Volume 1

A text-book of medicine for students and practitioners / by Adolf v. Strümpell.

  • Adolph Strümpell
Date:
1911
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of medicine for students and practitioners / by Adolf v. Strümpell. Source: Wellcome Collection.

    854/874 page 818
    If the process invade the ureters, their walls also are infiltrated with tuber¬ cular deposits, and hence they are thickened, while the mucous membrane is often changed in great part to a necrotic ulcerating surface. Precisely analo¬ gous conditions are found in the bladder, and in some cases even in the urethra; while in the prostate, the vesiculse seminales, and the testicles there is more frequently the formation of cheesy tubercular nodules, and rarely disintegration and perforation of the tubercular formations. Clinical Symptoms.—The picture of genito-urinary tuberculosis corre¬ sponds in most of its details completely to that of a severe chronic pyelo- cystitis. The occasional local symptom is pain in the region of the kidneys and bladder. This may sometimes assume great severity, like colic, if the ureter become plugged by a broken-down, crumbling mass. If the bladder is also affected, frequent pressure and pain in urinating arise. In other cases, however, the pain is but slight during the whole disease. The urine shows the most important diagnostic changes. It almost inva¬ riably contains an abundant sediment, consisting of pus corpuscles and detritus. Its amount usually remains normal for a long time; its reaction is faintly acid, but in severe cases it may become alkaline through complica¬ tion with an alkaline fermentation of the urine. The discovery of shreds of tissue in the urine, elastic fibers and connective tissue, is sometimes possible, and is of diagnostic value because it is direct evidence of an ulcerative process. The discovery of tubercle bacilli in the purulent urinary sediment (Rosen- stein and others) is, however, far more important. This is possible in almost all cases, and is a reliable and absolutely decisive factor in diagnosis. There is, however, one unfortunate circumstance about the demonstration of tubercle bacilli in the urine, for not infrequently other bacilli (smegma bacilli) are stained by the ordinary method of staining, which is that employed for sputum, and are thus mistaken for tubercle bacilli. As yet, no easy and cer¬ tain method of distinguishing these two varieties of bacilli has been discov¬ ered, and hence in doubtful cases it is necessary to resort to pure cultures and to inoculation, in order to reach a decision. Still, if the urine is taken by the catheter, and, at the same time, all other phenomena considered, we may, as a rule, manage with the ordinary staining method. [Stain with carbol- fuchsin; decolorize with twenty-per-cent nitric acid; wash in water; and still further decolorize in seventy-per-cent alcohol for at least ten minutes. This will bleach the smegma bacilli.] Other bacilli are usually entirely absent in tuberculous pyuria. Admixtures of blood in the urine are also seen in genito¬ urinary tuberculosis, but they may often be entirely absent. In several of our cases a slight haematuria was the first symptom which called the patient's attention to the trouble with the bladder. Pyuria, however, ordinarily pre¬ cedes haematuria. The more profuse renal hemorrhages generally occur only in the earlier stages of the disease. On the other hand, the microscope will frequently demonstrate a slight admixture of blood. In some cases the urine is entirely free from blood. The local objective examination of the kidneys usually gives a negative result. Only in a few cases have we been able to feel the diseased kidney as a tumor through the abdominal walls. This is usually due less to the tuber¬ culous infiltration of the kidney itself than to the dilatation of the pelvis of the kidney from hydronephrosis. We can sometimes feel the thickened walls
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