URJNE. 



of the fphinfler of the bladder ; but they have not remem- 

 bered that the bladder itfelf alfo participates in the paralytic 

 affeftion ; for tiie f^hinfter not being a particular mufcle, 

 but only a fafcicilus of flefhy tibres, formed, as Default 

 obferves, by the junftion of thofe which compofe the inner 

 layer of the mnfcular coat of the bladder, it can only be 

 weakened in the fame degree, and at tlie fame time, as the 

 reft of this organ. Bcfides, fays Default, we have proved, 

 and all phyfiologifts admit the faift, that the aftion of 

 the bladder is abfolutely neceflary for the expulfion of the 

 urine, and that an inert condition of this vifcus is always fol- 

 lowed by a retention. 



An incontinence of urine is not attended with fo much 

 danger as a retention. It is, however, a moft afflifting in- 

 firmity to a pcrfon obliged to mix with fociety : his clothes 

 being continually wet with urine, the ftench which he carries 

 about with bin is equally an annoyance to himfelf, and every 

 body elfe who approaches him. 



An incontinence of urine in children ufually gets well of 

 itfelf as they grow up. When they wet their beds really 

 from idlenefs and careleflnefs, moderate chattifcment may be 

 proper, inafmuch as the fear of correftion will make them 

 pay more attention to the earlieft fenfations of the defire to 

 make water. We fear, however, that this doftrine is carried 

 to rather an unjuftifiable extent, particularly in fchools ; and, 

 at all events, punifhment in fuch cafes fliould never be fevere, 

 as, in ninety cafes out of a hundred, the diforder is a true 

 infirmity, arifing from the caufes already indicated, and not 

 from indolence ; the fuppofed crime taking place, in 

 faft, when the child is afleep, and unconfcious of what is 

 happening. 



When an incontinence of urine depends upon an cxceflive 

 irritability, in which ftate the bladder is forced to contrail 

 by a very fmall quantity of urine in it, and involuntarily 

 overcome the refiftance of the urethra, an endeavour fliould 

 be made to lelfen fuch irritability by the ufe of the warm or 

 cold bath, fea-bathing, mucilaginous drinks, &c. If the 

 accident fhould happen only in the night-time, the child 

 fhould not take any drink for fome time before being put to 

 bed ; fhould empty the bladder before going to fleep ; and, 

 if neceffary, be taken up in the night to do the fame thing 

 again. 



When the incontinence depends on a want of aiflion in 

 the parts producing the refiftance in the urethra, tonics may 

 be externally and internally employed. They feldom fuc- 

 ceed, however, when the diforder is of long (landing. In 

 this circumftance, palliative means muft be reforted to ; viz. 

 inftruments calculated to comprefs the urethra, and intercept 

 the pafl'age of the urine. This objeft is more difficult to 

 accomplifh in women than men ; but it may be done by- 

 means of an inftrument which coiififts of an elaftic hoop, 

 which goes round the pelvis, and from the middle of which, 

 in front, a curved elaftic piece of (leel defcends, and termi- 

 nates in a fmall comprefs, which is contrived to cover accu- 

 rately the orifice of the meatus urinarius. See CEuvres 

 Chir. de Default, par Bichat, t. iii. p. 95, &c. 



The apphcation of blifters to the facrum has often proved 

 very cffcftual in curing incontinence of uiinc, both when the 

 complaint feemingly arofe from excefiive irritability of the 

 bladder, or from paralyfis and lofs of tone in this organ, and 

 the parts which naturally refift the expulfion of the urine 

 from it. The reader will find fome very intcrefting cafes of 

 this kind in the Medical Obfervations and Inquiries. 



UlUNE, Retention of. When, from any particular caufe, 

 the urine cannot be difcharged from the bladder through 

 the urethra, it accumulates in that receptacle, which it gra- 

 dually diftends fometimes even to an incredible magnitude. 



