Diseases of the urinary and male sexual organs / by William T. Belfield.

  • Belfield, W. T. (William T.)
Date:
[1884], ©1884
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the urinary and male sexual organs / by William T. Belfield. Source: Wellcome Collection.

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    cme from the operation. The most frequent source of failure and disaster in opening the bladder by either one of these methods is the neglect to as- certain in advance the condition of this organ and to recognize the dangers attendant upon the sudden evacuation of residual urine. In those cases in which the bladder is habitually distended and hypertrophiccl, serious reaction or even a fatal result may be expected from either of the two op- erations, however skilfully performed. After opening the bladder, the best results are obtained by placing the patient in a continuous bath of slightly alkaline water, as is the custom of many German surgeons. In this way the inflammatory products are pre- vented from accumulating upon the vesical mucous membrane, which is, moreover, kept constantly warm and moist. If this plan be impracticable, the patient should at least take several warm hip-baths daily. The experi- ence of Whitehead, Thompson, and other English surgeons during recent years in the digital examination of the bladder will doubtless lead to the more frequent performance of urethrotomy in the membranous portion for the relief of chronic cystitis. In my last two cases of chronic cystitis (both caused by enlargement of the prostate in elderly men) I have employed with great advantage the method of continuous application of hot water to the vesical mucous membrane. Among the measures employed is counter-irritation above the symphy- sis ; even the actual cautery has been used for this purpose. It is doubtful whether benefit is derived from anything more severe than the use of a flaxseed poultice liberally s]3rinkled with mustard or turpentine. Morphine as a subcutaneous injection or in a rectal suppository is often required to relieve pain and tenesmus. The possibility that a chronic cystitis may be of tuhercular origin should be remembered, especially in the treatment of scrofulous individuals or those w^ho exhibit evidences of tuberculosis elsewhere. Tuberculosis rarely causes pronounced symptoms in the bladder until it is well developed in other organs of the genito-urinary tract ; nodular enlargements of an epi- didymis, an asymmetrical and nodular prostate, or a thickened seminal vesicle are usually present to indicate the character of the cystitis. Some- times, however, all these organs remain apparently normal, while the kidney may be the seat of extensive tubercular change. It is to be remembered that tuberculosis of the genito-urinary tract occurs as a primary alfection, and may even lead to a fatal result without causing pulmonary or general disease. This local tuberculosis frequently dates its development from gleet, orchitis, or a simple cystitis ; the affected organs never recover en- tirely their former condition ; a mild, subacute affection remains, which after months have elapsed first exhibit symptoms that arouse suspicion of the tuberculous nature of the affection. In a few rare instances tubercular cystitis has been developed during the course of a gonorrhoea, both the tubercle bacilli and the gonorrhoeal micrococci having been detected in the discharge (Cornil and Babes). The symptoms of tubercular cystitis are often identical with those of chronic inflammation of the bladder from other causes. They vary in in- tensity according to the extent of the urinary mucous membrane involved. So far as the bladder itself is concerned, tubercular inflammation is usually limited to the trigonum and its immediate vicinity ; sometimes the kidneys and urethra remain intact, while in other cases the entire urinary mucous membrane from the kidney to the meatus externus, is studded with tuber- cles and ulcers. As a rule hsematuria is a prominent symptom in tubercu- lar cystitis; the quantity of blood may not be large, but it constitutes a