HEMATURIA.
This is but a symptom or sign common to various diseases affecting the genitourinary tract or to certain general blood conditions, the treat ment of which will be found detailed under its own appropriate heading. The first step before any treatment can be thought of must consist in a careful search for the discovery of the source of the ha•morrhagc. Though the trained eye will in the great majority of cases easily detect even a small percentage of blood in the urine. nevertheless many instances occur in which pigments such as indican, ltmatoporphyrin, bile, rhubarb. rosaniline, or bodies formed by the decomposition in the system of carbolates, salicylates, sulphonal. &c.. on elimination by the kidney give to the urine the appearance of a hiumaturia which cannot be without the microscope. The presence of free red blood cells must therefore be demonstrated in all doubtful cases, and only in this Wa? can haimoglobinuria be eNcluded. The endoseope or urethroscope and cystoScope should be employed when the microscope fails to demonstrate the source of the bleeding.
Urethral hemorrhage comes before the stream of urine reaches the meatus, and it may flow between the acts of micturition. If due to a gonorrhoeal condition the injection of the Silver Salts may be resorted to, but if the blood should appear during the chronic gleetv stage the endoscope should he introduced and the bleeding spot swabbed with a strong solution of Nitrate of Silver. If the hemorrhage he the result of a ruptured urethra an attempt must be made to pass a soft rubber catheter into the bladder, and should this prove successful the instrument may be kept in for 8 to 12 days. Where the bladder cannot be entered in this manner, Cock's operation or an external urethrotomy should he performed at once to prevent extrayasation, and most surgeons prefer to deal with the wound from without after a grooved staff has been passed along the urethra, as extravasation may take place even though a soft rubber instrument is tied in the bladder.
If the bleeding be caused by a urethral calculus the stone should be extracted by forceps introduced through the meatus. It may be pushed hack into the bladder and crushed by a lithotrite or removed by an external incision in the penile portion of the urethra or in the perinea] region. Should the haemorrhage only appear after the stone has been spontaneously passed the bleeding may be controlled by passing a full sized catheter or sound into the bladder. leaving it in situ, and should blood still continue to flow by the side of the instrument. pressure from without will arrest it when a bandage or strapping is applied.
Bladder hwmorrhage must be dealt with by a removal of the cause when this is possible. Thus calculus, enlarged prostate, cystitis, cancer, parasites, vinous growths, tuberculosis, diseases affecting the posterior urethra with back-flow of the blood into the bladder, and injuries, in cluding those produced by catheterism, must be met by the use of the drugs or operative procedures suitable in each case, as will be found detailed under the heading of each primary disease causing the haemor rhage.
Sometimes the bleeding will require to be controlled when the primary disease is beyond reach, or it may be necessary to treat the hemorrhage as a symptom till the patient's strength is restored so as to enable him to undergo a radical operation for the removal of the primary cause. Under such circumstances absolute rest in the horizontal position, with the application of iced compresses or Leiter's tubes to the perineum, rectum, vagina, or hypogastric region may be tried. Drugs by the mouth are of little value. Chloride of Calcium is, however, always clearly indicated, and may be safely given in 3o-gr. doses every 4 hours in pur puric cases. It may be combined with Tincture of Jaborandi, which seems to exert some feeble influence over haemorrhages from the urinary tract, and many surgeons believe that Hazeline by the mouth acts in a similar manner.