BLADDER, ABNORMAL ANATOMY. 395 



The bladder is also very small in cases of affection we are about to consider was of ex- 

 incontinence of urine and in vesical fistulae, tremely unfrequent occurrence. This, however, 



Increase. The volume of the bladder aug- is an erroneous opinion, for the experience of 



ments when the whole or a great portion of modern times has demonstrated, that though 



the urine is retained in its cavity, and under the less frequent than hernia of the intestines or of 



opposite conditions to those which have just the epiploon, cystocele is not an unfrequent 



been named. To such an extent may this in- disease.* 



crease proceed, that it may be mistaken for The inguinal ring, the crural arch, the peri- 



ascites.* Inflammation of the bladder com- neum, and the anterior walls of the vagina 



monly accompanies its excessive dilatation, may become the seat of a hernia of the biad- 



but many circumstances related by Morgagni der. At whichever of these points the disease 



and others prove that this viscus may be con- may be manifested, the bladder, fixed deep in 



siderably distended by urine without becoming the pelvis and hidden behind the pubes, is 



inflamed. It may, however, lose its contractile never completely displaced ; only prolongations 



power, and the assistance of art may be neces- of the organ can pass these several points. It 



sary for the evacuation of the urine. A fact must be at once evident that besides the dila- 



stated by Mauchartf shews that a man had tation of the opening through which it passes, 



ischuria, which had commenced four days before there must be a great increase in the capacity 



he was sounded. Some days after this he died ; of the organ itself, and a great relaxation of 



the bladder was found inflamed in different its parietes, occasioned most commonly by 



points. It was entirely empty and yet very retention of urine, or by a habit of only rarely 



voluminous, without being contracted as it is attending to a desire for its evacuation. Whe- 



commonly after death . ther the protrusion occur at the one or the other 



Introversion. Among the acquired changes of the several regions I have named, there are 



of conformation of the urinary bladder, there certain general characters by which it may be 



is one which may be termed introversion. In more or less readily detected. We shall find 



this affection, which is rare, the superior por- a soft tumour, accompanied by a fluctuation 



tion of the organ is so depressed as to be brought which is as much more sensible, and which 



near to its neck, to project into the urethra, acquires a volume as much more considerable 



and in woman to make its appearance at the as the time which may have elapsed without 



external orifice of that canal. ChopartJ relates an evacuation of urine is greater. This tumour 



from Percy the following observation : The may be easily lessened by compression, but 



patient was an abbess aged fifty-two, in whom the reduction is immediately followed by an 



the fundus of the bladder was impacted in the urgent desire to pass the urine, 



neck, having also passed along the urethra, This species of hernia is only partially co- 



and forming at its external orifice a tumour of vered by peritoneum. Dominique Sala is, 



the volume of the eye of a pigeon, red, fleshy, according to Bartholin,f the first person who 



unequally tumefied, which, when pressed upon mentioned this peculiarity. The reason of this 



with the finger, returned into the canal and circumstance is obvious : when the bladder is 



reappeared without any violent exertion. An distended, it is raised to the level of the crural 



analogous case occurred to Foubert. The arch and of the inguinal ring ; it pushes before 



patient died, the body was examined after it the peritoneum, and insinuates itself between 



death, and it was found that the posterior and the peritoneum and the abdominal muscles, 



superior region of the bladder was depressed If at this time a violent effort determine the 



into the form of a cone whose apex had pene- escape of the corresponding part of the organ 



trated the neck of the bladder, a portion of by one or other of these openings, it is the 



ileum about six inches long being lodged in anterior, superior, and lateral part of the 



this depression. organ which will be presented, and this is the 



When, in the female, the summit of the portion which is without a peritoneal invest- 



bladder is engaged in the neck, the simple ment; so that at this time the hernias we have 



inspection of the tumour, its increase after described are completely deprived of a sac. 



walking or in consequence of a fit of coughing, It usually happens, however, that the posterior 



its disappearance with compression, are sym- portion of the organ soon follows, dragging 



ptoms sufficient to enable us to recognize the with it the peritoneum by which it is covered ; 



disease. Those aged persons whose bladders this portion in turn drags down that which is 



are very capacious, and who are become feeble, in the vicinity of the ring; and in this way a 



are most subject to this affection, which is hernial sac is formed, ready for the reception of 



produced by the pressure which the other the intestine or the omentum. This is the 



viscera exercise on this organ. reason why a hernia of the bladder is so fre- 



Hernid. The absence of information in old quently accompanied by an intestinal or omen- 

 authors on the subject of hernial displacement tal hernia, 

 of the urinary bladder induced an opinion 



which was current for very many years, that the * For a confirmation of this opinion, see Blegny, 



Traite des Hernies, 1688; Mery, Mem. de 1'Acad. 

 des Sciences, 1713; Petit, memo ouvrage, 1717; 



^hopart, Smellie, Black. Le Dran, Garengeot, and La Faye. Heister and 



Epbxmaeridcs Acad. Nat. Cur., cent. ix. obs. 41. Platner, Instit. Chir. 3. G. Gunzii, Obs. an. Chir. 



ut , e . des Maladies dea Voies Urinaires, t. i. de Hernia, Lipsiee, 1744; Monro, Levrct, Sharp, 



Edit. 1830. Pott, Scarya, Lawrence, and others. 



Mem. de 1 Acad. de Chir., t. ii. p. 36. t Hist. Anat., cent, xviii. 



