Death took place two years after the onset of the hematuria, and by the kindness of Dr. Travers Stubbs I obtained an autopsy. Not only was the bladder filled with soft whitish growth, but the walls had been transformed into carcinoma so that the entire pelvis was filled with the neoplasm. Both kidneys were in a state of suppura tive nephritis.
Case 2. Hematuria of Two Years' Duration ; Calculus; Lithotrity. —No Decrease in the Amount of Hematuria. Stalked Carcinoma."— Mr. J., mt. 62, under the care of Dr. Fred Simms, who brought the patient to me in October, 1888, with a diagnosis of vesical growth. The patient was perfectly sound until two years ago, at which date he suddenly had an attack of painless hfflmaturia after long exposure and fatigue. The hmmaturia was typical of new-growth; and though a small calculus was discovered and crushed, the loss of blood contin ued unabated. He suffered when I first saw him from no pain or fre quency of micturition; the hemorrhage was persistent, occurring after micturition. On examination with the cystoscope, a whitish-gray walnut-sized growth, evidently stoutly pedicled, was seen hanging from the right postero-lateral wall above the right ureter. There was no
cystitis ; the patient was advised that the growth could be removed by operation, but that in all probability it would rapidly recur. I saw him nine months after this (July, 1889) ; he was apparently in perfect health. He suffered, however, from slight pain at the tip of the penis and in the perineum after passing water, induced most likely by the increased growth of the tumor. He had intermittent attacks of bleeding; no cystitis was as yet present.
In March, 1890, I received the following from his medical attendant : " Mr. J. called upon me early in December and did not appear much worse or much weaker. He reminded me that the year of life given him by myself had passed; he was bleeding pretty steadily. Soon afterward the patient went to stay with some friends in Somerset shire, and there on January 31st he died. His friends and the medi cal man at Burton wrote to me, and it appears that it was found that the epithelioma had extended through the base and back of the bladder."