SENILE PROSTATIC ENLARGEMENT.
a. Without Vesical A tony.—The hemorrhage in many of these cases is beneficial, free from danger, and yields to recumbency, acidulated drinks, and gallic acid and opium. Ergot has occasionally appeared in my hands to increase the bleeding. It is surprising for what length of time clots will remain in healthy acid urine, without undergoing bacterial decomposition. They slowly disintegrate and are passed like tea-leaves or slips of light tan. For this reason I should advise that the catheter be not hastily used unless the bladder is atonic and unable to cope with the obstruction caused by the clots. If, however, the urine is alkaline and ammoniacal, cystitis from the decomposition of the clot will rapidly develop, and the catheter should be used at once to anticipate this, the bladder being thoroughly washed out.
b. With Vesical Atony. —The hemorrhage which ensues in cases of enlarged prostate in atonic bladders is often difficult to treat. In a clinical lecture upon hcematuria at St. Peter's Hospital, my colleague, Mr. Harrison, made the following very apt and valuable remarks, apropos of this subject : "There is, however, a condition of the senile bladder which adds considerably to the trouble connected with bleeding. I refer to those instances where it occurs with a large
prostate, and an atonic or almost completely atonic bladder. The great safeguard against prostatic hemorrhage is the power of the bladder to exercise pressure. In two instances not only had I to empty the bladder of blood, but to keep it empty by pressure upon it and the retention of a catheter until the tendency to bleed had ceased, just as is clone with the flaccid uterus. In both the instances I refer to this was successfully accomplished, and the patients recov ered, though the loss of blood was considerable. It is not the least use depending upon hemostatics in cases such as these. The me chanical reason why the bleeding will not cease must be recognized and acted upon, or the patients will flood to death, with their bladders distended with blood up to the umbilicus."