4io 



The Bladder 



base of the bladder is thrust down against the rectum, and, by digital 

 exploration, a semi-elastic and rounded bulging may be detected 

 against its anterior wall ; and, on gently striking the hypogastric 

 region, fluctuation may be detected by the finger in the bowel. When 

 the bladder is distended to the utmost, urine begins to leak out by the 

 urethra ; this overflow may continue for days or even months, the 

 patient believing that the viscus is efficiently emptying itself. Incon- 

 tinence oj ' u rim -huhe adult thus generally means a bladder full and over- 

 flowing ; but in the child it suggests irritation. The more distended 

 the bladder the more thinly are the coats spread out, and the greater 

 the risk of rupture from injury. Over-distension may so stretch the 

 muscular coat as to produce temporary paralysis. Thus, when a 

 catheter is introduced the urine flows without force, and under the 



influence of the diaphragmatic 

 contraction rather than of the 

 vesical wall. But when stricture 

 has long impeded micturition 

 the muscular coat of the bladder 

 i s found thickened from exercise. 

 In the same way the left ven- 

 tricle of the heart grows thick 

 and strong in the effort to force 

 blood through the arterial sys- 

 tem in Bright's disease. 



In cystitis the mucous mem- 

 brane swells, and perhaps to 

 such an extent as to block the 

 openings of the ureters and 

 prevent the descent of urine. A 

 malignant growth may have 

 the same effect, and the ureters 

 may in time be dilated to the 

 size of apiece of small intestine. 

 If this change be slowly and 

 quietly brought about, the glan- 

 dular structure may almost en- 

 tirely disappear under pressure, 

 the kidney being represented by 

 a multilocular cyst into which its 

 fibrous framework is expanded. 



Dilatation of ureters and disease of kidneys, the B Ut more Commonly the result 

 result of enlargement of middle lobe of pro- of obstructed Outflow is the SC- 

 state. (ERICHSEN.) . 



quence of pathological events 



associated with the so-called surgical kidney, which are as follows : 



The bladder being distended, decomposition of the urine occurs, 



and the inflammation of the mucous membrane extends along the 



