It is the grouping of all these urinary troubles, (not included in albu minuria), which Monod and Terrillon have studied lately with great care, and both have shown that they are much more frequent than one would suppose. Thus Monod, on questioning 124 primiparte or multipane, not only as regards the existence of the urinary trouble, but also as to the pain, the frequency, and the time of the appearance of the trouble, has found that in 4 cases the vesical symptoms have shown themselves at the beginning of pregnancy in 33 women out of 131 cases. Here are the observations taken of 124 women: Women who did not suffer from urinary troubles in any period of pregnancy, 61.
Women having urinary symptoms, 63.
Women who had frequent micturition in the last two or three months, or rather in the last four months of pregnancy, 37.
Women having vesical symptoms during the first weeks, 26.
Of these 26 women, frequent desire to urinate only, 11; frequent and painful micturition and complicated by luematuria, 15. Among the 26 cases of urinary troubles at the beginning of pregnancy, 16 were primiparse, 10 multiparx. To these figures must be added seven cases of Monod, and we have the following total of cases in which the urinary troubles began at the commencement of pregnancy: Number of women, 131; with urinary trouble, 33.
The causes of these troubles are, lst. Mechanical. 2d. Inflammatory. They occur not only during pregnancy but more frequently after con fmement. They are due to pressure exerted by the fcetal head on the *base of the bladder, and to obstetrical operations, and are the product of true inflamtiatory lesions, which may produce sloughs or fistulae. But during pregnancy there is one cause more important than all others, the pressure exerted. by the gravid uterus, which causes retention, and all the sequelte more or less severe which accompany it.
Monod rightly distinguishes four cases; 1st.. Retention during preg nancy; 2d. Cystitis beginning at the commencement of pregnancy; 3d. Cystitis after the puerperal period; 4th. Cystitis independent of the puerperal state, but dependent upon uterine influences.
1. Retention during chief cause is retroversion of the gravid uterus. We only mention it here, and treat of it at length in a special chapter. We will say here, that it may become the cause of cystitis more or less severe, and can go on to the exfoliation of the vesical mucous membmne, (Wardell, Spencer Wells, Wittich, Philips, White head-Haussman, Moldenhauer, Schatz, etc.). Filially, Playfair has re ported a case in which retention was due to a mal-position of the fcetus- transverse position.
2. there is another Catlfe of urinary troubles which declares itself in the first weeks of conception, and which is independent of all the ordinary causes of vesical inflammation. This cause of urinary troubles, mentioned by Terrillon, 011ivier, Hervieux, Madame Puejac of Montpel lier, is simple cystitis, whicta may be accompanied by slight frequent micturition or dysuria, or acute pain, or luematuria, or even by abor tion, as in 011ivier's case.
Cystitis, according to Monod, may be the result of passive hyperaemia of the vessels which supply the bladder and uterus, accompanying those uterine congestions which occur at the beginning of pregnancy. It is not of special importance, except in regard to the conditions causing it.
Mons has already mentioned cystitis of the first month of pregnancy, which he, with Churchill, attributes to a vesical c,atarrh, produced by reflex irritation: after the second month it is to be attributed to irritation, to pressure of faecal matter, the result of constipation, and also to retrover thou.
He acknowledges several varieties of cystitis, and mentions the fact that Tillaux, Parent, Richet have reported °saes of varicose cystitis or hemor rhoids of the bladder. Aside from this kind of cystitis, he mentions two varieties which he calls post-puerperal cyetitis. One is produced only by traumatism during confinement, the other is idiopathic, and may be produced after abortion, after a normal labor, and may disappear almost immediately after confinement, or more slowly (six weeks according to Monod, Galleon de Mussy, Hervieux, Olshausen, Kaltenbach, Voille mier, etc.). Finally, he mentions cystitis in women independent of the puerperal state, but not treated of here, and he arrives at the following conclusions: let. Urinary symptoms, in pregnant women, arise from two different causes, and to each are attached a distinct group of clinical symiltoms. One, the pressure of the gravid uterus which produce,s retention, the other vesical congestion, which is explained by the vaacular connection between the uterus and bladder, and which produces, in the latter organ, &predis position to inflammation. 2d. An acute cystitis, which is manifested during the first weeks of gestation. 3d. Cystitis observed immediately after or in the first weeks following a normal labor, which is called post puerperal cystitis on account of the time of its appearance. 4th. The anatomical relation and vascular connection between the uterus and the bladder accounts for the frequency with which urinary troubles accom pany a great many diseases of the uterus, even under certain physiological modifications of this organ during menstruation or at the menopause, for example.
There are, then, certain inflammations of the bladder peculiar to women, and, contrary to the common opinion, cystitis is far from being rare.
Terrillon has reported a number of analogous cases, and the discussion of the subject (1880) in the Surgical Society, allowed several surgeons to increase the number of observations.