Chapter V: Part 5

BLACK ROD (more fully, "Gentleman Usher of the Black Rod "), an official of the House of Lords, instituted in 1350. His appointment is by royal letters patent, and his title is due to his staff of office, an ebony stick surmounted with a gold lion. He is a personal attendant of the sovereign in the Upper House, and is also usher of the order of the Garter, being doorkeeper at the meetings of the knights' chapter. He is responsible for the maintenance of order in the House of Lords, and on him falls the duty of arresting any peer guilty of breach of privilege or other offence of which the House takes cognizance. But the duty which brings him most into prominence is that of summoning the Commons and their speaker to the Upper House to hear a speech from the throne or the royal assent given to bills. If the sovereign is present in parliament, Black Rod _commands_ the attendance of the gentlemen of the Commons, but when lords commissioners represent the king, he only _desires_ such attendance. Black Rod is on such occasions the central figure of a curious ceremony of much historic significance. As soon as the attendants of the House of Commons are aware of his approach, they close the doors in his face. Black Rod then strikes three times with his staff, and on being asked "Who is there?" replies "Black Rod." Being then admitted he advances to the bar of the House, makes three obeisances and says, "Mr Speaker, the king commands this honourable House to attend his majesty immediately in the House of Lords." This formality originated in the famous attempt of Charles I. to arrest the five members, Hampden, Pym, Holies, Hesilrige and Strode, in 1642. Indignant at this breach of privilege, the House of Commons has ever since maintained its right of freedom of speech and uninterrupted debate by the closing of the doors on the king's representative.

BLACK SEA (or EUXINE; anc. _Pontus Euxinus_),[1] a body of water lying almost entirely between the latitudes 41 deg. and 45 deg. N., but extending to about 47 deg. N. near Odessa. It is bounded N. by the southern coast of Russia; W. by Rumania, Turkey and Bulgaria; S. and E. by Asia Minor. The northern boundary is broken at Kertch by a strait entering into the Sea of Azov, and at the junction of the western and southern boundary is the Bosporus, which unites the Black Sea with the Mediterranean through the Sea of Marmora and the Dardanelles. The 100-fathom line is about 10 to 20 m. from the shore except in the north-west corner between Varna and Sevastopol, where it extends 140 m. seawards. The greatest depth is 1030 fathoms (1227 Russian fathoms) near the centre, there being only one basin. The steepest incline outside 100 fathoms is to the south-east of the Crimea and at Amastra; the incline to the greater depths is also steep off the Caucasus and between Trebizond and Batum. The conditions that prevail in the Black Sea are very different from those of the Mediterranean or any other sea. The existence of sulphuretted hydrogen in great quantities below 100 fathoms, the extensive chemical precipitation of calcium carbonate, the stagnant nature of its deep waters, and the absence of deep-sea life are conditions which make it impossible to discuss it along with the physical and biological conditions of the Mediterranean proper.

The depths of the Black Sea are lifeless, higher organic life not being known to exist below 100 fathoms. Fossiliferous remains of _Dreissena_, _Cardium_ and other molluscs have, however, been dredged up, which help to show that conditions formerly existed in the Black Sea similar to those that exist at the present day in the Caspian Sea. According to N. Andrusov, when the union of the Black Sea with the Mediterranean through the Bosporus took place, salt water rushed into it along the bottom of the Bosporus and killed the fauna of the less saline waters. This gave rise to a production of sulphuretted hydrogen which is found in the deposits, as well as in the deeper waters.

Observations in temperature and salinity have only been taken during summer. During summer the surface salinity of the Black Sea is from 1.70 to 2.00% down to 50 fathoms, whereas in the greater depths it attains a salinity of 2.25%. The temperature is rather remarkable, there being an intermediate cold layer between 25 and 50 fathoms. This is due to the sinking of the cold surface water (which in winter reaches freezing-point) on to the top of the denser more saline water of the greater depths. There is thus a minimum circulation in the greater depths causing there uniformity of temperature, an absence of the circulation of oxygen by other means than diffusion, and a protection of the sulphuretted hydrogen from the oxidation which takes place in homologous situations in the open ocean. The temperature down to 25 fathoms is from 78.3 deg. to 46.2 deg. F., and in the cold layer, between 25 and 50 fathoms, is from 46.2 deg. to 43.5 deg. F., rising again in greater depths to 48.2 deg. F.

