URINE. 



emiiloycd. In caries of the fpine, Default alfo gave a pre- 

 ference to the ufe of tlie moxa, inllead of caullic. 



5. Retention of Urine brought on by Dijlentton of the Fibres 

 of the Bladder. — As Default obferves, this fpecies of reten- 

 tion of urine may be called fecondary, fince it is invariably 

 preceded and produced by a primary retention. It follows 

 of courfe, that its remote caufcs confift of all thofe circum- 

 ftanccs which may bring on the other forms of the com- 

 plaint ; but its immediate caufe altogether depends upon the 

 weaknefs and lofs of irritability in the bladder, occafioned 

 by the immoderate diftention of its coats. Thus, we fre- 

 quently find the diforder occur in perfons who, from bafh- 

 fulnefs, indolence, or intenfe occupation, negleft to make 

 water when they firft have the deiire, or who cannot for a 

 time empty the bladder, in confequence of fome temporary 

 obftruftion in the urethra. Although the impediment to 

 the efcape of the urine no longer exifts, and the bladder is 

 in other refpetts found, yet as this organ has been weakened 

 by the excefTivc diltention of its coats, it cannot contrail 

 with fufficicnt force to obliterate the whole of its cavity, and 

 expel the lall portion of urine. 



The indication in this cafe is very fimple, for there is not 

 here, as in other retentions of urine, anotlier difeafe to be 

 remedied. The catheter, when left in the bladder, generally 

 proves adequate to the reftoration of the tone and contraftile 

 force of this vifcus. Default alfo conceived, that the objeft 

 might be promoted by the exhibition of warm diuretics, and 

 the employment of tonic injeAions, and other ftrengthening 

 means. Before the catheter is difcontinned, the furgeon 

 ought to be fure that the bladder can completely expel the 

 whole of the urine, without the aid of this inftrament ; for 

 it is impoflible to fpecify any particular period when the 

 bladder will regain its power of contracting. The time 

 will vary according to the duration of the difeafe, and the 

 age and conllituticn of the patient. In fome perfons, a 

 cure is effe£led in a few days ; in fome, not till after feve- 

 ral weeks or months ; and in others, the contraftile funAion 

 of the bladder is fo irremediably deftroyed, that the catheter 

 is neceflary during the rcil of the patient's life. 



6. Retention of Urine from Inflammation of the Bladder. — 

 The majority of authors who have written on the difeafes 

 of the urinary organs, fays Default, have afcribed different 

 effedts to an inflammation of the neck of the bladder, and 

 to the fame afieftion of the body of this vifcus. They have 

 in facl regarded the firll occurrence as one of the caufes of 

 retention, and the lall as a caufe of incontinence of urine. 

 It has been imagined, that an inflamed highly fenfible blad- 

 der, inftead of being weakened in this flate, acquired an in- 

 crcafe of energy, and contradtcd with greater than ordinary 

 vigour. But, even if we had not been undeceived upon this 

 fubjedl by the obfervation of retentions of urine, wiiich 

 could be referred to nothing but inflammation of tlie bladder, 

 flill analogy would have proteftcd ns from error. We never 

 find an inflamed mufclc contraift, and if we oblige it to adl, 

 its aftion is always weak. Default alfo conllantly noticed, 

 in opening the bodies of perfons who had died of inflammation 

 in the abdomen, that the inflamed intellincs were dillcnded, 

 and not diminilhed and contraiited. 



Plethoric bilious fubjedls, with full habits, are particularly 

 liable to this fpecies of retention. It is alfo frequently oc- 

 cafioned by the abufe of wine or other fpirituous liquors, 

 heating diiirt tic drinks, or the external or internal emphiy- 

 ment of cantharides. This form of the complaint makes its 

 attack fiiddenly, and may be recognized; itl, By the fre- 

 quent deiire to make water. 2dly, By the acute pain in tiic 

 region of the bladder; pain which is iiicreafed by the eflorts 

 to make water, and which fhools up to the loins and along 



the urethra to the end of the glans. ^dly. By the frequency 

 and liardiiefs of the pulfe, and other fymptoms of fever. 

