Pye's surgical handicraft : a manual of surgical manipulations, minor surgery and other matters connected with the work of house surgeons and surgical dressers / [Walter Pye].

Walter Pye

Date:: 1891

Credit: Pye's surgical handicraft : a manual of surgical manipulations, minor surgery and other matters connected with the work of house surgeons and surgical dressers / [Walter Pye]. Source: Wellcome Collection.

68/604 (page 44)

$Local treatment. Internal treatment. Wanaftement of bladder when distended with blood clot. From rupture o the corpus spongiosum- Bleeding from granulation tissue. Generally speaking, in any of these cases, rest and the relief of all congestion in the neighbouring viscera, as by clearing out the rectum, will prevent haemorrhage into the bladder or from the prostatic vessels assuming a serious character. But if in consequence of the vascular nature of a new groAvth, or from some similar cause, important hasmorrhage should occur, it will be found to be somewhat difficult to treat. Locally, ice may be applied to the perinaeum and hypogastrium, or inserted into the rectum, or an enema of iced water may be given. The indications for internal treatment generally point to the employment of such styptic drugs as turpentine, tannic acid, or lead acetate with opium, (and Ruspini's styptic has been found very useful in these cases). If the bladder becomes distended with blood clot, it may happen that the urine is retained. In this case a large catheter, such as is used in lithotrity after Bigelow's plan, should be introduced. After the clots have gently been broken up, the catheter should be connected with an aspirating apparatus (Clover's or Bigelow's) by means of which enough clot may be removed to allow of the passage of the urine, and with this relief the sui-geon should be content. E The question of the management of rupture of the urethra will be considered later. In all ordinary cases the bleeding although it may be rather free at first is easily arrested by rest, and cold to the periniBum. But a very furious bleeding into the urethra may occur in consequence of rupture of the bulb or corpus spongiosum from external ^dolence; in these cases the blood pours from the erectile tissue and escapes from the meatus urinarius at a rate which will qmckly exhaust the patient unless it be arrested. Pressure is the only means of arrest, but pressure here is very difficult to malce effectually ; the best way is to pass a full-sized catheter and to make compression in the perinseum upon it, at first digitally and later by a pad and bandage. - a Bleeding from granulations occurs when they are ^n]\\rea, even when absolutely healthy, and may then readily be stopped by pressure. But if the granulations spring from the base of a ha^morrhagic ulcer, or in wounds or sores in patients who are extremely feeble, or who are scorbutic, the hiemorrha-e sometimes is difficult to arrest. In these cases, as in others, the sheet anchor of treatment must be pressure but much may be done by constitutional treatment* and * Vide the hfemorrhagic diathesis, p. 50.$