74 DISEASES OF THE BLADDER. 



patient of mine, suffering from tuberculosis of the bladder, urinary 

 passages, and kidneys, I found an irregular eroded ulcer, with peculiar 

 edges, in the vulva, surrounding the orifice of the urethra. 



The treatment of tuberculosis of the bladder is identical with that 

 of chronic vesical catarrh, but is generally quite unavailing. 



Carcinoma of the bladder is not common. Sometimes it is primary, 

 sometimes it occurs secondarily to similar disease of the uterus or rec- 

 tum. It assumes the form of scirrhus, more often the medullary form, 

 but the villous cancer is more frequent than either. The former twt 

 sometimes produce diffuse degeneration of the wall of the bladder, 

 which, upon breaking down, forms communicating openings with the 

 vagina, uterus, or rectum. Sometimes they take the shape of circum- 

 scribed and even pedunculated growths. The villous cancer forms 

 soft tumors, consisting of thin, delicate villous excrescences, which float 

 in water, and which often become detached during life, giving rise to 

 haemorrhage. 



The most prominent symptoms of cancer of the bladder are, like- 

 wise, those of chronic vesical catarrh. Haemorrhage is still more com- 

 mon than in tuberculosis. Diagnosis must depend upon the continuance 

 and constant aggravation of the symptoms, the early appearance of a 

 bad cachectic condition, in the discovery of cancer of other and espe- 

 cially of neighboring regions, and, above all, upon microscopic exami- 

 nation of the detached particles of the growth discharged with the 

 urine. Treatment is in vain, and should be limited to a repression of 

 the haemorrhage, the relief of any retention of urine which may arise, 

 and the combating of intercurrent symptoms. 



CHAPTER Y. 



HAEMORRHAGE FROM THE BLADDER H^EMATTTRIA VESICALIS. 



HAEMORRHAGE from the vessels of the bladder is often of traumatic 

 origin. Sharp-edged stones, or foreign bodies, which have entered the 

 viscus, are the usual causes of the bleeding. In hysterical women, we 

 must be prepared for the most extraordinary devices. Not at all un- 

 frequently, they introduce foreign bodies into their genitals, or into 

 their urethra, which may be the cause of the haemorrhage. In other 

 cases, ulcers of the bladder cause erosion of its vessels, and consequent 

 bleeding. Neoplastic formations also, tubercle, carcinoma, but espe- 

 cially the villous cancer, give rise to losses of blood. Very rarely, 

 such haemorrhages depend upon the misuse of cantharides (haematuria 

 toxica), or upon a haemorrhagic diathesis. Finally, an excessive dila- 

 tation .)f varicose veins of the part may result in their rupture, with 