The difeafe has been defcribed by the ancients under the 



generic name of ifchuria. Certain writers make a diftinc- 

 tion between this diforder and other cafes, to which they 

 apply tiie terms dyfury and Jlrangury ; while others have 

 confidered thefe lail only as different kinds of retention of 

 urine. Some furgeons always mean by dyfury the cafe in 

 which the urine is difcharged with great pain and difficulty ; 

 and by the wordjlran^ury, the example in which the evacu- 

 ation can be made only by drops ; while they reftrift 

 ifchuria to the form of the difeafe in wliich no urine at all 

 can be voided. Default very jullly imputed this variety in 

 the fymptoms to different degrees of the fame difeafe, and 

 he therefore, with much propriety, preferred the diviiion 

 into the complete and incomplete retentions nf urine. 



As Mr. Hey has obferved, the diftinftion which has 

 fometimes been made between a fupprcjfion and retention of 

 urine, is practical and judicious. The former moft properly 

 points out a defeft in tlie fecretion of the kidneys ; the latter 

 an inability of expelling the urine when fccreted. We alfo 

 like the following iimple and plain definition : " The difeafe 

 (fays he), of which I am fpeaking, under the term retention 

 of urine, is an inabihty, whether total or partial, of expeUing 

 by natural efforts the urine contained in the bladder." Praft. 

 Obf. in Surgery, p. 389. edit. 2. 



When the urine is retained in the bladder, the parietes of 

 this organ fuffer from diilention, and after the tone of its 

 mufcular fibres has been flraincd, it can make only a feeble 

 refiftance to its further dilatation, and fometimes it becomes 

 of confiderable lize. In an infant a year and a half old, it 

 has been known to contain a pint of urine ; and in adults, 

 fix or feven pints. The bladder, thus didended, has been 

 found to fill not only the cavity of the pelvis, but to rife up 

 into the abdomen higher than the navel. It has fometimes 

 been obferved to extend itfelf even througli the abdominal 

 rings, fo as to conftitute a fcrotal rupture ; or under the 

 crural arcli into the groin. Such elongations of the blad- 

 der, it is true, are not very common ; yet many inllances 

 of them are recorded in the Memoirs of the French Aca- 

 demy of Surgery. In ordinary cafes of retention of urine, 

 the natural fhape of the bladder does not undergo any ma- 

 terial change ; but ftill all its dimenfions do not increafe in 

 the fame proportion. It fpreads more from below upward 

 than in any other direftion. Its inferior portion becomes 

 broader, and more deeply fituated, preffing downwards and 

 forwards the perineum ; and propelling, in women, the va- 

 gina backwards ; or, in the male fubjed, the rettum. In 

 thefe latter tubes, it forn^s a fwelling, which either com- 

 pletely or partially obftrufts them, and interrupts the paf- 

 fage of the feces thrcugh the reftum. The pofterior part 

 of the bladder, which is covered by the peritoneum, lifts 

 upward and backward the mafs of fmall inteftines, and rifes 

 into the cavity of the belly. The extreme part of its 

 fundus mounts above the os pubis, and, as it were, in- 

 finuates itfelf between the peritoneum, which it raifes, and 

 the abdominal mufcles. Indeed, t!ie anterior and fupcrior 

 portion of the bladder forms a fwelling in the hypogaftric 

 region, and is in aftual contact with the redi and tranf- 

 verfales mufcles, with which it is connefled by means of a 

 loofe cellular fubftance. The knowledge of this lall difpo- 

 fition of the parts is of great importance to tiie furgcon, 

 fince it leads him to underlland, tliat the liladder admits of 

 being pundured, without any danger ot wounding the peri- 

 toneum, and caufing an extravafation ot urine. It is not 

 uncommon ( fays Default ) to find in bladders, which have 

 fnffered fuch diilention, cells or pouches often containing 

 calculi, and fituated between the fafciculi of Hefliy fibres. 

 See UniNARV Calculi. 



5 Whi-n 



