For irritability of the vesical neck we may use narcotics locally in the form of vaginal suppositories, bougies and vesical injections.
Atrophy of the female bladder may occur in consequence of very great distension and dilatation, but happens more frequently from that condi tion of paralysis of the muscularis which we shall describe more fully under the head of neuroses of the bladder in Chapter XVI. Occasionally it is seen with a hypertrophied muscular coat, ae in one of our own cases; and in old women it may occur without any paralytic condition being present, the vesical walls being sometimes almost as thin as paper. All three coats seem to participate in the atrophy, and I believe that it is a cause of the frequent occurrence of cystocelo in advanced life. This latter condition is of course only to be treated by mechanical means of retention or by anterior colporraphy. If disturbances of micturition still persist, the use of local stimulants, cold douches, catheterism, and the induced current are indicated.
Chronic Vesical Catarrh in an old Woman. Rapid Dilatation of the Urethra; Illutninat ion. of the Inner Surface of the Bladder with Ru tenbery's Apparatus; Great Mobility of Mucosa upon 3Iuscuktris. Washing of Bladder twice Daily with Salicylic Acid Solutions. Cure in 8 Days.
A woman 60 years old, large sized and of strong frame, entered my gynecological division July 6th, 1876. Since her last pregnancy, 20 years before, she had not menstruated. Four weeks ago she underwent severe bodily exercise, and began to have pains in the vesical region, especially before and after micturition. The epi- and hypogastric regio:as were very tender, the vagina was narrow and in condition of senile atrophy; the posterior bladder-wall was very sensitive to the touch; the urine was pale and muddy, and contained a little albumen. A chronic cystitis was
diagnosed. The urethra was dilated under chloroform, and to my aston ishment I found that a pale bluish-red portion of the mucous membrane forced itself into the lumen of the largest speculum, making me believe there was a vesical polyTus. But I could feel none when examining with the finger, though I recognized then that the entire mucosa was loosened and movable upon the muscularis. No polypus were visible when the bladder was dilated with air and illuminated. Thero were only the appear ances of chronic hyperEemia, moderate redness, swelling of the mucosa and ready bleeding of the inner vesical surface when injured. Injections of salicylic acid 1:600 were ordered twice daily, and tra. quinine and later decoct. colombo with tra. tbebaica internally for her diarrluea. The urethral dilation, though done strictly according to Simon's rules, did cause a moderate-sized bleeding fissure at the base of the clitoris. The urine was drawn by catheter for the first two days. There was no other reac tion. The temperature was never over 99.3° F., nor the pulse above 63 to 84. The burning after injecting lasted about one hour, and then the patient felt better. The urine cleared, and on July 15th the patient was discharged cured.
The peculiar loosening of the mucous membrane, which might have become inverted through the urethra, and the slight amount of reaction in spite of the patient's age render the case especially interesting.