But in every hematuria some sedative ought to be incorporated with the drug selected. I usually employ opium freely, except when there is reason to suspect serious renal change or where opium is contra-indicated, and then I substitute bromide of potassium, hyos cyamns or cannabis indica. Belladonna is best avoided, for it tends to weaken that contractile power of the bladder which is of real ther apeutic value.
Oil of turpentine is a favorite with many. It has the disadvan tage of irritating the neck of the bladder in some patients; the dose is five to ten minims cautiously increased, given either in capsules or in mistura Far below these in value, but warmly recommended by various writers as having especial power to arrest Inumaturia, are a number of drugs such as matico, cinnamon, liquorice, lemon juice.
Professor Guyon places very little reliance on styptics by the mouth. He aims at improving the general constitutional tone.
An attempt may be made, suggested by Professor Wright's work the coagulation of the blood, to increase the coagulability of the blood by administering chloride of calcium. I believe, however, that care must be exercised with this and other strong styptic drugs in profuse hoematuria, for the tendency with such remedies is to increase the size of the clots, and this is especially the case with chloride of calcium. In many of the diseases giving rise to hemorrhage after the age of fifty there is perceptible diminution of the expulsive power of the bladder, and clot dysuria and retention and all their accompanying septic evils may easily be produced.
Diet.—Solid food had better be avoided until the severity of the attack has abated. The diet should be bland, very limited in quan tity, and taken cold. If thirst be complained of, it may be allayed by sucking ice. As the patient improves, the diet may be cautiously increased. Alcohol should be avoided at first, but in a day or two port wine may be added, for it will be found a valuable astringent. In fact, in the earlier part of the century port wine used to be consid ered as indicated in all forms of hmmaturia. As the clots which have sealed the bleeding orifices are liable to become dislodged on the slightest straining, all vomiting and retching must be checked. Nutrient enemata must be administered if the patient continue to show a tendency to sickness.
Bowels.—In profuse hwmaturia the entire intestinal canal had better be kept quiet for a few days; purgatives are contra-indicated.
I have seen a copious prostatic hemorrhage supervene, and the case terminate fatally, on the exhibition of a purgative three days after a perineal lithotomy. On the other hand, if the abdOmen gets distended, and solid foeces collect, they had better be removed by means of a rectal enema of oil or soap and water.
Morris" states "that he has seen sharp from an in jured kidney brought on unexpectedly more than a fortnight after the infliction of the wound, and when the patient appeared to be con valescent, by the passage of hardened matter along the colon, and thus across the surface of the kidney." Clot Retention.—The practitioner may find himself suddenly called to a case in which the bladder is full of clot and the viscus is felt like a hard mass projecting above the pubes. Under such circumstances, it is advisable to inquire whether the bladder has proved itself able to evacuate its contents before the onset of the trouble, and if it has always worked well, it is wise to wait awhile and give the vesical muscle time to do its own work and rid the viscus of the clots. The pain should be subdued by means of opium and warm applications to the suprapubic and perineal regions.
If clot retention and vesical colic are not spontaneously relieved within a few hours, and the patient is obviously made worse by wait ing, then the practitioner must intervene. A large-eyed soft catheter, which has been syringed through with oil, must be passed very gently. This may suffice—the clots and accumulated urine coming away, or most of the urine may be evacuated and the clots which cannot issue may be allowed to come away at a subsequent micturi tion. This manoeuvre is not always successful, for the eye of the catheter sometimes becomes blocked with clot, and the retention is thus unrelieved.
A large-eyed silver catheter had then better be passed and warm boracic solution syringed in whenever the channel becomes choked. By alternately syringing in solution and sucking out clot and fluid the bladder will probably be cleared. When this is accomplished it is wise to throw into the bladder eight ounces of nitrate of silver solu tion (gr. i. ad S viij.), which slightly coagulates the surface epithelium and prevents septic absorption.