86 The Philippine Journal of Science 1920 
During these admissions he was not cystoscoped, nor was he 
X-rayed. 
On July 24, 1918, the patient was transferred to Letterman 
General Hospital for four months; diagnosis of hypertrophied 
prostate and fungus growth of the bladder was made (this 
without a cystoscopy). An operation was advised, but it being 
explained to the patient that the operation was a very serious 
one he refused operation and returned to Manila, in February, 
1919. 
During his stay at the Letterman General Hospital he had 
daily bladder irrigations and was on urotropin internally. On 
admission his weight was 106 pounds and at the end of his four 
months’ stay under good diet, rest, and daily bladder irriga- 
tions his weight increased to 140 pounds. 
In August, 1919, the patient first came under my care with 
the past history as just given. Rectal examination showed a 
markedly enlarged prostate. 
On cystoscopy an acute cystitis was found, the inflammation 
involving the entire bladder wall. The cystitis was so marked 
that it required four or five bladder washings before a clear 
field could be obtained. The ureteral orifices were easily located 
and were found to be normal. Slightly external to and about 
2 centimeters. above the left ureteral orifice was found the 
_ opening of a diverticulum. A ureteral catheter (X-ray) was 
passed into this opening and it was found that the catheter 
curved up within the diverticulum. The opening into the diver- 
ticulum was about 1 centimer in diameter. An X-ray picture 
was taken and with the catheter still within the diverticulum 
10 per cent collargol was injected into the diverticulum and 
another X-ray was made. . 
At the first cystoscopy the maximum bladder capacity was 
50 cubic centimeters of bladder fluid, and it was with great 
difficulty that a satisfactory cystoscopic examination was made. 
The residual urine amounted to 60 cubic centimeters. This 
urine was very turbid and had an extremely foul odor. 
The patient has been on daily bladder irrigations of boric 
acid and silver nitrate, the latter in increasing strength. He 
has shown marked improvement in both general and local con- 
dition. His present weight is 140 pounds; his appetite is good; 
his bladder capacity at present is 140 cubic centimeters, as 
compared to 50 cubic centimeters when treatment was first 
started, Cystoscopically his bladder has shown marked im- 
