H HEMATURIA. 523 



is primary, it does not correspond to the period during which blood- 

 stained urine is passed, and is not sufifieienfc to explain it. It always 

 appears in the form of a more or less abundant hsmorrhagic intra- 

 mucous, sub-epitheHal spotting. 



Over the hemorrhagic area, which may be of very varied dimensions, 

 ranging from those of a small pin's head to those of a lentil, the epithe- 

 lium is swollen and loosened, and so separated from the surrounding 

 parts as to have lost its vitality. This patch of separated epithelium 

 soon falls away, leaving an epithelial ulceration of the mucous mem- 

 brane. The subjacent clot rapidly breaks up in contact with the 

 liquid in the bladder, and is replaced by a small ulceration which 

 becomes the seat of continual capillary hemorrhage. Nevertheless, the 

 neighbouring tissues react, and the process of repair may end either 

 in true cicatrisation, which appears to be rare, or more frequently in 

 the formation of exuberant granulations, which are also of the nature 

 of a soft, bleeding vegetation. This vegetation is either sessile or 

 pedunculated, and is of very varying size. 



The wall of the bladder also reacts, becoming sclerosed and thickened 

 beneath the granulations, so that, in animals which have long suffered 

 from hfematuria, it may entirely have lost its dilatability. 



When the disease has existed for a certain time, sub-ei^ithelial 

 hfemorrhages, ulcerations, vegetations and points of sclerosis may all 

 co-exist, a fact which shows that the disease does not develop all 

 at once, but that, on the contrary, every little lesion develops sepa- 

 ratelj' and continuously. This fact also exjDlains the length of time 

 for which blood may be passed, despite the presence of old or healed 

 lesions. 



I'inally, in very old standing cases dating from several years back 

 (Moussu saw an animal aged twenty-eight years which had suffered 

 from this disease for more than twenty years, but in a very inter- 

 mittent fashion), it is not exceptional to find numerous papilliform 

 vegetations 1 or 2 inches in length, either with a fine pedicle or 

 largely sessile, invading one-half or two-thirds of the internal surface 

 of the bladder. 



These vegetations sometimes, though rarely, invade the ureters. 

 When they occur towards the point where these conduits enter the 

 bladder, they obstruct the passage of urine, and lead to the develop- 

 ment of hydro-nephrosis or pyelo-nephritis. 



Symptoms. The early symptoms often escape notice, because 

 general disturbance is rare. The first appreciable signs are cystitis 

 and frequent urination. 



The urine passed is turbid, particularly towards the end of the act 

 of urination ; then it is of a pink or red colour, and all intermediate 



