DUNCAN EVE, M. D., NASHVILLE, TENN.,

Professor of Surgery and Clinical Surgery in the Medical Department of the University of Tennessee.

In presenting the above subject to the readers of the PRACTITIONER, I would say that I am not notably affected with the cacathes scribendi, or that I possess any unusual information regarding it, but I desire to call the special attention of the profession to some points which I deem not sufficiently emphasized in many of the systematic works on surgery, available probably to most practitioners.

Cystitis presents itself for consideration in two prominent

forms the acute and chronic. We propose to examine the latter only, referring incidentally to the former.

Chronic cystitis is a disease or condition of insidious invasion; the patient often not being able to recall any of the usual assignable causes which might have given it origin, and it may be regarded always as a secondary condition requiring often the most astute diagnostic powers to ferret out. The disease is always the result of local irritation from some one of the following causes: Retention of nrine, vesical calculi, tumors of the bladder or urethra, enlargement of the prostate gland, notably following gonorrhoea, paralysis of the bladder from over distention, the organ in this case being irritated by the retained and decomposing urine. Injuries to the spinal cord and organic diseases of the kidney are sometimes most potent factors, by causing perverted secretion and changes in the chemical constitution of the urine. Other causes may be noted, as the prolonged and injudicious use of stimulating diuretics, excesses in drinking or diet, excessive venereal indulgence, neuralgia and rheumatism, the retro-cession of gout, repression of cutaneous eruptions, the extension of diseases from contiguous structures, e. g., the rectum, anus, uterus or vagina, congenital or traumatic smallness of the external meatus, injuries of various kinds, particularly resulting from parturition. Persons having prolonged malarial attacks are very prone to its invasion.

The above may be noted as some of the principal causes of chronic cystitis, the disease rarely in my experience following as a sequence of the acute form, which is much less frequent than the chronic.

Of all the above causes, I desire to call the especial attention of the profession to the fact, that in my experience, strictures of the urethra and prostatic enlargements, resulting from gonorrhoeal attacks, are by far the most prolific factors in the causation of chronic cystitis. My experience extending over many years, and quite a number of cases confirm me in this opinion. Early in practice my attention was called to this fact, and since I have investigated it with more than ordinary care, and when I have called the attention of other surgeons to the fact, I