Case 2.—A man, aged fifty, was obliged to exert a strong pressure in order to empty the bladder. The flow of urine often stopped. He himself introduced a catheter, and on withdrawing it a piece of villous tissue was found. On Dec. 10, 1886, I saw, on cystoscopical examination, directly and immediately over the internal orifice of the urethra, a villous swelling hanging from the anterior wall of the bladder. (See Fig. 2.) On Jan. 15, 1887, extirpation of the tumor by means of the high section was performed by Professor v. Bergmann. The size of the tumor (which was as large as a pigeon's egg) and its position corresponded exactly to the endoscopic picture. The patient recovered.
Fig. 3.
Case 3.—A patient under the care of Professor Madelung, aged fifty-five, suffered from attacks of hæmaturia. Examination by sound and rectal palpation had given me negative results. On Feb. 20, 1887, cystoscopical examination was made. On the left side of the trigone a tumor with a broad base was seen, which resembled somewhat a strawberry in size and form. (See Fig. 3.) On March 1, Professor Madelung undertook the extirpation of the tumor. The appearance corresponded exactly to the cystoscopic picture. The patient recovered.
Fig. 4.
Case 4.—This was a patient on whom Dr. Israel had performed the high section a long time before, on account of a bladder tumor. The extent was so great that only its most prominent part could be removed. The microscopical examination proved the diagnosis of cancer. Quick healing took place. The patient became free from pain, and the urine became clear. In
order to see what had become of the remaining part, the cystoscopical examination was undertaken on April 3. It was easy to see that the right lateral wall was covered to an extent of from three to four centimeters with thick masses of verrucous and fungiform excrescences. (See Fig. 4.)
[We omit the description of the additional cases.]
The above shortly described fifteen[9] cases of bladder tumors have been diagnosed by me cystoscopically during the last sixteen months. This is a proof, on the one hand, of the value of the cystoscopic examination; on the other hand, of the fact that the new formations in question are not of so rare occurrence as has been hitherto thought. I would like to emphasize that the important results were often obtained under the most difficult circumstances. In several cases the external orifice of the urethra was found abnormally small; in others (Cases 8 and 11) the examination was made during the occurrence of a continuous hemorrhage from the tumor; in one case (Case 1) I introduced the instrument through the center of the tumor, which bled on the slightest pressure. In spite of this the appearances were seen satisfactorily. In the first case a post mortem examination was made; in eight other cases (Cases 2, 3, 9, 10, 11, 13, 14, and 15) the tumor was extirpated, seven times by the high section—in one case, that of a woman, through the dilated urethra. In these nine cases the endoscopic appearances were in every important respect confirmed in the most perfect manner. In every case my opinion regarding the size, position, and form was found to be correct. It is only in those cases where the edges of the tumor overlap the short pedicle that the latter cannot be observed. Besides, the relative good results of the operations undertaken on account of the cystoscopic appearance may be emphasized. Of the eight patients from whom the tumors had been extirpated, none died from the result of the operation. Case 9 proved fatal on account of the progressive extension of the growth. In the eleventh case there was a recurrence, but the patient is still alive. Five patients (Cases 2, 3, 10, 13, 14) must be considered entirely cured. Case 15 is still under treatment, and, as the conditions of the patient are at present (ninth day after operation) in every way satisfactory, a complete recovery is anticipated.