Volume 4, Slice 1 Part 8 (2/2)
A younger brother, John Blackwood (1818-1879), succeeded to the business; four years later he was joined by Major William Blackwood, who continued in the firm until his death in 1861. In 1862 the major's elder son, William Blackwood (b. 1836), was taken into partners.h.i.+p. John Blackwood was a man of strong personality and great business discernment; it was in the pages of his magazine that George Eliot's first stories, _Scenes of Clerical Life_, appeared. He also inaugurated the ”Ancient Cla.s.sics for English readers” series. On his death Mr William Blackwood was left in sole control of the business. With him were a.s.sociated his nephews, George William and J.H. Blackwood, sons of Major George Blackwood, who was killed at Maiwand in 1880.
See _Annals of a Publis.h.i.+ng House; William Blackwood and his Sons_ ...
(1897-1898), the first two volumes of which were written by Mrs Oliphant; the third, dealing with John Blackwood, by his daughter, Mrs Gerald Porter.
BLADDER (from A.S. _blaeddre_, connected with _blawan_, to blow, cf.
Ger. _blase_), the membranous sac in animals which receives the urine secreted from the kidneys. The word is also used for any similar sac, such as the gall-bladder, the swim-bladder in fishes, or the small vesicle in various seaweeds.
BLADDER AND PROSTATE DISEASES. The urinary bladder in man (for the anatomy see URINARY SYSTEM), being the temporary reservoir of the renal secretion, and, as such, containing the urine for longer or shorter periods, is liable to various important affections. These are dealt with in the first part of this article. The diseases of the prostate are so intimately allied that they are best considered, as in the subsequent section, as part of the same subject.
_Diseases of the Bladder._
Cyst.i.tis.
_Cyst.i.tis_, or inflammation of the bladder, which may be acute or chronic, is due to the invasion of the mucous lining by micro-organisms, which gain access either from the urethra, the kidneys or the blood-stream. It is easy to see how the diplococci of gonorrhoea may infect the bladder-membrane by direct extension of the inflammation, and how the bacilli which are swarming in the neighbouring bowel may find access to the urethra or bladder when the intervening tissues have been rendered penetrable by a wound or by inflammation. Sometimes, however, especially in the female, the germs from the large intestine enter the bladder by way of the v.u.l.v.a and the urethra.
Any condition leading to disturbance of the function of the bladder, such as enlargement of the prostate, stricture of the urethra, stone, or injury, may cause cyst.i.tis by preparing the way for bacillary invasion.
The bacilli of tuberculosis and of typhoid fever may set up cyst.i.tis by coming down into the bladder from the kidneys with the urine, or they reach it by the blood-stream, or invade it by the urethra. Another way of cyst.i.tis being set up is by the introduction of the germs of suppuration by a catheter or bougie sweeping them in from the urethra; or the instrument itself may be unsterilized and dirty and so may introduce them. It used formerly to be thought that wet or cold was enough to cause inflammation of the bladder, but the probability is that this acts only by lowering the resistance of the lining membrane of the bladder, and preparing it for the invasion of the germs which were merely waiting for an opportunity. In the same way, gout or injury may lead to the lurking bacilli being enabled to effect their attack. But in every case disease-germs are the cause of the trouble, and they may be found in the urine. The first effect of inflammation is to render the bladder irritable, so that as soon as a few drops of urine have collected, the individual has intense or uncontrollable desire to micturate. The effort may be very painful and may be accompanied by bleeding from the overloaded blood-vessels of the inflamed membrane. In addition to blood, pus is likely to be found in the urine, which by this time is alkaline and ammoniacal, and teeming with micro-organisms. As regards _treatment_, the patient should be at once sent to bed in a warm room, and should sit several times a day in a very hot hip-bath. When he has got back to bed, a fomentation under oil-silk, or some other waterproof material, should be placed over the lower part of the abdomen. The diet should be milk (diluted with hot or cold water), barley-water, and bread and b.u.t.ter; no alcoholic drink should be allowed. If the urine is acid, bicarbonate of soda may be given, or citrate of soda; if alkaline, urotropine--a derivative of formic aldehyde--may prove a useful urinary disinfectant. If the straining and distress are great, a suppository of or a grain of morphia may be introduced into the r.e.c.t.u.m every two or three hours. The bowels must be kept freely open. If the urine is foul, the bladder should be frequently washed out by a soft catheter and two or three feet of india-rubber tubing with a funnel at the other end, weak and abundant hot lotions of Sanitas or Condy's fluid being used.
_Chronic cyst.i.tis_ is the condition left when the acute symptoms have pa.s.sed away, but it is liable at any moment to resume the acute condition. If the cyst.i.tis is very intractable, refusing to yield to hot irrigations, and to was.h.i.+ngs with nitrate of silver lotion, it may be advisable to open the bladder from the front, and to explore, treat, drain and rest it.
