It rarely happens that the inflammation spreads over the entire extent of the bladder, or that it invades the muscular tissue; if it should complicate the latter, it would involve the peritoneum; this would add a very serious complication, namely, a peritonitis. Cystitis may be due to an extension of gonorrhœal infection from the vagina and urethra, or from other purulent affections. Women who are unable to pass water after confinement, may be liable to the disease from retained urine, decomposing in the bladder and causing inflammation. On the other hand, a filthy catheter used by a midwife or doctor who is careless or ignorant of the necessary antiseptic precautions, and who fails to brush and boil out the catheters, and uses one catheter on different patients, without the precaution of even thoroughly rinsing it, may give rise to dangerous cystitis. The most serious case that I ever have seen was directly traceable to this cause. If impure air gets into the bladder this will also excite cystitis; to prevent that, is to close with the finger the outlet of the catheter that is used for drawing off the urine, when withdrawing the instrument, a precaution seldom observed. Newly-brewed malt liquors, alcoholic stimulants taken in excess, diuretics of spirits of turpentine and cantharis, or highly-seasoned and rich food, are among the exciting causes; irritating injections into the bladder or vagina, and even cold-water injections into the vagina, must be added as exciting causes of this painful affection. Venereal excesses operate in exciting visceral inflammation, and when the slightest symptoms are felt, prudence and good common sense dictate continence. The first feeling that manifests itself is a dull, heavy, aching sensation, immediately after urinating, and an involuntary inclination to further relieve or empty the bladder by pressing or bearing down. Soon after the first indication to void urine, there is another desire to empty the bladder, and the same symptoms repeat themselves, only in a more aggravated form. The distress of micturition gradually becomes continuous so that during the short intervals between the times that urine is voided, and as the disease progresses, the pain becomes sharper. This is accompanied by a kind of gnawing uneasiness in the region of the whole bladder, which has intermissions, but is greatly increased when the desire to make water is felt. If the disease progresses, the pain is now felt in the neighboring organs and a general constitutional disturbance manifests itself. The patient will now generally have a severe chill; this is followed with heat and thirst and an increase in the pulse. The desire to void urine at shorter intervals becomes more prominent and only drop by drop, accompanied with distressing spasm and a burning sensation along the urinary canal.