BLADDEtt, ABNORMAL ANATOMY. 



403 



and inflammation of the brain and its meninges, 

 extravasations within the cranium, and still 

 more concussion and inflammation of the spinal 

 marrow and its membranes, and extravasations 

 within the spinal canal, consequences of con- 

 tusions of this part ; the excessive distention of 

 the bladder by the accumulation of urine 

 within its cavity, either in consequence of 

 neglecting to attend to the desire of excretion, 

 or because the want has been resisted by false 

 delicacy, or because an obstacle exists at the 

 neck of the bladder or in the urethra; inflam- 

 mation of the mucous membrane, especially 

 when it affects the neighbourhood of the neck 

 of the organ ; the sudden cessation of articular 

 pains, inflammations of the skin or of the 

 genital organs ; exasperated gastro-enteritic af- 

 fections which are accompanied by affections 

 of the brain and the spinal marrow ; abuse of 

 the sexual organs ; these are among the cir- 

 cumstances under the influence of which the 

 bladder loses partially or completely its con- 

 tractility. 



We must not therefore regard all cases of 

 paralysis of the bladder as evidence of feeble- 

 ness, nor confound the inability to contract, 

 with those mechanical obstacles which, acting 

 on the bladder or the urethra, oppose the ex- 

 cretion of urine. We should always endeavour 

 to ascertain whether there be a real paralysis of 

 the bladder in cases where the brain or the 

 spinal marrow is injured, and where there is 

 detected abuse of the sexual organs. When 

 retention is primitively the effect of inattention 

 to the desire to pass urine, there is only exces- 

 sive distention of the muscular fibres, but that 

 distention is formidable in its effects ; for no 

 fact is better established than this, that when 

 we submit muscular fibre to excessive distention 

 or contusion, it loses the faculty of contracting. 

 Again, in cases of inflammation of the bladder, 

 there is less of paralysis than a suspension of 

 contraction in the muscular tunic, in conse- 

 quence of the proximity of the mucous tunic, 

 which by reason of its inflammatory state be- 

 comes still more painful when its tissue is 

 ruffled by contraction. There may, however, 

 be atony or even a real paralysis of the mus- 

 cular tunic during the existence of inflammation 

 of the mucous tissue. 



It is important to distinguish the case where 

 paralysis is simple from those in which it is 

 complicated by inflammation of the mucous 

 membrane of the bladder or that of any other 

 organ, and for that purpose it is necessary to 

 analyse with care the symptoms. We must 

 also bear in mind that from simple, complete, 

 and primitive paralysis of the muscular tunic 

 to inflammation of its mucous tunic, the inter- 

 val is only very short, in consequence of the 

 irritating impression which is exercised by the 

 accumulated urine which has become much 

 deteriorated in its qualities by its prolonged 

 retention. From the time when paralysis is 

 fairly established, the bladder is quite insensi- 

 ble to the stimulus of the urine it is merely 

 an inorganic sac, which may become enor- 

 mously distended. Ilaller found in a drunkard 



the bladder so dilated that it was capable of 

 containing twenty pounds of water.* Frankf 

 saw a similar bladder which simulated ascites; 

 he evacuated from it at one time twelve pounds 

 of urine without removing all that it contained. 

 William Hunter, in his Anatomy of the 

 Gravid Uterus, plate 26, has given a fine repre- 

 sentation of a bladder which extended as far 

 as the xiphoid cartilage of the sternum. 



This affection may, according to Baillie,J 

 exist during two distinct states, one when the 

 muscular tunic of the bladder has lost its 

 contractile power, the other while that power 

 is still retained. He adds, that after death 

 these two cases cannot be distinguished the 

 one from the other, but that by an attentive 

 examination of the symptoms the existence of 

 each may be recognised during life. It may 

 be complicated with inflammation of the organ, 

 and in this case rupture of the bladder may 

 occur, to which may be added the case of 

 the celebrated Tycho Brahe.|| Zuber 1f dis- 

 tinguishes this affection into that of the neck 

 and that of the body, and this distinction is 

 important, for the second being sometimes 

 accompanied by a species of spasm or want of 

 consent in the neck, a retention of urine must 

 be the result, whilst the former occasions 

 incontinence of that fluid. 



Spasm. Spasm of the bladder is an affec- 

 tion of frequent occurrence ; it accompanies the 

 various forms of cystitis, calculus, and often in- 

 flammation of the urethra. In fact it may be ex- 

 cited by any kind of irritation of the bladder or 

 urethra, or by certain affections of the kidneys 

 and of the rectum. It is not our purpose to con- 

 sider in this place any other than what may be 

 termed the idiopathic species of this affection. 

 Hoffmann describes the case of a man who 

 sank under the numerous and violent attacks 

 of this disease, and in whom, after death, 

 except in one particular, the bladder was found 

 perfectly healthy ; this was in the thickening 

 and dilatation of its vessels, in which there 

 was still much blood. Of course, although no 

 anatomical lesion was found in this case, some 

 irritation capable of exciting the spasm must 

 have existed. 



BIBLIOGRAPHY, Rutty, A treatise on the urinary 

 passages, &c. 4to. Lond. 1726. Zuber, Diss. de 

 vesicae urinariae morbis, 4to. Argent. 1771. Adams 

 on stone and gravel, diseases of the bladder, Sec. 

 8vo. Lond. 1772. Lentin, Krankheiten der Harn- 

 blase der Alten, in Ej. Beytrage iii. Bd. 1780. 

 Trcja, Mali della vesica orinaria, 2 vol. 8vo. Nap. 

 1785-88. Frank, J. P. Oral, de vesica urinaria 

 ex vicinia morbosa aegrotante, 8vo. Ticin. 1786, in 

 Ej. opusc. No. 4. Malacarne, Osserv. anat. e 

 pathol. sugli organi uropoetici, in Mem. della Soc. 

 Ital. vol. iii. et vol. v. 1780. Chopart, Des ma- 



* Elementa Physiologias, art. Vesica. 



t Oratio de signis morborum ex corporis situ, 

 partiumque positione patendis, Ticini, 1/88. 



| Path. Anat. chap. xiii. 



See cases related by Ploucquet, Bibl. Med. 

 Pract. 



|| Petri Gassendi Tychonis Brahei vita, Paris, 

 1654, in 4to. p. 206. 



^1 Diss. de Morbis vesica?. 



2 D 2 



