Remarkable case of extrophy of the urinary bladder, with remarks / [Peter David Handyside].

  • Handyside, P. D. (Peter David), 1808-1881
Date:
[1839]
Catalogue details

Licence: Public Domain Mark

Credit: Remarkable case of extrophy of the urinary bladder, with remarks / [Peter David Handyside]. Source: Wellcome Collection.

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    gently raised from the penis, he can, by powerfully contracting the diaphragm, abdominal muscles, and levator ani, nrge forcibly a stream of urine from both ureters simultaneously. This flow of urine is rendered freer by previously dilating the orifices of the ureters, by introducing along them for about half an inch a moderately sized bougie. Beyond this distance these canals ap¬ pear to be much dilated and very tortuous, constituting ap¬ parently supplementary bladders or receptacles for the urine. The correctness of this suppositon I was enabled to put to the proof by plugging tightly the orifices of the ureters on one occasion for the period of two hours, and on another occasion for two hours and a half, so as to confine the urine within the dilated ureters. These experiments (which I repeated) produced in about an hour from their commencement, a sensation of great distension in the upper inguinal regions, and along the spermatic chord, attended with considerable uneasiness and pain, and a manifest recession of the protruded bladder, with a contraction of it in all its diameters. At the close of the experiments, I raised the tumour, and, much to the relief of the individual, removed the plugs, when a very lit¬ tle urine began to flow from each ureter; but on the introduction of my finger along the rectum, and the elevation by tins means of what seemed to be a watery sac or dilatation, the urine was dis¬ charged abundantly, and exhibited a well-marked straw-colour, whereas, in ordinary circumstances, this fluid is voided quite trans¬ parent in appearance. It may be added, that the flow of urine has always been regular and uninterrupted, and the quantity of it discharged in the twenty-four hours amounts on the average to six pounds. Its constituents, however, are not altogether healthy, a sufficient quantity of albumen existing in it to form a precipitate on boiling, and there are present also about ten per cent, of thick and very viscid mucus. Farther, a round soft pellet of a white de¬ posit like moist pipe-clay, of the size of a large pea, and compos¬ ed of the ammoniaco-magnesian phosphate, entangled in this ropy mucus, has, during the last nine months, been voided along with the urine from the left ureter every morning. The ordinary specific gravity of the urine varies from 1009-4 to 1022.1, and the specific gravity of that collected, in a vessel be¬ tween six p. m. and half-past one a. m., amounts to 1020.5. Fifty minutes after having taken one ounce of the infusion of rhubarb, the specific gravity rose from 1009-4 to 1022. Forty minutes after this, (an interval during which the urine was forcibly retained in the ureters by firm plugs introduced into their orifices,) its speci¬ fic gravity rose to 1020.5 ;—however, one hour and fifty minutes afterwards, (the ureters having still been kept closed,) the specific gravity of this fluid when forcibly expelled was found to have fallen to 1010.4.