URINE. 



ment perform a femicircular movement, by inclining thera ceffantly a pot for its reception. The bed praftlce, there 



towards the oppofite groin, and thence towards the abdo- 

 men. In the execution of this manoeuvre, care is to be 

 taken to keep the beak of the catheter ftationary, fo that it 

 may be the centre of the movement, and fimply revolve 

 upon itfelf. The handle of the inilrument is then to be de- 

 preffed, and the operation finiftied exaftly in the fame man- 

 ner as when the other mode is purfued. 



As Default properly obferves, the only circumftance in 

 tsrhich the two methods differ is, that, in one, the fame 

 thing is performed by two movements, which is <lone in the 

 other by one ; fo that the operation is protrafted, and ren 



fore, feems to be that of letting out all the urine, as foon as 

 the catheter is introduced, and then clofing the inftrument 

 until the bladder has become moderately diftended again. 

 Experience proves, that fuch moderate diftention and relaxa- 

 tion of the mufcular fibres of the bladder, alternately kept 

 up, have the fame good efFefts on the organ, as moderate 

 exercife has upon other parts of the body. 



When an elaftic gum catheter is ufed, care muft be taken 

 that it does not pafs unncceffarily far into the bladder ; and 

 if it be too long, a part of it ought to be cut off. 



When a catheter is to be left in the urethra, it fhould al- 



dered inore difEcult and painful. Hence, the majority of ways be properly fixed with a narrow piece of tape, or elfe 



good furgeons never praftife the " tour de maitre," except it is apt to flip out, or fometimes even to pafs too far down 



when their patients are either corpulent, or placed in the the paffage. Some furgeons ufe cotton thread for this pur- 



pofition ufually chofen for lithotomy, when the other mode pofe : they firft fatten it to the rings, or round the outer 



of introducing the catheter would be lefs convenient. portion of the catheter, and then carry its two ends fome 



When the urethra is free from obftruftion, an experienced way along the dorfum of the penis, when a fort of noofe is 



furgeon can generally fucceed in introducing a catheter into made, and the thread carried round the part and tied, 



the bladder, without any difficulty or force. But this When a filver catheter is employed, a tape or narrow rib- 



operation, which is fo eafy to furgeons accuftomed to it, 

 frequently proves extremely difficult to young praftitioners, 

 who, inflead of guiding the inftrument in the courfe of the 

 urethra, create obftacles by preffing its beak againft the 

 parietes of this canal, or entangling the inftrument in folds 

 of its membranous hning. When this happens, it muft be 

 withdrawn a little, in order to be pufhed on again, with its 

 direftion fomewhat altered. If this fecond attempt fhould 

 not anfwer better than the firft, and the catheter fhould be 

 flopped in the perineum, the furgeon muft apply his fingers 

 to the latter part, in order to difcover towards which fide 

 the beak of the catheter has deviated, and to guide it pro- 

 perly as it pafTes further. 



band is paffed through each of the rings, and conveyed to 

 the right and left fide of the pelvis, where it may be faf- 

 tened to a circular bandage. But there are numerous me- 

 thods of fixing, which need not be fpecified ; for, although 

 they ai-e of importance, the principles, which ought to be 

 obferved in adopting them, are the main things to be under- 

 ftood. Thefe are, firft, never to fix a catheter in fuch a 

 way, that too much of the inftrument projefts into the 

 cavity of the bladder ; and, fecondly, to be careful that 

 the thread, or tape, which is applied, will not chafe and 

 irritate the parts. 



Having premifed thefe general obfervations on the chief 

 indication in cafes of retention of urine, viz. that of giving 



When the catheter cannot be got through the portion of ifTue to this fluid, we next follow Default, in order to con- 



the urethra, which is contiguous to the re&um, the fore- fider the particular modifications to which the indication is 



finger ought to be introduced into the bowel, for the pur- liable ; a fubjeft which cannot be comprehended, without 



pole of fupporting the end of the inftrument, and rendering treating alfo of the caufes of the difeafe. 

 the coats of the inteftine fomewhat tenfe, by drawing them i. Of the Retention of Urine to -which Perfnns of advanced 



a httle downward and forward. If all thefe expedients Age are liable. — Old men are fo frequently afflifted with re- 



Ihould fail, the catheter fhould be changed for one of larger 

 or fmaller fize, or of another curvature. A gum elaftic 

 catheter ought alfo to be tried, without the ftilet. In no 

 cafe, however, is it juftifiable to pufh forward the catheter 

 with much force, left the urethra ftiould be lacerated, and a 

 falfe paflage produced. 



The depth to which the catheter has entered, the ceffa- 

 tion of any feeling of refiftance to the motions of the beak, 

 when revolved upon its axis, and the iffue of the urine, are 

 the circumftances by which the furgeon knows that the in- 

 ftrument has paffed into the bladder. 



According to the experience of Default, the praftice of 

 ktting out gradually only a part of the urine, after the ca- 

 theter has been introduced, is on every account wrong and 

 detrimental. He alfo difapproves of running into the op- 

 pofite extreme, that is to fay, of letting the urine flow out 

 of the bladder, through a catheter, as faft as it arrives in 

 this receptacle : as, by the laft praftice, the bladder is con- 

 ftantly kept in a ilate of relaxation, its fibres cannot recover 

 their proper tone. When alfo the bladder is continually 

 empty, it comes into contaft with the end of the catheter ; 

 a circumftance which has fometimes caufed confiderable irri- 

 tation, pain, and even ulceration of that vifcus. Befides 

 thefe inconveniences, there are other objeAions : the ca- 

 theter becomes fooner obftruAed witli mucus, and covered; 

 with incruftations, than when it is clofed with the ftilet. 

 The patients are likewife compelled to remain in bed, where 

 they are either wet with their urine, or obliged to have in- 



tention of urine, that the diforder is generally allowed to be 

 one of the grievances to which their period of life is parti- 

 cularly expofed. The bladder, hke the reft of the body, 

 becoming lefs irritable, is no longer duly ftimulated by the 

 prefence of the urine, and is only apprifed of the neceffity 

 of emptying itfelf by the painful fenfation arifing from the 

 diftention of its coats. It then contrafts ; but, to ufe De- 

 fault's expreffion, its elongated fibres have hardly force 

 enough to overcome the natural reaftion oppofed to them 

 by the canal of the urethra. There is almofl an equilibrium 

 betwixt the power and the refiftance, and the urine could 

 not riow out, if it were not for the affiftance derived from 

 the powerful aftion of the abdominal mufcles. Nor is tbe 

 expulfion of the urine even now complete, fince the bladder 

 no longer retains fufficient contraftile power to efface the 

 whole of its cavity. Some drops of the urine, after each 

 evacuation, are ftiU left undifcharged, and already conftitute 

 an incipient retention. The quantity daily augments, and 

 the fibres of the bladder becoming habituated to the pre- 

 fence of the urine, it happens at length that, at each eva- 

 cuation, not m.ore than half the fluid contained in this organ 

 is aftually voided. 



According to the obfervations of Default, all old men 

 are not equally liable to the complaint. It particularly at- 

 tacks thofe who are of a phlegmatic temperament, plethoric, 

 and of fedentai-y and fludions habits. It alfo efpecially 

 afflifts thofe who, from careleffnefs or indolence, do not 

 give themfelves time to expel the laft drops of urine ; and 



others, 



