Secondary vesical tuberculosis / by James N. Vander Veer.

  • Vander Veer, James N., 1877-1937.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Secondary vesical tuberculosis / by James N. Vander Veer. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    [Reprint from Ame^^^^^urnai, of Dermatology, Vol. XIII., No. 2, 1909.] t KsT- •Xt V V SECONDARY VESICAL TDBERCDL»^onJ^ Viands of the average practitioner, there enters in the factor of trauma, whereby the bladder By James N. Vander Veer, A. M., M. D., Lecturer on Surgical Technique and Instructor in Genito- urinary Surgery. Albany Medical College, Albany, N. Y. The consideration of such an important sub- ject as tuberculosis of the bladder demands the closest attention of the general medical man especially, as well as of the surgeon and the specialist in genito-urinary diseases. Too often, alas! a patient goes to his family physician complaining of bladder or kidney symptoms, usually the former, and is given a very superficial examination—if, in fact, he is given any at all. As a usual procedure, his physician says to him, after inquiring into the subjective symptoms of the case, “Oh, you are not a very sick man; just leave a specimen of your morning and evening urine at the office when you go by to-morrow.” Often this urine is never examined, and the patient is dismissed with simply a urinary antiseptic illy chosen and without any therapeutic re- gard to the condition at stake. For the purpose of bringing up and, if possible, of delineating the proper methods of examination and determination regarding an operation for tuberculosis of the bladder, this paper has been prepared. If I exhibit the subject in too,pedantic a form, I trust that I may be pardoned, for there is not much definite knowledge to be gleaned as yet from the literature. Considering the etiology of the condition, we should first take into account the fact that the infection may be of several forms. It may partake of a tuberculosis the same as in other organs, but a primary tuberculosis of the bladder is extremely rare. When it is of the primary type it usually affects the sexual organs as well. Herberg makes the broad statement that from several thousand autop- sies which he has performed he has found it secondary in two-thirds of the cases, leaving us to surmise that one-third was primary. I personally believe that he states the percent- age of primary tuberculosis of the bladder as being too high. When primary in the bladder we must make note of the ever-present fact of the point of least resistance entering into the case and the locating of the tubercle bacilli at this point. Therefore, a gonorrheal cystitis- or a cystitis secondary to an old gonorrhea may form a site very favorable for the location of the tubercle bacilli. Again, with the oft-mishandling of stric- tures by means of sounds and dilators at the wall is injured and the locating of the bacilli at this point through a hematogenous infec- tion. In this connection we should not take into consideration the transplanting of a pri- mary tuberculosis of the prostatic urethra or the genital organs through manipulation, on the bladder wall, or the carrying of the tu- bercle bacilli by means of the blood or lym- phatic stream from an already existing focus into the walls of the bladder, and thereby set- ting up a secondary tuberculosis in the blad- der proper. Casper in his admirable text- book speaks of the etiology of tuberculosis of the bladder as being usually present, to- gether with some focus of tuberculosis in the lungs, thereby making it a secondary feature where the primary lesion has not been located. Lastly, we might mention the factor (which is so often overlooked by the average man) of tuberculosis- of the bladder being secondary to a tuberculosis of the kidney; for, if we refer once more to Flerberg’s statistics, we find that in his several thousand autopsies a secondary infection of the bladder was usually present, accompanying the tuberculosis of one or both kidneys. And it is especially upon the subject of secondary infection of the blad- der from a tuberculosis of the kidney that I would lay special stress. As to whether the infection is by a deposit of tubercular germs around tne neck of the bladder, and the consequent irritation and lighting up of the infection there by means of the urine, or as to whether it is by means of a direct infection extending along the ureter and thus down into the bladder, I would call to your minds that the second method perhaps is the most common. Of course, this can only be arrived at through a complete examination of the patient and especially of the part involved, ending up with a cystoco]iic examination of the bladder, and by the picture thus presented reasoning out as to the probable infection of a ureter or kidney. Ammoulin is a firm believer in the theory that there is a submucous network of lym- phatics connecting the ureter, the kidney and the prostate, and by means of these lymphatics a primary tuherculosis in any of these parts is quickly carried to the bladder, where it presents its symptoms. We can readily ap- preciate that where there has been a previous history of tuberculosis in a family, and a chronic inflammatory condition is present in the patient, the bladder may become infected