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/lit25759/414/
BLADDER, ABNORMAL ANATOMY. 
Deschamps, in 1791, whilst removing a cal¬ 
culus from the bladder of'a boy of twelve 
years, discovered on the anterior and lateral 
parietes of this organ, a small fungous tumour 
of the size of a cherry, which projected to the 
distance of half an inch from the surface. 
Baiilie, in his Morbid Anatomy, has given a 
plate of a polypus of the bladder which he 
found in a child, and which not only occupied 
the whole of the cavity of the organ, but sent 
prolongations into the urethra. 
The structure of these tumours is very va¬ 
rious ; the greater number appear to possess a 
fibrous structure, others present a white homo¬ 
geneous, lardaceous texture at their base, whilst 
their free surface may be red, vascular, or even 
carcinomatous; sometimes they are hard and 
almost cartilaginous in their whole thickness ; 
at others they present calcareous concretions. 
Around the points from which these tumours 
arise the bladder is ordinarily thickened and 
indurated : this is, we apprehend, a consequence 
of the continued irritation which has attended 
their development. 
Varices. — The arteries and veins of the 
bladder present numerous ramifications in 
the cellular stratum, which separates the 
muscular from the mucous tunic of this 
organ ; and in the neighbourhood of its neck 
they form an immediately apparent plexus. 
This vascular structure in inflammation be¬ 
comes so marked that the mucous membrane 
appears to be entirely formed of these vessels. 
Though it might be expected that during the 
existence of inflammation these vessels would 
become more dilated and manifest, yet it 
cannot be regarded as a true varicose condi¬ 
tion, there being neither partial dilatations 
nor projecting indurations like those which 
characterize varices situated in other parts of 
the body. Bonnet describes the case of a 
man, who during life had suffered from the 
ordinary symptoms of stone, but in whose 
bladder no stone was discovered after death. 
The veins around the neck of the bladder 
were varicose and very much distended 
with blood.* Morgagni discovered in the 
body of a man aged sixty, in which the 
tunics of the bladder were very thick, large 
vessels creeping along its internal surface 
around its neck. They were so distended with 
blood, that at first he almost believed they 
were haemorrhoids rather than parallel vessels.j- 
A similar case is described by Chopart, in a 
calculous patient. There cannot, therefore, 
be any doubt that such' a disease may exist. 
It appears to occur principally when the 
parietes of the bladder are thickened, when it 
contains calculi or fungi, or when its neck or 
the prostate are tumefied. It is not unfrequent 
in old men and in inhabitants of warm 
countries. The disease has much analogy 
with haemorrhoids, and appears to increase 
under similar sources of irritation. It may 
contract the neck of the bladder and so cause 
* Sepul. lib. iii. sect. 25, p. 263. 
t. De Sed. ep. 63 art. 13. 
retention. These veins may become inflamed |! 
and produce divers alterations in the mucous t 
tissue. This membrane may be thinned, take |i: 
a fungous appearance, give rise to hæmor- l 
rhage, in fact assume somewhat of an erectile s 
character. 
Scirrhus and Cancer. — Cancer primitively L 
affecting the membranes of the bladder is an ii 
extremely rare disease. Chopart relates only.p 
one example of the kind.* Desault describes jf- 
anotherLallemand another.! Soemmering i) 
appears to doubt whether the disease ever ■ 
exists.§ In each case to which I have alluded ! 
the disease occurred in man, and I know of'll’ 
no case on record in which the disease has p 
primarily existed in the bladder in woman, L< 
In the whole of the cases the disease was jp 
characterized by lancinating pains behind the p 
pubis, and by the emission of particles of de- [ 
composed animal matter ; these were the only p 
symptoms which were calculated to excite i 
suspicion as to the nature of the disease. In If 
every one of them the scirrhus was situated in ii 
the fundus of the bladder and near its neck. L 
The whole of the membranes at that point ii 
were transformed into a scirrhous lardaceous | = 
substance, varying in thickness from two to b 
four inches, and in two cases the tumours were 
somewhat funnel-shaped, the internal surface i 
of which was unequal, bristling with very r 
projecting vegetations of a cauliflower cha- ■/. 
racter. Most commonly the affection is the 
result of the extension of a similar disease 
from the uterus or the rectum, and the symp- •; 
toms by which the affection might be announced a 
are confounded with those of the affection of f 
the uterus or of the rectum. This affection x 
may exist with dilatation or contraction of the 
cavity of the organ, with or without ulceration, ;■ 
with or without hypertrophy of the muscular, i 
tunic. When derived from the uterus, the n 
affection is manifested at the fundus of the : 
organ, and a communication is usually soon i 
brought about between it and the vagina, and 
as a consequence the urine flows involuntarily 
from the vulva. When derived from the rec- i • 
turn, the fundus is commonly affected ; and in 
either case these productions are manifested j 
within the vesical cavity under the form of u 
fungous vegetations. 
Paralysis.—The bladder is not an excep- - 
tion to the rule, that “ all parts of the body 
may become unfit for the functions which they ( 
are destined to perform it may lose the fa- 
culty of contractility, which is indispensable to 
the accomplishment of excretion. Under many 
circumstances it may contract with too much . 
force ; in a still greater number its contracti- ■. 
lity is enfeebled and ultimately destroyed. 
Apoplexy, hemiplegia, paraplegia, concussion, 
* Traité des Maladies des voies urinaires, tomei. L 
p. 466. Edit, de 1821. 
t Traité des Maladies des voies urinaires, 3d edit, 
p. 177. 
t Obs. sur les maladies des organes genito- f 
urinaires, p. 8. 
§ Traité des Mal. de la vessie et de l’urètre, trad. L 
de H. Hollard, 1824.
        

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