A Complete practical work on the nature and treatment of venereal diseases, and other affections of the genito-urinary organs of the male and female ...

Front matter

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Class ~RC & BookjS

Chapter I. Anatomy Of The Male Parts Of Generation

Parts within the Pelvis. — The Bladder.— The Sphincter of the Bladder. — The Prostate Gland. Muscles of the Ureters. — Structure of the Penis. — Of the Urethra. — Of the Testes. — Descent of the Testis. — Vessels of the Cord and Testis. — Vesiculae Seminales. p. 17.

CHAPTER H.

ANATOMY OF THE FEMALE PARTS OF GENERATION.

Anatomy of the Female Pelvis. — External Parts of Generation. — The Urethra. — Parts contained •within the Pelvis. — The Bladder. — The Vagina; its shape, connexions, &c. — The Uterus ; its blood vessels. — The Ovaries, p. 45,

VENEREAL DISEASES.

CHAPTER HI.

INTRODUCTORY REMARKS.

Venereal Diseases defined- — "Why is man afflicted with them ? — They are not to be considered as punishments for sin. — When and where did Syphilis originate 1 — Its modern origin. — Its first appearance in Europe. — Its frightful effects in Otaheite. — Nature of the Syphilitic Virus. — Its chemical properties. — Gonorrhceal Virus. — Its action supposed formerly to be identical with that of Syphilis. — Syphilitic chancre and bubo. — Constitutional effects. — Secondary symptoms. — Government interposition necessary to extinguish these diseases, p. 54.

CHAPTER IV.

PRIMARY SYHPILIS. — PROPHYLACTICS.

Tee disease can only be prevented by ihe Fublic Authorities. — What some European nations have done towards it. — England and the United States have done nothing. — No antidote has been discovered which can prevent its develoj ment. — General suggestions to avoid infection. — Government

X TABLE OF CONTENTS.

regulations to protect the public against other contagious diseases. — Neglect of this disease. — The medical profession should earnestly take up the subject, p. 77.

CHAPTER V.

PRIMARY SYPHILIS. — CHANCRE.

Definition of chancre. — Infallible test of its syphilitic character. — Different varieties. — Remarks upon its diagnosis. — The time that may elapse between the infection and the appearance of the sore. — It may sometimes be seen on the lips or tongue. — Prognosis; this is affected by the variety. — The complications. — Buboes not a necessary result of chancre. — When does chancre cease to produce the specific virus 1 — The Abortive Treatment. — The secondary symptoms influenced by the variety of chancre. — Local Treatment: Excision; Caustic. — Constitutional Treatment: Mercurials; Regimen. — Circumstances modifying the Treatment. — Chancres in the Urethra ; in the Vagina; aj*d in the Os Uteri. — When Cantharides may be useful. — Chancres accompanied with violent inflammation, with hemorrhages, &c. p. 88.

CHAPTER VI.

PRIMARY SYPHILIS.— BUBO.

Definition of Bubo. — First symptoms. — Other causes than Syphilis produce it. — Men more liable than women to have bubo. — Chancres about the frenum most apt to cause it. — Diagnosis of Syphilitic bubo. — Treatment — the abortive: cold; compression; and antiphlogistic regimen. — Treatment in a more advanced stage : when pus has formed, the bubo must be immediately opened. — Treatment of the Ulcer. — Inoculation a test of its specific character. — Mercury should be employed for its constitutional effects. — Powerful stim ulants or caustics required in some cases. — Indurations following bubo. — Fistulous openings, p. 116.

CHAPTER VII.

SECONDARY SYPHILIS. —GENERAL DESCRIPTION.

There is always danger of secondary symptoms after the primary disease, if mercury be not employed. They manifest themselves at uncertain times. — The most frequent form of secondary affections. — Tertiary affections. — Secondary disease cannot produce chancre. — Secondary and tertiary affections contagious. — Some reasons for this opinion. — Prognosis of constitutional syphilis, p. 130.

CHAPTER VIII.

SECONDARY SYPHILIS. — GENERAL PRINCIPLES OF TREATMENT.

Spontaneous cures may occasionally occur. — Anti-mercurial treatment. — Effects of climate ; clothing ; diet ; bleeding. — Necessity of attending to the digestive organs. — Woody decoctions. — Quinine. — Iron. — Iodine. — Mercury. — Preparations of gold and silver. — The experience of three centuries in favor of mercury. — General rules for administering it. — May be administered by frictions, by fumigations, and by the mouth. — The different preparations — iodide, proto-chloride, and bi-chloride, the cyanide, and the deuto-phosphate of Mercury most usually employed. — The calcined Mercury. — The iodide of Potassium, p. 138.

