STONY CONCRETIONS IN THE BLADDER. 75 



an effusion of blood. Haematuria from this cause, however, is very 

 rare, although the laity are much inclined to ascribe all haematuria 

 to " haemorrhoids of the bladder." The conditions producing impedi- 

 ment to the circulation and dilatation of the vessels are far less favor- 

 able in the bladder than in the rectum ; and, as a rule, this last and 

 rarest of the causes of vesical haemorrhoids is not to be thought of, 

 unless, after a scrupulous review of all the symptoms, all other forms 

 of the disease can be excluded from the diagnosis. 



In haemorrhage into the bladder, the blood and urine are less inti- 

 mately mixed than when the bleeding comes from the ureters, renal 

 pelvis, or kidneys. The clots which form are also of larger size. Nev- 

 ertheless, both these signs may jprove fallacious, and hence diagnosis 

 of the region whence the bleeding proceeds is often a matter of great 

 difficulty. The attendant symptoms furnish the most trustworthy aids 

 to diagnosis of the source of the haemorrhage. Vesical haemorrhage 

 is almost always accompanied by evidence of change of structure in 

 the bladder. '. During the intervals between the bleedings the urine 

 contains mucus and pus, and there is dysuria, etc. 



Our main task in the treatment of vesical haematuria should be to 

 combat the original disease. In severe cases, cold should be applied 

 to the region of the bladder, and large doses of tannin should be given. 

 Where the bleeding threatens to exhaust the patient, we must have 

 recourse to injections of cold water, with a solution of alum, sulphate 

 of zinc, or nitrate of silver. In vesical haemorrhoids as well as othei 

 forms of vesical haemorrhage, cold injections have the best effect. 



CHAPTER VI. 



STONY CONCRETIONS IN THE BLADDER. 



ETIOLOGY. The manner in which stones form in the kidney and 

 bladder is obscure. None of the current explanations of the process 

 have shown themselves proof against the various objections made to 

 them. Especially is this the case with the theory that these concre- 

 tions are the result of a peculiar derangement of assimilation, of a 

 diathesis, wherein uric acid, oxalic acid, the phosphates, etc., form so 

 profusely in the system, and are eliminated from the blood through 

 the kidneys in such quantities, that they are precipitated in the urinary 

 passages. 



The explanation of Scherer is very plausible. He believes that 

 the substances deposited in the urinary passages, and which sometimes 

 form stones, are not eliminated from the kidneys in then* present shape., 

 and only form through the decomposition which the urine undergoep 



