STATISTICAL INQUIRY INTO THE FREQUENCY OF OC CURRENCE OF THE VARIOUS DISEASES OF THE FE MALE URETHRA AND BLADDER _ _ The reports of the large hospitals are, however, too imperfect to be of much assistance. Thus the medical report of the Imperio-Royal General Hospital in Vienna of 1874, those of the Rudolph Hospital in the same city, and those of the Royal Charite in Berlin of the same year, give only the following list of cases of urethral and bladder disease: Such figures may be of some importance in estimating the relative oc currence of these diseases in men and in women. They teach us that urethral and vesical diseases are much more infrequent in women than in men. It would however be erroneous to conclude that 0.5 per cent. of all the sick have maladies of these organs; though the Charite shows 59 ca,,les in 15,013 recorded, the Rudolph hospital 24 in 6,254, and the general hospital 141 in 20,563. Such a conclusion we will show in fu ture pages to be precipitate and unwarranted.
We must exercise care in accepting the statistics of the various spe cialists, Simon, Sims, Bozeman, and others, since many cases came to them that were pronounced incurable by other physicians; and their sta tistics as to the occurrence, frequency, and causes of the various diseases will vary with the conditions prevailing in tbe regions whence their patients are drawn. Where authors have collected all the cases to be found in cur rent literature, their statistics are apt to exclude ordinary cases, which are not reported, and hence to be erroneous. Thus, to cite but a single instance, the excellent article by Ed. F. Boucqu6 on the treatment of uro-genital fistula in women by secondary union (Paris, 1875) often men tions pregnancy as a cause of fistula, without specifying any of the cir cumstances of the delivery, since the physicians reporting the cases them selves mentioned none. Then, again, among his 204 fistula only 8 per cent. are non-puerperal, the author not mentioning or taking into ac count in a monograph upon the cure of fistula incurable ones such as those caused by epithelioma. So that not even upon the points specially discussed do we get reliable data, though they are the best available to us.
I know of only one set of disease reports from which any certain facts can be gleaned, and they are those of the medicinal district of Meissen from 1867-72. They show that among 58,466 sick people, 353 had. kid ney disease, 399 had bladder disease, and 577 had gonorrhcea. This makes vesic,a1 diseases rather more frequent than those of the kidneys, and rates them at 0.68 per cent. of the whole.' The more attention is directed to any special affection, the more frequently it is found. In my reports on 3775 sick females, there were 246 cases or 6.5 per cent. of
diseases of the urethra and bladder; but 118 of these, or 15 per cent. occurred in the last 776 cases. It is worthy of remark that cystocele vaginalis was noticed 68 times, being 27 per cent., since it is so seldom found at the autopsy (see below).
If we now finally turn to the tables of mortality for information as to bladder and urethral affections, we shall obtain but little satisfaction, since the question is so general a one. Thus in Vienna, in 1874, out of 17,316 deaths only' 33 men and 6 women, or 0.2 per cent. of the Ivhole, are registered as having succumbed to diseases of these organs.' In order to obtain statistics of some accuracy, I applied. to the former Pro-sector of the Dresden City Hospital, Professor Birch-Hirschfeld, who kindly placed the records of his department at my disposal.
In the Dresden City Hospital in the twenty-five years from 1851 to 1876 there were made 6861 autopsies, 4147 being on males, and 2714 on females. In 209 of the latter the records were not properly kept, leav ing us 2505 autopsies as a basis for our statistics.
Of these 184 or 7 per cent. showed evidences of urethral or bladder disease: I. Affections of the Urethra: Malformation, malposition, inflamma tion, new growth, once each, 4 times=2.1 per cent.
II. Affectiora of th4 Bladder: (a.) Malformations (aequired,) 10 times =5.7 per cent.; diverticulas, 4 times; *dilatations, 5 times; scar, 1 time. (b.) Fistula) due t,o violence, 2; due to carcinoma, 36=38 times=26.5 per cent. (c.) Malpositions, 0 times. (d.) Inflammations, 72 times=39.1 per cent.; hypera3mias, 4 times; hiemorrhages and ecchymoses, 21 times; oatarrhs, 16 times; cystitis purulenta, 6 times; cystitis diphtheritica, 4 times; cystitis crouposa, 4 times; ulcers of mucous membrane, 2 times; abscess of bladder wall, 4 times; cystitis chronica, 4 times; cede= of wall, 1 time; pericystitis, 2 times; tuberculosis, 4 times. (e.) New growths, 41 times=22.3 per cent.; carcinoma vesics3, 37 times, (non perforating); muscular hypertrophy, 4 times. (f.) Functional anoma lies, 6 times=3.2 per cent.; incontinence, 3 times; paralysis, 3 times. (g.) Abnormal contents, 13 times=7 per cent.; stony concretions in vesi cal mucous membranes, 7 times; calculi, 6 times.
Gurlt found ' in 101,411 sick cases in the three largest Vienna hopsitals, 16,637 suffering from tumors. 11,140 of these were women, and 16 had tumors of the urethra, 1 fibroma, 3 papillomata, 3 polypoid growths, 1 gamma, and 8 carcinomata. 20 had cancer of the bladder, as against 46 men that suffered from it.
I myself found among 575 female autopsies the following diseases of the urethra and bladder: Thus 25 per cent. of all female autopsies showed some trouble in the bladder.