PRIMARY TUBERCULOSIS OF THE KIDNEY AND BLADDER.
This hemorrhage is rarely of much moment, and the treatment of • it is the same as that which is usually directed against inflammation or ulceration of the genito-urinary mucous membrane. Of drugs the oil of sandalwood is the best. It is taken in capsules in closes of five minims, cautiously increased to fifteen, thrice a day Eater food.
If the renal pain is aggravated by its use, the balsamic oil had better be at once replaced by a less stimulating drug, such as citrate of potash, boric acid, or benzoate of ammonia. In all cases prepara tions of opium are of value, and later on the orthodox maltine and cod-liver oil. The patient should be sent for change of air, and have a liberal and fatty diet. Change to the sea-side for town-dwellers, and to an inland dry climate for those living on the seaboard, is usually sufficient to hold the hemorrhage in abeyance.
In the earlier stages of tubercular ulceration of the bladder the bleeding may be checked by the administration of santal oil or malt ine, and in some cases by the insertion twice a clay of a rectal sup pository of morphine. As a last resource a single but thorough wash
ing out of the bladder with boiled filtered water will often be quite sufficient to check even smart hemorrhage due to vesical ulceration in the earlier stages. As the disease progresses, tincture of witch hazel, a drachm to the ounce pf boiled water, may be used, or five grains of iodoform suspended in an ounce of mucilage may be thrown into the bladder and left in; or lactic acid 1 per cent. may be injected to overcome the tendency to phosphatic deposits which induce and keep up hmmaturia. There is, however, great need for extra circumspec tion as regards cleanliness and gentleness in dealing with tuberculosis topically. In the later stages when the prostate has become involved, it is better not to wash out the bladder or to pass any instrument through the deep urethra at all. I have known bleeding from deep ulceration resist all remedies and yield only to drainage, but this step should be a last resource.