Bladder

“ As the bladder is approached, a good many veins are seen to be in the way, some of which have to be wounded. The bladder-wall is recognized by its coarse network of pale muscular fibres, through which, on each side of the middle line, a strong suture is passed, so that when the bladder is opened and the lotion comes rushing out, the opening which has been made into the bladder may not sink into the depths of the pelvis. ”

“ The sensations or sensitive motions of the glans penis, and of the sphincter of the bladder, have been accustomed to exist together during the discharge of the urine; and hence the two ends of the urethra sympathize by association. When there is a stone at the neck of the bladder, which is not so large or rough as to inflame the part, the sphincter of the bladder becomes stimulated into pain ”

“ But if the urine is in great quantity in the bladder, and it has acquired by remaining in it a long time that deep colour which indicates the concentration of its principles, then the irritation that it produces on the organ brings powerfully into action the sensible organic contractility; the bladder contracts, and in spite of the animal, there is an evacuation of urine. ”

“ How Bladder Diseases come to be Confounded with other Diseases. The bladder is largely supplied with blood-vessels, lymphatics, and nerves, given off from the same systems that supply the rectum or lower bowel, and in females the uterus or womb, and the ovaries. This accounts, in a great measure, for the symptoms of bladder disease in those afflicted with piles, or other diseases of the lower bowel, or of diseases of the uterus or womb in the female. ”

“ The bladder is a viscus somewhat similar in structure to the stomach. It is composed of several coats—muscular, nervous, and mucous. Each are liable to diseases peculiar to their several structures. The size of the bladder differs in most persons, and in the sexes.
The female bladder is generally the largest; but the largeness is observable more especially in females who have borne children. The proverbial ability of females to retain their urine longer than men is thus accounted for. ”

“ We first, however, rubbed the bladder gently with oil, so as to make it air-tight, by closing its pores with the oil. We tied the bladder tightly round the mouth of the vial, which we had inserted in it, and with a piece of waxed thread to make it fit better and more tightly, and then placed the vial on some hot coals in a brazier. The vapor or steam of the spirit, dilated and become aëriform by the heat, gradually swelled out the bladder, and stretched it in every direction like a sail. ”

“ When urine contains a larger amount of chemical constituents than it can conveniently hold in solution, a certain quantity crystallizes out, and may be deposited in the kidney or in the bladder. If the crystals run together in the kidney the resulting concretion may either remain in that organ or may find its way into the bladder, where it may remain to form the nucleus of a larger vesical calculus, or, especially in the case of females, it may, while still small, escape from the bladder during micturition. ”

“ The division of the bladder into different lobes has proceeded from a very sufficient reason. When the bladder has only one cavity, as in the case of fishes of prey, the motion of ascent or descent takes place slowly, and without a break; because, as they compress the whole bladder at once, the whole body is moved horizontally, upwards or downwards, as the case may be; a circumstance which has the effect of lessening, in consequence of the resistance of the water, the swiftness of those tyrants of the deep. ”

“ Retention of urine is not always present even in those cases in which the limbs are completely paralysed, as the fibres of one side of the cord are sufficient to maintain the functions of the bladder. The patient may be aware that the bladder is full, although he is unable to empty it. Similarly, sensation in the rectum and anus may be retained although the control of the sphincters is lost. ”

“ In some old people, who have experienced a long retention of urine, the bladder never regains the power of completely emptying itself; and many who are beginning to be weak from age can make water a second time, a few minutes after they supposed they had emptied the bladder.
I have believed this pain to originate from sympathy with some distant part, as from ascarides in the rectum, or from piles in women; or from caruncles in the urethra about the caput gallinaginis in men ”

“ When the urine is too long retained, it is not only resorbed, or taken up again into the mass of fluids, but by stagnating in the bladder it becomes thicker, the more watery parts flying off first, and the more gross and earthy remaining behind. By the constant tendency which these have to concrete, the formation of stones and gravel in the bladder is promoted. Hence it comes to pass, that indolent and sedentary people are much more liable to these diseases, than persons of a more active life. ”

“ When full, the bladder is pear-shaped; when empty, it is collapsed and lies low in the pelvis. The functions of the bladder are to collect and retain the urine, which has reached it drop by drop from the kidneys through the ureters, until a certain quantity accumulates, and then to expel it from the body. ”

“ On the other hand, the diseases incident to the bladder are various, but principally arise from debility, spasms, and calculous concretions; for an account of which, we refer to the articles Gravel, Stone, and Urine. At present, we shall confine ourselves to the inflammatory state of that vessel, which requires immediate relief. This dangerous malady is occasioned by stimulating medicines; gravel or stones lodged in the orifice of the bladder; violent exercise after a long retention of urine, and especially in hot weather ”

“ We have shown that all causes producing a contraction of the blood-vessels have the same effect on the muscles of the bladder. I have often seen excitable, good-tempered dogs, in whom caresses and the sight of food were sufficient to produce such a contraction of the bladder, that the urine was expelled; and this suffices to confirm the fact that in [221] our organism the same phenomena may be produced by opposite causes. ”

