BASE OF THE BLADDER - EXAMINATION OF THE PATIENT FOR THE SOURCE OF HEMATURIA OR HAEMATURIA.
Any hardening or thickening in the bladder base can be de tected by gentle examination with the finger. I consider it very necessary to insist upon the caution that all digital examination must be gentle, rapid, and purposive. I have several times witnessed a slight vesical bleeding increased to grave and uncontrollable hem orrhage by rough examination per rectum. Probably the undue finger pressure has split the thick but friable structure of the base of the growth and laid open its vascular channels. I have seen cases of large encapsulated vesical calculus pass through very dangerous renal reaction with high temperature after prolonged rectal examina tion. I have, moreover, known vesical and renal tubercle decidedly worse for energetic examination with the fingers. The most common cause of thickening after the age of forty-five is carcinomatous infiltra tion. This is usually felt at one or other side of the base in the earlier
stage because the growth generally commences near one or other .ureter. It is almost conclusive if examination of a dense hard plaque by the rectum is followed by a sharp hemorrhage from the blad der, testifying that the carcinomatous surface toward the bladder has been split by the pressure of the finger.
Two other forms of definite hardness of the bladder base may be encountered, one localized, the other diffused. The former is due to encysted stone, in which the finger feels the round stone through the thinnest of thin partitions, the walls of the sac; and the latter—the diffuse hardness which coexists with tubercular testicle—is due to one or other of the vesicular seminales (rarely both) being transformed into a long, flat, hard cake of tubercular material.