BLADDER, NORMAL ANATOMY. 



than those in the corresponding coat in most 

 of the other hollow viscera, being intermediate 

 in these respects to those of the stomach and 

 oesophagus ; this tunic, however, presents great 

 diversity as to colour and density in different 

 individuals. In the contracted state of the 

 bladder, it of course appears more dense than 

 in the distended ; in the latter, but particularly 

 in the over-distended state, it appears thin and 

 imperfect in some places, in consequence of 

 the fasciculi being separated from each other. 

 In the young, cateris puribus, it is stronger 

 than in the old, and in the female than in the 

 male ; but long-continued irritation at any age 

 and in either sex has the effect of thickening it, 

 as also any disease which causes obstruction to 

 the flow of urine. If the bladder be removed 

 from the body, slightly distended and sub- 

 jected to maceration for a few hours, this tunic 

 will admit of more distinct examination ; its 

 fibres will then be seen to take such different 

 directions as to admit of a tolerably easy, 

 though not a perfectly natural separation into 

 distinct laminae, the fibres in the first or super- 

 ficial of which have a longitudinal course ; be- 

 neath this is a second stratum, whose fibres 

 are transverse or circular; and in some situa- 

 tions even a third lamina can be distinctly 

 seen, the fibres of which are by some des- 

 cribed under the name of oblique, but the 

 term reticular would appear more correct : in 

 general these three laminae can be made dis- 

 tinct, particularly on the anterior part of the 

 bladder. The first or longitudinal lamina con- 

 sists of the longest, strongest, and most nu- 

 merous fasciculi ; many of these are connected 

 superiorly to the urachus, thence they descend 

 principally on the fore and back part of the 

 bladder, a few only along the sides ; inferiorly 

 they terminate about the neck. These fibres are 

 very parallel, and much stronger on the an- 

 terior and posterior aspects than upon the sides, 

 where they run more obliquely or irregularly, 

 and decussate with one another. The inferior 

 attachment of these fibres in the male subject 

 may be ascertained by careful dissection to be 

 as follows : those on the fore part of the bladder 

 are connected chiefly to the anterior ligaments, 

 or to the reflections of the fascia from the pubis 

 on this organ ; these appear as shining and dis- 

 tinct as tendons, and have been by some con- 

 sidered as such to these muscular bands. Above 

 this insertion these longitudinal fibres appear 

 very numerous, and those on the right and 

 left of the median line distinctly decussate or 

 interlace. Several here also take a transverse or 

 an arched or semicircular course; some of these 

 are very distinct and are inserted laterally; 

 they must serve to strengthen and to bind 

 down the longitudinal fasciculi. The latter 

 in this situation can be divided into layers, 

 the superficial of which only are inserted, 

 as has been described, into the anterior 

 ligaments of the bladder, and through these 

 into the pubis. The deeper set are inserted, 

 some into the dense cellular tissue about the 

 upper surface of the prostate, and some pass 

 deeper, and intermingle with that circular mus- 

 culo-cellular tissue which surrounds the cervix, 



381 



and which constitutes the true sphincter. Some 

 of those longitudinal fibres, particularly more 

 laterally, pass so deep in this situation as to 

 be very distinctly seen, when the bladder is 

 opened, through the mucous lining of the orifice 

 of the urethra. This disposition of the longitu- 

 dinal fibres we consider as important, as it must 

 enable them during their contraction to draw 

 out or expand the sphincter, so as to allow of 

 the escape of the urine. Laterally these longi- 

 tudinal fibres are attached, a few of them to 

 the margin of the prostate, while others expand 

 over the lateral lobes of this gland, and are in- 

 serted into the fascia which covers it. Poste- 

 riorly these fibres are very distinct, particularly 

 near the inferior surface of the bladder between 

 the two ureters ; to these last-named tubes seve- 

 ral of these fibres are connected : some ascend 

 upon them in arches concave upwards ; these 

 we have traced several inches along the ureters ; 

 while others descend in the same course with 

 them, and are inserted into the trigone of the 

 bladder. The longitudinal fibres collect into a. 

 strong flat band between and beneath the two 

 vesiculee, over which however no fibres pass 

 as they do over the prostate, which circum- 

 stance clearly separates these vesicles from, 

 while the contrary disposition rather connects 

 the prostate with, the urinary excretion. This 

 band of fibres can be followed near to the base 

 of the prostate ; some of its fibres are then in- 

 serted into the submucous fibrous tissue in this 

 situation, others into the base of the gland itself; 

 and very generally one long delicate but distinct 

 band enters the notch in the base of the gland, 

 passes beneath the uvula and middle lobe of 

 the prostate, into which it is sometimes insert- 

 ed, but it can frequently be traced nearly an 

 inch further forward to be inserted by a delicate 

 tendon beneath the seminal caruncle or the 

 verumontanum, which is partially covered over 

 by a fold of mucous membrane or by a sort of 

 prepuce. The effect of this band of the longitu- 

 dinal fibres must be to depress the uvula, and 

 thus to open the orifice of the urethra, and also 

 to depress and to draw the seminal caruncle (a 

 sort of organized glans) downwards and back- 

 wards within the prepuce or sinus pocularis, 

 which covers it, and thus protects it from the 

 irritation of the urine. In the female the lon- 

 gitudinal fibres are inserted anteriorly and late- 

 rally into the cellular, glandular, and vascular 

 tissue which surrounds the neck of the bladder, 

 and posteriorly into a more dense tissue which 

 connects the urethra to the vagina; some fibres 

 also pass in deep, as in the male, to be attached 

 to the sphincter. This muscular lamina is de- 

 scribed by the older authors as a distinct mus- 

 cle, the ' detrusor uriruej arising from and 

 around the urachus by numerous fibres, which 

 thence descend and expand over the whole 

 surface, and again concentrate towards the neck 

 of the bladder to be inserted by one or two 

 tendons into the ossa pubis. This account, 

 however, is by no means perfectly correct ; for 

 on attentively examining this muscular lamina, 

 we frequently find strong transverse fasciculi 

 crossing superficially to the longitudinal fibres, 

 most frequently on the anterior region, but also 



