402 BLADDER, ABNORMAL ANATOMY. 



Deschamps, in 1791, whilst removing a cal- retention. These veins may become inflamed 



culus from the bladder of a boy of twelve and produce divers alterations in the mucous 



years, discovered-, on the anterior and lateral tissue. This membrane may be thinned, take 



parietes of this organ, a small fungous tumour a fungous appearance, give rise to haemor- 



of the size of a cherry, which projected to the rhage, in fact assume somewhat of an erectile 



distance of half an inch from the surface, character. 



Baiilie, in his Morbid Anatomy, has given a Scirrhus and Cancer. Cancer primitively 



plate of a polypus of the bladder which he affecting the membranes of the bladder is an 



found in a child, and which not only occupied extremely rare disease. Chopart relates only 



the whole of the cavity of the organ, but sent one example of the kind.* Desault describes 



prolongations into the urethra. anotherjf Lallemand another.J Soemmering 



The structure of these tumours is very va- appears to doubt whether the disease ever 



rious; the greater number appear to possess a exists. In each case to which I have alluded 



fibrous structure, others present a white homo- the disease occurred in man, and I know of 



geneous, lardaceous texture at their base, whilst no case on record in which the disease has 



their free surface may be red, vascular, or even primarily existed in the bladder in woman, 



carcinomatous ; sometimes they are hard and In the whole of the cases the disease was 



almost cartilaginous in their whole thickness ; characterized by lancinating pains behind the 



at others they present calcareous concretions. pubis, and by the emission of particles of de- 



Around the points from which these tumours composed animal matter ; these were the only 



arise the bladder is ordinarily thickened and symptoms which were calculated to excite 



indurated: this is, we apprehend, a consequence suspicion as to the nature of the disease. In 



of the continued irritation which has attended every one of them the scirrhus was situated in 



their development. the fundus of the bladder and near its neck. 



Varices. The arteries and veins of the The whole of the membranes at that point 



bladder present numerous ramifications in were transformed into a scirrhous lardaceous 



the cellular stratum, which separates the substance, varying in thickness from two to 



muscular from the mucous tunic of this four inches, and in two cases the tumours were 



organ ; and in the neighbourhood of its neck somewhat funnel-shaped, the internal surface 



they form an immediately apparent plexus, of which was unequal, bristling with very 



This vascular structure in inflammation be- projecting vegetations of a cauliflower cha- 



comes so marked that the mucous membrane racter. Most commonly the affection is the 



appears to be entirely formed of these vessels, result of the extension of a similar disease 



Though it might be expected that during the from the uterus or the rectum, and the symp- 



existence of inflammation these vessels would toms by which the affection might be announced 



become more dilated and manifest, yet it are confounded with those of the affection of 



cannot be regarded as a true varicose condi- the uterus or of the rectum. This affection 



tion, there being neither partial dilatations may exist with dilatation or contraction of the 



nor projecting indurations like those which cavity of the organ, with or without ulceration, 



characterize varices situated in other parts of with or without hypertrophy of the muscular 



the body. Bonnet describes the case of a tunic. When derived from the uterus, the 



man, who during life had suffered from the affection is manifested at the fundus of the 



ordinary symptoms of stone, but in whose organ, and a communication is usually soon 



bladder no stone was discovered after death, brought about between it and the vagina, and 



The veins around the neck of the bladder as a consequence the urine flows involuntarily 



were varicose and very much distended from the vulva. When derived from'the rec- 



with blood.* Morgagni discovered in the turn, the fundus is commonly affected ; and in 



body of a man aged sixty, in which the either case these productions are manifested 



tunics of the bladder were very thick, large within the vesical cavity under the form of 



vessels creeping along its internal surface fungous vegetations. 



around its neck. They were so distended with Paralysis. The bladder is not an excep- 



blood, that at first he almost believed they tion to the rule, that " all parts of the body 



were haemorrhoids rather than parallel vessels.f may become unfit for the functions which they 



A similar case is described by Chopart, in a are destined to perform ;" it may lose the fa- 



calculous patient. There cannot, therefore, culty of contractility, which is indispensable to 



be any doubt that such a disease may exist, the accomplishment of excretion. Under many 



It appears to occur principally when the circumstances it may contract with too much 



parietes of the bladder are thickened, when it force ; in a still greater number its contracti- 



contains calculi or fungi, or when its neck or lity is enfeebled and ultimately destroyed, 



the prostate are tumefied. It is not unfrequent Apoplexy, hemiplegia, paraplegia, concussion, 

 in old men and in inhabitants of warm 



countries. The disease has much analogy * Traite des Maladies des voies urinaires, tome i. 



with haemorrhoids, and appears to increase p- 466. Edit, de 1821. 



under similar sources of irritation. It may t Traite des Maladies des voies urinaires, 3d edit. 



contract the neck of the bladder and so cause p< 1 Zl 



$ Obs. sur les maladies des organes gemto- 



urinaires, p. 8. 



' Sepul. lib. iii. sect. 25, p. 263. Traite des Mai. de la vessic et de 1'uretre, trad, 



t De Sed. ep. 63 art. 13. de H. Bollard, 1824. 



