Single ulcer of the urinary bladder, non-tuberculous and non-malignant : with report of cases / by George E. Armstrong.

  • Armstrong, George E., 1854-1933.
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: Single ulcer of the urinary bladder, non-tuberculous and non-malignant : with report of cases / by George E. Armstrong. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    matter was adherent about the edges of the ulcer. The woman had been confined with a live child about a month previously by a midwife, and from what I could make out she had had a favorable labor, and attended to her usual work after the first week. She had never referred any pain to the region of the bladder, but had been heard to complain, both before and after labor, of an inability to empty her bladder completely. Thurston12 reports a case of chronic perforating ulcer of the bladder occurring in a married woman, aged fifty-two years. The symptoms had been present for over four years before the perfora- tion of the fundus or the bladder occurred. The hole had been closed by adherent omentum. We are all familiar with tuberculous ulceration of the bladder and with the breaking down of tissue secondary to neoplasms, and Proksch11 has told us something of syphilitic ulceration, and it occurs rarely in cases of long-standing prostatic cystitis. Does there occur an ulceration of the bladder wall independently of trauma (including pressure), tubercle, syphilis, and new-growth? I am not prepared to answer that question in a monosyllable. The evidence that I have collected favors, in my opinion, an answer in the affirmative. An ante-mortem diagnosis before the advent of the cystoscope was impossible, and the true condition was only determined after the occurrence of perforation, and then generally in the autopsy- room. I have selected these seventeen cases from a larger number in which the reports were sometimes too incomplete to permit of classi- fication. In some instances perforation has occurred after a fall' or the receipt of some form of violence. It yet remains to be deter- mined just how much force is needed to rupture a full or distended bladder, not weakened at any one point by ulceration or saccula- tion. In this list all such doubtful cases are excluded. I think that we must look to one or more of three conditions for the cause of single ulcer of the bladder—infection, thrombosis, and syphilis. It has been thought by some that probably most perfor- ating ulcers were due to a breaking-down gumma in the bladder