BLADDER, ABNORMAL ANATOMY. 



393 



extroversion of the bladder, which should be 

 mentioned in this place. The ureters, of 

 course, open immediately upon the surface of 

 the body ; the urethra no longer serves for the 

 emission of urine, and is often incomplete. 

 Commonly in woman it opens above the cli- 

 toris, in man above the penis. Occasionally 

 the testicles do not descend. Meek el has 

 remarked that there is commonly a separation 

 of the two lateral moieties of the external 

 genital organs, like that of the abdominal 

 muscles and the pubis. It has been remarked 

 by Duncan (loc. cit.) that this infirmity more 

 commonly happens to the male than the female. 

 Meckel doubts this proposition, and adds many 

 cases to those cited by Duncan, in which the 

 disease affected the female. Isidore Geoffrey 

 St. Hilaire, who has carefully examined the 

 recorded cases, which are now very numerous, 

 supports the conclusion of Duncan : he says 

 that of these one-fourth appertain to females, 

 nearly two-thirds to males, and in the re- 

 mainder the sex was undetermined. Ex- 

 trophy of the bladder is a very serious af- 

 fliction, because of the incontinence of urine 

 which is its inevitable consequence, and the 

 deformity of the genital organs by which it is 

 constantly accompanied, and which, in man 

 especially, very commonly occasions impo- 

 tence. It constitutes a more serious disease in 

 the male than in the female, for in the latter 

 the external genital organs, except the want of 

 projection of the pubic eminence, commonly 

 suffer only slight modifications of form : the 

 ovaries, the uterus, and their appendages may 

 not even present any anomalies. * 



Persistence of the urachus. The last of 

 the congenital malformations to which I shall 

 allude is the persistance of the urachus some- 

 times even to adult age. For a considerable 

 time much doubt was expressed whether the 

 urachus was ever a canal, pervious from the 

 bladder to the umbilicus ; and it was not gene- 

 rally admitted until the fact had been re- 

 peatedly demonstrated by Haller and his pupil 

 Noreen. In January, 1787, Boyer exhibited 

 a bladder taken from a man aged thirty-six, in 

 which the urachus formed a canal an inch and 

 a half long, and containing twelve urinary 

 calculi, each of the size of a millet-seed; and 

 it was demonstrated that this canal was not a 

 vesical sac or a prolongation of the mucous 

 membrane. But these cases of persistance of 

 the cavity of the urachus in adult or even in 

 infant life are unquestionably extremely rare ; 



1 For more minute details of this affection the 

 reader may consult Blasius, part iv. obs. 6. Stal- 

 part Vandor\\irl, vol. ii. p. 56. Bartholin, cent. 

 ii. hist. 65, the Edinburgh Essays, vol. iii. p. 257, 

 the Journal Encyclopedique, August, 1756, the 

 Journal de Medecine of Paris, t. v. p. 108, et t. 

 xxvii. p. 26, the Memoirs of the Academy of Sci- 

 ences ot Paris, 1761, where we find an observalion 

 of Lemery made in 1741, and three facts observed 

 by Tenon, also the second volume of Medical 

 Commentaries by a Society of medical men at 

 Edinburgh, p. 437, and the Memoirs of Duncan 

 ( Kdinb, Mod. and Surg. Journ. 1805), and Velpeau 

 (Mem dc 1'Acad. Royalc dc Med. torn, iii.) 



and it is certain that a protrusion of the mu- 

 cous tunic in the form of a canal at this 

 point has been mistaken for the canal of the 

 urachus ; it is even probable that generally 

 where the urine is prevented from escaping by 

 the urethra, and where it escapes by the umbi- 

 licus, it results from the rupture of the species of 

 hernia formed near the situation of the urachus 

 by the mucous tunic of the bladder, and not 

 from the dilatation of this membranous cord. 



When this canal remains pervious only in a 

 part of its extent, the anomaly is not indicated 

 externally. When its cavity is preserved even 

 from the bladder to the umbilicus, nothing 

 marks its existence at the exterior if the urinary 

 passages are unobstructed ; in the opposite 

 condition a very remarkable physiological ano- 

 maly accompanies it, and reveals the presence 

 of the anatomical anomaly; it is the total or 

 partial excretion of urine by the umbilicus, 

 either constantly and from the moment of 

 birth, which is the case when a vice of confor- 

 mation or a disease prevents the urine from 

 passing by its natural channel ;* or tempo- 

 rarily, when the course of the urine, which 

 was at first by the urethra, comes to be inter- 

 rupted by any cause. 



Sigismund Konigf relates the case of a 

 woman in whom the urine, usually excreted 

 by the urethra, passed by the umbilicus during 

 some days in consequence of a severe labour ; 

 but this example and others which might be 

 mentioned do not appear to possess the authen- 

 ticity which is required to establish* that this 

 infirmity may be acquired. It is probable 

 that many of these cases were simply a hernia 

 of the mucous membrane of the bladder, such 

 as occurred in the case detailed by Portal.} 



ACQUIRED CHANGES. 



Sacculi or cysts. A sacculated or encysted 

 condition of the bladder is never a congenital 

 vice of conformation of that organ, but an 

 effect of disease. Sacculi may be produced 

 by any thing which can oppose itself to the 

 excretion of urine, or which may enfeeble the 

 muscular tunic of the organ. In this way the 

 urine becomes collected in the bladder, the 

 parietes are distended, the internal tunic is 

 forcibly applied upon the muscular coat, and 

 if at any point this tunic be weakened, less 

 resistance is offered, a separation between some 

 of its fasciculi takes place to a sufficient dis- 

 tance to admit of the mucous membrane pass- 

 ing between them, and in this way sacculi 

 may be formed. 



This, however, is not the only way by which 

 this state may be produced ; in some bladders 

 the muscular tunic is so developed, probably 

 by irritation, that its fasciculi are grouped and 

 a columnar aspect is produced, not very unlike 

 to the appearance of the interior of the ven- 

 tricles of the heart. 



* Littre, Mem. de 1'Acad. des Sciences, 1701, p. 

 23. Sabatier, Traite d'Anat. t. ii. p. 402, et t. iii. 

 p. 498. Cabrol, Alphabet Anat. obs. 20. This 

 case occurred at Beaucaire in 1550. 



t Phil. Trans, v. 16. 



j Mem. de 1'Acad. des Sciences, 1769. 



