Diseases of the urinary organs / [Henry Thompson].

  • Thompson, Henry, Sir, 1820-1904.
Date:
Between 1860 and 1869]
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the urinary organs / [Henry Thompson]. Source: Wellcome Collection.

    31/210 (page 339)
    lit io probable t]ia|^^UcUiv tlicao C'fl'iigs, nffinnod to Lc Tjluaii'ativc of malformatioii/are in reality also the effects of disease. 3. Extroversion of the bladder. This is the least rare of all the vices of conformation to which the organ is subject. In these cases the anterior wall of the bladder is wanting, while frequently, but not invai'iably, the jDubic symphysis is absent also. The pos- terior wall and base of the organ are then pushed forward by the, abdominal viscera, and form a red and vascular flattened promi- iience, covered by mucous membrane, in the situation of the pubes. The extroverted portion is in the adult usually about the size of the palm of the hand; the orifices of the ureters may be seen just below the centre, and from beneath the lower margin a short imperfect penis projects, which is flattened, as if cleft in the median line, into the methra. At the root of the penis a rudimentary prostatic struc- tm'e exists, the ducts of which can be seen opening into the angle between the bladder and j)ubes. There is usually more or less liernia of the bowels on either side and beneath the extroverted bladder, into a pouch-like fold of integument, which is covered with hair, represents the scrotum, and contains the testes. The mucous membrane is very sensitive, readily bleeds when touched, and from the projecting orifices of the ureters urine is almost continually dis- tilling over its surface. This condition produces much excoriation of the skin on the parts beneath, besides infecting the patient with a continual urinous odour. The malformation thus described affects both sexes, but appears to be more common in the male. Of eight ■cases which I have personally examined, two only were in the female. From the condition thus described, there are some slight peculi- arities of detail in different cases ; but most conform very much to the characters given. The defect is of a less serious character, sexTially considered, in the female, as the generative function does not necessarily remain in abeyance; the male, however, is, from the condition of the penis, wholly incapacitated for its exercise. Treatment of malformatiom. The results of extroversion may be palliated by well-adapted mechanical means ; an artificial reservoir may be employed, but great nicety of fit and capability for adjustment in various positions of the body must be attained by the mechanician. Little can be said, from the results of past experience, in favour of the employment of operative measures to remedy these defects. Mr. Simon, of St. Thomas's Hospital, has attempted, m a male ca.se, to turn back the orifices of the ureters into the rectum ; but with results which could scarcely be considered successful, although apjn-oxi- mating thereto. Other cases of operation have been fatal. In the fcnialo the nature of the operation required is less formidable, inasmuch as the indi- cation is rather simply to cover the bladder than to alter the course of the ureters. Dr. Daniel Ayrea, of Brooklyn, U.S., appears to have succeeded in covering the extroverted bladder of a young woman with integuments bor-