples of this species are given by 

 Morgagni.-j- A woman, two years before her 

 death, introduced into the urethra " a long hair 

 pin ;" this instrument slipped from her grasp 

 and passed into the bladder, where it became 

 arranged transversely, so that whilst the point 

 rested upon the left, its head rested on the 

 right side of the organ. The head became 

 inciusted with calcareous matter; a stone of 

 the size of a nut was thus formed, which was 

 contained in a quadrilateral sac produced by 

 the extension of the whole of the tunics of the 

 bladder. 



Cells or cysts may be otherwise formed at 

 the expense of the vesical parietes. Calculous 

 concretions may be formed in the kidney, and 

 may pass unobstructed through the ureter into 

 the bladder; but if the magnitude of the stone 

 be disproportioned to the capacity of the canal 

 of the ureter, it may sojourn at any point of the 

 continuity of this canal, or at the point where 

 it terminates in the bladder. If also the cal- 

 culous matter be abundant in the urine, it will 

 be deposited upon this nucleus, which will more 

 or less rapidly augment in volume, and will 

 be impacted at or near the point where it may 

 have acquired this augmentation. The first 

 author who speaks in a clear and precise man- 

 ner of this affection is the celebrated Pierre 



* Heist er. 



t De Scil. ixc. <]>. \ln. art. 18. 



Franco.* Since Franco, it has been described by 

 by many others, particularly by Alexander Mon- 

 rof and Iloustet.J The existence of this affection 

 is certainly not frequent, but its occasional occur- 

 rence is amply proved : formed in the way I 

 have described, these calculi occasionally glide 

 between the mucous and muscular tunics of the 

 organ by means of an opening which they form 

 at the point where the ureter obliquely pierces 

 the bladder, instead of entering the bladder by 

 the natural channel. The volume of these cysts 

 is never very considerable, for such calculi do 

 not acquire anything like the volume of those 

 which are commonly found moving freely in the 

 cavity of the bladder. The reason of this is ob- 

 vious; they are not exposed to the action of any 

 considerable quantity of urine, and they cannot 

 consequently receive a large accession of calcu- 

 lous matter. Covillard and Garengeot|| have 

 seen them of the size of a hen's egg, but such 

 cases are rare. Commonly they are very little 

 removed from the insertion of the ureters. The 

 reason of this is not, however, that which was 

 assumed by Littre,^[ because the contraction of 

 the muscular fibres is made towards the fundus, 

 and that in consequence the calculus would be 

 forced towards that region, but by reason of the 

 resistance offered by the membrane of the cyst 

 by which they are surrounded. 



CHANGES OF CAPACITY. 



The bladder may suffer certain modifications 

 of capacity as consequences of disease. It may 

 become so distended as to contain nine pounds 

 of urine (in puella pro hydropica habita, 

 Kcenig)** novem chopines ab ischuria, La 

 Motte;)ft or even twelve pounds, Felix Pascal: 

 or it may become so diminished that its volume 

 shall not exceed that of a small walnut. In 

 1764, M. Portal found at Montpellier, in the 

 dead body of a woman aged sixty, the bladder 

 so small that its volume did not exceed that of 

 a hazel-nut. 



Decrease. In persons who pass urine fre- 

 quently, the bladder is small ; still more so in 

 those whose kidneys do not perform their func- 

 tions properly. It is small in those cases of 

 irritation by which frequent contractions are 

 excited. Lithotomists have frequently remarked 

 that in calculous patients the bladder closely 

 embraced the stone. Morgagni, JJ in opening 

 the body of a girl of fourteen, found the bladder 

 adherent to the parietes of the abdomen imme- 

 diately above the pubis, and so contracted 

 around a needle, which had been introduced 

 sixteen months before her death, that this viscus 

 could scarcely have contained anything more. 



* Trait6 dcs hcrnics. chap. xxxi. p. 107, Lyon, 

 1561. 



t Essays and Observations of the Medical So- 

 ciety of Edinburgh, vol. vi. p. 257. 



t Mem. do 1'Acad. dcs Sciences de Paris, aim. 

 1702. 



$ Obs. 11. 



tM'm. de I'Acad. de Chir., t. i. p. 411. 

 Mt'm. dc l'.\c;ul. dcs Sciences, an 1702. 

 ** Litli. :['. c. K|)ist. 11. 

 ft Traite dcs Accouchmens, Obb. 44. 

 }{ DC Scil. cji. xlii. art. 20. 