CHAPTER IX.

SECONDARY SYPHILIS. — CUTANEOUS ERUPTIONS.

The usual premonitory symptoms. — Exanthemata : treatment. — Squama : treatment.— Vesiculce treatment. — Pustulce — two species, the psydraceous and the phlyzaceous : treatment. — Papulce

T UBLE OP CONTENTS. xi

treatment. — Tubtrcula — several varieties: treatment. — Ulcerations, Vegetations, or Excrescences : treatment. — Condylomata or MucousTiiherelcs ; treatment, p. 150,

CHAPTER X.

SECONDARY SYMPTOMS.— ULCERATIONS, &c.

Or tlie tonsils, mouth and throat. — The premonitory general symptoms. — The local. — Tonsils most liable to he first attacked. — The ulcer sometime-; resembles cancer. — Many varieties of ulcer. — General sloughing alarming. — The local treatment: mainly gargles and caustic. — The general treatment : the same as in the primary disease. — Iritis : symptoms. — General and local anti-phlogistic treatment: Blisters; Mercurial dressings; Belladonna. — Syphilitic Sarcocele : symptoms: treatment. — Falling of the hair and nails ; treatment. — General advice upon practice, p. 163.

CHAPTER XL TERTIARY SYPHILIS. — GENERAL SYMPTOMS.

Tin v are liable to be confounded with other affections. — This form loses in a great measure its specific character. — The secondary has neai'fy always preceded the tertiary disease. — Lupus Syphiliticus : general treatment — local treatment. — Pains in the hones: treatment. — Inflammation of the peril istium. — Bones diseased: treatment. — A prevailing error that the disease of the bones is caused by mercury. — Osseous tumors : treatment — Iodide of Potassium — Blisters. — Deep-seated Tubercles of the cellular tissue : treatment, p. 172.

CHAPTER XII.

SYPHILIS IN INFANTS.

Disease inherited from a parent, contracted from a nurse, or by other infection from a person having secondary syphilis. — Curious case in illustration. — At the time of birth the child may manifest symptoms of the disease. — Sometimes the symptoms aie not noticed until several days or weeks afterwards. — The ordinary symptoms are copper-colored blotches on the skin; ulcers in the throat. — Consequences when imperfectly cured. — The disease in the infant contagious. — Treatment : Mercurials. j } - 179.

Table showing the result of Inoculations of Syphilitic Virus, &c. p. 205.

CHAPTER XIII.

GONORRHOEA.

Its definition. — Its synonyms. — Its antiquity. — May be produced by leucorrhceal discbarge. — Until lately regarded as a variety of syphilis — May be complicated with syphilis. — Difference in the liability of individuals to contract it. — The matter will retain its infectious character for a long period. — Illustrative Cases. — Varieties of the disease. — Symptoms of the disease in the male, in the first, second, and third stages. — Prognosis very difficult, p. 209.

CHAPTER XIV.

GONORRHOEA.— TREATMENT.

Prophylaxy. — No antidotes known. — Police regulations. — Ablutions. — Abortive treatment. — Antiphlogistic regimen and avoidance of all excitement. — "When the disease is first established it x ii TABLE OF CONTENTS.

may be checked by astringent injections. — Revulsive treatment. — General and local depletion in the more advanced stages. — Purgatives; Cubebs ; Balsam Copaiba; Antimonials. — Ulcers, and their treatment. Inflammation reaching the bladder : its treatment. — Gonorrhoea in women : treatment Some complications requiring different treatment. — Injections into the uterus. — Tampon.

The diagnosis of gonorrhoea in the female sometimes very difficult, p. 215.

CHAPTER XV.

BALANITIS AND POSTHITIS.

Their definition. — The symptoms. — The common causes : treatment — cauterization ; astringent and anodyne lotions; antiphlogistics. — Operation for phymosis. — Some of the consequences of Balanitis when improperly treated. — Gonorrhoea common to both sexes. — Of the eyes: men and infants most liable to it. — Caution. — Treatment : general and local antiphlogistic measures ; cauterization ; narcotics. — Chemosis : treatment — excision; scarification; cauterization; issues. — Gonorrhoea of

' the mouth and nose ; of the anus : treatment, p. 221 .

