70 DISEASES OF THE BLADDER. 



ultimately dies of vesical-phthisis, especially if it be associated tnth 

 abscess about the bladder, or tedious suppuration from fistulous pas- 

 sages. 



When catarrhal inflammation of the bladder passes over into dif- 

 fuse suppuration, the patient becomes collapsed, his countenance ap- 

 pears sunken, the pulse is small and thready, and the skin cold. The 

 urine is discolored, of a brownish or blackish hue, contains shreds 

 of mucous membrane, and exhales a fetid odor. Even though the wall 

 of the bladder be not completely destroyed, and though there be no 

 escape of its contents into the abdominal cavity, yet malignant peri 

 tonitis soon develops, and the patient dies within a few days, of gen- 

 eral prostration. 



Thickening of the wall of the bladder, from hypertrophy of its mus- 

 cular fasciculi, may be detected when the viscus also is dilated, by the 

 appearance above the symphysis pubis of a firm tumor, which some- 

 times extends as high as the navel, or even higher, and which in fe- 

 males is apt to be mistaken for a distended womb. Generally speak- 

 ing, patients are unable to empty a bladder thus thickened and dis- 

 tended, even though there be no obstacle to its evacuation in the vesi- 

 cal neck or urethra. It is only the excess of urine (for which, so to 

 speak, there is no room left in the already enormously overfilled blad- 

 der) that is passed by the patient, or which runs from him involuntari- 

 ly if the sphincter be palsied. Thus it may happen that, in the course 

 of twenty-four hours, he may pass a normal amount of water, and still 

 retain from two to six pounds or more in his bladder, which can only 

 be removed by means of the catheter. In concentric hypertrophy, the 

 bladder can be felt through the wall of the vagina or rectum, as a hard 

 tumor, which may give rise to all sorts of blunders. In these cases, 

 the bladder being incapable of distention, there is a constant desire to 

 pass water, which does not give the patient a moment's rest ; and, 

 when the sphincter is relaxed, there is an incessant dribbling of urine. 



TREATMENT. The causal indication, first of all, demands the pro- 

 tection of the vesical mucous membrane from the injuries which have 

 occasioned the disease. This is most difficult of accomplishment 

 where rude catheterization or careless injections into the urethra have 

 provoked catarrh of the bladder ; as well as where the exhibition of 

 cantharides and the like, or the long-continued use of fly-blisters, or of 

 irritating ointments, or where persistent retention and decomposition 

 of the urine are the irritants which are acting upon the mucous mem- 

 brane. When it proceeds from the extension of an inflammation of the 

 urethra or womb, the application of a few leeches upon the perinaeum, 

 or portio vaginalis, is advisable. If the apparent cause be cold, we 

 should resort to a diaphoretic course of treatment. It is only when 



