TUBERCULOSIS AND CARCINOMA OF THE BLADDER. 73 



pathically without known cause, in persons previously in good health. 

 This inflammation shows great tendency to pass into suppuration, and 

 to destroy the parts involved ; it is very apt to spread into the tissues 

 which attach the bladder to the other pelvic viscera, and to the sides 

 of the pelvis. The pus may ultimately penetrate into the bladder, 

 rectum, vagina, or externally into the perinoeum. There is also a form 

 of chronic pericystitis, which not unfrequently accompanies chronio 

 vesical catarrh, and vesical ulceration, and which creates induration 

 of the surrounding connective tissue, and causes firm adhesion of the 

 bladder and surrounding parts. Sometimes this also results in the 

 formation of an abscess. 



The affection is generally difficult of recognition, as the resulting 

 painful tenesmus of the bladder, the dull, continuous pain in the pelvis, 

 the repeated chills, and the complete retention of urine, which occur 

 when the urethra or the ureters are obstructed by an abscess, furnish 

 insufficient data for a diagnosis. A diagnosis can only be in some de- 

 gree certain w;hen an abscess projects above the pubis from the ante- 

 rior surface of the bladder, presenting a spherical prominence, which 

 does not disappear when the bladder is emptied ; or else when we can 

 feel a tumor in the perinaeum, or through the rectum or vagina. The 

 treatment of pericystitis belongs to the province of surgery. 



CHAPTER IV. 



TUBERCULOSIS AND CARCINOMA OF THE BLADDER. 



TUBERCULOSIS of the bladder usually appears as a complication of 

 tuberculosis of the ureters, renal pelvis, and kidneys. Discrete and 

 conglomerate tubercles also form in the bladder sometimes, which, upon 

 breaking down, produce rounded or irregular excavated ulcers. Some- 

 times (but more rarely than in the ureters and pelvis of the kidney) 

 there is a diffuse caseous degeneration of the mucous membrane, which 

 occasions wide-spread destruction. 



The symptoms of tuberculosis of the bladder are very similar to 

 those of chronic vesical catarrh and vesical ulceration. The copious 

 admixture of mucus and pus in the urine, which is often in a state of 

 ammoniacal decomposition, the tormenting desire to urinate, the fre- 

 quent hsemorrhages from the bladder, which are the signs of excentric 

 and concentric vesical hypertrophy, also attend vesical tuberculosis. 

 Our only positive data for a differential diagnosis are the coexistence 

 of degeneration of the prostate or testicle, and the appearance of elastic 

 fibres, or of larger bits of tissue in the urine, from which we may infer 

 the destructive nature of the process which is going on. In a female 



