STONE IN THE BLADDER.
The symptoms of stone in the bladder need not be discussed in detail. In the child and young adult they are especially marked, be cause there is, at these ages, no prostatic enlargement which can prevent the calculus from falling upon the sensitive neck of the blad der and from eliciting those symptoms which we recognize as char acteristic of the disease. In the less sensitive bladder of the aged the stone may be lodged behind the upraised prostate, and thus be "latent" or symptomless, except for the cystitis it produces. In some of these cases, as I remarked when considering the symptomless humaturias, blood after exercise is the only symptom noticed, but the urine is soon found to contain traces of pus or mucus.
The hemorrhage of calculus in ninety-three per cent. of my cases was preceded by that feeling of irritation which a foreign body excites in a cavity sheathed by sensitive mucous membrane and surrounded by muscle, viz., by involuntary spasmodic contractions, and by a con stant desire to urinate. These symptoms are soon followed by pain at the end of the penis ou micturition, and a teasing sensation that the bladder has not been thoroughly emptied. Attacks of cystitis supervene and blood appears. It is to be noted, however, that when the catheter is habitually used and the prostate is upraised, the symptom which is characteristic of stone is not blood but pain on movement.
Calculous Cystitis.—This is a fitting opportunity to remind the reader that cases are met with in which the hemorrhage persists even after a skilful litholapaxy. The spongy mucous membrane still bleeds, and the patient has suspicions that some fragments have been left behind by the operator. This does undoubtedly happen, but there are blad ders which still ooze although all grit has been removed. In some of these cases it will be found that phosphate of lime adheres to the inflamed surface in patches, and that when these deposits scale off the bleeding and irritation cease.
I have seen two patients lately, in whom a calculus had been crushed by one of the best European lithotritists, but in whom the hemorrhage continued. On returning to their surgeon they were told that they were suffering from a growth in the bladder. I was subsequently asked to examine with the cystoscope, in order to con firm or rebut the diagnosis. In each case I saw merely an intensely congested spongy mucous membrane, and by administering a little port wine to the patients and sending them to the seaside, the hem orrhage vanished.
Case.— Calculus , Chronic Cystitis, Lithotrity, Hannaturia.—M., mt. 59, consulted me for hematuria. His history was as follows : In March, 1885, lithotrity was performed for a small angular phos phatic calculus. The amount of blood which then appeared in the urine depended upon the amount of exercise taken. Since this opera tion he has suffered more or less from catarrh of the bladder, which increased greatly in December, 1888. The patient has always had very irritable mucous membranes, his throat and stomach fre quently becoming inflamed upon any sudden increase of mental work or worry. In January, 1889, he commenced to pass blood, and continued to do so without intermission for five months. The urine was of a dark-brown color, the blood being uniformly mixed, the amount of blood being greater at night. He suffered no pain, and only occasional irritability. On examination I found that the prostate was not enlarged, that no residual urine was present, that the stream was full and forcible, never intermitting. On cystoscopy no tumor nor growth was visible; the mucous membrane was swollen and gelatinous in every part, and of a dark, dull purple color. Evidently the blood was oozing from many points. The injection of warm water irritated the bladder greatly, and he passed an increased quantity of blood for a few hours after the examination. This excess, however, rapidly subsided. He was eventually cured by change of air.