URINARY BLADDER TUMORS. 417 



chronic, and varies considerably in its severity. The inflam- 

 matory process may extend from the urethra in gonorrhoea ; or 

 result from the presence of vesical calculus ; or occur in the 

 course of acute infectious diseases. The introduction of 

 septic matter during catheterization is of common occurrence ; 

 and the decomposition of urine consequent upon the retention 

 of urine in urethral stricture or hypertrophied prostate is also 

 a frequent cause. 



The mucous membrane in acute cases may be greatly swollen, 

 and congested, and present numerous punctate hemorrhages 

 and, at times, superficial sloughs ; its surface is covered with 

 a muco-purulent exudate, and in some cases a pseudo-mem- 

 brane. 



In chronic cases the mucous membrane is greatly thickened, 

 and is often the seat of extensive ulceration ; if there be some 

 obstruction to the outflow of urine, the hypertrophied trabec- 

 ulae of muscle-fibres may give the surface a ribbed appear- 

 ance. 



In other cases, as the result of the organization and subse- 

 quent contraction of the inflammatory infiltration of its walls, 

 the bladder is often much diminished in size. Incrustations 

 of phosphates deposited from the alkaline urine may cover 

 the surface of the mucous membrane. 



The thick, tenacious, gelatinous material often present in 

 the urine, in addition to large quantities of migrated leuko- 

 cytes, is not due to the presence of mucin, but is the result of 

 the action of the alkaline urinary salts on the purulent exu- 

 date. Infection is liable to extend along the ureters to the 

 kidneys. 



Tuberculosis of the bladder may occur in phthisis, but is 

 much more frequently secondary to tuberculosis of the kidney, 

 uterus, prostate, epididymis, or seminal vesicles. 



The lesion generally presents as a single large, or numerous 

 small ulcers, most abundant at the base of the bladder and 

 around the orifices of the ureters. 



Tumors : Papillomata, varing in size from a pea to that of 

 a pigeon's egg, and often having a cauliflower-like appear- 

 ance, are of rather frequent occurrence. They are quite 

 vascular and bleed readily. Carcinoma is nearly always 



27 Hist. 



