BLADDER, ABNORMAL ANATOMY. 



399 



membane covering tho posterior and superior 

 surface of the bladder was destroyed ; a simi- 

 lar case is given also, with a plate, by Walter; 

 another is described by Pare.* A case is 

 described by Jalon,f in which the whole of 

 the muscular tunic was as well displayed as if it 

 had been prepared by dissection. There are 

 several well-marked cases on record in which 

 this species of ulceration, consequent upon 

 chronic inflammation, had extended to the 

 whole of the tunics and caused an extrava- 

 sation of urine. These ulcerations are some- 

 times very numerous, almost like erosions, and 

 they are often concealed between the folds 

 of the relaxed mucous membrane, so that they 

 are not discovered until the membrane is 

 stretched out. Under the influence of either 

 acute or chronic inflammation, pseudo-mem- 

 branes are now and then generated upon the 

 surface of the mucous tunic of the organ, 

 usually during the suppurating period of the 

 affection. These membranes are either ad- 

 herent or free, and they are sometimes ex- 

 pelled through the urethra : this circumstance 

 nas induced a belief in an often repeated error, 

 that the mucous tunic of the bladder may be 

 entirely detached and expelled with the urine ; 

 among those who have perpetuated this error 

 are Ruysch and Morgagni.J 



Under the influence of chronic, and much 

 more rarely of subacute inflammation, the 

 mucous membrane of the bladder furnishes in 

 large quantity a species of muco-purulent 

 fluid. This affection was termed by Lieu- 

 taud catarrh of the bladder. When the 

 affection presents the subacute form, it is fre- 

 quently extended to the other tunics of the 

 organ; and if we examine it after death, we 

 shall find similar appearances to those which 

 have been described in speaking of acute in- 

 flammation. When the disease is chronic, it 

 often lasts for years, and we then discover 

 little change of colour in the membrane, but 

 we find it often prodigiously thickened, the 

 vessels varicose, and the cavity much con- 

 tracted. 



Idiopathic softening. During the progress 

 of some acute and many chronic diseases, 

 the mucous membranes of the body not un- 

 frequently become softened, in the absence 

 of inflammatory action in their tissues : in the 

 bladder, however, this state has been only very 

 rarely witnessed. This fact is important, espe- 

 cially when we reflect upon the functions of 

 the organ and the great variations to which the 

 liquid of which it is the reservoir is exposed. 

 M. Louis,|| in a very careful examination of 

 five hundred bodies, found this idiopathic 

 softening in only two cases. In these the 

 mucous membrane in a great portion of the 



' Lib. xvii. ch. 59. 



Eph. Nat. Cur. D. 11. an 11. obs. 129. 



t A case of the kind is detailed by M. Destrees 

 in the Journal General de Mcdecine, tome Ixviii. 

 p. 206. 



Med. Prat. torn. i. 



f| Repertoire General, tome iv. part i. Fails 

 reutifs aux lesions de la membrane muqueuse de 

 la vessie. 



fundus of the organ was reduced into a 

 " mucilage" possessing a consistence little if 

 at all superior to that of mucous pseudo-mem- 

 branes. The membrane thus altered was pale, 

 even at the limits of the softening ; there was 

 no injection or vascular congestion at any point 

 of the bladder, nor in any of the vessels which 

 existed on the exterior of the organ ; neither 

 was there at the interior any erosion or other 

 product of inflammation. It is probable that 

 it is in such cases that even a careful intro- 

 duction of the sound has occasioned a per- 

 foration of the bladder; it may be as well to 

 mention that no true friability of the mucous 

 membrane, so commonly found in inflam- 

 mation, existed in these two cases ; the tunic 

 was soft, as if formed of a viscid jelly, but it 

 did not present either the redness, the infil- 

 tration or the induration by which inflam- 

 mation is characterised. So general is the 

 opinion that softening is uniformly a conse- 

 quence of inflammation, that in taking an 

 opposite opinion it appears to be incum- 

 bent upon us to state our reasons for doing 

 so. Although the differences which may be 

 remarked between softening of this tissue 

 and its inflammatory condition appear to be 

 very great, yet able observers have still be- 

 lieved themselves justified in regarding all 

 softening as the result of inflammation. It is 

 so important to have correct ideas on this 

 point, that we ought here to refute the reason- 

 ing by which that opinion is supported. It is 

 stated that softening of mucous tunics is, in 

 the greater number of cases, united to evi- 

 dently inflammatory alterations; such as a 

 more or less vivid redness of the softened 

 parts, together with an injection and tume- 

 faction. This assertion is gratuitous; for in 

 all cases where the condition has been well 

 observed, softening in the first degree has 

 scarcely ever been united to unequivocal in- 

 flammatory alterations. In the second degree 

 of softening, the existence of inflammation is 

 frequently demonstrable. 



It is especially by studying the anatomical 

 characters of the early stage of softening 

 that we shall be enabled to establish the 

 non-existence of inflammation ; we may go 

 farther, and say that the characteristics of sof- 

 tening are directly opposed to those of in- 

 flammation. In the latter we find injection 

 and vascular congestion; in the former the 

 capillaries have disappeared; in inflammation, 

 thickening, and at first augmentation of density 

 in the membrane, which becomes rugous to 

 the touch ; in softening we find thinning and 

 diminution in the density of the tunic, with 

 loss of its tenacity, and it is soft to the touch ; 

 in inflammation we observe specific inflam- 

 matory products at the surface and in the sub- 

 stance of the tissue ; in softening a diminu- 

 tion and absence, then a total extinction of this 

 secretion, which is not only not augmented at 

 the commencement of the disease, as in the 

 first stage of inflammation, but is immediately 

 diminished. 



Inflamed tissues at a certain epoch do, it is 

 said, become soft and friable ; why should it 