CHAPTER XVI.

VARIOUS MEDICINES FOR GONORRHOEA.

Balsam Copaiba : its mode of action — different methods of administration — its combinations with other medicines. — Cubebs — its forms and combinations. — Turpentines, p. 231.

CHAPTER XVII.

SYMPATHETIC BUBO, OR INFLAMMATION OF THE INGUINAL GLANDS.

Frequent consequence of Gonorrhoea. — Not produed by specific virus. — The result of irritation in another part. — Treatment : general antiphlogistic and revulsive, p. 235.

CHAPTER XVIIL

ACUTE INFLAMMATION OF THE TESTICLE.

The different designations by which it is known. — Symptoms. — The effects of sympathy upon different organs of the abdomen. — Seldom attacks both testicles at once. — Seldom suppurates when it is sympathetic. — Diagnosis. — May be mistaken for strangulated hernia. — The mode of distinguishing between them. — Causes. — Most common one, irritation of the urethra. — Objections to the view of Sir Astley Cooper. — It is most frequent when the inflammation has reached the prostatic portion of the urethra. — Injections — the effects. — Effusion of serum and coagulable lymph. — Swelling of the epididymis. — Wasting of the testis. — Treatment: purgatives; depletion; evaporating lotions ; fomentations ; poultices ; suspensory bandage ; bandaging the organ ; when abscesses form, they are to be early opened ; opium ; mercurials ; preparations of iodine ; stimulating plasters ; tartrate of antimony, p. 237.

CHAPTER XIX.

VENEREAL INFLAMMATION OF THE TESTICLE.

A secondary symptom. — The swelling of the testicle gradual. — Generally accompanied with syphilitic sore throat, venereal eruptions, and periosteal inflammation. — The disease very rarely proceeds to suppuration. — Treatment : Mercury a specific for it. p. 247.

rABLB OF CONTENTS. xiu

CHAPTEB w

PHYMOSIS AND PARAPHYMOSIS.

What it is thai constitutes phymosis. — What it is that constitutes paraphymosis. — Their causes. — Tin' effects of phymosis. — Treatment of phymosis: the soothing method ; operation by incision j operation l>y circumcision. — Treatment of paraphymosis: the same general indications as in phymosis ; gentle pressure ami dexterous manipulation ; operation with the knife for the reduction. — Subsequent treatment. p. 219.

CHAPTER XXI.

GLEET.

Its definition. — Commonly succeeds Gonorrhoea. — Its infectious character considered. — Proceeds from debility of the mucous membrane. — Various exciting causes. — Its treatment. — If there be general debility of the system, tonics and other remedies for the improvement of the general health are to be employed ; astringent injections — the manner in which they should be used; stimulants and bougies — rule for using them ; cauterization. — Glands of Cowper affected. — Treatment : bougies and blisters ; cauterization; counter-irritation. — Scrofula an occasional cause. — Treatment. — Stricture sometimes a cause. — Treatment. — Diseased prostate a cause. — Treatment, p. 253.

CHAPTER XXII.

STRICTURE OF THE URETHRA.

Definition of stricture. — Its causes. — Dimensions of the urethra. — Varieties of stricture. — Their symptoms. — The opinions of Hunter and Home controverted. — The seat of stricture. — Retention of urine. — Some of the consequences of stricture. — Diagnosis. — Mode of introducing catheters. p. 263.

CHAPTER XXni.

STRICTURE. — TREATMENT.

The use of the catheter and bougie. — Surgical operations for retention of urine. — Treatment for radical cure. — Internal remedies. — Dilitation by instruments. — The varieties of instruments. — False passages. — Hemorrhage : its treatment. — Constitutional symptoms consequent upon the use of the bougie. — Cauterization to remove the stricture not advisable. — Incision in ceitain cases the only proper treatment, p. 279.

CHAPTER XXIV.

STRICTURE. — CASES ILLUSTRATING ITS TREATMENT.

Case I. p. 299.

CHAPTER XXV.

FALSE PASSAGES.

Definition. — The usual causes of them. — Where they are most commonly situated. — A peculiar condition of the mucous membrane may favor the accident. — Certain instruments more liable than others to cause them. — The operator often in fault. — The proper way to pass the instrument. — Difficulty of knowing when a false passage exists. — Necessity for caution. — The porte-empreinte for taking a cast of the part. — Further directions for proceeding. — No certain sign for distinguishing a false passage — pain, hemorrhage. — Experience useful. — The treatment : catheter sometimes necessary. — Puncture of the bladder, p. 313.

