CATARRH OF THE BLADDER CYSTITIS CATARRHALIS. 69 



opaque, and of white or yellow color. If the urine undergoes the 

 so-called alkaline fermentation in the bladder the secretion of the 

 diseased mucous membrane, full of pus-cells and disintegrating epi- 

 thelium, suffers a peculiar transformation (already mentioned when 

 treating of pyelitis) forming a gelatinous coherent mass, which, when 

 poured from one vessel to another, holds together, and can be drawn 

 into long threads. 



In previous editions of my text-book I have stated that this pro 

 fuse secretion of mucus often acted as a ferment upon the urine, giv- 

 ing rise to an " alkaline fermentation ; " that in this alkaline fermen- 

 tation the urea was decomposed into carbonate of ammonia, and that 

 new ammoniacal combinations formed, namely, urate of ammonia and 

 phosphate of ammonia and magnesia (triple phosphate). I was 

 compelled to add that the mucus contained in the urine did not al- 

 ways act as a ferment ; and that, in many cases of protracted vesical 

 catarrh, I had constantly found the reaction of the urine to be acid. 

 In the course^of the last year,* from observations made by Traube, 

 as well as from investigations and experiments of my own, which have 

 oeen published by Teuffel^ in the ^Berliner Jflinischen Wbchenschrift, 

 I have become convinced that this alkaline fermentation is not pro^ 

 duced by the mucus, but is owing to the presence in the urine of or- 

 ganisms of a low grade, which probably usually find their way thither 

 through the introduction into the bladder of dirty catheters. A high- 

 ly interesting observation, made in my clinic, upon a young girl with 

 palsy of the bladder, affords striking evidence of the correctness of 

 this opinion. In the bladder of this patient, who for weeks had been 

 catheterized with an ill-cleansed instrument, there had developed a 

 most typical alkaline fermentation. Her urine, which was of a pun- 

 gent ammoniacal odor and alkaline reaction, contained the thorn- 

 apple-like crystals of urate of ammonia, large coffin-lid-shaped crystals 

 of ammonio-magnesia-phosphate, with many vibriones and fungi of a 

 low order ; but it contained neither cellular elements nor large quan- 

 tities of mucus. A careful research into the history of the case showed 

 that the pdiient never had had any symptoms of vesical catarrh. 

 Chronic vesical catarrh drags on for weeks, months, and even for 

 years. It is a remarkable fact, and one difficult to explain, that it usu- 

 ally i accompanied by loss of appetite and by derangement of diges- 

 tion. The longer the disease has lasted, sc much the less are the 

 chances of a perfect recovery. 



Ulceration of the vesical mucous membrane is to be suspected 

 when the sediment of the urine grows more and more purulent, when, 

 from time to time, blood is discharged with the urine, and when a slow 

 fever arises, which consumes the strength of the patient. He then 