 4thly, By the aggravation of the pain, when the hypogaflric 

 region is handled or preffed upon. 5tlily, By the eafy paf- 

 fage of a catheter into the bladder. 6thly, By the acute 

 pain which is excited by the inflrument touching the infidc 

 of the bladder, ythly. By the red inflammatory colour of 

 the urine. 8thly, By the abfence of all thofe fymptoms 

 which peculiarly characlerizc other cafes of retention. 



This form of the diforder demands the mofl prompt affift- 

 ance. The urine, the prefence of which is a new fource of 

 irritation, fliould be immediately drawn off* The catheter 

 fhould be introduced with great gentlenefs, and merely far 

 enough to let its eye get beyond the neck of the bladder, as 

 its beak might other wife ferioufly irritate this vifcus, the 

 lining of which is now extremely fenfible. 



After the urine had been difcharged. Default ufed to 

 throw in mucilaginous injeftions ; but of thefe we entertain 

 no opinion. The inflammation of the bladder is to be re- 

 filled by the mofl powerful antiphlogiftic remedies, fuch as 

 repeated venefedlion, the apphcation of leeches to the peri- 

 neum and hypogaftric region, the warm bath, glyflers, , fo- 

 mentations on the abdomen, and cold mucilaginous beverages. 

 When, notwithllanding thefe means, the inflammation in- 

 creafes, extends to the other abdominal vifcera attended with 

 hiccough and vomiting, and continues beyond the fixth day, 

 the patient's life is in extreme danger, and death almoft in- 

 etitable. 



7. Retention of Urine from Hernia of the Bladder. — The 

 fecond volume of the Memoirs of the French Academy of 

 Surgery prefents us with numerous inllances of this fpecies 

 of retention of urine. We there learn that it is a fymptom 

 almoll conllantly attending hernia of the bladder. But the 

 weaknefs of this organ is not always the fole caufe ; for the 

 urethra itfelf alfo makes greater refillance than natural to 

 the ilfue of the urine. The neck and adjoining part of the 

 bladder are drawn out of their right pofition by the portion 

 of this organ which protrudes. Hence, the beginning of 

 the urethra alfo undergoes an elongation, and a change of 

 its curvature, by being preffed towards the fymphyfis of the 

 pubes, and its diameter is likcwife diminilhed. The urine 

 may alfo be detained in the pouch compofing the hernia, in 

 confequence of the communication between thts and the other 

 part of the bladder biiing too diminirtive. This ftate, indeed, is 

 very common, and it accounts for thofe partial retentions of 

 urine which take place only in the protruded portion of the 

 bladder, and not in that of the receptacle which lies within 

 the pelvis. Sometimes, however, fuch retentions depend 

 upon the preffure of the abdominal mufclcs being removed, 

 and upon weaknefs of the protruded part of the bladder. 

 At the fame time, it rarely happens that the rcll of this or- 

 gan, fituated in the pelvis, can itfelf expel the lall drops of 

 the urine whicii it contains. Its complete contraiflion can- 

 not be accompliflied without great difficulty ; and, in the 

 end, it almolt invariably follows that the urine is retained in 

 both the protruded and unprotruded portions of the 

 bladder. 



When a retention, ariling from a hernia of the bladder, is 

 complete, and occurs in both parts of this organ, there is, 

 in addition to the fymptoms common toother retentions pro- 

 dnced by weaknefs of the bladder, a more or Kfs confider- 

 able fweiliiig in tlie fitualion of the hernia. The tumour is 

 unattended with any change of the colour of the fl<in ; is 

 not very lender on being handled ; and it prefents a feeling 

 of fluftuation, fonutimes obfcure, foinotinies very dilliiiifl. 

 When tlic fwelling is prclVed upon, the defire to make water 

 is excited or incrcafcd, and occafioiially a few drops cfcapc 

 3 Y 2 from 



