ORGANIC DISEASES OF THE BLADDER.
Hyperæmia.
This is an acute congestion of the mucous membrane due to a disturbance in the balance of the circulation. It may be common to both bladder and urethra, or limited to either; may terminate within a short period of time (a few hours), or it may go on and end in hemorrhage or inflammation. If the mucous membrane is seen with the endoscope, it appears of a bright-red color; the blood-vessels are distended, more prominent, and apparently more numerous. The arteries are the first to be affected. If the cause is transient, this is all that is seen, the membrane returning to its usual color. When the congestion is of a higher grade, rupture of some of the vessels occurs either on the free surface or beneath the epithelium. The venous side of the circulation now becomes more prominent. In a few cases the above order may be reversed, the veins being the first congested, as in the case of a sudden interference with the portal circulation.
SYMPTOMS.—The attack occurs suddenly. Frequent but painless urination is the most prominent feature. There is a sense of heat and heaviness in the bladder, aggravated by standing. When the urethra is involved the patient complains of scalding during urination. The pulse and temperature are practically normal. The composition of the urine is but little changed; there may be excess of mucus and a few blood-corpuscles.
DIAGNOSIS.—This has to be made by exclusion. It is apt to be confounded with a neurosis of the bladder or a displacement.
ETIOLOGY.—The most frequent cause is exposure to cold, especially during menstruation; over-taxation in walking or using the sewing-machine; excessive venereal indulgence; disorders of the portal circulation; and the use of improper articles of food.
TREATMENT.—Every means should be employed to equalize the circulation. The most important element is rest in the recumbent position. Diaphoretics and warm applications to the feet and epigastrium, and, as a rule, a saline laxative. Where there is frequent urination and vesical tenesmus and pain, Dover's powder and camphor should be given, or a suppository of morphia and belladonna by the vagina.
Hemorrhage.
This is a symptom rather than a disease itself. It is usually due to acute congestion or ulceration occurring in advanced inflammations, new growths, or the lacerations caused by foreign bodies and instruments. Hemorrhoids of the bladder due to obstructed circulation is not infrequently the source of the bleeding. The amount of blood transuded varies very greatly, though it is seldom so great as to prostrate the patient. In all cases when it is considerable it is of great importance to localize the bleeding point. The urethra can be excluded if there is no bleeding between the acts of micturition. The differential diagnosis between hemorrhage from the bladder or kidney is less easy. The old rule, that the blood and urine are more intimately mixed in renal hemorrhage than in cystic, is of little service. Sir Henry Thompson's method of detecting the source of pus in the urine may be employed in cases of hemorrhage. He introduces a soft catheter, and then washes out the bladder gently with warm water; if after a time the water comes out clear, the inference is that the bleeding point is higher up. To make sure, he corks the catheter until a drachm of urine has collected; if this is bloody, the diagnosis of its being extra-cystic is tolerably certain. With the endoscope it is occasionally possible, and always desirable, to locate the bleeding point.