URINE, 



bladder. This circumftance cannot be accounted for by 

 their weight, and it mull be atciibcd to a contractile power 

 of the urethra. 



T!ie bougies formerly made, and particularly metallic 

 ones, and catheters made of fpiral wire fprings, frequently 

 broke, and thus pieces of thefe inilrumeuts were often left 

 in the bhidder. Such an accident, however, is much lefs 

 common now, that the fabrication of all forts of bougies 

 and catheters has been brought to a high Hate of per- 

 feftion. 



Tlie infinuation of thefe foreign bodies into the bladder is 

 a ferious occurrence both for the patient and furgeon. The 

 former cannot avoid the confequence, which will fooner or 

 later originate from the extraneous fubllance, except by 

 fubmitting to a dangerous and painful ope/ation : the latter 

 will be accufed of being the author of all the evil, and will 

 find it difficult to exculpate himlelf. In order to do away 

 the neceffity of cutting into the bladder, in fuch cafes, 

 Default propofed the ufe of fmall fpring forceps, pafled 

 into the bladder through a cannula ; but although the in- 

 ilrument feemed to anfwer on the dead fubjeA, there 

 have hitherto been no inftances of its doing fo on living 

 patients. 



We next proceed to notice the retentions of urine arifing 

 from afteftions of the urethra. 



13. Reteri/ion of Urine from Iiiflammation oj the Urethra. — 

 It is cafy, fays Default, to conceive how inflammation of 

 the urethra may occafion a retention of urine. In order to 

 underlland the mechanifm of the cafe, we need only re- 

 member tlie axiom in chiri.rgical pathology, tliat inflam- 

 mation never exifts without a fwelling of the inflamed part, 

 and that every tumefaflion of tlie lining of the urethra muft 

 neceffarily diminifh its diameter. Inflammation of the 

 urethra is moll commonly produced by the external appli- 

 cation, or internal exhibition, of cantharides, gonorrluea, the 

 unfliilful ufe of the catheter, the employment of flimulating 

 injeftions, bougies, &c., together with the lefTening of the 

 canal by the eff'eA of fwelling ; there can alfo be no doubt, 

 that, in many of thefe inilances, a fpafmodic contradlion of 

 the urethra and neck of the bladder alfo contributes to the 

 retention of urine. Default, indeed, entertained the opinion 

 that inflamed parts, endued v\ith a contrattile power, were 

 not difpofed to contraft in that ilate ; yet, it fliould be re- 

 coUefted, that even admitting this to be true, it feldom 

 happens that the whole length of the urethra is inflamed, 

 and that the rell may be afFefted with a fpafmodic aclion. 

 The eflFefts of opium, tobacco, and other antifpafmodics, 

 often evinced in immediately relieving thefe kinds of reten- 

 tion of urine, feem indeed to leave no doubt refpefting the 

 cxiftence of a fort of fpafm in the pafl^age. Whatever may be 

 the caufe of the inflammation of the urethra, the diagnolis is 

 free from all obfcurity. Befides the general fymptoms of 

 inflammation, the patient complains of a fcalding fenfation 

 in the paflage ; he experiences a great deal of fmarting, 

 which is fometimes infupportable when he makes water ; 

 the penis becomes in fome degree fwollen, and more ten- 

 der ; and a very little prefTure on the urethra gives acute 

 pain. In the mean time, the llream of urine becomes gra- 

 tlually but yet quickly lefli-'ued ; and at lengtli this fluid can 

 only be voided in a very narrow current, or only by drops, 

 and often not at all. 



The difordcr is to be treated on antiphlogiflic principles. 

