CHANGES OF CAPACITY.
The bladder may suffer certain modifications of capacity as consequences of disease. It may become so distended as to contain nine pounds of urine (in puella pro hydropica habits, Koenig) " novem chopines ab ischuria, La Motte;)-ft or even twelve pounds, Felix Pascal : or it may become so diminished that its volume shall not exceed that of a small walnut. In 1764, M. Portal found at Montpellier, in the dead body of a woman aged sixty, the bladder so small that its volume did not exceed that of a hazel-nut.
Decrease.—In persons who pass urine fre quently, the bladder is small ; still more so in those whose kidneys do not perform their func tions properly. It is small in those cases of irritation by which frequent contractions are excited. Lithotomists have frequently remarked that in calculous patients the bladder closely embraced the stone. Morgagni, IT in opening the body of a girl of fourteen, found the bladder adherent to the parietes of the abdomen imme diately above the pubis, and so contracted around a needle, which had been introduced sixteen months before her death, that this viscus could scarcely have contained anything more.
The bladder is also very small in cases of incontinence of urine and in vesical fistulae.
Increase.--The volume of the bladder aug ments when the whole or a great portion of the urine is retained in its cavity, and under the opposite conditions to those which have just been named. To such an extent may this in crease proceed, that it may be mistaken for ascites.* Inflammation of the bladder com monly accompanies its excessive dilatation, but many circumstances related by Morgagni and others prove that this viscus may be con siderably distended by urine without becoming inflamed. It may, however, lose its contractile power, and the assistance of art may be neces sary for the evacuation of the urine. A fact stated by Mauchartt spews that a man had ischuria, which had commenced four days before he was sounded. Some days after this he died; the bladder was found inflamed in different points. It was entirely empty and yet very voluminous, without being contracted as it is commonly after death.
the acquired changes of conformation of the urinary bladder, there is one which may be termed introversion. In this affection, which is rare, the superior por tion of the organ is so depressed as to be brought near to its neck, to project into the urethra, and in woman to make its appearance at the external orifice of that canal. Chopart relates from Percy the following observation :—The patient was an abbess aged fifty-two, in whom the fundus of the bladder was impacted in the neck, having also passed along the urethra, and forming at its external orifice a tumour of the volume of the eye of a pigeon, red, fleshy, unequally tumefied, which, when pressed upon with the finger, returned into the canal and reappeared without any violent exertion. An
analogous case occurred to Foubert.§ The patient died, the body was examined after death, and it was found that the posterior and superior region of the bladder was depressed into the form of a cone whose apex had pene trated the neck of the bladder, a portion of ileum about six inches long being lodged in this depression.
When, in the female, the summit of the bladder is engaged in the neck, the simple inspection of the tumour, its increase after walking or in consequence of a fit of coughing, its disappearance with compression, are sym ptoms sufficient to enable us to recognize the disease. Those aged persons whose bladders are very capacious, and who are become feeble, are most subject to this affection, which is produced by the pressure which the other viscera exercise on this organ.
absence of information in old authors on the subject of hernial displacement of the urinary bladder induced an opinion which was current for very many years, that the affection we are about to consider was of ex tremely unfrequent occurrence. This, however, is an erroneous opinion, for the experience of modern times has demonstrated, that though less frequent than hernia of the intestines or of the epiploon, cystocele is not an unfrequent disease.* The inguinal ring, the crural arch, the peri neum, and the anterior walls of the vagina may become the seat of a hernia of the blad der. At whichever of these points the disease may be manifested, the bladder, fixed deep in the pelvis and hidden behind the pubes, is never completely displaced; only prolongations of the organ can pass these several points. It must be once evident that besides the dila tation of the opening through which it passes, there must be a great increase in the capacity of the organ itself, and a great relaxation of its parietes, occasioned most commonly by retention of urine, or by-a habit of only rarely attending to a desire for its evacuation. Whe ther the protrusion occur at the one or the other of the several regions I have named, there are certain general characters by which it may be more or less readily detected. We shall find a soft tumour, accompanied by a fluctuation which is as much more sensible, and which acquires a volume as much more considerable as the time which may have elapsed without an evacuation of urine is greater. This tumour may be easily lessened by compression, but the reduction is immediately followed by an urgent desire to pass the urine.