The _Sea of Marmora_ may be looked upon as an arm of the Aegean Sea and thus part of the Mediterranean proper. Its salinity is comparable to that of the eastern basin of the Mediterranean, which is greater than that of the Black Sea, viz. 4%. Similar currents exist in the Bosporus to those of the Strait of Gibraltar. Water of less salinity flows outwards from the Black Sea as an upper current, and water of greater salinity from the Sea of Marmora flows into the Black Sea as an under-current. This under-current flows towards Cape Tarhangut, where it divides into a left and right branch. The left branch is appreciably noticed near Odessa and the north-west corner; the right branch sweeps past the Crimea, strikes the Caucasian shore (where it comes to the surface running across, but not into, the south-east corner of the Black Sea), and finally disperses flowing westwards along the northern coast of Asia Minor between Cape Jason and Sinope. This current causes a warmer climate where it strikes. So marked is this current that it has to be taken into account in the navigation of the Black Sea.

The _Sea of Azov_ is exceedingly shallow, being only about 6 fathoms in its deepest part, and it is largely influenced by the river Don. Its water is considerably fresher than the Black Sea, varying from 1.55 to 0.68%. It freezes more readily and is not affected by the Mediterranean current.

See N. Andrusov, "Physical Exploration of the Black Sea," in
_Geographical Journal_, vol. i. p. 49.

FOOTNOTE:

[1] The early Greek navigators gave it the epithet of _axenus_, i.e.
unfriendly to strangers, but as Greek colonies sprang up on the
shores this was changed to _euxinus_, friendly to strangers.

BLACK SEA (Russ. _Chernomorskaya_), a military district of the province of Kuban, formerly an independent province of Transcaucasia, Russia; it includes the narrow strip of land along the N.E. coast of the Black Sea from Novorossiysk to the vicinity of Pitsunda, between the sea and the crest of the main range of the Caucasus. Area, 2836 sq. m. Pop. (1897) 54,228; (1906, estimate) 71,900. It is penetrated by numerous spurs of this range, which strike the sea abruptly at right angles to the coast, and in many cases plunge down into it sheer. Owing to its southern exposure, its sheltered position, and a copious rainfall, vegetation, in part of a sub-tropical character, grows in great profusion. In consequence, however, of the mountainous character of the region, it is divided into a large number of more or less isolated districts, and there is little intercourse with the country north of the Caucasus, the passes over the range being few and difficult (see CAUCASUS). But since the Russians became masters of this region, its former inhabitants (Circassian tribes) have emigrated in thousands, so that the country is now only thinly inhabited. It is divided into three districts--Novorossiysk, with the town (pop. in 1897, 16,208) of the same name, which acts as the capital of the Black Sea district; Velyaminovsk; and Sochi. Novorossiysk is connected by rail, at the west end of the Caucasus, with the Rostov-Vladikavkaz line, and a mountain road leads from Velyaminovsk (or Tuapse) to Maikop in the province of Kuban.

BLACKSTONE, SIR WILLIAM (1723-1780), English jurist, was born in London, on the 10th of July 1723. His parents having died when he was young, his early education, under the care of his uncle, Dr Thomas Bigg, was obtained at the Charterhouse, from which, at the age of fifteen, he was sent to Pembroke College, Oxford. He was entered in the Middle Temple in 1741. In 1744 he was elected a fellow of All Souls' College. From this period he divided his time between the university and the Temple, where he took chambers in order to attend the law courts. In 1746 he was called to the bar. Though but little known or distinguished as a pleader, he was actively employed, during his occasional residences at the university, in taking part in the internal management of his college. In May 1749, as a small reward for his services, and to give him further opportunities of advancing the interests of the college, Blackstone was appointed steward of its manors. In the same year, on the resignation of his uncle, Seymour Richmond, he was elected recorder of the borough of Wallingford in Berkshire. In 1750 he became doctor of civil law. In 1753 he decided to retire from London work to his fellowship and an academical life, still continuing the practice of his profession as a provincial counsel.

