Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson.

  • Sir Henry Thompson, 1st Baronet
Date:
1882
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Licence: Public Domain Mark

Credit: Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson. Source: Wellcome Collection.

    172/192 page 160
    sence realised by the sound. Here the haemorrhage is usually fiorid, and in pro- portion to the patient's movements. But the third condition—namely, that the hemorrhage arises irom tumour—is not always so readily to be affirmed. As a rule, however, blood from such a source is larger in quantity than from stone, and may be associated with less of muco- pus. If the tumour is malignant, it may be felt by rectal or suprapubic examina- tion, and the pain is often severe ; if villous, it gives an even pale-red tint for days together to the urine; and in both cases the blood is florid, unless it is long retained in the bladder, when dark sanies, like coffee-grounds, results. 3. In ha?morrhage from the prostate, the third principal locality or source, a deep dark tint is often observed, if the organ is hypertrophied and the blood is retained ; but here the age of the patient, the history of gradually increasing trouble, and the ascertained condition of the organ from the bowel, aid the diagnosis. A slight appearance of blood mixed with the last few drops of urine is not a rare occur- rence in chronic prostatitis; this of course in younger subjects. 4. When bleeding arises from stricture of the urethra, the patient's history and the cause of the bleeding, almost always following the use of instruments, leave no room for doubt. From the use of instru- ments also in the bladder, haemorrhage sometimes arises. 5. Lastly, it is not to be forgotten that occasionally blood is found in the urine from the action of violent diuretics, from purpura, in fevers, and in the hemorrha- gic diathesis. Now for the treatment of hasmorrhage. When you have determined that its source is above the bladder—that is, in the kidney or in its pelvis, probably the first and most influential remedial agent is rest in the recumbent position. Whether from a lesion affecting the intimate struc- ture, or from the mechanical irritation of a calculus in any part of the organ, rest is the first and the essential condition. The patient is, moreover, to be maintained in as cool and tranquil a state as possible. It is in renal more than in any other form of haematuria, perhaps, that direct or internal astringents or styptics are useful. I shall do no more than name those which are most commonly used—namely, alum, gallic and tannic acids, lead, and turpen- tine; equal to them is, I think the infu- sion of matico, say in doses of two ounces every two or three hours. The tincture of the perchloride of iron, and also sul- phuric acid may sometimes be taken with advantage. But see page 157 in the pre- ceding lecture. It is, however, in cases of severe he- morrhage from the bladder, or more com- monly from an enlarged prostate, that active and judicious treatment is neces- sary. You will be called sometimes to a patient whose bladder is distended with coagulated blood, or who is passing fre- quently a quantity of fluid in which blood is the predominating element. Usually this has arisen from some injury inflicted by the instrument, although it may also be from tumour of the vesical walls. Here you will keep the patient on his back, and forbid the upright position, or any straining, so far as you can prevent it, in passing water. To this end give opium liberally, to subdue the painful and continued action of the bladder. It has always been the rule of practice to apply cold by means of bags of ice to the perineum and above the pubes: it is more to the purpose to introduce small pieces of ice into the rectum. But I doubt very much the value of ice applica- tions, externally, for vesical hemorrhage. One thing is quite certain, that the cold has no penetrating power from the surface to that organ : and that the ice does not ab- stract a single particle of caloric therefrom. A thermometer in the bladder is not lowered a single degree by all the ice-bags you can apply. Whether it is of value by any indirect agency is another question; perhaps the spine would be a better local- ity if ice is to be used at all. When bleeding is severe, do not use an instru- ment if it is possible to do wdthout it. There is a great dread in some people's minds about the existence of a large co- agulum in the bladder. I have even known a bladder to be opened above the pubes by the surgeon, for the mere pur- pose of evacuating a mass of clotted blood. Leave it alone: it will gradually be dis- solved and got rid of by the continued action of the urine; Avhile if you are in haste to interfere with instruments, and are very successful in removing it, you will very probably also succeed in setting up fresh hemorrhage. The bleeding vessels have a far better chance of closing effectually if they are not subjected to
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