Edmund Owen

“ In the adult the cause which produces the over-distension must be removed if possible; but, as a rule, the patient has to be provided with a catheter, which he can pass before the bladder has filled to overflowing. A soft flexible catheter should be given in preference to a rigid or semi-rigid one. The best form is the red-rubber catheter, and he should be taught the need of keeping it absolutely clean. In the case of children incontinence of urine means irritability; in adults it means overflow. ”

“ Malignant disease of the bladder is almost always the warty form of cancer known as epithelioma. It springs as a sessile growth from the mucous membrane of the floor near the opening of one of the ureters, and, worrying the sensory nerves, causes irritability of the bladder and incontinence of urine. In due course septic germs reach the bladder, either from the urethra, the bowel, the kidneys or the blood-stream, and cystitis sets in. When ulceration has taken place, blood occurs in the urine, and the patient—generally beyond middle age—suffers dull or lancinating pains. ”

“ If at any time he should fail to perform the act of micturition, he ought not to strain, but should quietly wait for a little before making any further effort. Regularity in the times of making water is also of much importance.
Retention of urine may occur in paralysis of the bladder, or in conditions where the patient is suffering from an illness which blunts the nervous sensibility, such as apoplexy, concussion of the brain, or typhoid fever. It is, however, more commonly due to obstruction anterior to the bladder, as in stricture of the urethra or enlargement of the prostate. ”

“ As the bladder is approached, a good many veins are seen to be in the way, some of which have to be wounded. The bladder-wall is recognized by its coarse network of pale muscular fibres, through which, on each side of the middle line, a strong suture is passed, so that when the bladder is opened and the lotion comes rushing out, the opening which has been made into the bladder may not sink into the depths of the pelvis. ”

“ Pressure of the seat of the chair upon the perineum also causes distress, so the man sits sideways and on the edge of the seat. If abscess forms, it should be incised from the perineum; if allowed to run its course it may burst into the bladder, the urethra or the rectum, and set up serious complication. The treatment of prostatitis (inflammation of the prostate) consists in rest in bed, sitz-baths and fomentations. If retention of urine takes place a soft catheter must be passed. In the early stage of an acute attack a dozen leeches upon the perineum may do good. ”

“ But in every case disease-germs are the cause of the trouble, and they may be found in the urine. The first effect of inflammation is to render the bladder irritable, so that as soon as a few drops of urine have collected, the individual has intense or uncontrollable desire to micturate. ”

“ In tuberculous cystitis there is added to the symptoms the discovery of the bacilli of tuberculosis in the urine, and cystoscopic examination may reveal the presence of tubercles of the mucous membrane or even of ulceration. The patient is probably losing weight, and he may present foci of tuberculosis at the back of the testicle, the lung or kidney, or in a joint or bone, or in a lymphatic gland. Treatment is rebellious and unpromising. ”

“ If the stone be large and hard, half an hour or longer may be required to crush it sufficiently fine. When the surgeon fails to catch any more large pieces, the presumption is that the stone has been thoroughly broken up. The lithotrite is then withdrawn and the detritus is washed out by an “aspirator,” which consists of a stiff elastic ball which is connected with a trap, into which fragments of stone fall so as not to pass out on the instrument being used at later periods in the operation. A large catheter, with the eye very near the end of the short curve, is passed into the bladder ”

“ The trouble can sometimes be cured by the removal of irritating causes, and in these cases, as well as in those in which no such cause can be discovered, care should be taken to avoid those difficulties which have given rise to the patient’s worst failures. ”

“ In the child an attempt must be made to improve the tone of the micturition-centre by the use of belladonna or strychnine internally, and of a blister or faradism externally over the lumbar region, and every effort should be made to train the child to pass water at stated times and regular intervals. ”

“ When the stone is fixed between the blades the screw is used, and great pressure is applied evenly, gradually and continuously to the stone. The lithotrite is made of very tough steel, so that hard stones may be crushed without danger of the instrument breaking or bending. Care must be taken not to catch the bladder-wall with the lithotrite. This danger is avoided by raising the point of the lithotrite immediately after grasping the stone and before crushing. ”

“ The abundance of this deposit is in accordance with the amount of heat developed and work done in the body, and corresponds with the dust and ashes raked out of the fire-box of the locomotive after a long run. ”