On the shape of the empty female bladder / by D. Berry Hart.

  • David Berry Hart
Date:
[1881]
Catalogue details

Licence: Public Domain Mark

Credit: On the shape of the empty female bladder / by D. Berry Hart. Source: Wellcome Collection.

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    of interest. Anteriorly it is separated from the pubis by a large amount of fat—the retropubic pyramidal fat (Figs. 1 and 2). Posteriorly the connexion between it and the uterus and upper part of the vagina is also loose. Laterally the bladder is more fixed. The same facts as to looseness of anterior and posterior connexions holds good for the male bladder. The arrangement of the unstriped muscular fibres of the bladder is on the same plan as those of the uterus, i.e., we have external longitudinal unstriped muscular fibres, with their fixed point below ; circular ones running at right angles as well as obliquely to these, and an internal longitudinal layer below the submucous coat. It is evident that their unhindered contraction will give the bladder the cylindrical form which I have described as the one rarely found. So far, then, as the normal arrangements of the bladder go, we see provision made for muscular contraction which shall ultimately bring the anterior and posterior walls, diminished in area, in contact. I have now to take up the Y-shaped bladder and explain its occurrence. This can be beautifully studied in the specimen I here show, of which figure 1 is an accurate drawing. In this specimen the Y shape which the bladder forms with the urethra can be well seen. The causation of this shape is as follows:— It can be readily seen that the uterus is anteflexed. Starting from the posterior angle of flexion, and running to the left and upwards, thickened bands can be seen, the cicatrized left utero- sacral ligament. The shortening of the ligament has had a four¬ fold effect. It has dragged the uterus backwards and to the left side. Inasmuch as the cervix is fixed in the pelvic floor, and the fundus surrounded by intestine, the effect of this backward drag has been specially spent on the uterine insertion of the ligament, i.e., the uterus has become anteflexed. A simple experiment will make this clear. If a gum elastic bougie be fixed at either end, and then be grasped between the finger and thumb about two inches above its lower end and pulled back, the bougie will become flexed or bent. In the fourth place, the bladder has been pulled back so as to make its retropubic attachment tense and pull its posterior wall behind the urethra, i.e., to give it the Y shape seen. Fiirst has published a beautiful section of a uterus less ante¬ flexed, and a bladder less distorted, bearing out exactly the explana¬ tion already given (Fig. 2). The evacuation of the urine seems to be accomplished by the contraction of its unstriped muscular fibre and the action of intra¬ abdominal pressure. Both of these are effective only when the empty bladder can assume such a shape as figure 3 shows, i.e., when the anterior and posterior walls of the bladder diminish in area and come together. It is evident that when the bladder is tied back as already described (Fig. 1), its contraction is mini¬ mized, and the expulsion of the urine must be chiefly accomplished by intra-abdominal pressure. In one so-called case of hysterical retention I found the uterus anteflexed and drawn back so far as