FOREIGN BODIES IN THE FEMALE BLADDER 1. We ha-ve already mei;tioned a large number of the foreign bodies which gradually obtain access to the bladder on page 154, when discussing perforation of that organ. We have mentioned perforation by inflamed cystomata of the ovary, by the products of extra-uterine pregnancy, from elnlcerated portions of the intestine and from the gall-bladder. There remains to be mentioned penetration by echinococcus vesicles Cases of thlo nature have been recorded recently by S. Eldridge,' and in earlier tunes by Laennec, Parmentier, Vigla, Fleckles, Weitenkampf and Freund Chadwick. The latter has given us an excellent representation of the condition of things in his patient, which I reproduce here.
A is the bladder, B the ut,erus, C the rectum. The echinococcus is located in the posterior uterine wall, and thence has penetrated bladder and re,ctum. At F and e respectively, the bladder and rectum have been penetrated.
Such an invasion of the bladder is accompanied by the usual signs of Vesical irritation and by the subsequent passage of perhaps large num bers of pea- to walnut-sized vesicles in the urine. The diagnosis is therefore not difficult. The passage of vesicles may occur periodically for years, the patient in the meantime remaining fairly well. (See Vigla's case.) Several cases of this kind have got well under the alkaline Carlsbad waters. (Parmentier, Weitenkampf, Fleckles.) The echino cocci may reach the bladder from the pelvic connective tissue, from the pelvic bones, from the utero-vesical interspace, or from the kidneys through the ureters.
The other parasites which may be present in the bladder are the dis toma hmnatobium, which Bilharz has described, and Lewis's fllaria san guinus hominus, which causes the tropical chyluria. It is not improbable that the fflaria which I found in the ascitic fluid of a lady who had for merly long resided in Surinam, might penetrate the bladder, although I found none in her urine.
Kiissner found leptothrix upon the inner surface of the bladder of a diabetic, who had never before been catheterized, and whose water was drawn with a clean instrument.
From the pelvis of the kidney come renal calculi and fragments of renal substance, which have been detached by a suppurative nephritis. Taylor found such a fragment in a boy of eleven years, who had nephritis absee dens after scarlatina, and I, with Professor F. E. Schulze and Dr. Werd ner, found another in a puerperal woman with high fever, vvho, however, recovered.
2. Foreign bodies coming from without may reach the female bladder in four various ways. They may be forced into the bladder through the urethra or the vagina by a fall upon certain objects; or the patient, suffer ing from retention, may attempt to catheterize herself and either break the instrument or let it slip out of her hand; or a pregnant woman may attempt to bring about abortion by introducing something into the geni tals, or, probably most frequently during attempts at masturbation, the objects used slip into the bladder. The foreign bodies are very various. Odone found a piece of wood, Jobert de Lamballe a lead pencil, Dupuy a wisp of straw in the bladder as the result of a fall. In consequence of careless catherization a patient of Thomas Haigh Martin allowed the stem of a tobacco pipe, which she used for that purpose, to glide into the blad der, while one of Leonard's permitted a goosequill, and still another the blunt end of a catheter to disappear in the same way. To produce abor tion Zechmeister's patient thrust a splinter of wood 2i inches long into her genitals, while Ntlaton's pushed one of about the same size into the bladder. The number of articles which have been used by women for purposes of onanism are extremely various. In 238 of intentional intro duction into the bladder for this purpose, reported by Denue6, 119 were in men and 96.in women; and among them 5 girls under 14 yeais of age. Pins, hairpins, sewing and. knitting needles were introduced 82 times; needle-boxes 15 times (cases of Dupuy, Dieulafoy, Fleury and others); and toothpicks, iron wire, ivory nail-cleaners and many other objects.