DEFICIENT VW:11CA L DEVELOPSIENT, DOUBLE BLADDER, V ESICA DUPLEX, PARTITIONED_ BLADDER, VESICA BILOCULARIS.
" Cases of double bladder will become rarer as the knowledge of patho logical anatomy advances," said Vidal, remarking that pathologie,a1 septa have probably been taken for a double organ. He then mentions Molinetta, who in his Dissertatione8 speaks of a woman with five bladders, five kidneys, and six ureters; and Blasius, who has de scribed a case of complete division of the bladder into two halves, with a single urethra issuing from the joint neck, and a separate ureter for each. Besides this example, which Gerardus Blasius found at the autopsy of an adult man, double bladders have only been found in young children. Thus in Isaac Cattier's child, which lived to be fifteen days old, the two bladders were divided from one another by the rectum. Sommering found the abnormality in the body of a child two months old; and Schatz found it recently in a marasmic female infant that lived twelve hours, together vrith complete division of the entire genital apparatus, and congenital double vesico-vaginal fistula. (See Fig. 12.) .We noticed other double bladders when we considered vesical fissure (See Fig. 18). In these cases some obstacle has prevented the coalescence of the double rudiments of the allantois; and each portion has become a separate cavity, and has retained one ureter. This, of course, must occur during the first four weeks of embryonal existence, and Blasius's case shows that it does not always endanger life. The malformations which generally accompany it are of greater importance. It will probably never be the object of medi cinal treatment A diagnosis during life may be made by finding with the catheter two spaces in the bladder divided from one another, and feeling the partition through the abdominal walls.
A less marked degree of defective development is that in which the organ is externally apparently single, or is simply furrowed, there being a septum inside; vesica bilocularis. Thus Karpinsky found a partition running from the fundus to the urethra, but incomplete below; Ash demonstrated in one case the existence of a firm membranous wall, the opening between the two being so small that the two cavities could hardly be considered united; and Testa saw a complete septum. Scanzoni ac cidentally found the bladder divided into parts in a woman dead of tuber culosis; but he does not say whether it was complete, or whether the ex terior of the organ showed signs of division.
In all these cases the partition was vertical. But horizontal septa have been found, arising from the lig-ature of some part of the bladder by a band, possibly the involuting urachus.
The case of cyst of the urachus in the female, which Roger (Marburg) has recently described, belongs here. The canal was enormously dilated,
was closed at the umbilicus, and communicated by a small opening with the bladder. Contractions of the latter viscus would cause urine to be spurted into the cyst, and so fill it, till finally the exertion of abdominal pressure emptied both it and the bladder per urethram.
Of course many examples of divertieuhe of the bladder, of which we will speak later, have been mistaken for developmental faults. This E. Rose proved in the case that Tenon examined, where the bladder was divided by a septum perforated in its middle. A more exact examination showed that both great divisions consisted merely of projections of mucous membrane between the meshes of the muscularis. In the case of Vol cherus Coiter, who described a girl with two bladders, there was really only one bladder and a cyst, and Rose believes that in Molinetta's case with 5 kidneys, 6 ureters, and 5 bladders, there were possibly only multi ple sacculated dilatations of the urethra.
From all this it is plain that even upon the post-mortem table it is easy to be mistaken in the diagnosis of defective vesical development, and we must carefully examine the shape of the organ, look for external con strictions and internal septa, and scrutinize the substance of the lateral walls of the bladder. The very slightest degree of the malforination is that described by Chonsky, in which there was a simple marked longitu dinal constriction of the organ.
Diagnosis.—A vertical septum of the bladder may be diagnosed by the catheter, and by the finger after urethral dilata,tion. A horizontal sep tum can only be found after enlarging the canal of entrance. If there be a tumor above the empty bladder, concerning the nature of which we cannot make ourselves certain by external examination, again the urethra must be dilated, and the point of communication examined with the fin ger, and finally a long elastic catheter passed into the upper tumor.
Treatment.—The removal of vesieal septa is of course not to be thought of; if the bladder became diseased, it might be necessary to determine whether one or both halves were affected. This is to be done with the catheter and the specula, and finally with Rutenberg's illuminating ap paratus, and a suitable treatment begun. lf there is, as in Roser's case, a urachus cyst above the bladder, and if its constant dilatation by the con tractions of the bladder give rise to trouble, the extirpation of the cyst from the external abdominal walls, with freshening and suture of the walls of the orifice communicating with the bladder, would be the only meas ure that would radically cure the patient.