The affection is more common in men than in women, and at the approach of age than at any other period of life. BOisseau describes the disease in a male child of two years old ; Lesaive in a female child of two years and a half. Acute inflammation commonly affects at the same time more than one of the vesical tunics; there are, however, on record two cases in which acute inflammation was limited to the peritoneal tunic of the organ.* Dr. Bail lie suggests, as a reason for such limitation to this particular tunic, the quantity of cellular tissue interposed between the serous and mus cular tunic, and the laxity of their connection the one with the other. Chronic inflammation is frequently confined solely to the mucous tunic of the organ.
Acute cystitis may terminate by complete resolution ; it may cause a secretion of pus, which is either diffused in points over the greater part or even the whole of the surface of the organ, or circumscribed under the form of abscess ; may produce ulceration, may ter minate in gangrene, or it may assume a chronic form.
If death supervene during the intensity of acute inflammation, we find the mucous mem brane strongly injected, patches being pre sented of a brownish colour, commonly in the vicinity of the neck and fundus of the organ ; nor does it appear that the occurrence of such patches in these situations can be attributed to the irritation occasioned by the prolonged con tact of acrid urine. At other times the mucous membrane is thickened, and the veins much dilated ; pus is disseminated over the surface, or collected into foci; patches of false mem brane are extended over portions of the organ or floating in the contained fluid, and gan grenous points are presented; these points may only affect the mucous tunic, or they may affect the entire thickness; it is sometimes studded with small ulcerations,which are more or less concealed by folds of the membrane, and not unfrequently it is softened. Usually the organ is very much contracted, so much so as to present only a very small cavity. This effect is induced by the contraction of the muscular fibres which is excited by the exten sion of the irritation from the mucous mem brane.
When the disease terminates by resolution, ordinarily, in a short time, all trace of the existence of the affection disappears. In cer tain cases, however, where it has existed long, the parietes of the bladder have been found slightly thickened; one or more branches of veins have become varicose and consequently more apparent. If the disease have had a still
longer existence, we may find the mucous membrane thickened ; but this effect is more frequently manifested in the muscular tunic.
When a purulent secretion is produced, pus is found diffused through the substance of the parietes, more particularly, however, in the cellular and muscular layers, and an appear ance of hypertrophy is here produced ; or it is poured out upon the surface of the mucous tunic. Occasionally, but unfrequently,abscesses are formed between the tunics, but these are commonly a consequence of wounds or con tusions of this organ, or of the operation for stone. In such cases the abscess may open itself on the external surface of the bladder, or upon the interior. Sometimes it is pre sented upon the sides of the rectum, but according to Chopart it is usually in the neighbourhood of the neck of the organ that suppuration commences. When an abscess opens upon the internal surface of the bladder, the pus passes out, mixed with the urine ; in such cases we discover after death more or less extensive and profound fistulous openings, which are sometimes surrounded by varicose veins, sometimes covered by dark grumous blood, exiravasated from the small vessels which ramify on them : they all exhale a fetid odour.
Ulceration of the bladder as a consequence of acute inflammation is unfrequent ; indeed, of this affection there are only a very small number of cases on record. When it occurs, it is commonly caused by the opening of a purulent collection upon the mucous surface of the organ. A case, detailed by Marechal in the 28th vol. of the Recueil Periodique des Travaux de la Societe de Medecine de Paris, is the best marked case of the affection With which we are acquainted. It was that of a hussar, in whom the affection appeared to be brought about by a violent attack of gonor rhcea : the patient died on the fifth day. Upon an examination of the organ after death, it was found rather contracted.; though not filled with urine, its parietes sustained themselves ; it contained eight ounces of a greyish thick matter : the mucous membrane was extremely thick, and covered by a glutinous stratum. It presented, however, many ulcerations of varied extent; the parietes of the organ were six lines in thickness.