THE HEMATURIA OF BENIGN OR MALIGNANT GROWTHS.
No drug can be relied upon to check a well-established hemor rhage from vesical growth, whether benign or malignant. Any or no drug will suffice in the very early stages, gallic acid and opium being perhaps as good as any. Every hemostatic may be tried in turn, and one may be chanced upon which suits the patient and holds the loss in check. Should the bleeding become alarming, and operation be refused, much good can be done by the passage of a soft Jacques catheter in order to partially empty the bladder—the final contraction of the viscus and the consequent traumatic escape of blood from the growth being prevented by leaving an ounce or two of urine behind. If this fails, vesical irrigation should be tried. I know of few better injections than hot hazeline, or hot hazeline and water (equal parts). Prout recommends that twenty to forty grains of alum, dissolved in , a pint of water, should be injected into the bladder. He says : This remedy seldom fails to check the bleeding even when the cause is malignant disease. I have never known any unpleasant consequences follow the use of this expedient, and I have seen it immediately arrest the most formidable hemorrhage when all other means had failed, and when the bladder had repeatedly become again distended with blood almost immediately after its removal." Sir Henry Thompson has great confidence in astringent injections thrown into the bladder with extreme gentleness, and through a small catheter. The two which he uses for cases in which operation is not as yet decided on, and especially for those in which the tumor has been only partially removed, are perchloride of iron and nitrate of sil ver. "The strength employed is from twenty to sixty minims of the
tincture of the perchloride of iron in four ounces of cold water, to be used daily once or twice according to circumstances; of the nitrate of silver, from gr. i. to gr. vi. in four ounces of water, the stronger so lutions being rarely tolerated or necessary." I have, personally, the greatest objection to using styptic injections and very rarely employ them. They are often provocative of cystitis.
Now cystitis militates against the successful removal and rapid cure of a benign growth, while it is the turning-point in the life of a malignant vesical tumor. After cystitis has been induced, or upon its appearance in vesical carcinoma, there is an immediate increase in the pabulum of blood which is conveyed to the malignant mass and utilized in its construction.. All the misery and pain caused by irrita tive cystitis and the necrosis of the surface of the tumor are, therefore, summoned weeks or mouths before they otherwise would appear if the disease were permitted to take its course.
Operative Interference. —The suprapubic removal of vesical growth of the benign type ought to be free from risk if it be undertaken before degenerative changes in the kidney have ensued. A fatality in straightforward eases is a surgical discredit. Any interference with the surface of a benign growth checks the bleeding for mouths. This is not so in all carcinomata; nothing short of free surface re moval stops the hemorrhage.