652 THE URINARY ORGANS. 



nent in cystitis, and may then be mistaken for miliary tubercles (nodular 

 cystitis). 



Hyperplasia of the epithelium of the bladder sometimes occurs in 

 chronic cystitis and under other conditions. This may be diffuse or cir- 

 cumscribed and the epithelium may assume an epidermal character. Thus 

 masses of transparent epidermis- like cells may lie between papillary pro- 

 jections of the submucosa, forming structures which resemble glands (see 

 Fig. 413), or layers of flattened epithelium may cover or peel from the 

 surface (see Fig. 414). 



Croupous Cystitis. In connection with any of the above lesions the 

 mucous membrane of the bladder may be covered, in patches or some- 

 times over a considerable portion of its surface, with a layer of fibrin, 

 either granular or fibrillar, enclosing pus and epithelial cells and bac- 

 teria. The mucosa may be infiltrated with fibrin. 



This form of inflammation may occur in connection with severe in- 

 fectious diseases measles, diphtheria, scarlatina, typhoid fever ; in con- 

 nection with similar inflammation of the external genitals, in puerperal 

 fever, noma, and sometimes in the presence of foreign bodies. It rarely 

 occurs independently. 



In the so-called emphysematous cystitis, due to the presence of Bacillus 

 aerogenes capsulatus, larger and smaller gas blebs may be present in the 

 mucosa and underlying tissue. ' 



The most common micro-organisms which act as excitants of acute 

 catarrhal and exudative cystitis are Bacillus coli communis, Streptococ- 

 cus pyogenes, and Staphylococcus pyogenes, the gouococcus and typhoid 

 bacillus, 2 Bacillus proteus, and Bacillus aerogenes capsulatus. Many 

 other forms are of occasional occurrence. 3 



Tuberculous Cystitis. There may at first be miliary tubercles formed 

 in the submucosa. By the coalescence of these and the degeneration of 

 tissue about them, ulcers' are formed, and it is most frequently in the 

 ulcerative stage that the lesion is seen. The ulcers, which may be large 

 or small, are usually most abundant at the base of the organ. Their 

 edges may be cheesy, and miliary tubercles in greater or smaller num- 

 bers are usually found in the mucosa about them. Xot infrequently 

 large shreds of tissue are loosened and cast off. The mucosa about the 

 ulcers is apt to be infiltrated with small spheroidal cells. Tubercle ba- 

 cilli are present in many of the tubercles and in the edges and base of 

 the ulcers, and may be found in the urine. Catarrhal inflammation is 

 a very constant accompaniment of this lesion. Tuberculous cystitis may 

 occur in connection with tuberculous inflammation of the lungs, intes- 

 tines, or of the kidney, uterus, prostate, etc. 



1 Sec for bibliography Kedrowsky, Centralbl. f. Path., October 15th, 1898, p. 817. 



2 See Cnrschmann, Miinchener med. Wochenschr., October 16th, 1900, bibliography. 



3 For a study of bacteria of urinary passages see Faltin, Cbl. f. d. Kr. d. Harn- u. 

 Sex.-Org., Bd. xiii., 1902, p. 130, bibl. 



