INFLAMMATION OF THE BLADDER.
Cystitis, or inflammation of the bladder, is an affection of fre quent occurrence. It is a disorder which often requires some me chanical management, such as the use of the catheter or washing out the bladder; and therefore, for its successful treatment, much de pends not only upon the manual skill of the practitioner, but also upon his judgment in the selection of the necessary applications. Cys titis rarely occurs as an idiopathic disorder, but commonly in associ ation with some other derangement of the urinary system. Formerly it was a consequence of the old operation of lithotrity, where, after each crushing, rough fragments of stone were left in the bladder and excited inflammation. This complication often proved so rapidly fatal as seriously to compromise this proceeding. The important improvement introduced by Bigelow, of crushing and removing the fragments of stone by suction at the same time, disposed of the most frequent cause of acute cystitis we then had to deal with.
Acute cystitis is generally traceable to injuries involving the pelvis and bladder, to the introduction of foreign bodies or septic germs of an irritating nature into the bladder, and to the decomposition of urine. When the bladder is acutely inflamed we have all the local
and general symptoms more or less prominent of an active inflamma tion of a vital organ. There is supra-pubic pain and tenderness, sometimes running into general peritonitis, with vesical and rectal tenesmus, and the process of expelling the scanty high-colored urine is extremely distressing. Sometimes there is retention, but not ways. The urine is often remarkable in appearance, resembling thin prune juice, and containing blood and mucus intimately mixed with it. Under the acute cystitis of prolonged retention of decomposing urine, both in men and women, the whole mucous coat may come away entire, or in detachments as a sloughy mass.
A rapid disorganization of the bladder is sometimes observed in association with disease of the spinal cord, and is probably depen dent, as Charcot" suggests, upon irritation of certain parts of the latter, and more particularly of the gray matter. This is exemplified in the following case: