Urinal

“ It may, I think, be said that water urinals are never sweet except in those rare instances in which they are constantly wiped perfectly clean by an attendant. The decomposition of urine is due to micro-organisms, and it is well-known that if urine be passed into an impure vessel, its decomposition takes place with great rapidity, especially if the temperature be moderately high. All vessels intended for the reception of urine require a thorough washing and cleansing every day. ”

“ Spasmodic stricture is generally seated at the neck of the bladder, and may occur to persons in good health, from exposure to wet or cold; from some digestive derangement; from long retention of the urine, particularly while walking, owing to the absence of public urinals; or to violent horse exercise; but more frequently does it happen to those young men who, when suffering from gleet or gonorrhœa, imperfectly or only partially cured, are tempted to commit an excess in wine, spirits, or other strong drinks. ”

“ To test this function place the patient on the bed pan into which a pint of hot water has been put, and give her a reasonable time to make the effort to pass her water. Should she fail, take an ordinary small bath towel and wring it out of very hot water, just as hot as she can tolerate, and spread it over the region of the bladder and genitals: if there is running water in the room, turn it on full and let it run while the towel is in position as above. If the bladder is full, there is a peculiar, irresistible desire to urinate when one hears running water. ”

“ Mechanical contrivances are to be had to collect the escape of urine, whereby the offensive odor arising from the continually soiled bed-linen may be avoided, and oftentimes the fretting consequences of the urine passing over the person, which induce excoriations and troublesome sores. There are contrivances for both sexes. Where the disease prevails in mid-life, it is generally traceable to early improvident habits, and of course is the result of irritability and debility of the bladder. ”

“ If a boy has a clear and watery urine after it has been sandy, if he frequently scratches his foot, has involuntary erections and finally obstruction in micturition, I say that he has a stone in the neck of his bladder. If now he be laid upon his back with his feet well elevated, and his whole body be well shaken, if there is a stone present it is possible that it may fall to the fundus of the bladder. ”

“ On introducing the catheter sometimes part of the urine will come away and not the whole, which is difficult to explain; but may arise from the weakness of the muscular fibres of the bladder; which are not liable suddenly to contract themselves so far as to exclude the whole of the urine. In some old people, who have experienced a long retention of urine, the bladder never regains the power of completely emptying itself; and many who are beginning to be weak from age can make water a second time, a few minutes after they supposed they had emptied the bladder. ”

“ However speedily soap and lime-water may dissolve the greatest part of urinary stones out of the body, yet [215] being mixed with the aliment and humours of the stomach and guts, and afterwards with the whole mass of blood, it is impossible but their force must be greatly impaired before they arrive with the urine at the bladder. ”

“ To resume; the patient will content himself, that the only fault in his system is the disordered condition of his urine, and he earnestly seeks for something to touch that particular symptom, forgetting that trifling as he may fancy it, it is not merely owing to the office of the kidneys and bladder, but to the blood itself, whence the urine is formed, and to other circumstances in the economy that influence it. ”

“ Abnormal conditions of the bladder will cause difficulty in retaining the urine for a normal length of time. An inflammation of the bladder is greatly exaggerated by the [Pg 387] presence of urine, therefore an irritation would be set up which would result in a desire to empty the bladder. This would invariably result in nocturnal enuresis. An interference with the transmission of motor mental impulses to the sphincter muscle would be another cause for bed wetting. In this case, it would be impossible to retain the urine after a certain amount had passed into the bladder. ”

“ In the efforts of micturition, as in those of vomiting and defecation, we have combined movements of voluntary and involuntary muscles. The urine is retained in the bladder by the contraction of the sphincter surrounding its neck, and it is expelled by contraction of the body of the bladder itself with the assistance of the abdominal muscles. Both the sphincter of the neck of the bladder and the muscular walls of the organ itself may be reflexly excited to contraction, and we may thus have reflex incontinence or reflex retention. ”

“ If she find an obstruction or stoppage of the urine, by reason of the womb's bearing too much on the bladder, let her lift up her belly a little with her hands, and try if by that she receives any benefit; if she finds she does not, it will be necessary to introduce a catheter into her bladder, and thereby draw forth her urine. If the difficulty be from the ill posture of the woman, let her be placed otherwise, in a posture more suitable and convenient for her ”

“ When urine contains a larger amount of chemical constituents than it can conveniently hold in solution, a certain quantity crystallizes out, and may be deposited in the kidney or in the bladder. If the crystals run together in the kidney the resulting concretion may either remain in that organ or may find its way into the bladder, where it may remain to form the nucleus of a larger vesical calculus, or, especially in the case of females, it may, while still small, escape from the bladder during micturition. ”

“ Retention of urine is not always present even in those cases in which the limbs are completely paralysed, as the fibres of one side of the cord are sufficient to maintain the functions of the bladder. The patient may be aware that the bladder is full, although he is unable to empty it. Similarly, sensation in the rectum and anus may be retained although the control of the sphincters is lost. ”

“ From the neck of the bladder to the end of the penis, is the urethra; which canal serves for the emission of the urine, as well as that of the seed.
The whole is lined with a number of very little glans, to lubricate and protect the sensitive lining from the sharpness of the urine.
These are the urinary organs. We will in the next place, proceed to the organs of generation. ”

“ In most diseases the quantity of urinary water is diminished, especially in those in which the activity of the circulation is impaired. There are diseases, however, more especially the granular kidney and certain forms of chronic Bright’s disease, in which the quantity of urinary water is considerably increased, notwithstanding the profound anatomical changes that have occurred in the kidney. There are two forms of suppression of the urine: one is obstructive suppression, seen where the ureter is blocked by stone or other morbid process ”

“ The urinary apparatus (consisting of the kidneys, ureters, bladder, and urethra) is known to be the principal emunctory for eliminating and voiding the detritus formed by the continual decay of the parts comprising the animal economy. The urine is this detritus in a state of solution. The components of urine are chemically similar to those of calculi, and as the components of the one vary according to the disintegration occurring at the time in the vital alembic, so do those of the other. ”

“ Prophylaxis.—Certain directions are helpful and by occupying the patient's mind will overcome certain physical factors that underlie the affection. It is important that the bladder should not be allowed to be full, above all, not to be over-distended at night. Some care should be exercised in not taking too much to drink shortly before going to bed and the bladder should be faithfully emptied before retiring. The weight of a large amount of urine in the bladder pressing down upon the seminal vesicles situated below and behind it causes them to contract rather easily. ”

“ When the part becomes morbidly enlarged, it acts as a mechanical impediment to the passage of urine from the bladder, but from this circumstance we cannot reasonably infer, that while of its normal healthy proportions, its special function is to facilitate the egress of the urine, for the female bladder, though wholly devoid of the prostate, performs its own function perfectly. ”

“ In such cases the bladder often attains a very large size. At first the accumulation produces all the uneasy symptoms formerly mentioned, but after some time these subside, and the urine drains away according as it is secreted, without, however, the original accumulation and tumour being diminished. This state of the urinary system is very common in old people, who neglect natural calls to empty the viscus during the night, or while sitting socially after dinner. The uneasiness gradually goes off, and when they at length think of making water, none can be got to flow. ”

“ When full, the bladder is pear-shaped; when empty, it is collapsed and lies low in the pelvis. The functions of the bladder are to collect and retain the urine, which has reached it drop by drop from the kidneys through the ureters, until a certain quantity accumulates, and then to expel it from the body. ”

“ The desire to pass urine becomes greater, and is frequently insupportable, while it can in some cases be only passed by drops. In others these symptoms are less urgent. Nevertheless, the natural action of the bladder, or, in those severe cases, the additional efforts which are made for its expulsion by the abdominal muscles, may cause the urine to be forced through the wound into the cavity of the abdomen, whence the advantage to be obtained from the early use of the elastic catheter. ”

“ Some patients keep a catheter and "draw" their own urine. Unless the patient takes great care, the bladder and urethra will be irritated and perhaps infected through neglect of cleanliness. Medicines are not very useful in severe cases. Operation is the only reliable cure especially when some urine is always retained. ”

“ Among females, whose urethrae are short and dilatable, foreign bodies are often found in the bladder, and it is quite common for smaller articles of the toilet, such as hair-pins, to be introduced into the bladder, and there form calculi. ”

“ 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. ”

“ Independently of which, where so much disease exists as in the urethra, the urine also constantly pressing against ulcerating and irritable surfaces, extravasation of that secretion takes place, and the most formidable and alarming consequences ensue. In the simplest form of stricture, many important functions are disturbed. A very frequent consequence is permanent irritability of the bladder, so that the patient is obliged, ten or twelve times a day, to micturate, and is unable to pass through the night without suffering nearly the same inconvenience. ”

“ Local disorders of the urinary organs are more frequent causes of the trouble, as inflammation of any part of the urinary tract, diabetes, nephritis, stone in the bladder, tumors, and malformations. The involuntary passage of urine may arise from irritability of bladder—the most frequent cause—or from weakness of the muscles which restrain the escape of urine, or from obstruction to flow of urine from the bladder, with overflow when it becomes distended. ”

“ Removal of tonsils and adenoid vegetations might conceivably cure an enuresis which is nocturnal, it cannot account for an incontinence which spreads to the day. We might believe that to distend the bladder by hydrostatic pressure was a cure for incontinence of urine, and that it acted by removing the local cause,—the smallness and contraction of the bladder,—were it not that the loss of control is so apt to spread to the rectum as well. There is no evidence that the urine is peculiarly irritating. ”

“ The patient passes urine often in small quantity, and with whines or cries. He walks slowly and stiffly with the back arched, and compression of the abdomen and especially of the prepubian region is painful to a marked degree. The tense elastic bladder may often be distinctly felt through the abdominal walls. The inflamed bladder is liable to paresis and paralysis with great overdistension, and aggravation of the general symptoms, the eyes sunken, and dullness, stupor and coma betraying uræmic poisoning. Some claim rupture of the bladder as is so common in the ox. ”

“ If their urine (as is likely) be retained, owing to their delirium, we must foment the lower part of the belly and bladder with warm oil and water, and then, by applying the fingers of the hand to the part, we must try to incite them to make water. We must also anoint the rest of the body with warm oil; and the patients are to be kept in a recumbent posture, for a state of quietude is to be maintained as much as possible; and, if they be rich, they are to be restrained by their servants; but, if not, they are to be bound with ligatures. ”