We have already alluded to the more or less diffused inflammation of the cellular tissue surrounding the bladder, which supervenes upon intense inflammation of the muscular coat and suppuration of the bladder (vide p. 173), or is the result of infiltration of urine after accidental or intentional wounds of the bladder, of ulcerative perforation, and of an extension of inflammation from adjoining cellular structures; but we have besides these a spontaneous inflammation of the cellular tissue surrounding the bladder, which is designated as pericystitis. Like the inflammatory, suppurative, and gangrenous processes of the subcutaneous cellular tissue, or of the cellular tissue surrounding the caecum or rectum, it may be idiopathic, though it is more frequently a secondary process; it is to be considered as a localization of pyaemia, which was either spontaneous or dependent upon an absorption of pus, or of a degenerate typhous or anomalous exanthematic process. It spreads with facility through the cellular tissue of the pelvis, to the cellular septum of the rectum, to the anus, and into the scrotum; it attacks the submucous tissue of the bladder, and having passed into suppuration and necrosis, causes an exfoliation of the mucous membrane and perforation of the vesical parietes.

The affection is sometimes of a chronic nature, and then gives rise to induration, callosity, and rigidity of the bladder.

3. Gangrene Of The Bladder

Gangrene is the result of intense inflammation, brought on by the contact or imbibition of anomalous urine in the affected tissues, in which cases it assumes the appearance of sphacelous fusion (vide p. 173); or it results from contusion, and then we find an eschar formed (vide p. 174).

4. Softening

Besides the fusion of the mucous membrane accompanying the exudative process, we have but once observed a gelatinous softening of the vesical mucous membrane. It occurred in a case of typhus which had reached the ulcerative stage, and the bladder was found to contain a large quantity (three pounds) of putrescent urine.