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 Hildanust describes one of the size of a hen's egg, and weighing two ounces. Zacutus Lusitanus I 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 If has seen three, and Bartholinlf two. This affection is rarely seen before adult age. Morgagni" has never seen them in infants or in young persons.
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.f 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 retention. These veins may become inflamed and produce divers alterations in the mucous tissue. This membrane may be thinned, take a fungous appearance, give rise to haemor rhage, in fact assume somewhat of an erectile character.
Scirrhus and Cancer.—Cancer primitively affecting the membranes of the bladder is an extremely rare disease. Chopart relates only one example of the kind.* Desault describes another;- Lallemand another.I Soemmering 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 no case on record in which the disease has primarily existed in the bladder in woman. In the whole of the cases the disease was characterized by lancinating pains behind the pubis, and by the emission of particles of de composed animal matter ; these were the only symptoms which were calculated to excite suspicion as to the nature of the disease. In every one of them the scirrhus was situated in the fundus of the bladder and near its neck. The whole of the membranes at that point were transformed into a scirrhous lardaceous substance, varying in thickness from two to four inches, and in two cases the tumours were somewhat funnel-shaped, the internal surface of which was unequal, bristling with very 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 are confounded with those of the affection of the uterus or of the rectum. This affection may exist with dilatation or contraction of the cavity of the organ, with or without ulceration, with or without hypertrophy of the muscular tunic. When derived from the uterus, the affection is manifested at the fundus of the organ, and a communication is usually soon brought about between it and the vagina, and as a consequence the urine flows involuntarily from the vulva. When derived from'the rec tum, the fundus is commonly affected ; and in either case these productions are manifested within the vesical cavity under the form of fungous vegetations.