402 



BLADDER, ABNORMAL ANATOMY. 



Deschamps, in 1791, whilst removing a cal- 

 culus from the bladder of a boy of twelve 

 years, discovered on the anterior and lateral 

 parietes of this organ, a small fungous tumour 

 of the size of a cherry, which projected to the 

 distance of half an inch from the surface. 

 Baiilie, in his Morbid Anatomy, has given a 

 plate of a polypus of the bladder which he 

 found in a child, and which not only occupied 

 the whole of the cavity of the organ, but sent 

 prolongations into the urethra. 



The structure of these tumours is very va- 

 rious ; the greater number appear to possess a 

 fibrous structure, others present a white homo- 

 geneous, lardaceous texture at their base, whilst 

 their free surface may be red, vascular, or even 

 carcinomatous; sometimes they are hard and 

 almost cartilaginous in their whole thickness ; 

 at others they present calcareous concretions. 



Around the points from which these tumours 

 arise the bladder is ordinarily thickened and 

 indurated : this is, we apprehend, a consequence 

 of the continued irritation which has attended 

 their development. 



Vurices. The arteries and veins of the 

 bladder present numerous ramifications in 

 the cellular stratum, which separates the 

 muscular from the mucous tunic of this 

 organ ; and in the neighbourhood of its neck 

 they form an immediately apparent plexus. 

 This vascular structure in inflammation be- 

 comes so marked that the mucous membrane 

 appears to be entirely formed of these vessels. 

 Though it might be expected that during the 

 existence of inflammation these vessels would 

 become more dilated and manifest, yet it 

 cannot be regarded as a true varicose condi- 

 tion, there being neither partial dilatations 

 nor projecting indurations like those which 

 characterize varices situated in other parts of 

 the body. Bonnet describes the case of a 

 man, who during life had suffered from the 

 ordinary symptoms of stone, but in whose 

 bladder no stone was discovered after death. 

 The veins around the neck of the bladder 

 were varicose and very much distended 

 with blood.* Morgagni discovered in the 

 body of a man aged sixty, in which the 

 tunics of the bladder were very thick, large 

 vessels creeping along its internal surface 

 around its neck. They were so distended with 

 blood, that at first he almost believed they 

 were haemorrhoids rather than parallel vessels.-f- 

 A similar case is described by Chopart, in a 

 calculous patient. There cannot, therefore, 

 be any doubt that such a disease may exist. 

 It appears to occur principally when the 

 parietes of the bladder are thickened, when it 

 contains calculi or fungi, or when its neck or 

 the prostate are tumefied. It is not unfrequent 

 in old men and in inhabitants of warm 

 countries. The disease has much analogy 

 with haemorrhoids, and appears to increase 

 under similar sources of irritation. It may 

 contract the neck of the bladder and so cause 



* Sepul. lib. iii. seit. 25, p. 263. 

 + De Sod. *]). 63 uit. 13. 



retention. These veins may become inflamed 

 and produce divers alterations in the mucous 

 tissue. This membrane may be thinned, take 

 a fungous appearance, give rise to haemor- 

 rhage, in fact assume somewhat of an erectile 

 character. 



Scirrhus and Cancer. Cancer primitively 

 affecting the membranes of the bladder is an 

 extremely rare disease. Chopart relates only 

 one example of the kind.* Desault describes 

 another ;f Lallemand another. J Soemmering 

 appears to doubt whether the disease ever 

 exists. In each case to which I have alluded 

 the disease occurred in man, and I know of 

 no case on record in which the disease has 

 primarily existed in the bladder in woman. 

 In the whole of the cases the disease was 

 characterized by lancinating pains behind the 

 pubis, and by the emission of particles of de- 

 composed animal matter ; these were the only 

 symptoms which were calculated to excite 

 suspicion as to the nature of the disease. In 

 every one of them the scirrhus was situated in 

 the fundus of the bladder and near its neck. 

 The whole of the membranes at that point 

 were transformed into a scirrhous lardaceous 

 substance, varying in thickness from two to 

 four inches, and in two cases the tumours were 

 somewhat funnel-shaped, the internal surface 

 of which was unequal, bristling with very 

 projecting vegetations of a cauliflower cha- 

 racter. Most commonly the affection is the 

 result of the extension of a similar disease 

 from the uterus or the rectum, and the symp- 

 toms by which the affection might be announced 

 are confounded with those of the affection of 

 the uterus or of the rectum. This affection 

 may exist with dilatation or contraction of the 

 cavity of the organ, with or without ulceration, 

 with or without hypertrophy of the muscular 

 tunic. When derived from the uterus, the 

 affection is manifested at the fundus of the 

 organ, and a communication is usually soon 

 brought about between it and the vagina, and 

 as a consequence the urine flows involuntarily 

 from the vulva. When derived from the rec- 

 tum, the fundus is commonly affected ; and in 

 either case these productions are manifested 

 within the vesical cavity under the form of 

 fungous vegetations. 



Parali/xis. The bladder is not an excep- 

 tion to the rule, that " all parts of the body 

 may become unfit for the functions which they 

 are destined to perform ;" it may lose the fa- 

 culty of contractility, which is indispensable to 

 the accomplishment of excretion. Under many 

 circumstances it may contract with too much 

 force ; in a still greater number its contracti- 

 lity is enfeebled and ultimately destroyed. 

 Apoplexy, hemiplegia, paraplegia, concussion, 



* Traite des Maladies des voies urinaires, tome i. 

 p. 466. Edit, de 1821. 



t Traite des Maladies des voies urinaires, 3d edit, 

 p. 177. 



| Obs. sur les maladies des organes genito- 

 urinaires, p. 8. 



$ Traite des Mai. de la vcssic et de Purutre, trad. 

 de H. Hollard, 1824. 



