PAPILLOMA OF THE BLADDER.
DR. SAMUEL ALEXANDER presented a specimen obtained from a man, forty-two years old, who was admitted to Bellevue Hos pital on December 20, 19oo, complaining of hwmaturia and inter rupted urination. He stated that four weeks previous to his ad mission he had had a severe attack of renal colic, which lasted two hours ; the pain was very intense and stopped suddenly. The first urine passed after this attack contained blood. Previous to this attack there was no history of hmmaturia. The patient was advised at a dispensary to go home and remain in bed ; he did so, and on the first day the bleeding ceased. Four days later he resumed his work as a peddler, and the hxmorrhage immediately recurred. He again went to bed, and the bleeding ceased as before. Since then the hxmaturia has recurred from time to time, but it was never of a very severe type. During his second attack of hmmaturia he first noticed an interruption in the stream of urine.
Dr. Alexander said that when the patient was admitted to the hospital and gave the above history, the case was regarded as one of stone in the kidney. Upon palpation, the left kidney appeared to be normal ; the right rectus muscle was rigid, and the right kidney seemed to be either displaced or enlarged. Press ure over the pelvis of the right kidney elicited pain, which ex tended down along the course of the ureter. The bladder was easily able to hold six or eight ounces of fluid, and upon disten tion there was no bleeding. Upon washing the bladder with two injections, the fluid last injected returned absolutely clear. This apparently excluded the bladder as the source of the hxmaturia. With the searcher the mucous membrane on the right side of the bladder was found to be decidedly roughened. No stone was found and the examination did not excite bleeding. The urine contained epithelial and granular casts, considerable pus, and a little blood. The symptoms thus far elicited strengthened the original view that the case was one of renal calculus. Before operating, however, it was decided to make a cystoscopic exami nation. This revealed a mass about the size of a man's thumb springing from the base of the trigone. It was removed through a suprapubic incision, and proved to be a villous papilloma.
Dr. Alexander said that in closing the suprapubic wound he followed the method suggested by Dr. Charles L. Gibson, namely, to invert the mucous membrane. In cases of secondary operation, where a suprapubic opening has already been made, the method is apt to prove difficult on account of the adhesions, but in primary cases it is a most perfect method of securing dry suprapubic drainage.