A System of gynæcology : by many writers / edited by Thomas Clifford Allbutt and W.S. Playfair.

  • Allbutt, T. Clifford (Thomas Clifford), 1836-1925.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: A System of gynæcology : by many writers / edited by Thomas Clifford Allbutt and W.S. Playfair. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    973/1000 (page 953)
    by which a portion of the epiblast fills in a deficiency, or they are peri- \ esical in origin. Jlncoui! polypi, having a texture resembling that of ordinary nasal polypus, except that the epithelial covering is squamous instead of ciliated, have been found in the bladders of children under two years of age, as well as in adults. In the early stage they may not give rise to any symptoms; later they may simulate vesical calcvilus, and growing to a considerable size project even beyond the urethra, or distend the bladder to the level of the umbilicus. Bilharzia hcematobia sometimes causes masses of fungating exudation of considerable size in the bladder. It is not an uncommon cause of hiBmaturia in the Nile district. [Art. Bilharzia in Si/st. of Med. vol. ii.] Pathological complications of bladder timiours are :—(i.) local thickening of the bladder walls due to hyperti'ophy of muscular and interstitial tissue; (ii.) hydronephrosis; (iii.) calcareous deposit on the surface of the tumour ; (iv.) occasionally a phosphatic calculus free in the bladder, the result of a cystitis provoked by the growth, possibly a portion of the growth broken away from the rest may form its nucleus; (v.) suppurative pyelo-nephritis with or \\dthout distension of the kidney. Symptoms.—Bladder tumours are met with at all ages, the sarcomas and myxomas in children; cancer between forty and sixty. They are much more common in men than in women. A small number of tumours of the bladder are quite unsuspected diu'ing life, as large calculi have been found as a surprise in autopsies. But as a rule their presence is made only too aj)parent by htemor- rhage, jDain, frequency of micturition, and, not unfrequently, by the presence of a swelling felt either through the vagina or through the anterior abdominal wall. Hsematuria is by far the most constant symptom; in some cases it is the only one, and sometimes is alone the cause of death. It is nearly always the first symptom complained of, and the one which brings the patient to his doctor. Its onset, its course, and its abundance are characteristic of tumoiu. It comes on spontaneously without injury, fatigue, or even movement; and it causes no difficulty in micturition unless a clot for a while obstruct the urethra. It may be excited by catheterism or by distension of the bladder; and rest e^-en in the recumbent position has no effect in stopping it. After the hsematuria has existed for hours, days, or weeks, the urine may suddenly become quite clear. Whilst the hsematuria lasts, the urine is not equally charged with blood at each micturition; more blood is passed at the end of micturition than at any other period of its flow : the quantity is often exceedingly great, and the loss, even from a small iiniocent growth, may be fatal. In cases of repeated or prolonged hajmorrhage the patient becomes anaemic and waxen-looking, and the lower extremities csdematous. Pain is not a constant symptom ; it appears late, and is generally due to cystitis. When it exists it is often very intense, and is worse at the end of micturition. It is felt in the hypogastrium and at the neck of the