BLADDER, ABNORMAL ANATOMY. 



401 



empty, it almost always becomes contracted ; 

 in all cases its capacity is considerably di- 

 minished. 



Hemorrhage from the bladder. Instead of 

 the mucus which is furnished by the mucous 

 membrane of the bladder when in the state of 

 health, it may be the seat of a sanguineous 

 exhalation. When a sanguineous fluid is 

 excreted from the bladder, it does not of neces- 

 sity follow that it has proceeded from the 

 mucous membrane of that organ ; it may be 

 brought by the ureters from the kidneys. 

 When the fluid is produced within the vesical 

 cavity, the mode of production is not uniform : 

 it may be a simple exhalation from the mu- 

 cous membrane, or it may be a consequence 

 of the destruction of the mucous membrane 

 by gravel, by a calculus, or by a foreign body 

 introduced from without ; or it may be a con- 

 sequence of the rupture of varicosed vessels. 

 Blood is, however, rarely exhaled at the in- 

 ternal surface of the bladder, unless the mu- 

 cous membrane be in a state of structural 

 disease : yet this exhalation is occasionally 

 manifested as a result of intemperance, or the 

 use of certain irritating diuretic medicines, 

 concussions of the pelvis ; in woman the sud- 

 den suppression of the menstrual evacuations, 

 and in man of a hemorrhoidal discharge. 



It is very difficult, and sometimes even al- 

 most impossible to determine whether the 

 fluid be derived from the kidney or from the 

 bladder; and to arrive at anything like a sound 

 opinion, it is necessary to consider carefully all 

 the circumstances of the case. Much as it has 

 been relied on, we cannot consider as a sym- 

 ptom peculiar to vesical haemorrhage, the mix- 

 ture of blood with the urine, and the sensation 

 of burning and weight behind the pubis, at the 

 perineum, and at the extremity of the penis ; 

 for these symptoms occur in some cases where 

 there is no effusion of blood, and in others 

 where the blood has arrived from the kidneys. 



It is also very difficult to decide as to what 

 is the exact state of the bladder, even when 

 we are convinced that the blood discharged 

 from the urethra is derived from that organ, 

 Chopart found the vesical mucous membrane, 

 more particularly at the fundus, studded with 

 red points in an old man subject to haematuria; 

 these points appeared to him to be vascular 

 orifices.* In other persons who have suffered 

 from a similar affection, different kinds of 

 fungus have been discovered on this mem- 

 brane. A man, aged seventy-three, had hsema- 

 turia, but there was no stone in the bladder. 

 As there was no appearance of disease about 

 the kidneys, it was attributed to the rupture of 

 some varicose vessels in the neighbourhood 

 of the neck of the organ. After death the 

 bladder was found of great size, and within the 

 trigone was a fungous rounded ulceration, six 

 lines in diameter, surrounded with varicose 

 veins and small fungous excrescences. Ordi- 

 narily, however, gravel or calculi appear to be 

 the exciting causes of this disease. 



Fungous tumours. The information which 

 we possess on the subject of fungous tumours 

 or excrescences of the bladder is not sufficiently 

 precise to enable us to attempt to arrange 

 them according to their variety in structure or 

 development. The tumours which we pro- 

 pose to describe are those which do not im- 

 plicate the whole of the parietes of the organ, 

 but project into its cavity under the form of 

 more or less perfectly pediculated excrescences. 

 We are, therefore, under the necessity of con- 

 sidering simultaneously all those tumours, 

 however variable in structure, which come 

 under the definition which we have given. 

 Many eminent pathologists have expressed an 

 opinion that these tumours are always directly 

 connected with the prostate ; but their occa- 

 sional existence in the female sufficiently 

 proves that this opinion is incorrect. In 1750 

 Mr. Warner removed from the bladder of a 

 woman a fungous tumour of the shape and 

 size of a turkey's egg. Walter* details the 

 case of a young woman in whose bladder he 

 discovered what he calls a. polypus, which ex- 

 tended itself nearly to the external orifice of the 

 urethra. It is true that these morbid products are 

 more commonly seen at the fundus of the blad- 

 der than at any other point of its surface, and it 

 is equally true that a large number of those 

 affections which are described as fungous tu- 

 mours of the bladder, were really morbid 

 products arising from the prostate, which will 

 be described in the article on the PROSTATE 

 GLAND. 



The circumstances necessary for the develop- 

 ment of these tumours are unknown,but it would 

 appear that the larger number occur under the 

 influence of irritation produced by calculus. 

 Ordinarily only one of these tumours is found, 

 and then occasionally it attains a considerable 

 volume. Fabricius Hildanusf describes one 

 of the size of a hen's egg, and weighing two 

 ounces. Zacutus LusitanusJ found one of 

 these polypi of the size of a goose's egg, and 

 so hard that he could not cut it with scissars. 

 There are, however, many examples in which 

 a greater number existed, but in these cases 

 the tumours are usually small. Chopart de- 

 scribes a case which he examined at the Hotel 

 Dieu, in which there were found three tumours, 

 the largest being nearly as large as a cherry. 

 Ludwig describes a case in which he found 

 two of small size in the bladder of a man of 

 sixty-three. Desault once saw the whole of 

 the cavity of the bladder studded with small 

 " fungous tubercles." Lobstein || has seen 

 three, and Bartholin^f two. This affection is 

 rarely seen before adult age. Morgagni** has 

 never seen them in infants or in young persons. 



* Einige Krankheiten d. Nieren und Harnblase, 



Berlin, 1800, tab. iii. 

 t Cent. ii. obs. 65. 



Prax. Med. Ader. lib. ii. obs. 71. 



Loc. cit. tome ii. p. 52. 



$ Loc. cit. tome ii. p. 77. 



Jl Diss. de Dysuria. 



^[ Anat. cent. ii. Hist. 52. p. 243. 



VOL. i. 



* De Sed. ep. Ixvi. ait. 12. 



2 D 



