G. ARCHIE STOCKWELL, New York.
CYSTITIS.—Lat., from Gr., xiiartg, the bladder, and cri; inflammation.
Definition.—Inflammation of the uri nary bladder, involving one or more of its four coats: mucous, submucous, mus cular, and serous.
Varieties.—Cystitis has been divided into a large number of varieties, the sub divisions being based upon the many etiological and pathological features of the disease. A further classification of this disease into the acute, the subacute, and the chronic is dependent upon the intensity of the symptoms and the length of time of their existence and is utilized in this article.
Symptoms.—In acute cystitis the com mencement differs somewhat according to the determining cause. When trau matic, it may be ushered in with rigors or marked chill succeeded by burning pain in the bladder and glans penis, etc. In other instances, and when from other causes, it is announced by a feeling of uneasiness, which is located in the per ineum. There is increased frequency of urination and spasmodic pain during mieturition and more or less fever. Usu ally the fever is absent, but, in the severe forms, there is moderate fever and some times, in the pseudomembranous variety, quite high fever. -Usually the tempera ture in cases of fever range from 100° to 102° F., though it may be higher. These constitute the ordinary symptoms. Pressnre upon the bladder is intolerable. The urine may be blood-tinged through out the attack, but more usually is re placed soon by pus, and becomes am moniacal. Acute retention is common. If complete retention ensues, the bladder gradually becomes more and more dis tended and can be felt as a rounded tumor, giving a dull sound on percussion, rising higher and higher above the pubes. The tenesums vesicce, or the feeling that the patient has not emptied the bladder after the viseus has been emptied, may occasionally be communicated to the rectum; and, in point of fact, all of the pelvic organs may participate in the pain ful and distressing sensation.
The frequent desire to pass water va ries in intensity. It may be every few
moments or almost incessant; several times an hour or once in a couple of hours.
The constitutional disturbance, when the disease is of grave form, is very marked, as indicated by a frequent pulse, thirst, headache, and nausea, with great restlessness and mental anxiety. When cystitis progresses toward a fatal termi nation, portions of the walls of the blad der may suppurate or even slough, and may be discharged in stringy fragments; tbe urine emits a vile odor, from the products of its own decomposition and the gases resulting from the dead mucous and submucous tissue which it contains; the patient is harassed with hiccough; the pulse becomes very small and fre quent, the tongue dry and hard, streaked with a dark coat; the strength rapidly fails; the secretion of the kidneys di minishes or is entirely suspended; the countenance becomes sunken and cadav erous, the extremities cold, the surface moistened with perspiration, from which emanates the odor of urine, and the pa tient at last passes into a state of pro found stupor, from which he never awak ens. (D. Hayes Agnew.) In chronic cystitis the symptoms are mainly those of the acute variety, but in a milder degree. Only slight fever is present, but the combination of pain and other distress rapidly undermines the general health.
Case of cystitis without symptoms. Tbe urine was pale, bad a, specific grav ity of 101S, and contained much albumin and some leucocytes, with epithelial and granular casts. There was no uruentia. At the autopsy was found chronic cystitis, especially around the trigone. Martha Wollstein (Med. Rec., jan. 23, '97).
The urine is turbid, alkaline, and contains much mucus and pus, which forms a tenacious clot at the bot tom of the retaining vessel. While the urine is usually alkaline, it occasion ally is faintly acid, but, if so, promptly becomes alkaline, due to the formation of ammonium carbonate out of the nor mal urea, the probable result of the oper ation of bacteria.