Volume 1
A text-book of medicine for students and practitioners / by Adolf v. Strümpell.
- Adolph Strümpell
- Date:
- 1911
Licence: Public Domain Mark
Credit: A text-book of medicine for students and practitioners / by Adolf v. Strümpell. Source: Wellcome Collection.
855/874 page 819
![of the bladder. The local examination of the prostate and the testicles is far more important in diagnosis. Especially in the latter we often feel the hard¬ ening corresponding to the tuberculous infiltration, and manifesting itself chiefly in the epididymis, while the hardening and enlargement of the prostate and seminal vesicles can usually be easily detected by rectal palpation. Among the general symptoms we must mention, first of all, fever, which is only exceptionally absent, and usually, in the severe cases, shows a pronounced remitting, hectic character. The other general symptoms are the same as in most of the other tubercular diseases—angemia, persistently rapid pulse, ema¬ ciation, loss of appetite, increasing bodily weakness, etc. We must be alert to detect the occasional coexistence of other tubercular diseases in the body, the lungs, the intestines, the bones, etc., but these may also be wholly absent, so that we may have to do with a purely local genito-urinary tuberculosis. The course of the disease is steadily progressive. Recovery does not occur, at least not in any cases where the disease has attained any extent. The disease lasts from a few months to a year or two, but sometimes much longer. The fatal termination usually ensues from the increasing general weakness, more rarety under the symptoms of ammonisemia, or sometimes from a miliary tuberculosis or some other tuberculous disease, such as pulmonary tuberculosis, tuberculous meningitis, etc., or general amyloidal affection. Diagnosis.—The diagnosis of genito-urinary tuberculosis is now seldom difficult in fully developed cases, since it can be made with complete certainty by the discovery of the tubercle bacilli joined to the presence of pus in the urine. Of course this gives no information as to the exact local distribution of the process. In order to judge of this, we must add the local symptoms and the physical examination of the different organs. Cystoscopy and catheteri¬ zation of the ureters have become of great diagnostic importance. Further details will be found in the special monographs. We are aided in the confir¬ mation of our first suspicion of a tuberculous disease chiefly by the considera¬ tion of the general condition and the habit of the patient; the discovery of an hereditary taint, or at least the probability of tuberculous infection; and also the discovery of other tuberculous affections, especially the examination of the bladder, the testicles, the prostate and the seminal vesicles, the hectic fever, anjd the tedious course, upon which nothing has a favorable influence. At any rate we must make it a rule, in every case of apparently spontaneous hasma- turia and especially of persistent pyuria which cannot be otherwise explained, to examine the purulent urinary sediment for tubercle bacilli (vide supra). We may then often be able to recognize with certainty the milder and incipient cases of this not very rare affection. [Another valuable diagnostic method, briefly referred to by the author, is by inoculation of 8 to 15 minims of the urinary sediment into the peritoneal cavity of a guinea pig. If tubercle bacilli are present, the animal will develop tuberculosis in six to eight weeks.] Treatment.—Whether specific treatment of genito-urinary tuberculosis with Koch’s tuberculin is likely to have permanent success cannot yet be de¬ termined, as so few trials have been made. Nevertheless, it would be justifiable to make a cautious trial of the remedy, although we can hardly cherish the hope that it would prove very beneficial. Beyond this we must resort, in the treatment of tuberculosis of the urinary passages, to the same remedies as in 52](https://iiif.wellcomecollection.org/image/b3136276x_0001_0855.jp2/full/800%2C/0/default.jpg)