His lectures on the laws of England appear to have been an early and favourite idea; for in the Michaelmas term immediately after he abandoned London, he entered on the duty of reading them at Oxford; and we are told by the author of his _Life_, that even at their commencement, the high expectations formed from the acknowledged abilities of the lecturer attracted to these lectures a very crowded class of young men of the first families, characters and hopes. Bentham, however, declares that he was a "formal, precise and affected lecturer--just what you would expect from the character of his writings--cold, reserved and wary, exhibiting a frigid pride." It was not till the year 1758 that the lectures in the form they now bear were read in the university. Blackstone, having been unanimously elected to the newly-founded Vinerian professorship, on the 25th of October read his first introductory lecture, afterwards prefixed to the first volume of his celebrated _Commentaries_. It is doubtful whether the _Commentaries_ were originally intended for the press; but many imperfect and incorrect copies having got into circulation, and a pirated edition of them being either published or preparing for publication in Ireland, the author thought proper to print a correct edition himself, and in November 1765 published the first volume, under the title of _Commentaries on the Laws of England_. The remaining parts of the work were given to the world in the course of the four succeeding years. It may be remarked that before this period the reputation which his lectures had deservedly acquired for him had induced him to resume practice in London; and, contrary to the general order of the profession, he who had quitted the bar for an academic life was sent back from the college to the bar with a considerable increase of business. He was likewise elected to parliament, first for Hindon, and afterwards for Westbury in Wilts; but in neither of these departments did he equal the expectations which his writings had raised. The part he took in the Middlesex election drew upon him many attacks as well as a severe animadversion from the caustic pen of "Junius." This circumstance probably strengthened the aversion he professed to parliamentary attendance, "where," he said, "amidst the rage of contending parties, a man of moderation must expect to meet with no quarter from any side." In 1770 he declined the place of solicitor-general; but shortly afterwards, on the promotion of Sir Joseph Yates to a seat in the court of common pleas, he accepted a seat on the bench, and on the death of Sir Joseph succeeded him there also. He died on the 14th of February 1780.

The design of the _Commentaries_ is exhibited in his first Vinerian lecture printed in the introduction to them. The author there dwells on the importance of noblemen, gentlemen and educated persons generally being well acquainted with the laws of the country; and his treatise, accordingly, is as far as possible a popular exposition of the laws of England. Falling into the common error of identifying the various meanings of the word law, he advances from the law of nature (being either the revealed or the inferred will of God) to municipal law, which he defines to be a rule of civil conduct prescribed by the supreme power in a state commanding what is right and prohibiting what is wrong. On this definition he founds the division observed in the _Commentaries_. The objects of law are rights and wrongs. Rights are either rights of persons or rights of things. Wrongs are either public or private. These four headings form respectively the subjects of the four books of the _Commentaries_.

Blackstone was by no means what would now be called a scientific jurist. He has only the vaguest possible grasp of the elementary conceptions of law. He evidently regards the law of gravitation, the law of nature, and the law of England, as different examples of the same principle--as rules of action or conduct imposed by a superior power on its subjects. He propounds in terms the doctrine that municipal or positive laws derive their validity from their conformity to the so-called law of nature or law of God. "No human laws," he says, "are of any validity if contrary to this." His distinction between rights of persons and rights of things, implying, as it would appear, that things as well as persons have rights, is attributable to a misunderstanding of the technical terms of the Roman law. In distinguishing between private and public wrongs (civil injuries and crimes) he fails to seize the true principle of the division. Austin, who accused him of following slavishly the method of Hale's _Analysis of the Law_, declares that he "blindly adopts the mistakes of his rude and compendious model; missing invariably, with a nice and surprising infelicity, the pregnant but obscure suggestions which it proffered to his attention, and which would have guided a discerning and inventive writer to an arrangement comparatively just." By the want of precise and closely-defined terms, and his tendency to substitute loose literary phrases, he falls occasionally into irreconcilable contradictions. Even in discussing a subject of such immense importance as equity, he hardly takes pains to discriminate between the legal and popular senses of the word, and, from the small place which equity jurisprudence occupies in his arrangement, he would scarcely seem to have realized its true position in the law of England. Subject, however, to these strictures the completeness of the treatise, its serviceable if not scientific order, and the power of lucid exposition possessed by the author demand emphatic recognition. Blackstone's defects as a jurist are more conspicuous in his treatment of the underlying principles and fundamental divisions of the law than in his account of its substantive principles.

