URINE. 



ing, the warm bath, aiiJ opium, which will frequently 

 enable the patient to make water. The lad means, how- 

 ever, will not fuffice, when the caufe of the retention is 

 likely to continue any length of time. 



11. Retention of Urine from Tumours Jituatcd in the 

 Bladder. — Fungous difeafes, carcinoma, and hydatids, fays 

 Default, are the principal tumours which may caufe a reten- 

 tion of urine. Of all the difeafes of the bladder, there are 

 none which are fo afflifting as fungous tumours ; fortu- 

 nately, they are not frequent. Default, however, had feen 

 feveral cafes in the dead fubjeft. By the introduction of 

 a found into the bladder, the prefence of a fungus might 



•be fufpefted ; fomething unufual would be felt ; but the 

 cafe could hardly be difcriminated from an induration of the 

 coats of the bladder, or other forts of tumours of this vif- 

 cus. The caufes and mode of curing the affliftion are 

 equally unknown. In one inftance, however, in which the 

 fungous excrefcence had a narrow bafe. Default is faid to 

 have made an incifion into the bladder, .and extrafted the 

 fwelling with a pair of forceps. No hemorrhage, nor any 

 other bad fymptoms, eufued. 



In carcinomatous difeafes of the bladder, the ufe of the 

 catheter is necelTary, at lead, until, by the progrefs of the 

 diforder, ulcerated commuaications are formed betvvixt that 

 organ and the rectum, or uterus and vagina. 



12. Retention of Urine from foreign Bodies in the Bladder. 

 — When the urine is obftruAed by a calculus at the neck 

 of the bladder, the patient, by altering his pofition, fre- 

 quently changes the fituation of the ftone, and he is imme- 

 diately able to make water again. This expedient, how- 

 ever, will only procure relief while the calculus is loofe in 

 the cavity of the bladder ; for, after it has become fixed in 

 the commencement of the urethra, it muft either be pufhed 

 back with a catheter, or extrafted by a kind of operation 

 refembling the apparatus minor. See Lithotomy. 



Default never met with any cafe in which the bladder con- 

 tained worms ; but he was aware of there being many fuch 

 inftances on record. Tulpius, Schenckius, Bianchi, &c. 

 have been eye-witneffes of the occurrence. Thefe worms 

 are not all alike ; fome refemble fcarabasi, fome are like 

 afcarides, and others have the appearance of lumbrici. 

 Ruyfch and Hagendorn affirm, that they have feen fom.e 

 which had wings, and were able to fly as foon as they were 

 voided. An interefling paper on this fuhjeft was publilhed 

 about fix years ago by Mr. Lawrence, who met with an 

 example in which an undefcnbed fpecies of worms was 

 abundantly voided from the bladder. " The origin of thofe 

 animals (fays Mr. Lawrence}, which inhabit the internal 

 parts of living bodies, is involved in much obfcurity. Al- 

 though the inteftinal worms appear manifellly, from their 

 peculiar form, confiftence, and organs, to be particularly 

 defigned for thofe fituation s in which they are found ; al- 

 though they have generative organs, and no fimilar animals 

 are known to exift out of living bodies ; yet, it has been 

 generally conceived, that the genus from which they fpring 

 enter from the mouth. The production of hydatids in va- 

 rious parts of the body cannot, however, be accounted for 

 on fuch a fuppofition ; neither can we very eafily conceive 

 that ova (hould enter from without into the urinary organs." 

 The following fads, alfo ftated by Goeze, (as Mr. 

 Lawrence obferves,') entirely overturn this opinion. Pro- 

 felfor Brendel, of Gottiagen, found afcarides in the redlum 

 of an immature embryo. Blumenbach difcovercd tsnias in 

 the inteflinal canal of young dogs a few hours after birth. Sec. 

 Verfuch cmcr naturgefchichte dcr Eingeweidcwiirmer, 

 V' S5- 



7 



The cafe which Mr. Lawrence has recorded is interefting, 

 as it exhibits an unqueftionable inllance of peculiar and 

 undefcribed worms voided from the urinary palfages. This 

 gentleman fays, that he knew of no other cafe in which a 

 dillintt fpecies of worm has been clearly proved to corae 

 from the bladder. Moil of the cafes publifhed were in- 

 ftances of common inteftinal round worms, which fometimes 

 perforate the inteftines, and are difcharged by abfcelFes, or 

 get into the bladder, after the formation of adhefions be- 

 twixt this organ and the bowels. In other inftances, 

 coagula of blood, mucus, or portions of the mucous coat of 

 the bladder, have been miftaken for worms ; and, as Mr. 

 Lawrence further obferves, fome of the defcriptions can 

 apply only to larva? of infefts. Two fpecimens of this laft 

 fort he has feen himfelf, which were fent from the country as 

 worms voided from the bladder. See Medico-Chir. Tranf. 

 vol. ii. p. 382, &c. 



In whatever way thefe animals get into the bladder, a re- 

 tention of urine may be produced, either when they are 

 numerous, or when there is only one prefent, but large 

 enough to obftruft the vefical orifice of the urethra. In the 

 very curious example related by Mr. Lawrence, the paflage 

 of the urine was obftrufted, and the ufe of the catheter con- 

 tinually neceffary. The oil of turpentine was given in- 

 ternally, with fome appearance of benefit at firft ; but it 

 afterwards brought on febrile fymptoms and eryfipelas, and 

 its exhibition could not be kept up. It was then injefted 

 into the bladder, with an equal part of water. This rather 

 accelerated the difcharge of the worms ; but they came 

 away at times whether the injedlion was ufed or not, and as 

 this means produced the eryfipelatous indifpofition again, it 

 was left off. Olive oil was afterwards injefted ; the irrita- 

 tion after it was lefs, and the fits of pain about the bladder 

 lefs violent. It was calculated, that at the time when Mr. 

 Lawrence was writing the particulars of the cafe, from 800 

 to 1000 worms had been difcharged. For a detail of the 

 fymptoms, and a particular defcription of the worms them- 

 felves, we muft refer to the above-mentioned pubhcation. 



According to the obfervations of Default, a retention of 

 urine is frequently occafioned by coagula of blood in the 

 bladder. The blood is faid fometimes to come from the 

 kidneys, fometimes from the bladder, and fometimes it even 

 regurgitates from the urethra. While fluid, it may be ex- 

 pelled with the urine ; but when coagulated, it is no longer 

 capable of being difcharged. It is the blood which gets 

 into the bladder after wounds, or the operation of lithotomyj 

 that is moft difpofed to coagulate. 



The diagnofis of a retention of urine, produced by coagu- 

 la of blood, is not very clear. The ifl^ue of blood with the 

 urine might raife fufpicions ; but there could be no cer- 

 tainty of the nature of the cafe, until the catheter v;ere in- 

 troduced. If the clots of blood Ihould be too large to pafs 

 through this inftrument, lukewarm water fhould be injefted 

 into the bladder, for the purpofe of loofening and diflblving 

 the coagula. 



We fliall merely notice one more example of retention of 

 urine, arifing from the prefence of extraneous fubftances in 

 the bladder ; we mean that in which a piece of bougie has 

 flipped into this vifcus. It has frequently happened, that 

 entire bougies, which were not properly fixed, have glided 

 into the bladder. As Default obferves, the urethra appears 

 to poflefs a kind of antiperiilaltic aftion, by which it tends 

 to draw into the bladder whatever fubftances it includes ; 

 for, fays he, it is conftantly noticed, that when thefe fub- 

 ftances are once within the urethra, if they be not expelled 

 by the current of urine, they always advance towards the 



bladder. 



