390 



BLADDER, ABNORMAL ANATOMY. 



membrane a uniform deep red colour. More- 

 over, dark brown or black patches are found 

 to occupy portions of various extent of the 

 mucous membrane, which, as well as the 

 submucous tissue, is easily torn, and other 

 portions of this membrane are seen partially 

 detached, and converted into a soft spongy 

 substance having a strong gangrenous odour. 

 In the circumscribed form of gangrene, we 

 sometimes see a number of black eschars, 

 which are soft and nearly putrid : sometimes 

 greyish pulpy points are presented, which 

 appear to implicate only the mucous tunic, 

 but in the greater number of cases we see the 

 different stages of their progress ; they are at 

 first whitish, they then become yellowish, grey, 

 slate colour or brown, and blackish ; but these 

 changes are much more marked when the organ 

 has been subjected for a short time to the 

 action of the atmosphere. Where the whole 

 of the parietes are involved, the eschar is 

 characterised by a greyish slaty tint. These 

 eschars are frequently confounded with the 

 violet or brown portions or patches by which 

 they are surrounded ; these latter are simply 

 extreme congestion, bordering, it is true, upon 

 gangrene, but susceptible of being restored to 

 a healthy state, whilst the death of the other 

 points is inevitable. 



When acute inflammation affects the mus- 

 cular tunic of the bladder, the organ usually 

 becomes strongly contracted, and the parietes 

 present an appearance of considerable thicken- 

 ing; at the same time pus is commonly in- 

 filtrated through the tissue, or it is circum- 

 scribed into the form of abscess ; the tunic is 

 then of a dark red colour and strongly in- 

 jected. In a case which was seen by Gendrin, 

 where the patient refused to submit to the 

 operation for stone, the internal tunic was 

 ulcerated and of a red-brown colour ; the mus- 

 cular tunic was more than half an inch in 

 thickness, and contained two abscesses, each 

 of the size of a small nut. Velpeau saw in a 

 patient who had died of a diarrhoea, the blad- 

 der reduced to the size of a small fist ; it was 

 hard and elastic ; its parietes were more than 

 an inch thick. In the cases described by 

 Martin Ripaux, Molat, Maret, and Berard,* 

 the mucous membrane was not in any way 

 implicated, the hypertrophy being entirely 

 limited to the muscular tunic. In these cases 

 the bladder was reduced to very small dimen- 

 sions, and the mucous coat made many pro- 

 jections into the cavity; the summit of these 

 projections was red and vascular. It is not 

 unlikely but that it may be owing to the excess 

 of extent of the mucous over the contracted 

 muscular tissue in such cases, that the former 

 so easily becomes engaged in the formation of 

 appendices. The muscular tunic may be 

 much increased in thickness in the absence of 

 acute or even chronic inflammation of the 

 organ ; any irritation by which a frequent con- 

 traction of the organ may be excited will most 

 probably produce a great increase of thickness 

 of this tunic. Among these causes we may 



range the existence of fistula or calculi in the 

 organ. Sometimes the thickening is limited 

 to the mucous tunic. M. Portal, in examining 

 the bladder of an old man, the parietes of the 

 organ being eight or nine lines in thickness, 

 found the internal tunic like cartilage, and 

 that this was the only tunic which had acquired 

 an increase of substance ; the peritoneal tunic 

 was in its natural state, the muscular scarcely 

 apparent. Chopart made a similar remark 

 with regard to the bladder of an adult. Mor- 

 gagni mentions a like case.* 



Instead of either of the modifications which 

 have been described, acute cystitis may dege- 

 nerate into a chronic form of the disease. 

 This form of the affection does not commonly 

 succeed to a single and simple attack of the 

 acute affection ; almost always there will have 

 been sundry recurrences of the acute form 

 before this degeneration takes place. Most 

 frequently chronic cystitis occurs without hav- 

 ing the acute disease as a precursor, and it is 

 upon chronic inflammation that extensive dis- 

 organisations of the various tissues of the eco- 

 nomy are mainly dependent ; and the altera- 

 tions of texture in the parietes of the bladder 

 are, therefore, most commonly produced by its 

 agency. 



In such cases we may see the mucous mem- 

 brane of an uniformly dark violet colour, thick- 

 ened and unyielding, the organ so contracted 

 as to present only a very small undilatable 

 cavity, incapable of containing more than a 

 few drams of fluid. Fungous excrescences 

 are sometimes developed upon its internal 

 surface, especially in the vicinity of the neck. 

 In some cases ulcerations will be found to 

 have destroyed the muscular tunic and pene- 

 trated to the peritoneum ; in others, the 

 mucous follicles present a most exaggerated 

 development, communicating to the membrane 

 a considerable increase of thickness, but with- 

 out change of colour. In other cases, the 

 muscular tunic having acted with increased 

 energy, its fibres have become more volumi- 

 nous and project into the interior of the 

 organ in the form of columns, between which 

 the mucous membrane sometimes forms what 

 is termed ' hernia/ But the more ordinary 

 consequence of chronic inflammation of this 

 organ consists in the thickening and more or 

 less uniform induration of the vesical pa- 

 rietes. The tissue of the bladder is then con- 

 verted into a homogeneous, lardaceous sub- 

 stance, similar in appearance to that of the un- 

 impregnated uterus; the vessels which surround 

 the organ are dilated, varicose, and form on 

 the external surface considerable plexuses, 

 which attest the long existence of its excitation, 

 and the continuance of the afflux of blood of 

 which it has been the seat. 



Ulceration as a consequence of chronic in- 

 flammation of the mucous membrane of this 

 organ is unfrequent, but as an effect of the 

 presence of a calculus is less so. Of the first 

 species a description, with a fine plate, is given 

 by Baillie, of a case in which the mucous 



* Vide Transact, de la Socictc Anatomique. 



Ep. 41, art. 6. 