Blackstone by no means confines himself to the work of a legal commentator. It is his business, especially when he touches on the framework of society, to find a basis in history and reason for all the most characteristic English institutions. There is not much either of philosophy or fairness in this part of his work. Whether through the natural conservatism of a lawyer, or through his own timidity and subserviency as a man and a politician, he is always found to be a specious defender of the existing order of things. Bentham accuses him of being the enemy of all reform, and the unscrupulous champion of every form of professional chicanery. Austin says that he truckled to the sinister interests and mischievous prejudices of power, and that he flattered the overweening conceit of the English in their own institutions. He displays much ingenuity in giving a plausible form to common prejudices and fallacies; but it is by no means clear that he was not imposed upon himself. More undeniable than the political fairness of the treatise is its merits as a work of literature. It is written in a most graceful and attractive style, and although no opportunity of embellishment has been lost, the language is always simple and clear. Whether it is owing to its literary graces, or to its success in flattering the prejudices of the public to which it was addressed, the influence of the book in England has been extraordinary. Not lawyers only, and lawyers perhaps even less than others, accepted it as an authoritative revelation of the law. It performed for educated society in England much the same service as was rendered to the people of Rome by the publication of their previously unknown laws. It is more correct to regard it as a handbook of the law for laymen than as a legal treatise; and as the first and only book of the kind in England it has been received with somewhat indiscriminating reverence. It is certain that a vast amount of the constitutional sentiment of the country has been inspired by its pages. To this day Blackstone's criticism of the English constitution would probably express the most profound political convictions of the majority of the English people. Long after it has ceased to be of much practical value as an authority in the courts, it remains the arbiter of all public discussions on the law or the constitution. On such occasions the _Commentaries_ are apt to be construed as strictly as if they were a code. It is curious to observe how much importance is attached to the _ipsissima verba_ of a writer who aimed more at presenting a picture intelligible to laymen than at recording the principles of the law with technical accuracy of detail.

See also the article ENGLISH LAW.

BLACK VEIL, in the Roman Catholic Church, the symbol of the most complete renunciation of the world and adoption of a nun's life. On the appointed day the nun goes through all the ritual of the marriage ceremony, after a solemn mass at which all the inmates of the convent assist. She is dressed in bridal white with wreath and veil, and receives a wedding-ring, as spouse of the Church. Afterwards she presides at a wedding-breakfast, at which a bride-cake is cut. She thus bids adieu to all her friends, and having previously taken the white veil, the betrothal, she now assumes the black, and for ever forswears the world and its pleasures. Her hair is cut short, and her bridal robes are exchanged for the sombre religious habit. Her wedding-ring, however, she continues to wear, and it is buried with her.

BLACKWATER, the name of a number of rivers and streams in England, Scotland and Ireland. The Blackwater in Essex, which rises near Saffron Walden, has a course of about 40 m. to the North Sea. The most important river of the name is in southern Ireland, rising in the hills on the borders of the counties Cork and Kerry, and flowing nearly due east for the greater part of its course, as far as Cappoquin, where it turns abruptly southward, and discharges through an estuary into Youghal Bay. The length of its valley (excluding the lesser windings of the river) is about 90 m., and the drainage area about 1300 sq. m. It is navigable only for a few miles above the mouth, but its salmon fisheries are both attractive to sportsmen and of considerable commercial value. The scenery of its banks is at many points very beautiful.

BLACKWATER FEVER, a disease occurring in tropical countries and elsewhere, which is often classed with malaria (q.v.). It is characterized by irregular febrile paroxysms, accompanied by rigors, bilious vomiting, jaundice and haemoglobinuria (Sambon). It has a wide geographical distribution, including tropical Africa, parts of Asia, the West Indies, the southern United States, and--in Europe--Greece, Sicily and Sardinia; but its range is not coextensive with malaria. Malarial parasites have occasionally been found in the blood. Some authorities believe it to be caused by the excessive use of quinine, taken to combat malaria. This theory has had the support of Koch, but it is not generally accepted. If it were correct, one would expect blackwater fever to be regularly prevalent in malarial countries and to be more or less coextensive with the use of quinine, which is not at all the case. It often resembles yellow fever, but the characteristic black vomit of yellow fever rarely occurs in blackwater fever, while the black urine from which the latter derives its name is equally rare in the former. According to the modern school of tropical parasitology, blackwater fever is neither a form of malaria nor produced by quinine, but a specific disease due to a protozoal parasite akin to that which causes the redwater fever of cattle.