XIV

TABLE OF CONTENTS.

CHAPTER XXVI.

INFILTRATION OF URINE, ABSCESS AND FISTULA.

Generally the consequences of gonorrhoea and stricture. — The immediate causes of infiltration : stricture ; ramollissement ; rupture of the urethra. — Symptoms : swelling in the perinaeum, scrotum or penis ; intense pain ; inflammation ; rigors; fever; great debility ; pulse intermitting ; hiccough;

delirium ; death. Gangrene — its treatment : incision; the constitution to be supported by tonics. —

Fistula* succeed. — Diagnosis. — Treatment: by dilating the stricture when it exists; the use of caustic. — Blind fistulae to be opened with the lancet, p. 318.

CHAPTER XXVII.

HYDROCELE.

Hydrocele of the Tunica Vaginalis. — Its definition. — Causes. — Symptoms. — Diagnosis. — Scirrhous testicle. — Treatment: divided into palliative and radical; tapping with trocar ; needles; injections into the cavity — the different kinds of injections — effects. — Accidents that may result from carelessness. — Treatment by electro-galvanism, p. 324.

Congenital Hydrocele. — Its causes. — Symptoms. — Diagnosis. — Treatment: if a hernia be complicated with it, it must first be reduced ; methodical compression upon the ring, with topical applications ; tapping ; injections objectionable, p. 330.

Hydrocele of the Cord. — Causes. — Infiltration, and an accumulation of water in cysts. — Symptoms of hydrocele from infiltration. — Treatment : if moderate it is best to do nothing. — If inflammation be threatened, the operation by incision only will be effectual, p. 331.

Encysted Hydrocele. — Causes. — May be mistaken for a supernumerary testicle. — Treatment, p. 332.

CHAPTER XXVIII.

CIRCOCELE AND VARICOCELE.

Description of Circocele. — Symptoms. — Causes. — It may be mistaken for omental hernia. — Its diagnosis. — Treatment : local bleeding and lotions ; tying spermatic artery ; castration. — Varicocele. It resembles circocele. — Produced by the same causes. — Cooper's operation for its relief, p. 333.

CHAPTER XXIX.

DISEASE OF THE PROSTATE GLAND.

The prostate gland, where situated. — Its diseases. — Their causes. — Symptoms. — The gland, if enlarged, may be felt by introducing the finger in the rectum. — Treatment, p. 336.

TABLE OF COLORED PLATES.

PLATE I. — (Frontispiece.) — Tuberculous syphilis : iritis: secondary symptoms. Case. PLATE II. — Primary ulcers beginning with pustules : regular inoculation, p. 74. PLATE III. — Primary follicular ulcer : virulent bubo : regular inoculation, p. 82. PLATE IV. — Primary ulcers : acute balano-posthitis : phymosis : gangrene, p. 85.

TABLE OF CONTENTS. xv

PLATE V. Fig. 1. — Primary ulcers of the meatus urinarius and prepuce : inflammation of a lymphatic vessel: bubo, followed by ulceration and accidental inoculation, p. 93.

Fig, 2. Blenorrhagia : primary ulcer of the meatus urinarius : suppurated lymphatic vessel and

lmho : artificial inoculation, with the result, p. 95.

PLATE 71. — Primary ulcer on the neck of the uterus, p. 103. PLATE 711. — Primary ulcers : early secondary symptoms, p. 110. PLATE VIII. — Fig. 1. — Non-indurated primary ulceration of tho upper gum. p. 112.

Figs. 2, 3. — Non-indurated primary ulceration of the frenum, (perforating chancre) : paraphymosis.

p. 113.

Fig. 4. — Indurated gangrenous chancre : vesiculo-pustulous eruption : early secondary accidents. , " P . LIS.

PLATE IX. — Diptheritic primary ulcer, with a non-indurated base : balano-posthitis, with erosion :

syphilitic roseola. p. 121.

PLATE X. — Polymorphous tuberculous syphilis: accident of transition, p. 127. PLATE XL — Pustulo-crustaceous syphilis : secondary symptoms, p. 136. PLATE XII. — Syphilitic Crustacea. (Variety of convex rupia.) p. 146. PLATE XII, BIS. — Polymorphous vegetations, p. 154.

