A case of extroversion of the bladder in a female child : with dissection / by Francis Henry Champneys.

  • Champneys, Francis Henry, Sir, 1848-1930.
Date:
[1877]
Catalogue details

Licence: Public Domain Mark

Credit: A case of extroversion of the bladder in a female child : with dissection / 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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    render the adult’s different from the child’s pelvis. The posterior edges of the ilia are pulled forwards by the weight of the body, acting through the sacro-iliac ligaments, and therefore the anterior extremities of the ossa innominata (the symphysis) tend to be drawn apart. In the normal pelvis, divarication is prevented by the symphysis, and the result is curving of the bones and increase of the transverse diameter ; but when the symphysis is cleft, this force can act unopposed, and separates the pubic bones more and more. Isodore Geoffroy St. Hilaire remarks on the solidarity existing between the bones and their superjacent soft parts (clitoris or penis), which are generally cleft in correspondence. But as extro- version of the bladder may exist without divarication of the pubic bones, so may divarication of the pubic bones exist without extro- version of the bladder (M‘Whinnie, Meckel, Vrolik). In Mayo’s case the pubes were five inches apart, yet the bladder was perfect, only projecting through a weak point in the linea alba, forming a hernia; it even contained a large calculus. Yet here the external generative organs were defective. Mr. Mayo remarks well that tliis state of pelvis bears a resemblance to that of female guinea- ])igs near the end of pregnancy, and M‘Whinnie adds, after Vrolik, that in birds, who have no urinary bladder, there is no symphysis (the struthionidm, however, have a symphysis pubis) ; j that in the two-toed sloth the pubic bones are permanently : separated, and that in the mole, whose pelvis will scarcely admit I a small probe, the ossa pubis unite to enclose the caudal vessels I only, forming a simple haemal arch. Lastly, divarication of the I pubic bones does not necessitate abnormality of the generative ) organs (Vrolik, Walther). k Bladder.—This was formerly described merely as cleft. To t Tenon is due the credit of pointing out in 1761 the fact that all e tlie anterior part is wanting, that little, in fact, beyond the Trigone 1 remains. [ Behind the extroverted bladder an exceedingly strong aponeu- < rosis is continued from the abdominal muscles and fasciae. This 5 has many times been described, and was very well marked in my > case. The whole of the bladder is thus completely extra-abdominal. ;) Ihe protruding bladder becomes larger and more prominent as ! age advances, which is attributed by Tenon to distension by the ■ intestines and abdominal pressure. 1 The bilobed appearance which I have described has been noticed by Chaussier and Breschet. It is of extreme value in ' explaining the origin of the deformity, and forms a step in the j direction of that remarkable set of cases related by Bartels, Retzius, ' Briedlander, Dietrich, Vrolik,roerster, Rose, and Priinckel, in which