The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis.

  • Wharton, Henry R. (Henry Redwood), 1853-1925
Date:
1902
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    1237/1268 (page 1217)
    to empty the bladder will geneially rupture it. Suprapubic as])iration and suprapubic cystotomy, with puncture of the abscess, have also been recom- mended in these cases. If it points towards the perineum or the rectum, a perineal incision should be employed. (See page 1092.) Foijyrostalic abscess may simulate prostatic abscess, and demands the same treatment. Chronic prostatitis is described under Diseases of the Prostate. Gonorrhoeal Cystitis.—This occurs as an extension of intlammatiou from the posterior urethra, and rarely involves the entire surface, being generally confined to the neck of the bladder. Its symptoms are those of posterior urethritis, with vesical tenesmus especially pronounced. In the chronic stage the symjjtonis abate in severity. There is increased ft-equency of micturition, with pain following, and often htematuria from a villous condition of the mucous membrane. Eesidual urine is present, and finally alkaline fermentation. The pelvis of the kidney may become secondarily involved through the ureter. Treatment.—This in the acute stage consists in the stopping of injections, rest in bed, light diet, alkaline diluent drinks, and local applications, either hot or cold. In subacute and chronic cases the antiblennorrhagics act well. Irrigation of the bladder should be prac- tised with boric acid or Thiersch's mild solution, or with a weak solution of j)ermanganate of potassium or of nitrate of silver, or with a bichloride solution (1 to 30,000). Perineal drainage may be necessary as a last resort. Vesiculitis.—Inflammation of the seminal vesicles as a consequence of gonorrhoea may be acute or chronic. Lloyd claims that it is a very frequent unrecognized complication of gonorrhoea. It comes on in the third or fourth week, and is often assoiiated with epididymitis. In the acute stage the symptoms resemble those of posterior urethritis and prostatitis, from which it must be excluded by rectal examination. The subacute and chronic forms are more common, the most important symptoms being sexual de- rangements, such as exaggerated sexual desire, delayed ejaculation, seminal emissions, mental depression, and sometimes a purulent discharge. Eectal examination shows distention of the seminal vesicles. Treatment.—This in acute cases is sedative, and if pus forms it should be evacuated. In chronic cases, tonic treatment, the cure of the posterior urethritis, if it is present, and stripping or milking the vesicles through the rectum, as recom- mended by Fuller, are indicated. Chronic Urethritis.—Gleet.—If instead of the discharge ceasing it persists and becomes chronic, we have to deal with chronic urethritis, or gleet. It is due to a persistence of inflammation in some portion of the urethra in the form of congested, ulcerated, granular, or papillomatous areas, with a submucous infiltration as a primary cause. It is due also to stricture already formed, or to inflammation lingering in the follicles, and sometimes in Oowper's glands. It may be attended by a profuse discharge, or only a drop may be noticed in the morning, or the only indication may be the presence of fine threads in the urine, called dai) threads, which consist of the scabs from patches of ulceration, and if examined under the micro- scope are seen to consist of epithelial and pus cells embedded in mucus, sometimes containing gonococci. The bulb is a favorite seat for the locali-