Injections of haemostatic solutions directly into the bladder are often markedly efficacious. The most reliable of these is Adrenalin Solution, but all such injections are practically valueless unless the bladder has been first emptied of clots. The largest-sized soft rubber instrument, with a wide opening at its distal extremity, should be introduced, and by attaching its proximal end to a Clover's suction apparatus the organ should be thoroughly washed out or irrigated by a stream of iced water till all clots have been extracted, after which about 4 oz. of Adrenalin Chloride solution (r in 4,000) may be left in the bladder.
Alum solution (saturated), Nitrate of Silver (2 to 5 grs. per oz.), Hazeline (r in 2), Perchloride of Iron (r in zoo), or other local astringents may be employed for irrigation, and a few ounces afterwards left in the bladder.
In the bleeding occurring in enlarged prostate, Harrison ties in a soft catheter and applies pressure from without, as in the treatment of post partum ha.morrhage.
Should the bleeding resist all palliative treatment the best procedure is to open the bladder above the pubes and remove the primary cause. This is the only satisfactory routine in villous growths. In the female equally brilliant results may be obtained by widely dilating the short urethra, which permits exposure of the growth or ulcerated spot, which can then be curetted and its base cauterised.
Htematuria of renal origin must be dealt with by removal of the primary cause. In acute Bright's disease the diagnosis is usually clear, and the danger from hwmorrhage alone may usually be discarded. The loins may he dry cupped; hot sinapisms or the mustard pack, brisk saline purgatives and Chloride of Calcium internally meet all requirements.
In the renal hmmaturia of such blood conditions as scurvy, purpura and rickets the internal administration of the lime salt, with a diet of fresh vegetables and fresh meat, answers all requirements.
produced by the administration or absorption of such irritating diuretics as cantharides, turpentine or copaiba is checked by the withdrawal of the drugs aided by dry cupping of the loins, hot packs, and copious diluents like barley water.
Where the nature of the cause is less obvious the cystoscope should be used, and the urine from the ureters collected by catheterising each separately. The faulty organ is then to he dealt with when the diagnosis has been cleared up by X rays. Calculus, kidney, tuberculous growths, sarcomatous or cancerous tumours, hydatids, Bilharzia, &c., will require either nephrotomy, nephro-lithotomy, nephrostomy, nephrec tomy, decapsulation, nephropexy or nephrorrhaphv, as indicated in each case.
Renal Hornophilia, Essential Hcematzeria, or Renal Epistaxis are the names given to the rare condition in which a profuse hemorrhage is found to proceed from one kidney in which no lesion may be discoverable even after the exposure or removal of the organ. The calcium treatment can do no harm in such cases; when the condition has been diagnosed by the eliminatory method the kidney should be cut down upon and the organ exposed and freely incised for exploratory purposes (nephrotomy), after which the local hmmorrhagic condition may be expected to disappear even when the organ is apparently healthy.