On tumours of the bladder; their nature, symptoms, and surgical treatment preceded by a consideration of the best methods of diagnosing all forms of ... including digital exploration and its results

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. 1884 Excerpt: ...the use of an evacuating catheter of small size, connected with the aspirator employed in lithotrity, and by this means have easily obtained specimens which were complete evidence of the presence of a growth. This occurred in rny last case, No. 20. There is still another method which, when a fimbriated growth is present, will secure a specimen, and will, moreover, sometimes identify the presence of a salient tumour. It consists in carefully exploring the bladder with a small flat-bladed lithotrite. I discovered my first tumour thus; it was coated with phosphates, and I thought it might be a partially sacculated calculus, as I could seize but could not move it. I have been able to detach small portions of a growth thus, a little haemorrhage necessarily resulting. Supposing, however, that some fragments have been washed out, these should be placed under a J-inch object-glass, when the following elements may be sought. First, a portion of a slender papilla, or so-called 'villus,' sufficiently complete for identification, may be met with; the arrangement of columnar epithelium, at right angles to a central axis, and radiating round the terminal point, and presenting a structure which is unquestionable proof of the existence of such a growth in the bladder. On two occasions I have decided to operate on the strength of this evidence. Secondly, the appearance to the naked eye of small, slightly translucent, semigelatinous fragments in the urine are, of course, very significant. Under the power named, these mostly appear to be made up of spindleshaped nucleated cells, some comparatively short and broad, others elongated, and some nearly acquiring the character of a short fibre. These fragments have been present in several cases in which tumour has been subsequently...