URINE. 



difeafe of the bladder, and limply originate from general 

 languor and debility. Their commencement is indicated by 

 the fame circumftances, their progrefs is iimilar, they ex- 

 hibit refembling fymptoms, and they merely differ in their 

 predifpofing caufe ; the defeft of irritability being in one 

 cafe the confequence of old age, in the other that of intem- 

 perance. In the former inftance, the diforder depends upon 

 a decrepitude, the natural effett of advanced age ; in the 

 other, it arifes, as it were, from a premature and unnatural 

 old age. Nothing is more weakening to the conftitution 

 than an immoderate indulgence in venereal pleafures. From 

 this kind of excefs, the bladder, as well as other organs, be- 

 comes lefs irritable, and is at length rendered totally inca- 

 pable of expellmg the whole of the urine. Hence originates 

 a retention. It is unnecefTary here to repeat the diagpoftic 

 figns of this diforder, depending upon weaknefs of the 

 bladder. The hiitory of the cafe can alone difcriminate it 

 from that which is produced by old age. The prognofis, 

 however, is not fo unfavourable as in the other example ; 

 for, when the patient is gifted with a ftroug conftitution, 

 and he has not been too much reduced, the complaint may 

 be radically cured. 



An elaftic gum catheter left in the bladder is here, ac- 

 cording to Default, one of the moft powerful means of 

 rehef which can be employed. It not only has the advan- 

 tage of affording a ready outlet for the urine, exciting the 

 irritability of the bladder, and promoting the aftion of its , 

 mufcular fibres ; but its continual prcfence in the urethra 

 hinders the patient from yielding to thofe depraved habits, 

 which are the very caufe of the diforder. The latter ufe of 

 the catheter is the more worthy of confideration, inafmuch 

 as it is proved by experience, that moft patients, who are 

 not reftrained by this obflaclc, cannot rcfift the force of 

 habit, though fully aware of the dangers. 



Together with the employment of the elaftic gum cathe- 

 ter, every endeavour (hould be made to ftrengthqn the 

 patient, and obviate the general relaxation and debility of 

 the parts. Cold bathing, fteel medicines, and cinchona, are 

 the means which are ufually preferred. The patient ought 

 likewife to have the advantage of a falubrious air, nutritious 

 and eafily digeftible food, undifturbed fleep, plenty of exer- 

 cife, regular evacuations, tranquillity of mind ; and more 

 efpecially lie ought to be diverted from what has been the 

 caufe of his iiidifpofition. 



3. Relention of Urine from the immoderate Ufe of Diuretics. 

 — This is the next cafe which Default confiders. Diuretics, 

 both cold and warm, taken in excefs, may equally occafion 

 the diforder. He conceived that, by the former, the fibres 

 of the bladder were hurtfully relaxed ; and that, by the lat- 

 ter, their proper fenfibility was gradually deftroyed. In 

 this laft circumftance, the bladder being habituated to the 

 impreflion of ftimulating diuretics, is, when thefe are dif- 

 continued, not fufficiently irritated by the urine to contraft, 

 and it no longer obeys the calls of nature. Default has the 

 candour, however, to acknowledge that the foregoing theory 

 is rather founded upon reafon than experience ; he even 

 confelfes that he has met with no example eftabliftiing its 

 reality, but he thought there was fome probabihty in it, 

 deduced from the well-known effeAs of ftrong liquors on the 

 ftomach. 



If we exclude from confideration the information refpeft- 

 ing the nature and quantity of the drink which the patient 

 has been taking, before the funftions of the urinary organs 

 were difturbed, there are abfolutely no circumftances, nor 

 fymptoms, by which this fpecies of retention of urine can 

 be diftinguiflied from that induced by old age and intem- 

 perance ; nor is the local treatment to be different from 



what has been advifed for the above cafes. Befides the ufe 

 of the elaftic gum catheter, the furgeon muft recommend 

 cold bathing ; the throwing of ice-cold water on the abdo- 

 m^, perineum, and thighs ; the application to the fame 

 parts of comprefles wet with vinegar ; dry friftion on the 

 hypogaftric region ; or ftimulating liniments, containing am- 

 monia or the tinftura lytts. Should all thefe means prove 

 ineffe£lual, a blifter may be laid over the facrum and lower 

 part of the loins ; and it may either be kept open, or healed 

 and then apphed again, as Default particularly advifed. 



4. Retention of Urine from an AffcBion of the Nerves of the 

 Bladder. — Thefe nerves may be affefted either at their origin, 

 or in the courfe of their diftribution. Injuries of the brain 

 arc feldom followed by a retention ot urine ; but the com- 

 plaint often accompanies thofe ot the fpinal marrow. A 

 concuflion of this medullary fubftance, from blows or falls 

 upon the vertebral column ; the injury which it fuffers in 

 fraftures and diflocations of the vertebrae, or from a violent 

 ftrain of the back ; its compreffion by blood, purulent mat- 

 ter, or other fluid etfufed in the vertebral canal ; and the 

 effefts which a caries of the fpine has upon it, may all ope- 

 rate as fo many caufes of a retention of urine. Tliis form 

 of the complaint may alfo be the confequence of tumours 

 lituated in the track of the nerves which are diftributed to 

 the bladder. It is not neceffary that all the nerves, which 

 ramify on this organ, be affefted before the complaint is oc- 

 cafioned ; for the compreffion of fome of the nervous fila- 

 ments is adequate to weaken the action of the bladder, and 

 render it incapable of overcoming the natural refiftance to 

 the difcharge of the urine. 



When a retention of urine is caufed by an affeftion of the 

 fpinal marrow, an infenfibility and weaknefs of the lower 

 extremities are almoil always concomitant fymptoms. The 

 patients fnffer very little ; moft of them are ignorant of their 

 condition, and do not complain of any thing being wrong in 

 the funftions of the urinary organs. The furgeon, aware that 

 a retention of urine is a very common occurrence in thefe cafes, 

 fliould examine whether any interruption of the evacuation 

 prevails, either by feeling the ftate of the abdomen juft above 

 the pubes, or by introducing a catheter. 



As this fpecies of retention of urine is only fymptomatic, 

 and not dependent upon any previous defeft in the bladder, 

 it is not in itfelf alarming ; but, with reference to the caufe 

 that has produced it, it is exceedingly dangerous. Affec- 

 tions of the fpine, compHcated with injury of the fpinal 

 marrow, are frequently fatal. By means of a catheter, it is 

 always eafy to relieve the inconveniences arifing from the 

 bladder not contrafting, and thus fulfil the only indication 

 which this fort of retention of urine prefents, okz. the eva- 

 cuation of the urine. But thefe means are merely palhative, 

 and the bladder will not recover its contraftile power until 

 the caufes of its weaknefs are removed. The laft then is 

 the main objeft in the treatment, which muft vary according 

 to the nature and extent of the diforder. 



The confidei-ation in detail of all the means which may be 

 requiilte for the relief of the different accidents and difeafes 

 of the fpine, would form too long a fubjeft to be brought 

 into the prefent article. (See Fractures and Luxations 

 of tfie Vertehrit, and Spine, Difeafe and Curvature of.) We 

 Ihall merely obferve here, that Default had a high opinion 

 of the utility of cupping in fhocks and concuffions of the 

 fpinal marrow. This was done on the part of the back 

 which had been ftruck, or in its vicinity ; and the fcarifica- 

 tions were multiphed accordirj to the ftrength of the 

 patient. The plan was fometimes r..neated the fame day, 

 and fpr feveral days in fucceffion ; anu when the patient 

 could not bear the lofs of more blood, dry cupping was 



employed. 



