Remarkable case of extrophy of the urinary bladder : with remarks / by P.D. 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 / by P.D. Handyside. 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.

    3/10 (page 3)
    remainder of the neck of the tumour presents a similar opaque and cicatrized appearance. The surface of the extrophied bladder is composed entirely of mucous tissue, with the exception of, Jirst, a naiTOw portion on the upper surface of the neck of the tumour, continuous with the cicatrized skin already adverted to as marking the attachment of the umbilical cord, and secondly, an insulated triangular portion of small size on the anterior surface of the left side of the tumour. Both of these spaces are covered with skin and epidennis, exhibit irregularly undulating borders, and resemble old cicatrices. No change in the relative size or general appearance of these spots has been observed. The mucous surface just refen-ed to is of a florid colour, of a smooth and fine villous appearance when examined under a lens, and it is exquisitely sensitive. For partial defence of this delicate surface it is covered altogether with an exudation of thin mucus. This secretion, however, is, from the high temperature of the part, (afterwards to be noticed), constantly being inspissated, and ac- quiring the character of loose opaque shreds or laminae, which in their turn are detached by the mucus effused beneath, so that the surface is, notwithstanding, kept constantly bedewed with this secretion. So sensitive to the touch and to the influence of a cool atmosphere is this surface (which, especially during the prevalence of frost, or previous to its approach, is very delicate and painful,) as to require the individual to guard it from exposure to the air, or to any irritation, with as much care as possible. This he suc- ceeds moderately well in doing by the use of a shield made some- what after the pattern recommended and figured by Dr Duncan.* On the lower surface of the protrusion is the well-marked trigone, bounding which space posteriorly, and at the distance of one inch and a half from each other, and three-fourths of an inch from the penis, are the apertures of the ureters, the left at the distance of one inch and an eighth, and the right three-eighths of an inch distant from the mesial line of the body. The border of the aperture of each ureter is surmounted by an elliptical projec- tion of mucous membrane, which, from its thickness and obliquity, prevents the free escape of the urine. Nevertheless, this fluid is observed constantly and involuntarily to ooze out of the left ureter, the orifice of which is a little wider than that of the right; while, on the other hand, the upper surface of the penis being in close con- tact with the latter opening, operates as a valvular hindrance in opposing the free escape of the urine through it. The individual possesses, however, a power of propelling at pleasure a small stream of urine from the left ureter, and when the tumour is