PLATE XIII. — Fig. 1. — Impetigenous tuberculo-crustacea : relapse of secondary symptoms : slow form. p. 159.

Fig. 2. — Ulcerated impetigenous syphilis. (Variety of impetigo rodens.) p. 161. PLATE XIV. — Rupia prominens. p. 193.

PLATE XV. — Exanthema roseolum. p. 1S5.

PLATE XVI. — Exanthema puniceum. p. 185.

PLATE XVII. — Puniceous patches with papulae, p. 187.

PLATE XVIII.— Papuhe elongatee. p. 187.

PLATE XIX. — Lichen venereus. p. 1S9.

PLATE XX. — Lichen circumscriptus, vesicles, maculae, and ultimately, lichen solitarius. p. 189. PLATE XXL — Large Vesicular lichen, p. 191.

PLATE XXII. — Herpes venereus. p. 191.

PLATE XXIII. — Herpes circinatus. p. 193.

PLATE XXIV. — Ecthyma venereum, p. 195.

PLATE XXV. — Ecthyma venereum : clustered lichen, p. 195. PLATE XXVI. — Large Ecthyma, p. 197.

PLATE XXVIL— Spili coccinei. p. 198.

PLATE XXVIII. — Spili cruentati. p. 199.

PLAT E XXIX. — Spili cuprei. p. 199.

PLATE XXX. — Phymatosis ovata. p. 201.

PLATE XXXI. — Phymatosis annulata. p. 202.

PLATE XXXII. — Lepra venerea*, p. 203.

PLATE XXXIII. — Psoriasis venereae. p. 203.

PLATE XXXIV. — Fig. 1. — Excoriations of the os uteri, p. 208. Fig. 2. — Granular condition of the os uteri, p. 208.

xvi TABLE OF CONTENTS. .

PLATE XXXV. — Fig. 1. — Ulcerations of the cervix uteri, p. 214.

Fig. 2. — Catarrh of the uterus, p. 214.

PLATE XXXVI. — Fig. 1. — Balanitis. Fig. 2. — Vegetations. Fig. 3. — Eczema. Fig. 4. Herpes preputialis. p. 226.

TABLE OF WOOD ENGRAVINGS.

PLATE I. — Showing the pelvis divided on the meridian line, and the right side of the genital organs

of the male. p. 18. , PLATE II. — Showing the bladder and urethra laid open in its whole length, p. 28. PLATE III. — Shows the spermatic cord and its relations, p. 37. PLATE IV. — Figs. 1, 2. — Injected human testes, &c. p. 40. PLATE IV. — Human spermatozoa, p. 42.

PLATE V. — External genital organs of an unmarried female, p. 46. PLATE VI. — External organs of the unmarried female with the labia separated, p. 47. PLATE VII. — A side view showing a portion of the internal female organs of generation, p. 50. PLATE VIII. — The uterus, fallopian tubes, the ovaria, and a part of the vagina of a young female

exposed, p. 57.

PLATE IX. — Truss for compressing buboes, p. 118.

PLATE X. — Inguinal bandage, p. 126.

PLATE XI. — Tri-valve speculum — the best in use. p. 223. PLATE XII. — Speculum chair, p. 224.

PLATE XIII. — Compression of the testicle, p. 245.

PLATE XIV. — Phymosis. p. 249.

PLATE XV. — Paraphymosis. p. 250.

PLATE XVI. — Operation for phymosis. p. 251.

PLATE XVII.— Cast of a urethra, p. 264.

PLATE XVIII. — Represents the formation of stricture in the urethra, and the bougie doubled

upon itself when improperly used. p. 267.

PLATE XIX. — Shows porte-empreinte for taking an impression of strictures in the urethra, p. 268. PLATE XX. — Shows strictures, and the impressions taken of them with the porte-empreinte. p. 269. PLATE XXI. — Shows curved bougies and catheters of full size. p. 276. PLATE XXII. — Shows mode of puncturing the bladder, p. 281. PLATE XXIII. — Shows conical and fusiform bougies, p. 288. PLATE XXIV. — Shows cauterizing instrument and bougies, p. 289.

