BLADDER, ABNORMAL ANATOMY. 



397 



the peritoneal tunic of the organ.* Dr. Bail- 

 lie suggests, as a reason for such limitation to 

 this particular tunic, the quantity of cellular 

 tissue interposed between the serous and mus- 

 cular tunic, and the laxity of their connection 

 the one with the other. Chronic inflammation 

 is frequently confined solely to the mucous 

 tunic of the organ. 



Acute cystitis may terminate by complete 

 resolution ; it may cause a secretion of pus, 

 which is either diffused in points over the 

 greater part or even the whole of the surface 

 of the organ, or circumscribed under the form 

 of abscess ; may produce ulceration, may ter- 

 minate in gangrene, or it may assume a chronic 

 form. 



If death supervene during the intensity of 

 acute inflammation, we find the mucous mem- 

 brane strongly injected, patches being pre- 

 sented of a brownish colour, commonly in the 

 vicinity of the neck and funclus of the organ ; 

 nor dues it appear that the occurrence of such 

 patches in these situations can be attributed to 

 the irritation occasioned by the prolonged con- 

 tact of acrid urine. At other times the mucous 

 membrane is thickened, and the veins much 

 dilated ; pus is disseminated over the surface, 

 or collected into foci ; patches of false mem- 

 brane are extended over portions of the organ 

 or floating in the contained fluid, and gan- 

 grenous points are presented; these points may 

 only affect the mucous tunic, or they may 

 aftect the entire thickness; it is sometimes 

 studded with small ulcerations, which are more 

 or less concealed by folds of the membrane, 

 and not unfrequently it is softened. Usually 

 the organ is very much contracted, so much so 

 as to present only a very small cavity. This 

 effect is induced by the contraction of the 

 muscular fibres which is excited by the exten- 

 sion of the irritation from the mucous mem- 

 brane. 



\\ hen the disease terminates by resolution, 

 ordinarily, in a short time, all trace of the 

 existence of the affection disappears. In cer- 

 tain cases, however, where it has existed long, 

 the parietes of the bladder have been found 

 slightly thickened; one or more branches of 

 veins have become varicose and consequently 

 more apparent. If the disease have had a still 

 longer existence, we may find the mucous 

 membrane thickened ; but this effect is more 

 frequently manifested in the muscular tunic. 



Vv hen a purulent secretion is produced, pus 

 is found diffused through the substance of the 

 parietes, more particularly, however, in the 

 cellular and muscular layers, and an appear- 

 ance of hypertrophy is here produced ; or it is 

 poured out upon the surface of the mucous 

 tunic. Occasionally, but unfrequently, abscesses 

 are formed between the tunics, but these are 

 commonly a consequence of wounds or con- 

 tusions of this organ, or of the operation for 

 stone. In such cases the abscess may open 

 itself on the external surface of the bladder, 

 or upon the interior. Sometimes it is pre- 



sented upon the sides of the rectum, but 

 according to Chopart it is usually in the 

 neighbourhood of the neck of the organ that 

 suppuration commences. When an abscess 

 opens upon the internal surface of the bladder, 

 the pus passes out, mixed with the urine ; in 

 such cases we discover after death more or less 

 extensive and profound fistulous openings, 

 which are sometimes surrounded by varicose 

 veins, sometimes covered by dark grumous 

 blood, extravasated from the small vessels 

 which ramify on them : they all exhale a 

 fetid odour. 



Ulceration of the bladder as a consequence 

 of acute inflammation is unfrequent ; indeed, 

 of this affection there are only a very small 

 number of cases on record. When it occurs, 

 it is commonly caused by the opening of a 

 purulent collection upon the mucous surface 

 of the organ. A case, detailed by Marc-clial 

 in the 28th vol. of the Recueil Feriodique des 

 Travaux de la Societe de Medecine de Paris, 

 is the best marked case of the affection with 

 which we are acquainted. It was that of a 

 hussar, in whom the affection appeared to be 

 brought about by a violent attack of gonor- 

 rhoea : the patient died on the fifth day. Upon 

 an examination of the organ after death, it was 

 found rather contracted; though not filled 

 with urine, its parietes sustained themselves ; 

 it contained eight ounces of a greyish thick 

 matter : the mucous membrane was extremely 

 thick, and covered by a glutinous stratum. 

 It presented, however, many ulcerations of 

 varied extent ; the parietes of the organ were 

 six lines in thickness. 



Occasionally it happens that inflammation 

 of the mucous membrane of the bladder pro- 

 ceeds to gangrene, which is characterised by a 

 change in the volume of the hypogastric tu- 

 mour, supposing the organ to be distended, 

 the cessation of pain, the sudden prostration 

 of the vital powers, the complete suppression 

 of the flow of urine, the excessive distention 

 of the bladder and the ureters, and sometimes 

 by the escape of urine by the umbilicus;* 

 more frequently, however, by the rupture of 

 the organ and the extravasation of its contents 

 into the abdominal or pelvic cavity. In cases 

 which are a consequence of retention, the gan- 

 grenous points may be presented either at the 

 fundus or at the summit of the organ ;f but 

 most commonly the affection is a consequence 

 of the irritation or pressure made upon the 

 bladder by a foreign body, and in these the 

 point implicated is that upon which the body 

 has directly exercised its influence. When 

 we examine the mucous surface of an organ 

 so affected, we discover that the disease exists 

 under two distinct forms, the diffuse and the 

 circumscribed ; but the latter of the two forms 

 is not often witnessed except as a consequence 

 of local violence. Dr. Carswell, however, bears 

 testimony to its occasional existence ; he states 

 that the congestion is extreme, and often ac- 

 companied by hemorrhage, which gives to the 



* See Baillie, Wardrop's edition, vol. ii. p. 259, 

 and Nauche, Maladies des Voies Urinaires, p. 27. 



* Walther, loc. cit. 



f See Hunter, Hey, and others. 



