3*2 PHILOSOPHICAL TRANSACTIONS. [aNNO 1750. 



at high and low water. All this is to be understood, when the weather is sea- 

 sonable ; for, otherwise, these motions are not so discernible. 



Case of a Tumour growing on the Inside of the Bladder, successfully extirpated 

 by Joseph JVarner, Surgeon to Guy's Hospital. N° 495, p. 414. 



Mary Bevan, aged 23, June 24, 1747, strained herself by endeavouring to 

 lift a great weight ; she was immediately seized with violent pain in the small of 

 her back, and a total suppression of urine ; which symptoms, notwithstanding 

 the several methods used for her relief, continued till the 29th of the same month ; 

 when an eminent physician and man-midwife was called to her assistance ; who 

 drew off her urine with the catheter. During the suppression she was seized with 

 an acute fever, and for 1 8 or 20 hours before her urine was dravra off, she dis- 

 charged by the mouth a great quantity of saltish water tinged with blood; which, 

 on lying down, flowed in so great quantities as to threaten suffocation. 



In April 1750, she applied to Mr. W. On inquiry he learnt she had never 

 been able, from the moment of the accident, to void a drop of urine without the 

 assistance of the catheter, which had been used ever since 2 or 3 times every 24 

 hours ; that she was in continual pain, and had been lately much weakened by 

 having several times lost considerable quantities of blood, occasioned by the force 

 used for the introduction of that instrument. On examining her with his fore- 

 finger, which he introduced with great difficulty through the meatus urinarius, 

 he discovered a considerable tumour, which seemed to be of a fleshy substance, 

 and took its rise from the lower part of the bladder near its neck ; the extent of 

 which he could with difficulty reach. She informed him, she first discovered 

 this swelling about 20 months before. He observed it to protrude a little way 

 out of the meatus urinarius on straining to make water when the bladder was 

 full; but on ceasing to strain it presently returned. It had preserved pretty nearly 

 the same appearance ever since it was first noticed ; and about 1 8 months before 

 a small incision was made into it, on presumption of its containing a fluid, but 

 without any effect. 



The method he took for the extirpation of the tumour was this : having first 

 prepared the patient as before the operation for the stone ; when her bladder was 

 fiill, he made her strain as though she was going to make water, on which he 

 perceived ihe tumour to protrude a little ; this he effectually secured from re- 

 turning into the bladder by the help of a crooked needle and ligature passed 

 through the tumour in different directions, and endeavoured to draw it out 

 through the meatus urinarius, but could not effect it by reason of its size ; on 

 this he dilated the meatus urinarius on the right side by cutting it upwards about 