PLATE XXV. — Shows the mode of cauterizing the prostatic portion of the urethra, p. 290. PLATE XXVI. — Shows Ricord's and Lallemand's porte-caustiques. p. 295. PLATE XXVII. — Shows hoth Ricord's scarificator and the one I prefer, p. 297. PLATE XXVITI. — Shows the mode of retaining a bougie in the urethra, p. 298. PLATE XXIX. — Shows the mode of operating for hydrocele, p. 327. PLATE XXX. — Shows some of the dangers in operating for hydrocele, p. 329. PLATE XXXI. — Shows the operation for tying the spermatic vessels, p. 334. PLATE XXXII. — Shows an enlarged prostate gland, p. 337. PLATE XXXIII. — Shows the douche-bath. p. 340.

ANATOMY

OF

THE ORGANS OF GENERATION.

Ln examining diseases, a difficulty is often experienced, by those who are not familiar with Anatomy, in understanding the descriptions involving the relations and structure of organs. Anatomy and Physiology is necessarily the basis of sound medical knowledge ; and every one must have felt how greatly labor is abridged, and how much more precise are our ideas of the pathological state, when we are acquainted with the situation, organization, and function of the parts we are studying. To make this work complete in itself, contrary to the practice which generally prevails, I have determined to introduce the subjects treated of, by presenting an Anatomico-Physiological account of the Genito-Urinary apparatus.

CHAPTER I.

ANATOMY OF THE MALE PARTS OF GENERATION.

Parts within the Pelvis. — The bladder of Urine. — The Sphincter of the Bladder. — The Prostate Gland. — Muscles of the Ureters. — Structure of the Penis. — Of the Urethra. — Of the Testes. — Descent of the Testicle. — The Vessels of the Cord and Testicle. — Structure of the Testicle. — The Vesiculae Seminales.

As there is no very accurate division betwixt the viscera of the abdomen and those of the pelvis ; as the uterus and bladder, being viscera of the pelvis, rise into the belly when distended, and are, in every respect, like the abdominal viscera, many have altogether objected to a division of the viscera of the abdomen and pelvis : nevertheless, there appears to be good reason for this division of the subject. The functions of the parts are different; the manner of their connexion is different, and their diseases have widely different effects. 8

ANATOMY OF THE MALE PARTS

The pelvis consists of the sacrum, os coccygis, and ossa innominata, and anatomists have distinguished the true and the false pelvis. The false pelvis is formed of the extended wings of the ossa ilii, and supports the viscera of the abdomen. The true pelvis consists of that cavity which is beneath the promontory of the sacrum and the linea innominata ; it contains, in man, the rectum, the urinary bladder, the prostate gland, the vesiculse seminales, and part of the urethra. In woman it contains the rectum, vagina, uterus, Fallopian tubes, ligaments of the uterus, and ovana.

EXPLANATION OF PLATE.

The pelvis is divided on the meridian line, and the engraving shows the right side of the organs.

1. The vertebral column. 2. Colon. 3. Bladder. 4. Ureter, conducting the urine from the kidney to the bladder. 5, 6. Vasa deferentiae. 7, 8. Vesiculae seminales. 9. Prostate gland. 10. One of the glands of Cowper. 11. Canal of the urethra. 12. Bulb of the urethra. 13. Grlans penis. 14. Right testicle. 15. Skin covering the penis. 16. Prepuce. 17. The Figenum. 18. Corpus Cavernosum. 19. Pubis.

OF GENERATION. L9

THE BLADDER OF UKINE.

The Madder of urine must be classed with the membranous or hollow viscera. It is a bag or receptacle into which the urine slowly distils through the ureters, that it may be expelled at convenient seasons. It is nearly of a regular oval form, when moderately distended, the ends being obtuse ; but from its connexions, and the pressure of snrronnding parts, this regular extension is not allowed in the living body. When seen moderately distended, in situ, it rises somewhat pyramidal upwards ; it is flat upon the os pubis on the fore part, and towards the back and lower part a portion may be seen somewhat sacculated, and below the level of the commencement of the urethra.

We describe the body, fundus, neck, and lateral parts. The fundus is the upper part ; the neck is where the urethra commences, and where the prostate gland is attached ; the lateral part is, where being distended it stretches at its lower part to the sides of the pelvis.

On the fundus there is a ligamentous process, continued in a direction towards the umbilicus ; this is the urachus. I would not give the name here, which is properly applicable to a tube peculiar to the foetus of quadrupeds, was it not to add that

sometimes, even in the adult human subject, there is an open tube, so that the urine passes out from the umbilicus.*

The bladder is situated higher in the boy than it is in the adult. In the foetus it is almost entirely out of the pelvis, and reaches nearly to the umbilicus. At three years it is said to rise no more than three fingers' breadth above the os pubis ; at twelve it is only half an inch above the level of the bone ; at eighteen it is said to be completely hidden behind the pubes.

