On the muscular arrangements of the bladder and prostate, and the manner in which the ureters and urethra are closed / by James Bell Pettigrew.

Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: On the muscular arrangements of the bladder and prostate, and the manner in which the ureters and urethra are closed / by James Bell Pettigrew. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    21/44
    {kk). The superficial and median fibres are continued into, and are principally concerned in the structure of the uvula and verumontanum (s). The deeper oblique fibres, which also assist in forming those structures, are mixed up with the very oblique or circular fibres of the prostate (Plate IV. figs. 25 & 26, They converge towards and cross at the verumontanum as in the letter X, so that the sinus pocularis is surrounded by fibres which radiate in every direction. This arrangement is useful in maintaining the relative position of the glandular ducts which open at this point. The verumontanum, as will be seen from this description, is essentially a muscular structure. It however contains, as Kobelt pointed out, a small quantity of erectile tissue, and in this many of the fibres terminate. The uvula and median ridge in the female and the caput gallinaginis in the male are analogous in structure, and both are connected with the ureters at their junction in the median line. While, therefore, the ureters are continuous with and drag upon each other directly (Plate IV. diagram 7, v z), they are continuous with and drag upon the median ridge (a!) and verumontanum [s] indirectly. This is important, as the ureters act against each other, and the two together tend to elevate or raise the median ridge and verumontanum during contraction. The shape of the verumontanum, on which its uses to a certain extent depend, is that of an inverted pyramid, the base of the pyramid being turned towards the base of the prostate. Its narrow end is conse- quently directed downwards and forwards. It is attached by one side of the pyramid to the posterior wall of the prostatic portion of the urethra, the two sides which are free terminating in a well pronounced crest. As the prostatic portion of the urethral canal is triangular in form (Plate IV. diagrams 12, 13, 14, 15, 16, & 17) and fitted upon or to the verumontanum so closely that water cannot be passed even in the dead bladder without exercising a considerable degree of pressure, it is not difiicult to perceive that in the living organism, when the parts are injected with blood, the obliteration must be very complete. The urine moreover by its own weight will tend to force the wedge formed by the verumontanum in a downward direction, the circular fibres of the sphincter and its own structure and connexions confining the wedging within certain limits. When the bladder contracts, the longitudinal fibres, which connect the verumontanum with the ureters where they meet in the mesial line, have the effect of elevating or withdrawing the wedge and thus assist in rendering the orifice of the urethra patent*. Sabatier speaks of the verumontanum as the gate-keeper of the prostatic portion of the urethra. In giving this explanation of the action of the verumontanum, I am aware that the office hitherto assigned to it is that of checking the reflux of the seminal fluid into the bladder. The semen, however, is passed so seldom when compared with the urine, that' this must be regarded as a secondary rather than a primary function. In the female, moreover, where no corresponding action can be performed, a median ridge or modified verumontanum can be detected. The uneasy feeling experienced by the patient when * The longitudinal fibres referred to are fully an inch and a half in length, so that their elevating power must be very considerable. 3 *