NUTRITIVE DISTURBANCES OF THE FEMALE BLADDER.
Hyperfemia is the _ slightest, though hemorrhages may occur in it. If hyperwmia persist long, there will be hyper-secretion, catarrh of the bladder. If with this the urine is decomposed, there will be croupous inflammation of the mucous membrane, or diphtheritic affections. The muscularis and soon the serosa is involved, until we have the so-called cystitis parenchymatosa and pericystitis, which may finally end in abscess, gangrene, or necrosis of the vesical wall. In many cases we find in one and the same organ the various stages of nutritive disturbance side by side. This Cossy has well described in his case of bladder disease in typhus fever, as also has Kru kenberg in his collected cases of gangrene of the bladder.
Of hyperfemia we have an acute and a chronic form. The mucous membrane is colored a more or less vivid red, its vessels are congested, its tissues swollen. If this congestion persists and becomes chronic, there occurs permanent dilatation of the smallest vessels, especially the veins. This condition easily leads to hemorrhages from rupture of vessels. If this occurs below the epithelium, there occur ecchymoses of the mucous membrane only. If the blood is poured into the bladder, it mixes with the urine or it may coagulae. If the blood remains any length of time in the bladder, it forms a coffee-grounds-like mass in the urine. Occa sionally a firm fibrinous clot forms the nucleus of a calculus. Severe hemorrhages are especially liable to occur when there are varicosities of the vesical neck, what may be called vesical hemorrhoids. They are especially liable to occur in pregnant multiparte.
Catarrh of the urinary bladder also may be acute or chronic. In the acute cases there is first dilatation and overfilling of the vessels, the sur face remaining intact. After a few days the epithelium, especially at the summit of the folds, is c,ast off, probably because of the abundant leuco cytic emigration. The bladder is usually contracted, and the folds of the mucous membrane contain a milky-white, purulent fluid. The chronic form of the malady is very likely to supervene. The redness and swelling,
formerly diffuse, become localized in spots; and the swollen mucosa is bathed with tough mucus or muco-purulent or purulent secretion. The swelling of the mucous membrane increases and may go on to a polypoid hypertrophy. The submucosa and the intermuscular connective tissue now take part in the process; there occur changes in the muscularis and the seroea. Under the influence of the abnormal secretion, the urine undergoes alkaline decomposition, and becomes a fresh source of irrita tion for the diseased vesicular wall. Incrustations with urine salts occur, and more or less deep ulcerative processes set in. The muscle-bundles withstand the progressive ulceration better than other tissues; they become exposed and undermined, and may be seen as bridges or loose pro jections in the midst of the ulcerated areas. (Blebs.) The muscularis as a whole is generally thickened.
Gradually the bladder-wall is perforated. Yet fistulous openings into neighboring organs rarely occur. The peritoneal coat becomes thickened, and then occur adhesions between the bladder and surrounding parts. Finally, perforation or infiltration of urine and septiconnia may occur.
The highest stage of inflammation of the bladder-wall terminates in gangrene. The organ is relaxed and dilated, its muscularis is paralyzed, and its contents are changed into a brownish chocolate-colored fluid. The urine contains mucous flakes, blood, pus, and urinary sediments; the mu cosa is softened, discolored, black, covered with flakes of mucous or urin ary salts; the submucosa and the muscularis are infiltrated with pus; the peritoneum is injected and covered with flocculi of lymph.
Thus we have, as a general thing, the entire wall of the bladder parti cipating in the inflammatory process. We have cystitis mucosa, c. paren chymatosa and c. serosa or pericystitis. Any distinction between these different varieties which we may make at the table is only valid in so far as it designates the point of origin and chief seat of the malady.