The Case of a Tumor Growing on the Inside of the Bladder, Successfully Extirpated by Joseph Warner, Surgeon to Guy's Hospital; Communicated in a Letter to the President

Leakies both at high and low Water. All this is to be understood, when the Weather is seasonable; for, otherwise, these Motions are not so discernible. This Account I have collected partly from my own Observation, having past a great Part of my Life at a Country-seat near Alga, where the Leakies are to be seen in great Perfection, and partly from what I have learned from People living on different Parts of the River, whose Observations, as well as my own, I find exactly agree with those of a learned * Relation of mine, who, near seventy Years ago, diligently observed and enquired into the Phænomena of this irregular Tide. IV. The Case of a Tumor growing on the Inside of the Bladder, successfully extirpated by Joseph Warner, Surgeon to Guy's Hospital; communicated in a Letter to the President. Read May 10. A N Excrescence or Tumor arising from the internal Coat of the Bladder is a Disease, though not very common, yet sufficiently known to the Curious: But I believe that hitherto, no one has attempted the Cure of this Disorder by Extirpation, nor indeed can it be supposed, that the Instances are frequent, where the Operation is practicable. But as it is notorious from the History of Physick, and Surgery, that several Disorders which were * His Observations were communicated to Sir Robert Snibald, in order to assist him in compiling a Scotish Atlas. were formerly unobserved, have been found to occur frequently, after their Nature has been once discovered, and exactly described, I flatter myself the Publication of this Account may possibly throw some Light on the present Subject. Mary Bevan, aged 23, on the 24th of June 1747, strained herself by endeavouring to lift a great Weight; she was immediately seized with violent Pain in the Small of her Back, and a total Suppression of Urine; which Symptoms, notwithstanding the several Methods used for her Relief, continued till the 29th of the same Month; when an eminent Physician and Man-midwife was called to her Assistance; who drew off her Urine with the Catheter. During the Suppression, she was seized with an acute Fever, and for 18 or 20 Hours before her Urine was drawn off, she discharged by the Mouth a great Quantity of saltish Water tinged with Blood; which, upon lying down, flowed in so great Quantities as to threaten Suffocation. In April 1750, she applied to me: Upon Enquiry I learnt she had never been able, from the Moment of the Accident, to void a Drop of Urine without the Assistance of the Catheter, which had been made use of ever since two or three times every twenty-four Hours; that she was in continual Pain, and had been lately much weakened by having several times lost considerable Quantities of Blood, occasioned by the Force made use of for the Introduction of that Instrument. Upon examining her with my Forefinger, which I introduced with great Difficulty through the Matius Urinarius, I discovered a considerable Tumor, which seemed to be of a fleshy Substance, and took its Rise from the lower Part of the the Bladder near its Neck; the Extent of which I could with Difficulty reach. She informed me, she first discovered this Swelling about twenty Months before. I observed it to protrude a little way out of the Meatus Urinarius upon straining to make Water when the Bladder was full; but, upon ceasing to strain, it presently returned. It had preserved pretty nearly the same Appearance ever since it was first taken notice of; and about eighteen Months ago, a small Incision was made into it, on Presumption of its containing a Fluid, but without any Effect. The Method I took for the Extirpation of the Tumor was this: Having first prepared her as before the Operation for the Stone; when her Bladder was full, I made her strain as though she was going to make Water, upon which I perceived the Tumor to protrude a little; this I effectually secured from returning into the Bladder by the Help of a crooked Needle and Ligature passed through the Tumor in different Directions, and endavoured to draw it out through the Meatus Urinarius, but could not effect it by reason of its Largeness; seeing this, I dilated the Meatus Urinarius on the right Side by cutting it upwards about half way towards the Neck, when by pulling the Tumor forwards, I had sufficient room for tying a Ligature round its Basis, which was very broad. For the three first Days after the Operation, she complained of a good deal of Pain in the Abdomen. On the sixth Day, the Tumor dropt off. From the first of the Operation, she voided her Urine without any Assistance, and is now perfectly well in every respect. V. Remarks