BLACKWELL, THOMAS (1701-1757), Scottish classical scholar, was born at Aberdeen on the 4th of August 1701. He took the degree of M.A. at the Marischal College in 1718. He was appointed professor of Greek in 1723, and was principal of the institution from 1748 until his death on the 8th of March 1757. In 1735 his first work, _An Inquiry into the Life and Writings of Homer_, was published anonymously. It was reprinted in 1736, and followed (in 1747) by _Proofs of the Enquiry into Homer's Life and Writings_, a translation of the copious notes in foreign languages which had previously appeared. This work, intended to explain the causes of the superiority of Homer to all the poets who preceded or followed him, shows considerable research, and contains many curious and interesting details; but its want of method made Bentley say that, when he had gone through half of it, he had forgotten the beginning, and, when he had finished the reading of it, he had forgotten the whole. Blackwell's next work (also published anonymously in 1748) was _Letters Concerning Mythology_. In 1752 he took the degree of doctor of laws, and in the following year published the first volume of _Memoirs of the Court of Augustus_; the second volume appeared in 1755, the third in 1764 (prepared for the press, after Blackwell's death, by John Mills). This work shows considerable originality and erudition, but is even more unmethodical than his earlier writings and full of unnecessary digressions. Blackwell has been called the restorer of Greek literature in the north of Scotland; but his good qualities were somewhat spoiled by pomposity and affectation, which exposed him to ridicule.

BLACKWOOD, WILLIAM (1776-1834), Scottish publisher, founder of the firm of William Blackwood & Sons, was born of humble parents at Edinburgh on the 20th of November 1776. At the age of fourteen he was apprenticed to a firm of booksellers in Edinburgh, and he followed his calling also in Glasgow and London for several years. Returning to Edinburgh in 1804, he opened a shop in South Bridge Street for the sale of old, rare and curious books. He undertook the Scottish agency for John Murray and other London publishers, and gradually drifted into publishing on his own account, removing in 1816 to Princes Street. On the 1st of April 1817 was issued the first number of the _Edinburgh Monthly Magazine_, which on its seventh number, bore the name of _Blackwood's_ as the leading part of the title. "Maga," as this magazine soon came to be called, was the organ of the Scottish Tory party, and round it gathered a host of able writers. William Blackwood died on the 16th of September 1834, and was succeeded by his two sons, Alexander and Robert, who added a London branch to the firm. In 1845 Alexander Blackwood died, and shortly afterwards Robert.

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 partnership. 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 Classics for English readers" series. On his death Mr William Blackwood was left in sole control of the business. With him were associated his nephews, George William and J.H. Blackwood, sons of Major George Blackwood, who was killed at Maiwand in 1880.

See _Annals of a Publishing 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._

Cystitis.

_Cystitis_, 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 vulva 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 cystitis by preparing the way for bacillary invasion. The bacilli of tuberculosis and of typhoid fever may set up cystitis 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 cystitis 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 butter; 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 1/4 or 1/2 a grain of morphia may be introduced into the rectum 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 cystitis_ is the condition left when the acute symptoms have passed away, but it is liable at any moment to resume the acute condition. If the cystitis is very intractable, refusing to yield to hot irrigations, and to washings 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 cystitis_ 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 testicle, the lung or kidney, or in a joint or bone, or in a lymphatic gland. _Treatment_ is rebellious and unpromising. Washings 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 quantities 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 glass they sink to the bottom with pus and mucus in a cloudy deposit. To remedy this condition it is necessary to treat the cystitis with which the bacterial decomposition of the urine is associated. 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 shell, 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 constituents than it can conveniently hold in solution, a certain quantity 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 crushing. 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, cystitis occurs, and the urine contains fetid pus. A stone in the bladder gives rise to pain at the end of the penis, and it is apt suddenly to stop the flow of urine during micturition.

The association of any of these symptoms leads the surgeon to suspect the presence of a stone in the bladder, and he confirms his suspicions by introducing a slender steel rod, a "sound," by which he strikes and feels the stone. Further confirmation may be obtained by the help of the X-rays, or, in the adult, by using a cystoscope. In a child the stone may often be felt by a finger in the rectum, the front of the bladder being pressed by a hand on the lower part of the abdomen. The _cystoscope_ is a straight, hollow metal tube about the size of a long cedar pencil, which the surgeon introduces into the adult bladder, which has already been filled with warm boracic lotion. Down the tube run two fine wires which control a minute electric lamp at the bladder end of the instrument. At that end also is a small glass window which prevents the fluid escaping by the tube, and also a prism; at the other end of the tube is an eye-piece. By the use of this slender speculum the practised surgeon can recognize the presence of tubercle or tuberculous ulceration of the bladder, stone, or other foreign material, and innocent or malignant growths. He can also watch the urine entering the bladder by the openings of the ureters, and determine from which kidney blood or pus is coming.

