SURGERY. 
ii 
siderable extent, the urine comes away by 
drops through the natural passage, leaving the 
bladder still distended. If the canal, through 
which the urine ought to flow be obstructed, 
inflammation and ulceration or sloughing 
ensue. Wlien this happens in the urethra, 
tistul® in perineo are the consequence. But 
the bladder itself may slough and burst. 
Retention of urine arises from the follow- 
ing causes. Weakness, or paralysis, of the 
bladder, inflammation of this viscus or of 
the adjacent parts, a spasmodic affection of 
the urethra, or some actual contraction of 
the passage. 
The paralytic retention of urine may be 
caused by an injury to some part of the spi- 
nal marrow ; by an overdistensioii of the 
bladder, arising from retaining the water 
too long after an inclination is felt to void 
it, &c. Two objects are to be accomplished 
in the treatment*; to draw oiF the fluid dis- 
tending the bladder, and to restore the na- 
tural contractile power of the viscus. The 
use of the catheter at certain stated periods 
accomplishes the first of these ; tlie internal 
use of cantharides, blisters to the sacrum, 
pubes, or perineum, cold water thrown on the 
hypogastrium, cold bath, &c. promote the 
second indication. The catlieter must be 
used regularly and frequently, until the 
cure is completed. 
The retention arising from enlargement 
of the prostate belongs to this, division. A 
negleet of the patient to obey the natural 
calls to void his urine is the first cause ; and 
the regular use of the catheter is the most 
efficacious means of cure. 
Use of the catheter. Thi^ instrument is 
either inflexible and made of silver, or flex- 
ible and elastic, which is composed of the 
elastic gum. There are also flexible cathe- 
ters made of a fusible metal, and others 
composed of the bougie plaster; but the 
former are employed the most frequently. 
The elastic catheter is less irritating to the 
urethra than a silver tube, and it can be in- 
troduced in cases wheie a metallic inflexi- 
ble instrument will not pass. The most 
favourable posture lor the introduction of 
the catheter is that in which the patient lies 
down, with his pelvis at the edge of the bed, 
and the legs hanging to the ground. The 
corona glandis should be held between the 
thumb and fore finger of the left hand, so as 
to avoid compressing the corona glandis. 
The catheter, well oiled, should be intro- 
duced, with the concavity towards the ab- 
domen, until its point has nearly reached 
the bulb. The handle should now be 
brought slowly forwards, between the pa- 
tient’s thighs, and the point will conse- 
quently describe that portion of a circle which 
is necessary for its entering the bladder. In 
the latter stage of the operation, the penis, 
which before had been drawn upwards, 
should be allowed to sink down. If an 
impediment is met with in any direction, 
let the point be withdrawn a little, and 
then pushed gently onwards according to 
the course of the urethra ; but force should 
be avoided by all means. The fore-finger 
of the left hand introduced into the rectum 
will sometimes facilitate the operation. 
When the prostate gland is enlarged, the 
urethra turns upwards very suddenly, just 
behind the pubes ; hence the end of the 
catheter should be more bent upwards. It 
has also been found, that by withdrawing 
the stilet of an elastic gum catheter for a 
small distance, the instrument itself be- 
comes more curved ; and by this means the 
point of the instrument may be elevated in 
the urethra in the due direction. Many 
surgeons into.duce the catheter as far as the 
perineum, with its convexity towards the 
abdomen, then keeping the point station- 
ary, they make the handle describe a semi- 
circular movement upwards, so as to bring 
the concavity of the instniment towards the 
pubes ; after which the operation is finished 
as in the former method. 
When the retention of urine arises from 
an inflammatory cause, the nature of the 
disorder is entirely altered. Strictures in the 
urethra, when very bad, and irritated so as 
to fall into spasmodic contraction, are the 
most frequent source of this kind of reten- 
tion. However, virulent gonorrhaea, bad 
piles, injuries of the perineum, fistula in 
ano, and the absorption of cantharides from 
blisters may have the same effect. The 
treatment of such cases must be of the anti- 
phlogistic kind ; venesection, leeches to the 
perineum, warm baths, fomentations to the 
perineum, and hypogastric region ; opium 
by the mouth, and in clysters, are conse- 
quently to be employed. The use of the 
tinctura ferri muriati internally is also a 
very powerful assistant in such affections. 
The patient may take fifteen drops every 
ten minutes until it acts. A common clys- 
ter will often suffice in slight cases. 
If none of these methods succeed, and 
the catheter or bougie cannot be intro- 
duced, it becomes necessary to puncture 
the bladder ; which operation is neither 
dangerous nor painful, and fails in success 
probably, because it is employed generally 