When the bladder is empty, or contains only a moderate quantity of urine, it takes a triangular figure in the dead body, the base of which rests on the rectum, and the apex is attached to the back of the os pubis ; and when in dissection you look down into the pelvis, you find the back part of the bladder flat, and as it were stretched obliquely upon the os pubis.

* Fernelius de part. mmrb. et symptom, gives an example of a man who, having an obstruction at the neck of the bladder, passed his mine by the umbilicus. Wepfer gives a similar case of a man with calculus. These are quoted by Albinus, Annot. Acad, and also the Philos. Transactions, n. 323. See also Sandifbrt The.e. vol. iii. p. 234 — 246. Haller. Elemen. Physiol, lib. xxvi. § ii.

20 THE BLADDER OF URINE.

Structure of the Bladder. — Like the other hollow viscera, the bladder consists of several coats.

The Peritoneal Coat of the bladder does not surround the bladder, but only covers the fundus and back part. It is like, in every respect, to the peritoneal coat of the abdominal viscera ; smooth without ; and adhering to the inner coat by cellular membrane ; which cellular membrane is, however, of a looser texture, and in greater quantity than under the peritoneal coat of the .abdominal viscera. This peritoneal coat is, no doubt, of much service, as a division in obstructing the course of inflammation arising from the diseases in the lower part of the pelvis, or from operations performed on the bladder, rectum, or perinseum. Were it not for the loose peritoneum spreading over the cellular texture of the pelvis, we could neither be so bold nor so successful in our operations here. That portion of peritoneum which covers the back part of the bladder, forms a particular transverse fold when the bladder is contracted. This fold surrounds the posterior half of the bladder, and its two extremities are stretched towards the side of the pelvis, so as to form a kind of lateral ligament.

Though in the contracted or moderately distended state of the bladder, the peritoneum stretches from the back of the os pubis to the bladder, the distension of the bladder, in an immoderate degree, raises the peritoneum off from the pubes, so that the bladder can be struck with a trochar, or lithotomy performed above the pubes, by an incision directly into the bladder, without piercing the outer or peritoneal coat.

Towards the lower part, the bladder, as we have seen, is invested only by cellular membrane, which takes the place of the peritoneal coat of the fundus. This tissue is very loose, and permits the distention and contraction of the bladder, which looseness of texture is a matter of regret, when blood or urine is forced into this tissue.

Muscular Coat. — The muscular coat of the bladder is veiy strong. Three strata of fibres are described by authors. They are so strong as to have been classed with the distinct muscles, and the whole coat has been called detrusor urinje. Towards the lower part of the bladder the fibres are particularly strong, and formed into fasciculi, and are like a net of muscles inclosing the bladder.* These fasciculi acquire greater thickness and strength when the bladder is excited by opposition, as from stricture in the urethra.

* Morgagni Advesar. Anal:, iii. Animad. xxxix.

Towards the tore and lower pari of the bladder, the muscular fibres Congregate

into a sort of tendon, which goes off to the back <>t" the os pubis, which we count to be the insertion of the tendon of the bladder, and certainly this hold, which the bladder lias upon the os pubis, causes it. in its contraction, to he drawn to the hack of the pubes.

\\ e have an idea of the wonderful degree of contraction in the bladder, and indeed the extent ol* motion in the nmsenlar fibres' in general, when we consider that the bladder extends so as to contain two pounds of urine, and contracts so as to force out the last drop from its cavity. When, however, the fibres are stretched loo far, they lose the power of contraction, and often the young surgeon is deceived by what he conceives to be an incontinence of urine, while it is really an obstruction.

THE SPHINCTER OF THE BLADDER.

If we consider the double office of the urethra, and suppose that the seminal vessels and the ducts of the prostate gland open into the canal at a part posterior to the muscles which close the orifice of the bladder, we must, be also forced to admit that there is some imperfection in the mechanism of these parts. For in that case, the fluids passing from those ducts would fall back into the bladder, and the orifices of the ducts would be exposed to the urine in the bladder, even when the bladder was closed. If this were really the case, it would be inconceivable how the contents of the vesiculfp seminalcs could be discharged forwards, or how the urine could be retained while the seminal discharge was made.