No. 3. (June 14, 1869, No. 180.) Cook, 63 years of age, died with pneumonia of the left lower lobe with induration of entire lung. Bron chitis, emphysema. Cheesy infiltration of kidney; enormous hydrone phrosis of right kidney with great dilatation of the ureter. Hypertrophy of the vesical wall. Tuberculous process in vesical mucosa, and purulent interstitial cystitis.
No. 4. (1876, No. 90.) Patient 29 years old. Dead of excavations of upper lobes of lung. Peri-bronchitis nodosa. Adhesive pleuritis. Dif fuse deep ulceration of small intestine. Tubercular ulceration of posterior bladder wall, pea-sized, and with swollen, hypermmic edges.
In the four cases of vesical tuberculosis which the autopsy books of the Dresden hospital record, two were plainly secondary, one to pulmonary and the other to renal and ureteral tuberculosis.
Kussmaul claims that tuberculosis of the urinary passages rarely lasts longer than one to two years.
There has recently been described an extremely interesting form of chronic catarrhal cystitis with the production of epidermoidal conere ments. Rokitansky long ago descrIed as a sequel to chronic catarrhal cystitis a condition of epidermoidal hypertrophy of the vesical mucosa, leading to the exfoliation of thick, shiny-white layers of epidermis cells. Lowerison (1862) has described the most instructive case of the kind oc curring in woman. The patient had mitral stenosis, and arrived at the hospital moribund. After death the bladder was found to be enormously dilated. In it was found a mass weighing 31 pounds and composed of small yellow round bodies, with a few shining discs interspersed, like a mass of boiled split peas, with a few beans in it. The entire inner sur face of the bladder was coated with these same placques, which were hth to an inch thick. The entire layer was elastic, and had a dull mother of-pearl glance. After removing this pavement epithelium, other mem branous layers could be stripped off from the mucosa. Urethra and ureters were normal, kidneys in condition of granular atrophy. Micro scopic examination showed that the epithelial cells of the mucosa had gradually acquired the properties of large epidermic cells, and were mostly without nuclei and granular. The spheres were composed of granular fat, lime, nucleated and epidermic cells. They contained stearin in abundance, but no cholestearin (which Reich—see Virchow-Hirsch Bericht f. 1875, II., 255—has lately found in the vesical mucosa of a man
suffering from chronic catarrh of the bladder). The bladder-wall was hypertrophic.
I.Zwenson ascribes the degeneration to a great epithelial overgrowth, with rapid degeneration and change into epidermic cells, while the blad der was in a continuous state of inflammatory irritation.
can be brief as regards the symptoms of hypermmia, acute and chronic catarrh of the bladder, since they are well known and have been thoroughly described in these volumes by Podrazky III. We will confine ourselves mostly to the symptoms of croupous and diphther itic inflammation. These consist of disturbances of function, dysuria, strangury and tenesmus, and not infrequently ischuria. There are pains after passing water, which radiate up to the kidneys. Then occur the urinary changes; the water becomes ammoniacal, it often contains blood, pus, epithelial cells, urinary sediments, and causes croupous inflammatory reaction in the parts which it flows over during evacuation. Thus in Bauer-Luschka's case, the entire vestibule was coated with a ragged mem branous layer, which was saturated with foul-smelling urine. The entire urethra is swollen, and becomes very sensitive. Not infrequently there now appear shreds and flocculi in the urine; the urethra may be plugged, the stream of urine broken, and even complete ischuria occur. Finally by increased abdominal pressure or by artificial means, the obstruction is removed. These flocculi may attain a considerable size. In Schatz's case (Fig. 62) and in that of Kiwsich, they were as large again a8 the palm of the hand; in Godson's case, as large as a clenched fist, and in Hausa raann's 2 inches in diameter.
In e,ases of ischuria due to plugging in this manner, it has often hap pened that the urine could not be evacuated, either by soft or metallic catheters. In piercing the soft mass, their fenestra become plugged up. In Bauer's case the bladder had to be punctured in consequence. Kiwisch also failed in the same manner; bat after extracting the mass he drew off three pounds of urine. Schatz could get nothing with the male instru ment; but with the elastic catheter he evacuated nine pounds of urine. Gradually the symptoms of urinary stasis appear. There is continual desire to pass water, the appetite fails, there is nausea and gagging, and constipation alternating with diarrhcea.