Chap, xviii.] THE BLADDER. 353 



The bladder. When empty the bladder is 

 triangular in shape as seen in an antero-posterior 

 vertical section, having its apex at the symphysis, 

 and its base resting against the rectum or vagina. 

 When moderately distended it is of rounded outline; 

 when completely distended it assumes an oval outline, 

 and rises out of the pelvis. As distension of the 

 bladder increases, the summit of the viscus is brought 

 more and more in contact with the anterior abdo- 

 minal wall, the organ becoming also more convex: 

 on its posterior than on its anterior surface. This 

 tendency for the summit of the distended bladder to 

 press itself against the anterior parietes is of good 

 service in tapping the organ above the pubes. When 

 greatly distended it may reach the umbilicus and may 

 even touch the diaphragm. The usual capacity of the 

 organ is about one pint, but when fully occupied it may 

 hold some quarts. When it is empty the anterior 

 wall of the abdomen is lined with peritoneum down 

 to the symphysis. As the distended bladder ascends 

 above the pubes it dissects the serous membrane from 

 the parietes, and the layer so lifted off forms a 

 cul-de-sac or fold of peritoneum between the upper 

 part of the anterior surface of the bladder and the 

 parietes. When the apex of the bladder is midway 

 between the umbilicus and the pubes there will be 

 about two inches (vertical) of the anterior abdominal 

 wall in the middle line and immediately above the 

 nymphysis, devoid of peritoneal lining. Thus it 

 happens that the distended viscus may be tapped 

 above the pubes without the peritoneum being 

 wounded. Between its anterior surface and the 

 symphysis, and shut in by the peritoneum above, is a 

 loose layer of connective tissue. The looseness of 

 this connective tissue permits the bladder to readily 

 alter its dimensions without disturbing the con- 

 nections of the organ. In injuries to the pelvis 

 x 



