THE LIFE HISTORY OF HEMORRHAGE FROM MALIGNANT GROWTHS.
Presuming the medical man to have induced no cystitis by sound ing or catheterism—and this is uncommon—the hematuria of soft malignant growth, situated away from the neighborhood of the ure ters, may be symptomless for months, the average duration of the stage being probably nine months. After this the inevitable cystitis supervenes, or the muscle-wall becomes infiltrated, and frequency of micturition and suffering ensue.
The initial hematuria is sometimes slight, as in benign growths, but more often than not it is profuse, the urine being very dark or maroon-colored with clots. The patient in many instances traces it to a slight indirect violence. At first it is intermittent, its return usually dependent on exercise, its cessation upon rest, but it rapidly loses these characters. It becomes more or less persistent, and is not so easily affected by drugs. The urine acquires the characters of the washings of flesh and becomes offensive. The color becomes changed by the alkalinity of the urine; muco-pus, and phosphatic grit appear in the secretion.
In order to distinguish between these two classes of hematuria, that due to benign and that the outcome of malignant growth, a careful rectal examination of the bladder is to be undertaken. If any hard infiltrated area is discovered in the base of the bladder behind the prostate, the growth is almost certain to be a carcinoma and not of a benign type. If with this there is constant pain, if the patient is of an age above forty-five, if there has been loss of flesh, if malaise is present, and finally if a history of family carcinoma, phthisis, or longevity, is obtainable, the suspicion of malignity is much strength ened.
Type of Soft Succulent Epithelioma.The following cases were recorded" while the patients were alive. A post-mortem examina tion has subsequently been obtained, so that the histories are now complete.
Case 1. Hcematuria, Cystoscopy Revealing a Russet-Gray Growth and an Altered Mucous Membrane; Removal of the Former by Suc tion, and Development of Cancer in the Latter.—Mr. 0., mt. 56 (under
Mr. Travers Stubbs). Five weeks before consulting me, being in perfect urinary health, he suddenly and without warning passed a quantity of coffee-colored urine. He suffered no pain, but had a tenderness in the right testicle. Since this time the urine has varied in its aspect; now and again it has been quite clear for a day or two, then it has become very dark.
On passing the cystoscope, a peculiar russet-gray lobulated growth was seen hanging from the posterior wall of the bladder, and swaying freely upon a pellicle. The mucous membrane in the immediate neighborhood had an injected nodular appearance, ex tremely suggestive of commencing carcinoma. The color of the hang ing body was very puzzling. As there was a difference of opinion among those present as to its nature, I sucked it out with a litho trite tube and balk It looked like an old blood-clot. On section it was subsequently found to be necrotic growth and blood-clot. The cystoscope was re-introduced and the diseased site re-examined. There was no bleeding. A. patch of stunted processes was seen where the stalk had been attached. As operative interference was contra indicated by the cystoscope, injections were resorted to, and the he maturia subsided.
Three months after this examination the patient visited me, look ing hale and hearty, and declaring himself in the best of health. His general condition gave no indication of carcinoma, and I doubted its existence, believing I had been optically deceived as to the nature of the group of nodules on the mucous membrane. I, therefore, re examined him, and was somewhat astonished to see that the group of isolated nodules had grown into a confluent walnut-sized tumor which was deeply cleft into lobules and of a gelatinous aspect, a growth which I at once recognized as a succulent epithelioma. He very gradually got worse. He suffered little pain, but his emaciation toward the end was extreme.