CANCEB 
OF THE 
BLADDER AND PROSTATE. 
By G. B. BALCH, M.D., 
Of Yonkers, New York. 
[Reprinted from the Ohio Medical and Surgical JouiyvX/ 
COLUMBUS: 
NEVINS & MYERS, BOOK AND JOB PRINTERS. 
1877. CANCER OF THE BLADDER AND PROSTATE. 
P. De F., aged fifty-seven years, was for many years an 
excessive user of alcoholic liquors. In June, 1875, he first 
began to have some pains above the pubis, with frequent 
desire to urinate, the stream being small; the pain was dull 
and heavy, but after urinating was quite severe. 
Sudden desire to urinate, with dribbling, has occurred 
since May, 1876. The desire was so severe and sudden at 
times that it was impossible for him to find a place of seclu- 
sion. On the 20th day of September, with urgent call to 
urinate, blood spurted from the meatus urinaris, and, appar- 
ently, without being mixed with urine, very little pain 
accompanying the hemorrhage. After this, bloody urine 
continued to be passed and dribbled from him. When in a 
recumbent posture, the dribbling was constant; when in an 
erect or sitting posture, he could retain it and pass it natu- 
rally. 
On the 5th day of October, 1876, I was first called to see 
him; he had just had a severe hemorrhage. I found him 
pale and weak, with an anxious expression of countenance. 
An examination revealed an enlarged prostate that was ex- 
ceedingly tender. On attempting to catheterize him he 
complained of the instrument hurting him so very much 
that I desisted, there being no urgent symptom that called 
for it. In the use of this instrument there was no force used, 
and not one drop of blood was drawn, and it could not have 
passed further than to the prostatic portion of the urethra. 
There was no interruption of the stream in urinating; no 
pain in the head of the penis, or pricking sensation in any part of the urethra; no priapism; no enlargement of the 
penis or elongation of the prepuce, or prolapse of the anus. 
After a thorough examination, my opinion was given that 
there was a malignant condition existing at the neck of the 
bladder. About the first of November he ceased to have 
blood in his urine. The urine continued to dribble, and he 
passed none'naturally. He lost his appetite at the time of 
the first hemorrhage, and never regained it; he continued to 
emaciate and lose strength. 
November 15th he began to have bleeding from the mouth 
and nose, which continued to the end. On the 25th of No- 
vember purpuric spots were noticed upon the lower extremi- 
ties. He died on the fourth day of December, 1876. The 
treatment was iron and quinine, moderate stimulants, and 
carbonic water and milk for drink and nourishment. 
His grandfather, on the maternal side, had osteo-sarcoma 
of the lower jaw. Autopsy six hours after death. The ab- 
domen and lower extremities were covered with purpuric 
spots, the body was very much emaciated. The bladder con- 
tained about 8 oz. of clear, healthy urine. The peritoneum 
was quite adherent to the bladder, except a small part of the 
fundus. In that part connected to the bladder there were 
many small tumors about the size of a pea, and many of the 
same tumors could be seen in the walls of the bladder. 
On opening the bladder its posterior and lateral walls were 
found very much thickened and infiltrated with these small 
growths. The prostate gland was very much enlarged and 
filled with this material. The mucous lining, particularly 
of the neck and lateral portions, was thickly studded with 
small tumors, from the size of a small Brazil nut to that of a 
small pea. The larger ones were located near the orifice of 
the urethra, and looked very much like organized blood clots ; 
the others shaded off to almost white in the smaller ones. 
The ureters were enlarged, and were somewhat obstructed 
by these tumors where they entered the bladder. The kid- neys were slightly fatty, and in the left was a dark hemorr- 
hagic spot. The liver was slightly enlarged, but quite 
healthy in appearance. The rectum and other bowels were 
healthy. The thoracic cavity was not examined for want of 
time. 
A microscopic examination has been made, and demon- 
strated the morbid condition to be encephaloid sarcoma.