In _tuberculous cyst.i.tis_ there is added to the symptoms the discovery of the bacilli of tuberculosis in the urine, and cystoscopic examination may reveal the presence of tubercles of the mucous membrane or even of ulceration. The patient is probably losing weight, and he may present foci of tuberculosis at the back of the t.e.s.t.i.c.l.e, the lung or kidney, or in a joint or bone, or in a lymphatic gland. _Treatment_ is rebellious and unpromising. Was.h.i.+ngs and lotions give but temporary relief, and if the bladder is opened for rest, and for a more direct treatment, the germs of suppuration may enter, and, working in conjunction with the bacilli, may cause great havoc. Koch's tuberculin treatment should certainly be given a trial. This consists of the injection into the body of an emulsion of dead tubercle bacilli which have been sterilized by heat. As a result of this injection the blood sets to work to form an ”opsonin”--a protective material which so modifies the disease-germs as to render them attractive to the white corpuscles of the patient's blood (phagocytes), which then seize upon and destroy them. Sir A.E. Wright has devised a delicate method of examination of the blood (the calculation of the opsonic index) which tells when the tuberculin injections should be resorted to and when withheld (see BLOOD).
Stone.
_Calculi and Gravel._--Uric acid is deposited from the urine either as small crystals resembling cayenne pepper, or else, in combination with soda and ammonia, as an amorphous ”brick-dust” deposit, which, on cooling, leaves a red stain on the bottom of the vessel, soluble in hot water. These substances are derived from the disintegration of nitrogenized food taken in excess of demand, and from the breaking down of the human tissues. They occur therefore in fevers, in wasting diseases, and in the normal subject after excessive muscular exercises, especially if these exercises have been accompanied with so much perspiration that the excess of water from the blood has escaped by the skin rather than by the kidneys. The abundance of this deposit is in accordance with the amount of heat developed and work done in the body, and corresponds with the dust and ashes raked out of the fire-box of the locomotive after a long run. But supposing that the uric acid debris continues to be excessive, the risk of the formation of renal or vesical calculi becomes considerable, and it may be advisable to place the patient on a restricted nitrogenized diet, to induce him to drink large quant.i.ties of water, and to keep his bowels so loose with watery laxatives, such as Epsom salts or sulphate of soda, that the waste products of his body are made to escape by the bowels rather than by the kidneys. In addition to the salts just mentioned, an occasional dose of blue pill will prove helpful. A course of treatment at Contrexeville or Carlsbad may be taken with advantage.
Alkaline urine is unable to hold the phosphates of ammonia and magnesia in solution, so they are deposited in abundance either in the kidney or bladder. If the voided urine is allowed to stand in a tall gla.s.s they sink to the bottom with pus and mucus in a cloudy deposit. To remedy this condition it is necessary to treat the cyst.i.tis with which the bacterial decomposition of the urine is a.s.sociated. It may be that a calculus of acid urine, such as one of uric acid or oxalate of lime, has been resting in the bladder and keeping up incessant irritation, and that the micro-organisms of decomposition or suppuration have found their way to the mucous lining of the bladder from either the bowel, the urethra or the blood-stream; undergoing cultivation there they break up the urea into carbonate of ammonia and so render the urine alkaline.
This alkaline urine deposits its phosphates, which light upon the calculus and encrust it with a mortary sh.e.l.l, which may go on increasing in size until it may even fill the bladder. Sometimes the nucleus of a calculus is a chip of bone or a blood-clot, or some foreign substance which has been introduced into the bladder. Sooner or later the urine becomes alkaline and the calculus is encrusted with lime salts.
When urine contains a larger amount of chemical const.i.tuents than it can conveniently hold in solution, a certain quant.i.ty crystallizes out, and may be deposited in the kidney or in the bladder. If the crystals run together in the kidney the resulting concretion may either remain in that organ or may find its way into the bladder, where it may remain to form the nucleus of a larger vesical calculus, or, especially in the case of females, it may, while still small, escape from the bladder during micturition.
In children, in whom there is a rapid disintegration of nitrogenized tissues, a uric acid calculus in escaping from the bladder may block the urethra and give rise to sudden retention of urine. On introducing a metal ”sound,” the surgeon may strike the stone, and if it happens to be near the bladder he may push it back and subsequently remove it by crus.h.i.+ng. But if it has made its way some distance along the urethra, so that he can feel it from the outside, he should remove it by a clean incision.
A stone in the bladder worries the nerves of the mucous membrane, and, giving them the impression that the bladder contains much water, causes the desire and need for micturition to be constant. The irritation causes an excessive secretion of mucus, just as a piece of grit under the eyelid causes a constant running from the eye. So the urine, if allowed to stand, gives a copious deposit. During micturition the contracting bladder bruises its congested blood-vessels against the stone, so that towards the end of micturition blood appears in the urine. Lastly, cyst.i.tis occurs, and the urine contains fetid pus. A stone in the bladder gives rise to pain at the end of the p.e.n.i.s, and it is apt suddenly to stop the flow of urine during micturition.
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