FORM AND POSITION OF THE BLADDER. 945 



in the male and the vagina in the female ; and its smaller end, or summit, 

 resting against the lower part of the anterior wall of the abdomen. Imme- 

 diately in front of the base is the thickened portion named the cervix, or 

 necky which bounds the outlet of the bladder, and connects it below with 

 the urethra. 



The long axis of the distended bladder is inclined obliquely upwards and 

 forwards from the base to the summit, in a line directed from the coccyx 

 to a point between the pubes and the umbilicus. In being gradually dis- 

 tended, the bladder curves slightly forwards, so that it becomes more convex 

 behind than in front, and its upper end is by degrees turned more and more 

 towards the front of the abdomen. Lastly, the bladder, when filled, appears 

 slightly compressed from before backwards, so that its diameter in that 

 direction is less than from side to side. Kohlrausch states that, when the 

 bladder is filled during life, it has the shape of a flattened spheroid ; and 

 that, owing to pressure of the intestines from above, and the gravitation of 

 fluid in its interior, its vertical diameter is the shortest. In its ordinary 

 state, the longest diameter in the male is from base to summit ; but in the 

 female its breadth is often greater than its height. The average capacity 

 of the bladder is often stated to be greater in the female than in the male ; 

 and, no doubt, instances of very large female bladders are not unfrequent, 

 but these have probably been the result of unusual distension : in the 

 natural condition, according to Luschka and Henle, the female bladder is 

 decidedly smaller than that of the male. 



While freely movable in all other directions upon surrounding parts, the 

 bladder is fixed below to the walls of the pelvis by the neck, and by reflec- 

 tions of the recto- vesical fascia, named the true ligaments of the bladder. It 

 is supported, moreover, by strong areolar connections with the rectum or 

 vagina, according to the sex, also in a slighter degree by the two ureters, tho 

 obliterated hypogastric arteries and the urachus, by numerous blood-vessels, 

 and, lastly, by a partial covering of the peritoneum, which, in being reflected 

 from this organ in different directions, forms certain folds or duplicatures, 

 named the false ligaments of the bladder. 



The anterior surface is entirely destitute of peritoneum, and is in 

 apposition with the triangular ligament of the urethra, the subpubic liga- 

 ment, the symphysis and body of the pubes, and, if the organ be full, the 

 lower part of the anterior wall of the abdomen. It is connected to these 

 parts by loose areolar tissue, and to the back of the pubes by two strong 

 bands of the vesical fascia, named the anterior true ligament*. This surface 

 of the bladder may be punctured above the pubes without wounding the 

 peritoneum. 



The posterior surface of the bladder is entirely free, and covered every- 

 where by the peritoneum, which in the male is prolonged also for a short 

 distance upon the base of the bladder. In the male, this surface is in con- 

 tact with the rectum, and in the female with the uterus, some convolutions 

 of the small intestine descending between it and those parts, unless the 

 bladder be very full. Beneath the peritoneum, in the male, a part of the 

 vas deferens is found on each side of the lower portion of this surface. 



The summit (sometimes named the superior fundus) is connected to the 

 anterior abdominal wall by a tapering median cord, named the urachus, 

 which is composed of fibro-areolar tissue, mixed at its base with some 

 muscular fibres which are prolonged upon it from the bladder. This cord, 

 becoming narrower as it ascends, passes upwards from the apex of the 

 bladder between the linea alba and the peritoneum, to reach the umbilicus, 



