TREATMENT OF HEMATURIA OR HAEMATURIA.
Before considering the treatment for the various forms of spon taneous hematuria, it would be as well to consider whether there is any which had better be left unchecked. I believe that in hard carcinomata of the bladder, in engorged senile enlargement of the prostate, and in renal hematuria the result of cardiac disease, the bleeding is, to a certain extent, beneficial. In bard carcinoma there is often a great increase of pain when the bleeding is arrested and a sensible diminution of the suffering when it has become re-estab lished. The treatment of these cases is hopeless, and it is better and kinder policy to allow the patient's life to ebb away rather than to prolong his misery by conserving his blood capital. In those con gested senile prostates which bleed periodically, I suspect that there is a tendency to atheromatous degeneration of the vessels, and the bleeding acts not only as a safety-valve, but serves to deplete an over tense tissue. In real hemorrhage from obstructive mitral disease or granular kidney, the high blood pressure is often greatly relieved by a slight intermittent hematuria.
In these three diseases, then, I would suggest that the practitioner do not hastily check a hemorrhage which may be affording his patient relief.
Although the successful and scientific treatment of spontaneous hematuria depends, of course, upon ascertaining and removing, if possible, the cause of the hemorrhage, yet occasionally the practi tioner is not able to do more, in sudden and urgent cases, than to combat the immediate effects of the loss of blood.
The first and most essential step is to allay the patient's fears and to restore confidence. To many the appearance of blood issuing from so unusual a channel as the urethra is most alarming. From my own experience, I am sure that in the large majority of cases a promise may be made that the hemorrhage, if it is the first or among the first attacks, will subside with proper precautions in two or three days. When the hematuria has once become established, it is other wise.
Position.—Absolute rest in bed is of primary importance; many severe hematurias can be readily controlled in their early stages by the recumbent position. It must be rigidly enforced in proportion
to the severity of the attack. High elevation of the pelvis is of real value in certain cases of vesico-prostatic bleeding.
Application of Cold.—The external application of cold is of value.
perhaps more to quiet the apprehensions of the patient than for much good it will do in the hematurias of the lower urinary tract. It is certainly of great value in ruptured kidney, for here it not only assists in checking the bleeding, but also mitigates the traumatic peritonitis* which sometimes ensues even when the peritoneum has been untorn and the other viscera uninjured. Cold may be very efficiently applied by means of ice-bags over the loin or over the bladder; but a cleaner and easier method is by Leiter's pliable coils, which may be moulded to any part, and through which a continuous current of cold water can be conveyed. I place a certain amount of reliance upon ice in the rectum for checking hemorrhage from the bladder and es pecially from the prostate. I believe it causes contraction of the muscle planes of the wall of the bladder as well as those of the blood vessels. It is a good plan to throw each piece of ice into warm water to smooth off the sharp edges of the fragment before pushing it into the rectum.
Drugs.—I cannot speak very highly of any styptic by the mouth. In sharp arterial bleeding, ergot is perhaps the most reliable. It is given in doses of half a to a drachm mixed with some prepa ration of opium, every two, three, or four hours, according to the severity of the case. If the hemorrhage be moderate and dark, fluid extract of witch hazel, in drachm doses, is of value. Iron preparations, such as the iron aluminate, or tannate of alumina or acetate of lead are worth a trial in moderate vesical hemorrhage. In the profuse vesical hemorrhage in atonic bladders, ergot and nux vomica combined with gallic acid is perhaps the best remedy to ad minister. In some cases, an acidulated drink, or the acid infusion of roses, answers well.