Account of the history and dissection of a case of malformation of the urinary bladder, with remarks / [Andrew Melville McWhinnie].

  • McWhinnie, Andrew Melville, 1807 or 1808-1866.
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: Account of the history and dissection of a case of malformation of the urinary bladder, with remarks / [Andrew Melville McWhinnie]. Source: Wellcome Collection.

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    only were females. Mr. Earle, at the date of the clinical lecture alluded to, found, on searching the records of in¬ stances of this congenital defect, that eight had been observed in the female, and sixty in the male. Subsequent to that period a large number have been added to the list of published cases; and at this time I am acquainted with several in and about the metropolis. Besides the urinous smell which ag¬ gravates so much their wretched condi¬ tion, there is frequently that peculiarity in the movements of the individual, most striking in early life, by which the nature of the infirmity may be de¬ tected, resulting from the soreness of the parts, and the consciousness that the tumor will bleed from the slightest friction, as well as from the imperfect structure of the pelvis, and the distance to which the acetabula and lower limbs are thrown asunder. Mr. Earle alludes to this feature in the early stage of the girl’s case, when she had a “rolling, waddling, insecure gait, and which is less remarkable now.” Mr. Giles, of Stourbridge, describes the effects produced in his patient by the constant efforts to protect the parts in walking, “ the inferior extremities having become bent outwards at the knee, making his gait extremely awk¬ ward.” The chafing and excoriation I have observed to ba greater in the female, whose skin is more delicate and suscep¬ tible, and the urine reaches the thighs and parts between them more readily than in the male. In the latter, too, the more or less open mucous surface of the imperfect urethra, upon which the urine is in part constantly drib¬ bling, may, during the erect posture, serve occasionally, in some degree, to conduct it away. Mr. Startin has obligingly informed me of the advantage to be derived from varnishing the surrounding parts with the collodion, rendered elastic by the addition to it of some fatty oil, thus preventing excoriation.* In regard to the generative functions, it may be noticed that there is, for the most part, entire abrogation of all pro- creative power in the male, although, in connection with the integrity of the internal organs, the ordinary sexual ap- * The preparation he employed is that of Mr. Thomas Taylor, of Vere Street, “ The Collodion Tinctum Praeparatum.” petite may exist,—the necessary conse¬ quence of the condition of the urethra. In this respect that sex has been pro¬ nounced less fortunate than the female, the varied imperfections of whose ex¬ ternal organs offer no material impedi¬ ment to conception, and even safe deli¬ very in some instances. In vol. xxxii. of the Philosophical Transactions is a letter from Oliver to Dr. Mead, describing this congenital defect in a female : he says:—“ Hunc in modum conformata, valetudine satis bona fruebatur virgo, et seterna virgini- tate ex necessitate laboraturam conclu- serant omnes quibus res innotuerat. Advenit tandem nauta quidem, cui aes triplex circa pectus erat: illam vidit, amavit, duxit, et non multo post im- pregnavit.” In both these cases the apparatus had fulfilled its object. The young man died just as it was about to be re¬ newed by some charitable persons. It was a modification of the concave shield worn by Matthew Ussem, the German traveller, described and figured by Dr. Duncan in the paper above referred to, and consisted of a silver bowl, covering and protecting the tumor and external organs, supported and maintained in its situation by bandages around the loins. The urine here collected flowed through a funnel at its lower part into an India rubber bottle placed between the widely-separated thighs (fig. 5). The efficiency and comfort are now further increased by fixing the cup with a double truss. The urine passes down a vulcanised India rubber pipe into a metallic reservoir, adjusted to the inner side of the calf of the leg, and which can be evacuated at pleasure by means of a stop-cock.* For the female the bowl will accomplish its purpose more completely by being so constructed that it may enclose the posterior commissure of the labia. (See Vrolik’s fig. 604, in Cyc. of An at. and Phys. loc. cit.) It is gratifying to find that Mr. Earle’s views have been confirmed, ex¬ perience having shown that the contri¬ vance has afforded the substantial and permanent relief he contemplated. Whatever improvements it may have received since his suggestions, the es¬ sential plan of its construction origi- * Fig. 6 represents the apparatus adjusted, as now manufactured by Messrs. Ferguson, Gilt- spur Street, London. Fig. 7, side view of the instrument.