The _treatment_ of stone in the bladder is governed by various conditions. Speaking generally, the surgeon prefers to introduce a lithotrite and crush the stone into small fragments, and then to flush out the fragments by using a full-sized, hollow metal catheter and an india-rubber wash-bottle. Even in children this operation may generally be adopted with success, the stone being crushed to atoms and the fragments being washed out to the last small chip. But if the stone is a very hard one (as are some of the oxalate of lime calculi), or if it is very large, or if the bladder or the prostate gland is in a state of advanced disease, or if the urethra is not roomy enough to admit instruments of adequate calibre, the crushing operation (_lithotrity_) must be deemed unsuitable, and the stone must be removed by a cutting operation (_lithotomy_).

_Lithotomy_.--Cutting for stone has been long practised; but up to the beginning of the 19th century it was performed only by a few men, who, bolder than their contemporaries, had specially worked at that operation and had attained celebrity as skilful lithotomists. Patients went long distances to be operated on by them, and certain of the older surgeons, as William Cheselden, performed a large number of operations with most excellent results. The operation was by an incision from the perineum, and is ordinarily spoken of as _lateral_ lithotomy. It was splendidly designed, and gave good results, especially in children. But it is now a thing of the past, having almost entirely given place to the _high_ or _supra-pubic_ operation. In the high operation the patient, being duly prepared, is placed upon his back and the bladder is washed out with hot boracic lotion, and when the lotion returns quite clean a final injection is made until the bladder is felt rising above the pubes. Then the india-rubber tube is removed from the silver catheter by which the injection has been made, and the end of the catheter is plugged by a spigot. An incision is then made in the middle line of the abdomen over the bladder region. The incision must be kept as low as possible, so that the bladder may be reached below the peritoneum, which, higher up, gives it an external, serous coat. As the bladder is approached, a good many veins are seen to be in the way, some of which have to be wounded. The bladder-wall is recognized by its coarse network of pale muscular fibres, through which, on each side of the middle line, a strong suture is passed, so that when the bladder is opened and the lotion comes rushing out, the opening which has been made into the bladder may not sink into the depths of the pelvis. A finger introduced into the bladder makes out the exact size and position of the stone, or stones, and the removal is effected by special forceps. Bleeding having ceased, the bladder-wound is partly or entirely closed by sutures and allowed to fall into the pelvis, the catheter having been removed. It is advisable to leave a drainage tube in the abdominal wound for a while, so that if urine leaks from the bladder-wound it may find a ready escape to the dressings.

_Litholapaxy_.--Lithotrity consists of two parts--the crushing of the stone, and the removal of the detritus. The two stages are now carried out at one "sitting," without an interval being allowed between them, as was formerly the practice, and the term "litholapaxy" designates this method. The patient having been anaesthetized, 10 oz. of hot boracic lotion are injected, and the crushing instrument, the lithotrite, is then passed into the bladder. The lithotrite has two blades, a "male" and a "female," the latter fenestrated, the former solid with its surface notched. When the stone is fixed between the blades the screw is used, and great pressure is applied evenly, gradually and continuously to the stone. The lithotrite is made of very tough steel, so that hard stones may be crushed without danger of the instrument breaking or bending. Care must be taken not to catch the bladder-wall with the lithotrite. This danger is avoided by raising the point of the lithotrite immediately after grasping the stone and before crushing. The stone breaks into two or more pieces, and these fragments must be crushed, one by one, until they are powdered fine enough to escape by the large evacuating catheter. If the stone be large and hard, half an hour or longer may be required to crush it sufficiently fine. When the surgeon fails to catch any more large pieces, the presumption is that the stone has been thoroughly broken up. The lithotrite is then withdrawn and the detritus is washed out by an "aspirator," which consists of a stiff elastic ball which is connected with a trap, into which fragments of stone fall so as not to pass out on the instrument being used at later periods in the operation. A large catheter, with the eye very near the end of the short curve, is passed into the bladder; the aspirator, full of boracic lotion, is attached to the catheter, and a few ounces of the fluid are expressed from the aspirator into the bladder by squeezing the rubber ball. When the pressure is taken off the ball, it dilates and draws the fluid out of the bladder, and with it some of the detritus, which falls into the trap. This is repeated until all the fragments have been removed. After the operation the patient sometimes suffers from discomfort. His urine should be drawn off by a soft catheter at regular intervals for a few days. If the pain be severe, it can generally be relieved by fomentations. The patient must be kept in bed after the operation, and in cases where the stone has been large and the bladder irritable, the surgeon should insist on his remaining there for at least a week; in those cases which go on favourably the patients are soon able to perform their ordinary duties. Fatal terminations, however, do now and again occur from suppression of urine, the result of the old-standing kidney disease which so often complicates these cases.

