A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
Between these limits the symptoms range, but in a general way it may be
said that the symptoms of chronic vesical catarrh are these: frequent
calls to urinate, attended by more or less pain, especially toward and
after the termination of the act. The sense of satisfaction normally
felt after urination is generally absent. Motion, particularly jolting
as in rough riding, causes pain. This pain is referred to the lower
part of the belly, to the perineum, to the end of the penis, the
urethra, the anus. The straining after urination may be absent or of
the most intense character, leading to prolapse of the rectum and
causing excruciating torture. The urine always contains pus scattered
through it, and generally also more or less pus in that semi-solid
condition known as stringy mucus. Stringy mucus is pus gelatinized by
the ammonia of the decomposing urine. These clots of muco-pus contain
gritty crystals of the ammonio-magnesian phosphate. More or less blood
is to be found in the urine, especially during acute paroxysms. Pure
blood sometimes follows the urine after each act of urination. Bacteria
abound in the fluid, which varies in odor greatly in different cases,
not always strictly in accordance with the severity of the actual
inflammatory process. Thus, the urine may be simply sweetish in its
odor, ammoniacal, flat, and stale, or be possessed of a putrid,
sickening sweetness of indescribably nauseating power. Again, it may be
rankly rotten. The bottom of the chamber in some cases becomes {130}
covered with a thick coating of the viscid muco-pus, which strings out
and reluctantly follows the fluid when the vessel is inverted.
Sometimes the urine contains shreds of false membrane or putrid masses
of sloughy tissue.
PATHOLOGY.--In chronic cystitis the mucous membrane of the bladder
undergoes gradual thickening, loses its pink salmon tint, and becomes
gray in color. The thickening extends to the submucous layer, and more
or less to the muscular walls as well. In cases of prolonged chronic
cystitis attending atony of the bladder, notably with hypertrophied
prostate, the cavity of the organ is large, its walls seemingly thinned
and flabby, its internal coat roughened by the crossing of bundles of
muscular fibres or perhaps perfectly smooth. In other conditions
(concentric hypertrophy), where there has been a serious obstacle to
the free outflow of urine without any atony of the muscular coat
(stricture of the urethra, some cases of stone and of enlarged
prostate), the walls of the bladder may be enormously thickened to the
extent of an inch or more, the inside surface rough, perhaps ulcerated.
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