CYSTITIS.
True acute cystitis is a rare complication of urethritis. The epithelium of the vesical mucous membrane is singularly resistant to gonorrhoeal infection. When it does become infected, it is by virtue of the mixed infection characteristic of gonorrhoea,. The majority of cases in which acute gonorrhoeal cystitis is diagnosed consist of acute follicular prostatitis—i.e., inflammation in and about the true vesical neck. When infection of the bladder does occur, the resulting inflam mation may become chronic. Extension to the ureters, renal pelvis, and even the renal structure proper may occur. Rare cases of acute general cystitis in the course of gonorrhoea have been reported. They are characterized by profound asthenia and a typhoid condition, with dry, brown tongue, delirium, and fever, and it is claimed sloughing of the vesical mucous membrane may occur in some cases.
Symptoms. —Frequent, painful, and perhaps bloody micturition. More or less tenderness of the vesical neck, as disclosed by palpa tion externally and per rectum. In severe general cases extreme hypogastric tenderness exists. In some severe cases the symptoms strongly resemble those of general peritonitis, the abdominal tender ness and pain being quite diffused. A certain degree of peritoneal involvement is quite possible. Severe constitutional symptoms are not unusual. The urine is scanty, high-colored, and perhaps bloody. It contains albumin proportionate in amount to the quantity of pus and blood present. If sloughing of the mucous membrane occurs, shreds of that structure are expelled with the urine. Clots may be formed and come away with the urine during micturition, their ex pulsion being attended by severe pain and tenesmus.