68 DISEASES OF THE BLADDER. 



pecially when associated with impediment to the exit of urine, the 

 mucous membrane, pressing asunder the muscular fasciculi, is forced in 

 between them, forming diverticuli. At first small and round, these 

 latter ultimately expand into large bottle-shaped pouches, of the size 

 of a fist. Their communication with the bladder is at first a narrow 

 chink, which afterward becomes round and sphincter-like. Owing to 

 the incompleteness with which these diverticuli are evacuated, they 

 often become the seat of urinary deposit, and of incapsulated calculi. 



SYMPTOMS AND COUBSE. Acute catarrh of the bladder is some- 

 times accompanied by febrile symptoms. As a rule, however, there is 

 neither elevation of temperature nor acceleration of pulse. In quite 

 recent cases, the patients complain of an undefined pain in the hypo- 

 gastric region and perinaeum, which extends upward toward the kid- 

 ney, and along the urethra toward the glans penis. In the more 

 severe forms of vesical catarrh, pressure exerted upon the region of 

 the bladder gives rise to pain. The hyperaemic and irritable vesical 

 mucous membrane evinces the utmost intolerance against its contents. 

 The collection of a few drops of urine in the bladder occasions the 

 most urgent desire for its expulsion. The sphincter vesicae also is in 

 a constant state of spasm, thus causing a vesical tenesmus quite analo- 

 gous to that of the rectum already described in catarrhal rectitis. 

 The patient scarcely has the urinal out of his hand, micturition is ex- 

 tremely painful, and the few drops of urine which are expelled in short 

 spirts from the urethra produce a feeling as though molten lead were 

 running through the penis. As in all recent catarrhs, at first the 

 quantity of mucus formed is small, so that but a few flocculi are 

 scattered through the urine. Afterward the urine passed becomes 

 turbid, and lets fall a mucous sediment in greater or less profusion. 

 The disease may run its course, and get well in a few days ; and that 

 form caused by drinking fresh beer usually passes off within a few 

 hours. In other cases it is more protracted, or passes into the chronic 

 form. Sometimes the spasmodic contraction of the sphincter vesicae, 

 which occurs in acute vesical catarrh, gives rise to complete retention 

 of urine, and in old persons especially, owing to secondary diseases 

 (oedema and fatty degeneration of the muscles of the bladder), a my- 

 opathic palsy of the detrusors arises, which also causes retention. It is 

 this circumstance which renders simple vesical catarrh a dangerous 

 disease to old persons. In chronic catarrh of the bladder, the pain 

 usually abates after a while, but the intolerance of the viscus against 

 its contents and the constant inclination to urinate continue. The 

 quantity of mucus increases considerably. At first a somewhat trans- 

 parent stratum of mucus sinks to the bottom of the vessel, after- 

 ward the urine becomes thick and turbid, and its sediment is moro 



