URINE. 



others, who make a praftice of voiding tlieir urine into a 

 pot as they lie in bed, inllead of getting up to make the 

 evacuation. •' Although," fays Bicliat, " the latter fad 

 may not be explicable upon any phyfiological principles, its 

 truth is fufficiently eftablifhed by clinical obfervalion, and 

 we cannot doubt its rcahty." Thus, the hillory of the 

 patients' lives, their ago, and kind of conftitntioiis, form fo 

 many grouncs for fufpetling the nature of this fpecies of 

 retention of urine ; but the fufpicion is changed into cer- 

 tainty, when the following circumllances are joined with the 

 ufual fymptoms of a retention of urine in the bladder. 



The patients declare that they have never had in the 

 urethra, or neighbouring parts, any afFcftion capable of 

 impeding the ilTue of the urine ; that this fluid has always 

 come away freely, and in a full ilream ; but tliat, although 

 the Uream was undiminifhed, the urine could not be dif- 

 charged with the fame force, nor to the fame diftance, as 

 formerly. At length, inllead of defcribing an arch as it 

 flows out, it falls down perpendicularly between the legs. 

 Towards the clofe of the evacuation", the patient alfo is no 

 longer fenfible of the fii:al cojitraclile effort of the bladder 

 to expel the lad portion of the urine ; a particular fenfation, 

 of which he ufed to be confcious in his younger days. 

 When he is about to make water, he likevvife rijids that he 

 has to wait fome time before the evacuation commences. 

 As the diforder increafes, he begins to perceive that he can- 

 not make water without conliderable efforts ; that the 

 quantity of urine, voided each time, manifeftly decreafes ; 

 that the defire to empty the bladder becomes more and more 

 frequent ; and, lalUy, that the urine only comes away by 

 drops, and that an incontinence has fucceeded to a re- 

 tention. 



In this flate, the patient's fufferings are not very great. 

 The tumour, formed by the bladder above the pubes, is al- 

 moft indolent ; and, if it be preii'ed upon with fome force, 

 a certain quantity of urine is difchargcd from the urethra. 



The retention of urine arifing from old age is feldom 

 complete : the urine, after having filled and diflendcd the 

 bladder, dribbles out of the urethra, fo that the patient 

 voids as much of this fluid in a given time as he does in a 

 Hate of health. Nor is this fpecies of retention of urine 

 commonly attended with very urgent fymptoms. It docs 

 not occafion, like complete retentions, a fuppreflion of the 

 urinary fccrction in the kidneys ; and as the urine efcapes 

 through t!ie urethra, after the bladder is diftcndcd to a cer- 

 tain degree, the diforder is lefs apt to produce a rupture of 

 this organ, and dangerous extravafations of the urine. The 

 fwelling of the bladder then continues, without the patient 

 being lerioufly annoyed, except by a fenfe of weight about 

 the pubes and perineum. Sabatier has feen patients, who 

 have laboured under the difeafe fix months, without ever 

 having fufpefted its nature. The efcape of the urine has 

 indeed fomctimes deceived furgeons, and led them to con- 

 fider the fwelling to be of a totally different character. 

 Sabatier once attended a lady, who had been recommended 

 to refort to a dillant town, in order to try the effeft of its 

 mineral waters in difperfing a fwelling brought on during 

 her confinement in childbed, and wliich proved to be no- 

 thing more than a diRention of the bladder with urine. . 



There are many old men who have been troubled with 

 this fort of retention of urine a long time, and yet make no 

 endeavour to get relief, fuppofing that the infirmity is na- 

 tural to their period of life. The uriii", however, llagnat- 

 ing in the bladd -r, undergoes a decompolition, and the coats 

 of that organ itfelf at length become difeafed. 



This cafe prefents two indications, I'/'s. to evacuate the 

 urine, and to rcllorc the tone of the bladder ; frequently, 

 Vol. XXXVII. 



both thefe things may be accompliflied by the fume means. 

 When the retention is incipient, and the bladder is merely 

 in an inactive ftate, its proper aftion may often be rcllored 

 by laying cold apphcations upon the hypogaltric region, or 

 the thighs, and by the patient going from a warm into a 

 cool place, in order to make water. 



The patient muft alfo be ilridlly careful not to defer 

 making water immediately the Icalt inclination is felt to do 

 fo ; for, when the call of nature is not at once attended to, 

 the dillended fibres of the bladder lofe their fenfibility more 

 and more ; the defire to make water fubfidcs ; and the re- 

 tention, which at firfl confifled of only a few drops, very 

 foon becomes complete. It would then be in vain, as De- 

 fault obferves, to have recourfe to the means which have 

 been above recommended. No flimuhis will now make the 

 bladder contratl with fufficient force to expel the mafs of 

 m-ine which it contains, and the catheter is the only thing 

 by which this fluid can be difcharged. This artificial m.ode 

 of evacuation, however, only affords momentary relief ; for, 

 as the relaxed fibres of the bladder are flow in recovering 

 their natural tone, the patient would necefTaiily fall into the 

 fame condition again, if the employment of the catheter 

 were not continued. Hence, it is abfolutely indifpenfable 

 either to leave this inflrument in tlie bladder, or to introduce 

 it as often as the patient has occafion to make water. When 

 there is a Ikilful furgcon conftantly at hand, or when the 

 patient knows how to pafs the catheter himfelf. Default 

 thinks it better only to introduce the inflrument when the 

 bladder is to be emptied ; by which means, the incon- 

 venience arifing from the continual prefcncc of a foreign 

 body is avoided. In this cafe, either a filver catheter or an 

 elaflic gum one may be ufed with equal advantage ; but if 

 the inflrument is to be kept in the bladder, that made of 

 elaflic gum, and provided with a curved ftilet, is to be pre- 

 ferred. Whatever fort of inflrument is ufed, however, ex- 

 perience fully proves, that in old fubjedls, in whom tlie 

 canal is as it were flaccid, a large catheter enters more 

 eafily, and with lefs pain, than one of fmaller diameter. 



As the treatment of the complaint mull be continued for 

 a long while, and the bladder feldom pcrfedlly regains its 

 proper tone in old age, the patient fliould be inilrufted how 

 to introduce the catlieter himfelf, and he is to pafs it when- 

 ever he wants to make water. After a certain time, how- 

 ever, he may try if he can empty the bladder without this 

 inflrument. When he finds that he can expel the urine, he 

 fliould certify himfelf by means of the catheter, that the lall 

 drops of this fluid are duly voided. Should they not be fo, 

 he muH perfevere in the ufe of that inllrnment. Without 

 this precaution, fays Default, the retenlion will foon attain 

 the fame pitch again, at which it was on firll commencing 

 the treatment. 



In this fort of retention of urine, it luisbcen propofed to 

 throw into the bladder a variety of ailringent injcAions, 

 made with the fulphate of iron, decodion of bark, &c. 

 Default tried them, but never found much good from their 

 ufe. 



Warm, balfamic, diuretic medicines, cold bathing, and 

 liniments containing the tinftura lyttx, have likcwile been 

 praifed ; but, according to Default, thefe means frequently 

 prove Inirlful to perfons of advanced years, .ind arc leldotn 

 ufcful. He rellricted his own practice to the ufe of the 

 catheter, which, when Ikilfnlly employed, often rcllored the 

 tone of the bladder; and when it failed, other means alio 

 were ineffectual. 



2. Ri'hiilion of Urhit from Debauchery. — This cafe, as De- 

 fault obfirvcs, is very analogou . to th.il which dviv.iuU upon 

 old age ; both of them are \\mcoimcdted with any previous 

 3 Y difeafe 



