URINE. 



fide, &c. a falfe pafTage wOuld inevitably be occafioned by 

 a laceration t>f the membranous portion of the urethra ; an 

 accident which is always of a ferious nature, increafing the 

 inflammation of the proftate, and rendering the introduc- 

 tion of the catheter more difficult. This bold praftice, 

 fnggeftcd by Default, is frequently purfued by Boyer and 

 Ronx, and fometimes in this country by Mr. A. Cooper, 

 Mr. Pearfon, &c. (See Crofs's Medical Sketches of 

 Paris. ) We have indeed heard, that Mr. Thomas Blizard, 

 and fome other furgeons in London, always force their way 

 through the proftate gland with a conical filver catheter, in 

 preference to punfturing the bladder, when no inllrument can 

 be introduced through the urethra in a gentle manner. The 

 urine afterwards paffes through this fort of falfe paffage, 

 feemingly as well as through the natural one. 



We have not, however, brought our own minds to think 

 that much good is ever likely to refult from tliis exertion of 

 violence in the urethra : therefore, when the cafe is urgent, 

 and no catheter can be introduced through the natural 

 canal, we (hould prefer punfturing the bladder, which, in 

 thefe cafes, ihould always be done above the pubes. See 

 Paracentesis nf the Bladder. 



Notwithftanding the many examples of the fuccefs that 

 has attended this operation, the proceeding, as Default ob- 

 ferves, has its dangers ; and, coafequently, it flionld never 

 be reforted to, before repeated unavading attempts have 

 been made to get a catheter into the bladder ; nor before a 

 trial has been made, whether a bougie left in the paffage a few 

 hours will not bring on an evacuation of the urine ; an event 

 which has often happened, even though the inftrument did 

 not pafs beyond the obftruftion.- Punfturing the bladder, 

 in fuch cafes, fhould alfo never be determined upon, without 

 a previous confultation with another praftitioner, efpecially 

 if one be at hand, who has had greater experience in the ufe 

 of the catheter. 



When a catheter has been introduced, ought it to be left 

 in the bladder, or witiidrawn, after the difcharge of the 

 urine ? Its prefence no doubt will increafe the irritation 

 about the neck of the bladder ; but, on tlie other hand, if 

 it be taken out, the furgeon may not be able to introduce it 

 again. No general precept, fays Default, can be laid 

 down on this point. The courfe which the praftitioncr will 

 purfue muft depend upon the difficulty he has experienced 

 in getting the inftrument into the bladder, and upon the 

 confidence which he may have in his own (kill, and which is 

 deduced from conilant fuccefs in analogous inftaiices. 



According to Default, when an abfccfs follows inflam- 

 mation of the proftate, the body of the gland itfelf does not 

 fuppurate, but only the fnrroundiiig parts, and the cellular 

 fubftance, whicli connefts its lobes together. This, at leaft, 

 was what was obfervcd in examining feveral dead fubjedls, 

 who were publicly opened in the amphitheatre of the 

 Hotel-Dicu. When the fymptoms of inflammation have 

 lafted a week, and all this lime have continued to increafe ; 

 when, after this period, they have abated a little, and then 

 become violent again ; and when the febrile fymptoms get 

 worfe in the evening, and have been preceded by fltiverings ; 

 there is realon to fufpcft the formation of matter. It can- 

 not be known whether the pus is coUefted in one particular 

 place, or diftufed. When the matter is external to the 

 gland, the cafe is lefs ferious than when it occupies the 

 cellular fubftance connefting the lobes. According to De- 

 fault, the latter form of the difeafe fcldom gets well. There 

 are no peculiar fymptoms which denote it ; the matter does 

 not readily make its way outward ; and the ftate of things 

 is not clear enough to admit of an incilion being made. Be- 

 tides, Default doubted whether an incifiou could be of 



Vol. XXXV II. 



much ufe, fince it would probably only let out the matter 

 in its vicinity. 



Things are different when the pus is coUefted in one place, 

 and is more fuperficial. If fituated between the gland and 

 neck of the bladder, it will often fpontaneoufiy burft into 

 this vifeus, or it may be let out with the pomt of the cathe- 

 ter. It will then either be difcharged through the inftru- 

 ment, or come away with the urine. Should the abfcefs lie 

 near the rectum and perineum, and admit of being diftinftly 

 felt, a free opening would expedite the cure. 



In all thefe cafes, the ufe of the catheter is requifite, in 

 order to let out the urine ; and as the inftrument muft be left 

 in the paflage fome time, one made of elaftic gum is to be 

 preferred. 



When the abfcefs burfts of itfelf, either into the urethra 

 or bladder, the catheter muft be kept in as long as pus con- 

 tinues to be difcharged with the urine. In the latter cafe, 

 however, Default chiefly ufed the inftrument for the pur- 

 pofe of throwing mucilaginous injeftions into the bladder, 

 which many furgeons would not confider necefTary. 



Morgagni has taken notice of the retentions of urine 

 arifing from the prefence of calculi in the proftate gland. 

 The nature of thefe concretions we have already defcribed 

 in a preceding article. See Urinary Calculi. 



CalcuH alio fometimes form after lithotomy, when the 

 outer part of the wound heals fooner than the bottom. A 

 kind of urinary fiftula tlien forms ; and as the extraneous 

 fubftance is conftantly expofed to the contatt of frefti urine, 

 it may increafe to a very large fize. The diagnofis of prof- 

 tatic calculi is feldom very clear. A retention of urine, and 

 an impediment to the emiffion of the femen, are only fymp- 

 toms which are common to feveral other afFeftions of the 

 proftate gland and urethra. When the finger is introduced 

 into the reftum, the gland may indeed be felt to be enlarged, 

 but the nature and caufe of fuch enlargement cannot in gene- 

 ral be diftinguiflied. In one inftance, however, lately re- 

 corded by Dr. Marcet, the calculi could be plainly felt 

 through the coats of the redlum, and a propofal was made 

 to extrad them by an incifion in that fituation ; but the 

 patient did not accede to fo judicious a meafure. ( Med. and 

 Chem. Ilift. of Calculous Difordere, Lond. 1817.) When 

 a calculus projefts from the proftate into the urethra, the 

 end of a found will ftiike againft it ; but then it can rarely 

 be known whether the extraneous fubftance may not be a 

 calculus that has pafted out of the bladder into the urethra, 

 or lies clofe to the neck of this vifeus. 



Whether the cafe be of one defcription or the other, how- 

 ever, the treatment flionld be the fame ; i)/z. the calculus 

 fliould be extracted by an incifion, refembling that praAifed 

 in the lateral operation. 



Another fpecies of retention of urine is that produced by 

 a confiderable varicofc aff'eftiou of the veft'els fiuroundinj* 

 the proftate gland, which part is alfo generally fomewhat 

 enlarged. In this cafe, the water ftiould be drawn off with 

 an elaftic gum catheter, which fliould be kept in the lu-ethra ; 

 and a large inftrument is to be preferred to a fmaller one. 

 For an account of the fymptoms of this cafe, we muft refer 

 to Default's Oiuvres Chir. t. 3. p. 234. The portion of the 

 urethra wliicii pafles tiirougii the proftate, is afterwards to 

 be gradually dilated with bougies or elallic catlielcrs, which 

 are to be worn a long while, and cleaned and changed at 

 proper intervals. 



A fcirrhous induration and enlargement of the proftate 

 gland form another very common difeafe in old fubjetls. The 

 fi/.c and hardnefs of the gland are faid to vary conliderably, 

 according to the duration of the complaint. It has often 

 been found as hard as a cartilage ; more commonly its ftruc- 

 3 Z tnrc 