To Brigade-Surgeon Lieutenant-Colonel Dennis Francis Keegan, of the Indian Medical Service, is due the fact that the operation of crushing and promptly removing all fragments of a vesical calculus is as well suited for boys as for men. In entire opposition to long-standing European prejudices, Keegan's operation is now firmly and permanently established. The old operation (Cheselden's) of cutting a stone out through the bottom of a boy's bladder is now seldom resorted to, and if a stone in a boy is found too large or too hard to lend itself to the crushing operation, it is removed by a vertical incision through the lower part of the anterior wall of the abdomen, as described above. For a successful performance of the crushing operation in a boy a small lithotrite has, of course, to be used, and it must be of the very best English make. The operation has to be done with the utmost gentleness and thoroughness, not a particle of the crushed stone being left in the bladder, since otherwise the piece left becomes the nucleus of a fresh stone and the trouble recurs.

The treatment of vesical calculi by other means than operative surgery is of little value. Attempts have been made to dissolve them by internal remedies, or by the injection of chemical agents into the bladder; but, although such methods have for a time been apparently successful, they have invariably been found worthless for removing calculi once actually formed. Nevertheless, much can be done towards _preventing_ the formation of calculi in those who have a tendency to their formation, by attention to diet, by taking proper exercise, and by the internal administration of drugs.

_Rupture of the bladder_ may be caused by a kick or blow over the
upper part of the abdomen, or by a wheel passing over it; or it may be
a complication of fracture of the pelvis. If the rupture is in that
part of the bladder which is uncovered by the peritoneum, the
extravasated urine may be cut down upon and let out with good prospect
of success; but if the rupture is in the upper or hinder part of the
bladder the urine is let loose into the general peritoneal cavity and
sets up peritonitis, which is more than likely to prove fatal. If the
surgeon knows that the bladder is ruptured he should operate at once
in order to provide escape for the urine, and also to sew up the rent.
If the possibility of the bladder being ruptured be even suspected,
the surgeon should pass a catheter. Perhaps he draws off an ounce or
two of blood-stained urine. This makes him doubly suspicious, so he
injects into the bladder five, eight or ten ounces of warm boracic
lotion, and, leaving it there for a few minutes, he measures the
amount which he is able afterwards to withdraw; if he finds that a
certain amount is lost he is assured that a leakage has taken place
and he at once proceeds to operate. If only the diagnosis is made
promptly, and the operation is at once undertaken, the outlook is not
unfavourable. A generation or so back nearly all the cases of rupture
of bladder ended fatally.

_Villous disease_ of the bladder is innocent; that is to say, it does
not spread to the neighbouring structures or implicate the lymphatic
glands. The villi are slender, branched, filamentous processes which,
springing from the floor of the bladder, float in the urine like
seaweed. They are freely supplied with blood-vessels, so that when a
piece of a villus is broken off there is likely to be blood in the
urine. Indeed, painless haemorrhage is one of the characteristic
features of the disease, and when fragments of the "seaweed" are found
in the urine the diagnosis is clear. If the bladder is opened from the
front, as already described, the villi may be nipped off by special
forceps and the disease permanently cured.

