BLADDER, NORMAL ANATOMY. 



387 



depends on this circumstance, that the veins 

 which are seen at the inferior region of the 

 bladder, and which return the blood from its 

 tunics, do not belong exclusively to this organ, 

 but are principally derived from the dorsal 

 veins of the penis ; they also receive several 

 branches from the vesicular and the prostate, 

 also from the rectum and intervening adipose 

 substance. In the adult and old these latter 

 veins are very numerous, indeed they may be 

 said to form a perfect ' venous plexus' on each 

 side, extending from the termination of the 

 ureter to the prostate gland. All these veins 

 are considerably less developed in children, 

 inasmuch as the organs, at least those of gene- 

 ration, from which they are principally de- 

 rived, are comparatively small. The vesical 

 veins ultimately discharge their blood into the 

 internal iliac or hypogastric veins. 



c. Lymphatics. The lymphatic vessels are 

 tolerably distinct, more particularly inferiorly 

 and about the cervix. They intermingle with 

 the lymphatics of the rectum and of the neigh- 

 bouring organs, and ultimately lead to the 

 internal iliac or hypogastric glands. Indepen- 

 dent of dissection, the existence of absorbents 

 in the bladder is proved by its functions, or 

 by the changes which the urine undergoes 

 when long retained in this cavity, a portion 

 of its water is absorbed, and the residue be- 

 comes pungent, high-coloured, and acrid. 



d. Nerves. The nerves of the bladder are 

 derived from the hypogastric plexus, which is 

 constituted of two orders of nerves, viz. some 

 from the sacral plexus of the spinal system, 

 and others from the sympathetic or ganglionic 

 system. This two- fold supply of nerves accords 

 with the functions of this organ, and entitles it 

 to be placed, as far as relates to the properties 

 of its muscular coat, among the mixed muscles, 

 being in part voluntary and in part involuntary : 

 the former endowment will, of course, depend 

 on its share of spinal nerves, the latter on the 

 sympathetic. It may also be observed that the 

 branches of the latter are principally distri- 

 buted about the cervix and inferior region, 

 while those of the former are seen distinctly 

 on the sides and superior regions ; but in all 

 these situations these nerves are more or less 

 intermingled. 



The cervix of the bladder is of a com- 

 pressed conical form, longer below and on the 

 sides than above. It is surrounded in the male 

 by the prostate gland ; only a small portion of 

 this is upon its upper surface : in the adult the 

 neck is placed nearly horizontally below the 

 pubis and behind the triangular ligament. 

 In the female the cervix vesicce is closely sur- 

 rounded by a whitish compact follicular tex- 

 ture, not possessing any perfect capsule, and 

 therefore without the accurate form of or any 

 resemblance to the prostate gland in the male. 

 The cervix in the child is more distinctly 

 conical, and is placed in a more oblique or 

 vertical direction than in the adult. The term 

 cervix is not very definitive, as there is no 

 exact limit, at least in the human subject, to 

 mark this region as in quadrupeds; according 



to most writers on human anatomy, it is syno- 

 nymous with the prostatic portion of the 

 urethra, and the full description of it is given 

 by such in connexion with the anatomy of the 

 urethra. We consider the neck of the bladder 

 to be that contracted portion of the viscus 

 which is embraced by the base only of the 

 prostate gland, and which contains internally 

 and below the slight elevation named the 

 uvula of the bladder, and laterally and above 

 the peculiar structure which fulfils the ollicc 

 of a sphincter. 



Having particularly noticed the situation of 

 the bladder, and the slight change of position 

 it admits of in consequence of its change in 

 form, we shall next consider its attachments, 

 or the media by which it is retained in its posi- 

 tion, for it may be considered as nearly a fixed 

 viscus. The bladder is held in its position 

 principally by three connexions ; first, by the 

 peritoneum; secondly, by the reflections of the 

 pelvic fascia; and, thirdly, by the continuity 

 of its cervix with the urethra, the commence- 

 ment of the latter being fixed by ligamentous 

 connexions to the arch and rami of the pubes. 

 First, the bladder is connected by certain folds 

 of the peritoneum to the parietes of the pelvis 

 and abdomen; these folds are named the 

 " false ligaments" of the bladder, and are five 

 in number, two lateral, two posterior, and one 

 superior. Each of the lateral ligaments or 

 folds extends from the lateral region of the 

 bladder to the iliac fossa, and contains in its 

 duplicature thevasa deferentiain the male, and 

 the round ligament of the uterus in the female. 



The posterior folds or ligaments are also two 

 in number; they lead from the fore-part of 

 the rectum to the back part of the bladder. 

 Each of these folds is of a semilunar form, 

 (the concavity looking forwards and upwards,) 

 and contains the ureter posteriorly, and the 

 obliterated hypogastric artery anteriorly. When 

 the bladder is distended, these posterior folds 

 are very short ; but when it is contracted, they 

 are distinct and long. Between them the pelvic 

 cul-de-sac of the peritoneum descends, which 

 in the empty state of the bladder and rectum 

 appears deep, narrow, and distinct, but in the 

 distended condition of these organs, particu- 

 larly of the former, it is of much less extent 

 and depth, as the bladder in becoming dis- 

 tended rises upwards and draws with it the 

 cul-de-sac of the peritoneum : hence in the 

 distended state of this organ the triangular 

 portion of its inferior region which is uncovered 

 by peritoneum is increased in extent, and is 

 larger than when the organ is contracted. 

 Between the two posterior ligaments one or 

 two semilunar folds of the peritoneum may 

 be generally observed on the posterior surface 

 of the bladder, provided the latter be in a con- 

 tracted state ; these folds are expanded as the 

 bladder enlarges, and thus they serve to ac- 

 commodate the serous membrane to the varying 

 conditions of the bladder without stretching or 

 extending the former a purpose which perito- 

 neal folds or ligaments in general are intended 

 to answer. 



2 c 2 



