look is not
unfavourable. A generation or so back nearly all the cases of rupture
of bladder ended fatally.

_Villous disease_ of the bladder is innocent; that is to say, it does
not spread to the neighbouring structures or implicate the lymphatic
glands. The villi are slender, branched, filamentous processes which,
springing from the floor of the bladder, float in the urine like
seaweed. They are freely supplied with blood-vessels, so that when a
piece of a villus is broken off there is likely to be blood in the
urine. Indeed, painless haemorrhage is one of the characteristic
features of the disease, and when fragments of the "seaweed" are found
in the urine the diagnosis is clear. If the bladder is opened from the
front, as already described, the villi may be nipped off by special
forceps and the disease permanently cured.

_Malignant disease_ of the bladder is almost always the warty form of
cancer known as epithelioma. It springs as a sessile growth from the
mucous membrane of the floor near the opening of one of the ureters,
and, worrying the sensory nerves, causes irritability of the bladder
and incontinence of urine. In due course septic germs reach the
bladder, either from the urethra, the bowel, the kidneys or the
blood-stream, and cystitis sets in. When ulceration has taken place,
blood occurs in the urine, and the patient--generally beyond middle
age--suffers dull or lancinating pains. Eventually the rectum may also
be involved and the distress becomes extreme. The presence of the
growth may be determined by sounding the bladder, by the cystoscope,
and by the finger in the rectum. If the growth invades the outlet,
retention of urine may occur, and the surgeon may be compelled to open
the bladder from the front of the abdomen. In cases where operation is
out of the question, washing the bladder with hot boracic lotion may
give great relief. The treatment of cancer of the bladder by operation
is, as a rule, unsatisfactory, because of the close proximity of the
growth to the ureters and to the rectum. If, however, the disease were
recognized early and had not invaded the neighbouring structures, and
if it were upon the upper or the anterior part of the bladder, its
removal might be hopefully undertaken.

_Hypertrophy and Dilatation._--When there is long-continued
obstruction to the flow of urine, as in stricture of the urethra, or
enlar