a. We have never observed the formation of cysts between the coats of the bladder, or in its mucous membrane, though from their occurrence in the ureters, pelvis, and calices (vide p. 167), we are not inclined to dispute the possibility of the former. We have to remark that the accounts of a discharge of hydatids or acepha-locysts from the bladder for the most part depend upon a descent of these growths from the kidneys, or from other organs (e. g. the liver), that have formed adhesions with the urinary passages, to the bladder, from which they are eliminated.

B. Tubercle

Tubercle of the vesical mucous membrane is a very rare occurrence, and is not even always found as a complication of tubercular affection of the urinary apparatus, which, as we have already seen, is combined with and results from tuberculosis of the sexual organs. When it presents itself on the vesical mucous membrane, it is commonly also associated with tubercle of the urethra and prostate gland.

It assumes the form of discrete granulation only, and is deposited, with more or less reaction and vascularity, under the mucous membrane; it becomes softened with greater or less rapidity, and after perforating the mucous membrane within a vascular area, leaves a small circular ulcer. According to our observations, and owing probably to the rapid development of the tubercular disease in the other segments of this and the sexual system, as well as to the high degree of the universal cachexia, secondary tubercular deposition and secondary enlargement of the tubercular ulcer in the bladder, are found to be very unusual. The cervix and fundus of the bladder are the main seat of tubercle; we sometimes however notice that the bladder is involved in secondary tubercular ulceration by an extension of the disease from the prostate gland.

C. Carcinoma

The bladder is either attacked primarily by cancer, or the disease is consecutive, having spread from neighboring organs, especially the uterus, the vagina, and the rectum. The latter is by far the more common case.

We have observed the following varieties of cancer: a• Fibrous cancer occurs but rarely in the shape of cancerous degeneration of the vesical membranes with thickening, cartilaginous induration, and the characteristic metamorphosis of the muscular layer; we have seen it spread over large surfaces, at the side of the bladder, both upwards and downwards, accompanied by carcinomatous degeneration of the female urethra.

B. Medullary cancer occurs in the shape of nodulated morbid growths between the coats of the bladder, and is commonly associated with cancer in the adjoining sexual organs of the female, and with cancer of the rectum. It perforates the mucous membrane, and occasionally gives rise to a characteristic carcinomatous ulcer with raised edges.

y. The most frequent form of cancer occurring in the bladder presents the appearance of soft, furred, cauliflower-like, vascular, and generally bluish-red vegetations, which bleed on the slightest touch, and are attached by a rounded flattened peduncle; they arise from the mucous membrane and the submucous cellular tissue with delicate fibres, and develope a very fine membranous tissue, within which a whitish or reddish-white, creamy or medullary (encephaloid) mass is formed. They are either isolated or grouped together, and at last coalesce so as to form a very large, loose, fissured, succulent, globular mass (fungus), which fills out the bladder in proportion as the latter becomes hypertrophied and contracted, in consequence of the permanent irritation. They chiefly occupy the neck and fundus, the trigonum and the parts near the urethral orifices; they are sometimes spread over the entire inner surface of the bladder, but they generally make their first appearance at the above-named spots, and it is there too that the large fungoid growths are found. Of several cases we may mention one in which these vegetations occupied and nearly filled the cavity of a diverticulum of the size of a duck's egg, which descended from the fundus of the bladder to the rectum and perineum.

The more they are developed, the more they are liable to produce considerable hemorrhage from their extreme vascularity; with consequent cachexia and exhaustion; they are occasionally found inflamed, covered, and interlaced with lymphatic exudation, and gangrenous.

This variety of cancer is frequently complicated with cancer in other organs; it is especially allied to the cauliflower excrescences occurring upon anomalous serous and fibro-serous membranes, and upon the inner surface of the compound cystoidea or of the peripheral follicles of areolar cancer that have been converted into large sacs; as also to erectile tumors or epithelial formations on other mucous membranes.