On dilatation of the ureters in extroversion of the bladder / by Francis Henry Champneys.

  • Champneys, Francis Henry, Sir, 1848-1930.
Date:
[1880]
Catalogue details

Licence: Public Domain Mark

Credit: On dilatation of the ureters in extroversion of the bladder / by Francis Henry Champneys. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    than the orifices of the nrel.ors. In this case the possibility ot irritation is not far to seek ; we need only recall the red and easily bleedin surface of the extroverted bladder. That this is the canse of the dilatation is rendered more probable by the fact that meters endinoj elsewhere than in the bladder are by no means so often dilated. In dealing with the problem of dilatation in connection with enuresis, nature has, as it were, helped ns to a solution by elimi- nating in extroversion all the non-essential parls of the organs concerned. I therefore adopt Dr. James’s theory of the dilatation of the nreters and kidneys in incontinence for the same conditions in extroversion of the bladder ; and wonld remark, that this asso- ciation of symptoms and pathological conditions is, after all, but an unexpected rider to the well-known axiom, “ Dribbling of urine is often a symptom of retention of urine.” It may be objected that there is no evidence to show that dilatation is anything but a very exceptional concomitant or consequence of incontinence. It is, of course, true that children rarely die with enuresis; but, on the other hand, ennresis is of various degrees, and again it is usually temporary; and there is some evidence of obstruction to the ureters in the low specific o-ravity of the urine, which is usually observed during inconti- nence, though this evidence is not secure from error. The diffi- culties of collecting the nrine are still greater in extroversion than in incontinence, and no trustworthy observations on its spe- cific gravity have, so far as I know, been yet made. It 7s probable that contraction of the bladder, at least if strong, closes the orifices of the ureters, and dams up the urine in them. The question whether this shall produce dilatation above de- pends on the length of time during which the closure of tlie ureters lasts and the frequency with which it recurs. This applies to cases of both classes. In the case of enuresis after birth it is, as above said, necessary that the obstruction should not be absolute or too long continued if life is to be maintained ; whereas, in the case of the foetus with extroversion, however complete the obstruction, tbe blood woiihl be kept sufficiently purified by the placenta. Alter birth this advanlatre ceases. As is well known, life may be prolonged in- definitely in cases of extroversion ; some cases, however, die soon after birth; in my case the child died at a month old after con- vulsions it is possible that in such cases the cause of death may be uraemia. _ , . i i Idle point is one of great interest in the very practical subject of the treatment of incontinence of urine.
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