Tumours of the bladder; their pathology, diagnosis, and treatment. Being the Jacksonian prize essay of 1887, rewritten, with 200 additional cases

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1897 Excerpt: ...latter symptom had continued up to the date of the present attack, but the headache had ceased two months ago. These symptoms suggested that an insidious interstitial nephritis had been progressing for some months. There was no supra-pubic distension. On the right of the pubes a firm fleshy mass could be felt. This I took to be an empty hypertrophied bladder pushed out of the pelvis. On passing the catheter there was a hitch at the prostate, but it entered easily and no urine was evacuated, the instrument being withdrawn without even a drop in the eye. To ascertain whether any pelvic obstruction was causing the suppression, I examined the rectum. The finger encountered a large, elastic, semi-fluctuant mass which did not spring from the prostate, but was obviously in the space between the rectum and the bladder. Many small shotty glands could be felt in the peri-rectal tissues. I did not know whether I was dealing with a soft sarcoma or a hydatid. I determined to aspirate per rectum, which I did next day. After proving by means of the catheter that the bladder was still empty, I withdrew by aspiration through the rectal wall three or four ounces of clear hydatid fluid from the recto-vesical cyst, and at once two ounces of blood-stained urine flowed into the bladder and were evacuated by the catheter. Obviously by reducing the bulk of the pelvic hydatid I had removed the pressure on the dilated ureters, and had thus enabled them to empty their dammed-up contents into the bladder. Next day the patient passed thirty ounces of urine voluntarily, and I proposed to incise supra-pubically, to lift up the peritoneum and open and drain the cyst. On the morning fixed for the operation (the sixth day of the attack) the urine again stopped, and at 8 a,m., whilst he was ...