“ When the part becomes morbidly enlarged, it acts as a mechanical impediment to the passage of urine from the bladder, but from this circumstance we cannot reasonably infer, that while of its normal healthy proportions, its special function is to facilitate the egress of the urine, for the female bladder, though wholly devoid of the prostate, performs its own function perfectly. ”

“ Again, all the symptoms of retention may exist, and all its bad consequences result, without any apparent swelling of the abdomen. But then the distended bladder can always be felt by the finger introduced into the vagina or rectum; indeed its posterior fundus bulges in towards the cavity of the gut, in every case, before it ascends upwards in the abdomen. Sickening and agonizing pain, with great anxiety and ineffectual straining, generally attend distention of the bladder to any great degree. ”

“ A distended bladder may so easily occur unless the patient is carefully observed during the puerperium that the nurse should charge herself to watch for this complication. She should give the patient a bedpan every four hours, note the contour of the abdomen and measure the urine during the first week, remembering that the patient should void considerably more than the average amount, both because of the amount of milk and water that she is taking, and the fluid which she is eliminating from her tissues. ”

“ In severe cases, most excruciating pain is experienced during the discharge of the contents of the bladder. The urine is often bloody; in general it is of a milky appearance, containing lymph or puriform matter, and vitiated secretion from the lining membrane. Micturition is almost constant, small quantities being voided at a time. Sometimes the inflammation extends to the ureters and pelves of the kidneys, causing violent pains in the loins, nausea, occasional vomiting, and colicky affections. ”

“ Prophylaxis.—Certain directions are helpful and by occupying the patient's mind will overcome certain physical factors that underlie the affection. It is important that the bladder should not be allowed to be full, above all, not to be over-distended at night. Some care should be exercised in not taking too much to drink shortly before going to bed and the bladder should be faithfully emptied before retiring. The weight of a large amount of urine in the bladder pressing down upon the seminal vesicles situated below and behind it causes them to contract rather easily. ”

“ If she find an obstruction or stoppage of the urine, by reason the womb bears too much on the bladder, let her lift up her abdomen a little with her hand, and try if she receives any benefit; if she finds she does not, it will be necessary to introduce a catheter into her bladder, and thereby draw forth her urine. If the difficulty be from the ill posture of the woman, let her be placed otherwise, in a posture more suitable and convenient for her ”

“ If the obstruction exist below the neck of the bladder, as in stricture of the urethra or enlarged prostate, then the bladder is the organ primarily affected, and it may become distended, sacculated, its muscular coat hypertrophied, its mucous membrane affected with catarrhal inflammation, and its contents changed from the normal by the addition of mucus, of pus, of bacteria, or a deposit of earthy phosphates from the ammoniacal reaction produced by decomposition of the urea. ”

“ For obviously the inlet to the stomach does not merely conduct food and drink into this organ, but in the condition of nausea it performs the neck of the bladder which is beside the liver, albeit single, both fills and empties the bladder. ”

“ Unless a specialist of experience be consulted, the bladder will most probably be examined, and medicine will be prescribed only to excite the kidneys to secrete more urine, which does harm instead of good; the disease slowly, but surely progressing. Patients often write us that they have had something wrong with the bladder for a number of years, having to urinate more frequently than they ought ”

“ But in every case disease-germs are the cause of the trouble, and they may be found in the urine. The first effect of inflammation is to render the bladder irritable, so that as soon as a few drops of urine have collected, the individual has intense or uncontrollable desire to micturate. ”

“ The various forms of gravel, Bright's disease of the kidneys, hæmaturia, inflammation of the kidneys and bladder, diabetes, and other functional and organic diseases of the urinary organs effect characteristic changes in the urine, thus enabling us to distinguish them with certainty and exactness. Some of the various microscopical appearances of the urinary deposits in diseases of the kidneys and bladder, are represented in Fig. 3. In division A is represented pus and mucus, with decomposition, indicating suppuration somewhere along the urinary tract. ”

“ The urinary apparatus (consisting of the kidneys, ureters, bladder, and urethra) is known to be the principal emunctory for eliminating and voiding the detritus formed by the continual decay of the parts comprising the animal economy. The urine is this detritus in a state of solution. The components of urine are chemically similar to those of calculi, and as the components of the one vary according to the disintegration occurring at the time in the vital alembic, so do those of the other. ”

“ On the other hand, a man may continue about and at his work with a patient flabby bladder containing constantly more or less stringy mucus and ammoniacal urine, suffering little or no pain or tenesmus, and perhaps having no subjective symptoms except a slight sense of weight in his lower belly and a rather frequent desire to urinate. ”

“ The bladder is most readily electrized by the introduction into the rectum of the rectal rheophore, and into the bladder—previously emptied—of a curved metallic sound insulated by an elastic catheter to within an inch of its vesical extremity. ”

“ The Bladder.— The female bladder is relatively broad and capacious, and is also highly distensible. When the bladder is allowed to become overdistended, it is carried backward and tends to cause a backward displacement of the uterus. ”

“ The intestines next to the stomach are the most often sympathetically affected in diseases. The bladder is the organic muscle that is the last to feel the influences that go from the diseased organ; this sometimes however happens. In fevers, we know that retentions of urine from sympathetic and temporary paralysis, are not very rare; incontinence of urine is less often seen. ”