THE BLADDER 365 



level in the abdominal wall, the inference that the pain is due 

 to an ureteral calculus, and that the calculus has travelled some 

 distance down the ureter would appear to be quite justifiable. 



It is also important to remember that attacks of ureteral 

 colic do not necessarily imply either complete obstruction or 

 even impaction in the tube. A small calculus in the pelvis of 

 the ureter may be quite sufficient to produce severe attacks 

 of colic, while it may be impossible to detect its presence by 

 means of radiograms. 



It has been said that the pain in renal calculus may be 

 referred entirely to the opposite side of the body, but this 

 statement has not been confirmed. From the fact that the 

 ureter does not develop in the median plane originally, such 

 an occurrence would be very difficult to understand. 



Areas of cutaneous or muscular hyperalgesia (p. 195) may 

 develop in connexion with renal calculi, and they are not 

 infrequently found in the areas supplied by the posterior rami 

 (primary divisions) of T. 10, n and 12, and L. i (Fig. 60). 



The Bladder. In the newly-born infant^ the bladder pro- 

 jects upwards from the pelvis into the abdominal cavity, and 

 its anterior surface is in direct contact with the anterior 

 abdominal wall. As the relative size of the pelvic cavity 

 increases, it sinks downwards, and, in the adult^ it is only when 

 it is distended that the bladder rises up out of the pelvis. 



When it is empty, the bladder is roughly pyramidal in shape. 

 The apex lies in contact with the pelvic surface of the pubic 

 symphysis, and the base is directed downwards and backwards 

 towards the rectum. The superior surface of the bladder 

 looks upwards and backwards, and is in relation to coils of the 

 small intestine or pelvic colon, while the infero-lateral surfaces 

 look downwards and laterally, and are related to the pubes 

 and to the floor and side walls of the pelvis. The retro-pubic 

 space (of Retzius\ which contains a small pad of fat, intervenes 

 between the bladder and the pubic symphysis. The neck of 

 the bladder, which is partly continuous with the prostate, is 

 traversed by the internal orifice of the urethra. 



