Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol 1: A-Dea
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25759/413/
BLADDER, ABNORMAL ANATOMY. 
empty, it almost always becomes contracted ; 
in all cases its capacity is considerably di¬ 
minished. 
Hemorrhage from the bladder.—Instead of 
the mucus which is furnished by the mucous 
membrane of the bladder when in the state of 
health, it may be the seat of a sanguineous 
exhalation. When a sanguineous fluid is 
excreted from the bladder, it does not of neces¬ 
sity follow that it has proceeded from the 
mucous membrane of that organ ; it may be 
brought by the ureters from the kidneys. 
When the fluid is produced within the vesical 
cavity, the mode of production is not uniform : 
it may be a simple exhalation from the mu¬ 
cous membrane, or it may be a consequence 
of the destruction of the mucous membrane 
by gravel, by a calculus, or by a foreign body 
introduced from without ; or it may be a con¬ 
sequence of the rupture of varicosed vessels. 
Blood is, however, rarely exhaled at the in¬ 
ternal surface of the bladder, unless the mu¬ 
cous membrane be in a state of structural 
disease : yet this exhalation is occasionally 
manifested as a result of intemperance, or the 
use of certain irritating diuretic medicines, 
concussions of the pelvis ; in woman the sud¬ 
den suppression of the menstrual evacuations, 
and in man of a hemorrhoidal discharge. 
It is very difficult, and sometimes even al¬ 
most impossible to determine whether the 
fluid be derived from the kidney or from the 
bladder; and to arrive at any thing like a sound 
opinion, it is necessary to consider carefully all 
the circumstances of the case. Much as it has 
been relied on, we cannot consider as a sym¬ 
ptom peculiar to vesical hæmorrhage, the mix¬ 
ture of blood with the urine, and the sensation 
of burning and weight behind the pubis, at the 
perineum, and at the extremity of the penis ; 
for these symptoms occur in some cases where 
there is no effusion of blood, and in others 
where the blood has arrived from the kidneys. 
It is also very difficult to decide as to what 
is the exact state of the bladder, even when 
we are convinced that the blood discharged 
from the urethra is derived from that organ, 
Chopart found the vesical mucous membrane, 
more particularly at the fundus, studded with 
red points in an old man subject to hæmaturia; 
these points appeared to him to be vascular 
orifices.* In other persons who have suffered 
from a similar affection, different kinds of 
fungus have been discovered on this mem¬ 
brane. A man, aged seventy-three, had hæma¬ 
turia, but there was no stone in the bladder. 
As there was no appearance of disease about 
the kidneys, it was attributed to the rupture of 
some varicose vessels in the neighbourhood 
of the neck of the organ. After death the 
bladder was found of great size, and within the 
trigone was a fungous rounded ulceration, six 
lines in diameter, surrounded with varicose 
veins and small fungous excrescences. Ordi¬ 
narily, however, gravel or calculi appear to be 
the exciting causes of this disease. 
* Lqc, cit. tome ii. p. 52. 
401 
Fungous tumours.—The information which 
we possess on the subject of fungous tumours 
or excrescences of the bladder is not sufficiently 
precise to enable us to attempt to arrange 
them according to their variety in structure or 
development. The tumours which we pro¬ 
pose to describe are those which do not im¬ 
plicate the whole of the parietes of the organ, 
but project info its cavity under the form of 
more or less perfectly pediculated excrescences. 
We are, therefore, under the necessity of con¬ 
sidering simultaneously all those tumours, 
however variable in structure, which come 
under the definition which we have given. 
Many eminent pathologists have expressed an 
opinion that these tumours are always directly 
connected with the prostate ; but their occa¬ 
sional existence in the female sufficiently 
proves that this opinion is incorrect. In 1750 
Mr. Warner removed from the bladder of a 
woman a fungous tumour of the shape and 
size of a turkey’s egg. Walter* details the 
case of a young woman in whose bladder he 
discovered what he calls a polypus, which ex¬ 
tended itself nearly to the external orifice of the 
urethra. It is true that these morbid products are 
more commonly seen at the fundus of the blad¬ 
der than at any other point of its surface, and it 
is equally true that a large number of those 
affections which are described as fungous tu¬ 
mours of the bladder, were really morbid 
products arising from the prostate, which will 
be described in the article on the Prostate 
Gland. 
The circumstances necessary for the develop¬ 
ment of these tumours are unknown,but it would 
appear that the larger number occur under the 
influence of irritation produced by calculus. 
Ordinarily only one of these tumours is found, 
and then occasionally it attains a considerable 
volume. Fabricius Hildanus-f describes one 
of the size of a hen’s egg, and weighing two 
ounces. Zacutus LusitanusJ found one of 
these polypi of the size of a goose’s egg, and 
so hard that he could not cut it with scissars. 
There are, however, many examples in which 
a greater number existed, but in these cases 
the tumours are usually small. Chopart § de¬ 
scribes a case which he examined at the Hotel 
Dieu, in which there were found three tumours, 
the largest being nearly as large as a cherry. 
Ludwig describes a case in which he found 
two of small size in the bladder of a man of 
sixty-three. Desault once saw the whole of 
the cavity of the bladder studded with small 
“ fungous tubercles.” Lobstein || has seen 
three, and Bartholin^! two. This affection is 
rarely seen before adult age. Morgagni** has 
never seen them in infants or in young persons. 
* Einige Krankheiten d. Nieren und Harnblase, 
4to. Berlin, 1800, tab. iii. 
t Cent. ii. obs. 65. 
I Prax. Med. Ader. lib. ii. obs. 71. 
$ Loc. cit. tome ii. p. 77. 
j| Diss. de Dysuriä. 
51 Anat. cent. ii. Hist. 52. p. 243. 
** De Sed. ep. lxvi. ait. 12. 
2 D 
VOL. I.
        

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