 Diluting, cooling, mucilaginous beverages, venefedion, 

 leeches to the perinruni, the warm-bath, opium, fonu-nt- 

 ationb to this part and the penis, are the means wliicii 

 ufually fufHce to give relief. Winn inflanunation exills in 

 the urethra, it is always delirable to avoid, as long as pof- 



fible, the employment of catheters, which create irritation, 

 and of courfe increafe the caufe of tlie retention. It is par- 

 ticularly in cafes of this defcription, and in the retentions of 

 urine arifing from ilridures, that Mr. Earle has fuggefted 

 the ufe of tobacco in the form of clyfters ; a method dc- 

 ferving adoption when the means above enumerated are una- 

 vailing, and preferable to the ufe of the catheter, becaufe 

 not occafioning any increafe of irritation and inflammation 

 in the urethra. See Medical and Chir. Tranf. vol. vi. 

 p. 82, &c. 



To this propofal we fliall advert again, in confidering the 

 retention originating from ftriclures. When, in confe- 

 quence of inflammation, however, an abfcefs forms in the 

 vicinity of the urethra, and burlls into this canal, the ufe of 

 an elailic gum catheter is proper, in order to prevent tlie 

 urine from infmuating itfelf into the cavity wliich contains 

 the pus. 



14. Retention of Urine from Laceration of the Urethra. — 

 The urethra is fometimes ruptured by violent contufions on 

 the perineum, and the rough and unfliilful ufe of metallic 

 catheters. The confequences ufually are, an extravafation 

 of urine in the cellular membrane of tlie fcrotum and penis ; 

 a cop.fiderable dark -coloured fwelling of thefe parts, often 

 followed by floughing ; and retention of urine. RefpeCting 

 fuch cafes, we fliall merely obferve, that the treatment 

 ought to confill in introducing an elailic gum catheter into 

 the bladder, and keeping it there until the breach of con- 

 tinuity in the canal is repaired. At the fame time, the evils 

 threatened from the efFufion of the urine are to be lefTened 

 as much as pofhble, by making two or three free incifions 

 in a depending part of the fwelling produced by the extra- 

 vafation. The tumour fliould ali^o be well fomented, and 

 antiphlogiftic means adopted. 



15. Retention of Urine arijmg from Tumours Jttuated in iht 

 Perineum, In the Scrotum, or on the Penis. — No confiderable 

 tumour can form in any of thefe fituations, without making 

 more or lefs prefl"ure on the canal of the urethra. Whether 

 fuch fwelling proceed from a fimple tumcfaftion of the 

 parts, or from a colleftion of any fluid in a cavity, or from the 

 lodgment of an extraneous body, the effeft will be tlie fame. 

 A retention of urine has been obferved to arife from phleg- 

 monous fwellings and abfceflls, extravafations of blood, 

 and urinary tumours and calculi formed in the perineum and 

 fcrotum. The diforder has alfo been known to be caufed 

 by a farcoccle, hydrocele, a very large fcrotal hernia, an 

 aneurifm of the corpus cavernofum, a ligature on the 

 penis, &c. 



We (hall not repeat what has been already faid refpefting 

 the fymptoms of a retention of urine originating from alTec- 

 tions of the reAuin. The impediment to the evacuation 

 will be known to depend upon one of the caufcs above 

 fpecified, if the patient could make water quite freely before 

 fuch caufe exifted, and no other reafori can be alllgned for 

 theobllacle. Of courfe, the radical cure of all fuch reten- 

 tions of urine can oiily be accoinpliflied by curing the other 

 difeafe, on which they are dependent. However, until the 

 caufe can be obviated, the urine mull be drawn oil with a 

 catheter. Elailic gum catheters ufuallv enter more eafily 

 tli.in thofe made of filver, as, by their flexibility, they ac- 

 commodate ihemfelves better to any deviation of the urethra 

 from its ordinary dirertion. Default particularly recom- 

 mended a catheter of luidilling fize to be leleCled, and in. 

 troduccd armed with its llilet, until it Hopped in the canal ; 

 when he advifed withdrawing the llilel for about an inch, in 

 order to leave the beak of the inllniment qi'ite free, fo that 

 it might follow the curve of the urethra. Then the tube and 

 the ililet are to be puflted further into the canal ; care being 



taken, 



