URINE. 



When the urine has diftended the bladder to the utmoft, 

 aad the obltruAion in the urethra continues unremoved, 

 that fluid next coUefts in the ureters, which in their turn 

 become dilated. The fort of valve which covers their ter- 

 mination in the bladder difappears, and the opening, by 

 which each of thefe tubes communicates with this recep- 

 tacle, fometimes becomes nearly an inch in diameter. As 

 the diforder advances, no more urine can at length defcend 

 from the kidneys, and the fecretion is totally fupprefled. 



To the well-informed furgeon, the diagnofis of a reten- 

 tion of urine is generally attended with no difficulty ; but 

 the cafe is far otherwife to the man whofe experience and 

 attention to the fubjec^ have been very circumfcribed. 

 What Default has called the rational fymptoms are numerous ; 

 but yet moft of them are of an equivocal nature : as, for 

 inftance, the ftoppage of the difcharge of urine for one or 

 feveral days ; its evacuation by drops, or in very fmall quan- 

 tities at a time ; continual inclination to make water ; the 

 efforts which precede the performance of this funftion ; the 

 defire which the patient Hill feels to empty the bladder, 

 after he has voided nearly as much urine as in the natural 

 ftate ; a diminution either of the force, or ftream of the 

 urine ; a fenfation of weight about the perineum, tenefmus, 

 conftipation, hemorrhoids. To thefe fymptoms are to be 

 added, acute pain in the hypogaftric region, extending 

 along the urethra to the extremity of the glans penis, and after- 

 wards towards the kidneys, fometimes attended with ftupor 

 and numbnefs of the thighs. The pain is rendered much 

 worfe when the patient walks about, coughs, or keeps him- 

 felf in an ereft pofition ; and it is leflened when he bends his 

 body forward, and relaxes the mufcles of the abdomen. 

 Laftly, we have to join to the foregoing fymptoms, fever, 

 naufea, laborious rcfpiration, and perfpiration, that is faid to 

 poffefs a decided urinary odour. 



All thefe rational fymptoms, as they were denominated by 

 Default, are vague and uncertain. The whole of them to- 

 gether can only afford more or lefs probable conjeftures re- 

 fpefting the exiftence of a retention of urine. The certainty 

 of the thing can never be made out, unlefs there be com- 

 bined with the preceding defcription of complaints an ob- 

 vious and manifeft tumour, formed by the bladder, not only 

 above the pubes, but likewifein the reftum of the male, and 

 in the vagina of the female fubjeA. The fwelhng above the 

 OS pub'.s varies confiderably in its fize. Sometimes it reaches 

 above the navel. It is circumfcribed, and unattended with 

 any alteration in the colour of the Ikin, or any hardnefs 

 at Us circumference. It is more expanded below than 

 above, elaftic, and free from tendernefs ; except it be 

 preffed upon with force, and then the propenfity to make 

 water is increafed, and fometimes a few drops are even urged 

 out of the urethra. 



The fwelling in the reftum or vagina is readily difcover- 

 ed by manual examination. It is fituated only at the anterior 

 fide of thefe cavities ; and, like the hypogaftric tumour, it is 

 every where elaftic, equal, and free from any particular in- 

 durations. 



Another pathognomonic fymptom, deferving the utmoft 

 attention of the practitioner, is the fluAuation, or rather the 

 fort of undulation, which is perceptible on alternately 

 preffing upon both the fwellings. Thefe, however, do not 

 conftantly exift ; for, as Default remarks, retentions of 

 urine, even of the moft complete kind, have been known to 

 occur, where the bladder, not being very extenfible, hardly 

 contained a few fpoonfuls of urine. 



Mr. Hey has not adverted to the fweUing in the reftum, 

 or vagina ; nor to the cafes of contrafted bladder, where, 

 of cpurfe, the information derived in ordinary inftanees from 



the tumour above the pubes, could not be acquired ; but, 

 in other refpefts, his obfervations on the diagnofis are prafti- 

 cal and correft. According to this experienced writer, the 

 charaAeriftic fymptom of a retention of urine, previous to 

 the introduftion of the catheter, is a diftention of the blad- 

 der (to be perceived by an examination of the hypogaftrium), 

 after the patient has difcharged all the urine which he is ca- 

 pable of expelling. 



" As this complaint may fubfift when the flow of urine 

 from the bladder is by no means totally fuppreffed, great 

 caution is required to avoid miftakes on this fubjeft. 



" Violent efforts to make Water are often excited at inter- 

 vals ; and during thefe ilrainings, fmall quantities of urine 

 are expelled. Under thefe circumftances, the diforder may 

 be miftaken for the ftrangury. 



" At other times, a morbid retention of urine fubfifts, 

 when the patient can make water with a ftream, and dif- 

 charge a quantity equal to that which is commonly dif- 

 charged by a perfon in health- Under this circumftance, I 

 have known the pain in the hypogaftrium, and diftention of 

 the bladder, continue till the patient was relieved by the 

 catheter. 



" And, laftly, it fometimes happens that, when the 

 bladder has fuffered its utmoft diftention, the urine runs off 

 by the urethra as faft as it is brought into the bladder by the 

 ureters. I have (fays Mr. Hey) repeatedly known this cir- 

 cumftance caufe a ferious mifapprehenfion of the true nature 

 of the difeafe. 



" In every cafe of retention of urine which I have feen, 

 the difeafe might be afcertained by an examination of the hy- 

 pogaftrium, taken in conneftion with the other fymptoms. 

 The diftended bladder forms there a hard and circumfcribed 

 tumour, giving pain to the patient when preffed with the 

 hand. Some obfcurity may arife upon the examination of a 

 very corpulent perfon ; but in all doubtful cafes, the catheter 

 fliould be introduced." Praft. Obf. p. 389. 



A retention of urine is always a ferious difeafe, and when 

 it is complete, it demands the moft prompt fuccour. When 

 relief is too long deferred, the confequences are truly afflift- 

 ing ; for, when the bladder continues for a time pretematu- 

 rally diftended, it lofes its contraftile power, which it re- 

 covers with difficulty. Irritated alfo by the quantity, and 

 perhaps by the quality of the confined fluid, it foon becomes 

 affefted with inflammation and gangrenous mifchief. 



Sometimes the bladder burfts, and the urine is extravafated 

 in the cellular membrane of the pelvis ; fpreading behind the 

 peritoneum as far up as the loins ; producing fwellings in the 

 perineum ; and becoming effiifed alfo in the fcrotum, com- 

 mon integuments of the penis, and upper part of the thighs. 

 Indeed, as Default remarks, the urine has fometimes been 

 known to be effufed in the parietes of the abdomen, as far up 

 as the fides of the cheft, producing gangrenous abfceffes and 

 fiftulae of the parts. To thefe evils are to be added others, 

 arifing from the total interruption of the fecretion of urine, 

 and from the abforption of a part of that which is confined 

 in the bladder. 



In the treatment of every retention of urine, there are two 

 principal indications. The firft is to give fpeedy iffue to this 

 fluid, in order to prevent the foregoing difaftrous confe- 

 quences ; the fecond is to obviate the caufes which prevent 

 its expulfion from the bladder. At prefent we ftiall confi- 

 der only the firft of thefe indications, as the fecond can be 

 more appropriately treated of when we come to notice the 

 various caufes of the complaint. 



The urine is commonly let out of the bladder by the in- 

 troduftion of an inftrument termed a catheter. Default con- 

 fiders this operation in two points of view ; firft, when the 



urethra 