_Malignant disease_ of the bladder is almost always the warty form of
cancer known as epithelioma. It springs as a sessile growth from the
mucous membrane of the floor near the opening of one of the ureters,
and, worrying the sensory nerves, causes irritability of the bladder
and incontinence of urine. In due course septic germs reach the
bladder, either from the urethra, the bowel, the kidneys or the
blood-stream, and cystitis sets in. When ulceration has taken place,
blood occurs in the urine, and the patient--generally beyond middle
age--suffers dull or lancinating pains. Eventually the rectum may also
be involved and the distress becomes extreme. The presence of the
growth may be determined by sounding the bladder, by the cystoscope,
and by the finger in the rectum. If the growth invades the outlet,
retention of urine may occur, and the surgeon may be compelled to open
the bladder from the front of the abdomen. In cases where operation is
out of the question, washing the bladder with hot boracic lotion may
give great relief. The treatment of cancer of the bladder by operation
is, as a rule, unsatisfactory, because of the close proximity of the
growth to the ureters and to the rectum. If, however, the disease were
recognized early and had not invaded the neighbouring structures, and
if it were upon the upper or the anterior part of the bladder, its
removal might be hopefully undertaken.

_Hypertrophy and Dilatation._--When there is long-continued
obstruction to the flow of urine, as in stricture of the urethra, or
enlargement of the prostate, the bladder-wall becomes much thickened,
the muscular fibres increasing both in size and number; the condition
is known as "hypertrophy." Hypertrophy may be accompanied by
dilatation of the bladder, a condition which the bladder may assume
when the voiding of its contents is interfered with for a length of
time.

_Paralysis_ of the bladder is a want of contractile power in the
muscular fibres of the bladder-wall. It may result from injuries
whereby the spinal cord is lacerated or pressed upon, so that the
micturition centre, which is situated in the lumbar region, is thrown
out of working order. The result may be either retention or
incontinence of urine; sometimes there is at first retention, which
later is followed by incontinence. Paralysis is also met with in
certain nervous diseases, as in locomotor ataxia, and in various
cerebral lesions, as in apoplexy.

_Atony_ of the bladder is a paresis or partial paralysis. It is due to
a want of tone in the muscular fibres, and is frequently the result of
over-distension of the bladder, such as may occur in cases of
enlargement of the prostate. The patient is unable to empty the
bladder, and the condition of atony gets increasingly worse.

In both paralysis and atony the indication is carefully to prevent
over-distension by the urine being retained too long, and at the same
time to treat by appropriate means the cause which has produced or is
keeping up the condition.

_Incontinence of urine_ may occur in the adult or in the child, but is
due to widely different causes in the two cases. In the child it may
be simply a bad habit, the child not having been properly trained; but
more frequently there is a want of control in the micturition-centre,
so that the child passes its water unwittingly, especially during the
night. In adults it is not so much a condition of incontinence in the
sense of water being passed against the will, but is a suggestion that
the bladder is already full, the water which passes being the overflow
from a too full reservoir. It is usually caused by an obstruction
external to the bladder, e.g. enlarged prostate or stricture of the
urethra; a calculus may produce the condition. In the child an attempt
must be made to improve the tone of the micturition-centre by the use
of belladonna or strychnine internally, and of a blister or faradism
externally over the lumbar region, and every effort should be made to
train the child to pass water at stated times and regular intervals.
In the adult the cause which produces the over-distension must be
removed if possible; but, as a rule, the patient has to be provided
with a catheter, which he can pass before the bladder has filled to
overflowing. A soft flexible catheter should be given in preference to
a rigid or semi-rigid one. The best form is the red-rubber catheter,
and he should be taught the need of keeping it absolutely clean. In
the case of children incontinence of urine means irritability; in
adults it means overflow.

The condition termed by Sir James Paget _stammering micturition_ is
analogous to speech stammering, and occurs in those who are nervous
and easily put out. It would seem to be due to the sphincter of the
bladder not relaxing synchronously with the contraction of the
detrusor, and is sometimes caused by external irritation, such as
preputial adhesions. Occasionally not a drop of urine can be passed,
or a little passes and then a sudden stoppage occurs; the more the
patient strains the worse he becomes, until at last there is complete
retention of urine. The trouble can sometimes be cured by the removal
of irritating causes, and in these cases, as well as in those in which
no such cause can be discovered, care should be taken to avoid those
difficulties which have given rise to the patient's worst failures. If
at any time he should fail to perform the act of micturition, he ought
not to strain, but should quietly wait for a little before making any
further effort. Regularity in the times of making water is also of
much importance.