This is perhaps seldom a condition by itself, but rather a complication
of the preceding disease. The ulcers occupy the place of what were
formerly little abscesses, that have broken into the cavity of the
organ. Foreign bodies in the bladder by their direct pressure on the
delicate tissues of the membrane have been the cause of ulcerations,
that gave rise to dangerous hemorrhage. Earthy concretions or stones
will naturally form in the bladder, and the end of a gum catheter
has also been found in the bladder broken off in the bungling act of
drawing off the urine, or, what is more likely, by boring and poking
within the cavity of the bladder, with a catheter or bougie, by persons
ignorant of pelvic anatomy or in the belief that the bougie was in the
cavity of the womb, for the purpose of inducing an abortion.
Ulcerations will always be accompanied with more or less inflammation
or visceral catarrh, so that the symptoms will fall under that head
which has already been considered.
CATARRH OR SUBACUTE INFLAMMATION.
The mucous membrane of the bladder, like that of the nose, mouth or
bronchial tubes, has its natural secretion of healthy mucous. When
any of these membranes become irritated or congested from any cause,
this natural secretion becomes so increased as to make a perceptible
_flow_ of the secretion of mucus, and this is what the term _catarrh_
signifies. Catarrhs always presuppose the existence of inflammation,
which in its nature is subdued or mild, so that it has been qualified
as subacute, which is intended to convey the idea that the tissue need
not be red nor hot and swollen as is always the case in the acute form
of inflammation.
Chronic catarrh of the bladder is traceable to any or all the causes
that have been enumerated in the acute processes, because every acute
inflammation of the bladder may terminate in a chronic form. It occurs
at any period of life, but it is most common in elderly subjects; it
is always an attendant of ulceration of the bladder or some abnormal
growth in the bladder. If the disease is once established and is due
to a complication, it is liable to become aggravated or re-established
after a brief subsidence by exposure to cold, excesses in diet and
drink, or diseases of the vagina, uterus or rectum.
The secretion of catarrh is white and glairy and resembles the
discharge of leucorrhœa or whites. When disassociated with acute
inflammation of the bladder, it comes on gradually, or in a slow,
insidious manner; for this reason the term subacute inflammation is
sometimes employed by authors, because there are no fiery symptoms at
the onset of the affection.
The urine is always more or less altered in character, because the
inflamed mucous membrane predisposes the urine to speedy decomposition.
There is frequent and difficult micturition, and the entire region, but
in particular the affected organ, is more or less sensitive and sore.