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Show 218 or "run esrnarsn. Ixrnonucrron or THE CATHETER. or the semicupium, or bladders of hot water to the perineum and pubes, and the injection of elysters, with warm water, oil, and opium, have the best efi'ect in this disease. The third cause of obstructed urine, viz. paralysis, is one which it is of peculiar importance for the young surgeon to observe; and with regard to which there have been many very terrible mistakes. It may be produced by any accident: al or occasional over-distension of the bladder, by which the fibres being extended beyond their natural length, lose their power of action. The extension of the bladder' by three pounds of water has caused it. After the urine is drawn oil", the paralysis will continue for weeks, and the bladder reeow vers its powers very slowly. The best example of the effect of distension, in producing paralysis, and the plainest proof that the action of the muscular coat of the bladder will not be restored while the dis- would be rent, nor a mortification and sloughing, like the uterus when it is ruptured; or why should it be so very small and circumscribed a hole 9 It appears to me more to tension remains, is to be found in women after labour. When the child's head descends into the pelvis, it presses w... .4nrm4/ "w" aunt-*3: - . the urethra, and the urine is accumulated in the bladder. The woman, after a tedious labour, perhaps is delivered. But now that the obstruction is removed, the urine does not pass, the bladder has lost its power, and the abdomen is distended as if the child had not been delivered. The circumstance which most deceives the ignorant, in the paralytic state of the bladder, is that in its great distension there is a dribbling of the urine from the penis, which seems inconsistent with obstruction. The patient now expresses no dc» sire to pass the urine. The attendants express their satisfaction, and their fears are allayed when there is most cause for alarm. During this insensible flow of the urine, the distension of 219 resemble a small ulcerated hole, with black edges; an ulcer similar to that which is formed behind the stricture of the urethra. But here the bladder being distended to its utmost stretch, the irritation produces this ulcerative process in the fundus of the bladder; the most distended and the weakest part. The intestines gangrene from distension; but the ap» pearanee is very different from this. I have in two cases dissected out the bladder of patients (lying of suppression, yet in them the bladder was not found full of urine, though much enlarged and thickened. But what was more particular, was the high degree of venous vas= cularity, and the turgidity of the vessels with very dark blood; and the amazing load ol'aceumulated fat, which sur; rounded the whole bladder. The last occasion which I have enumerated of introducing the catheter, is the enlargement of the prostate gland. In this case, the patient is sensible of a tumour, and feels as if the feces distended the lower part of the rectum. The feces are discharged compressed by the tumour. The tumour is distinctly felt by the finger in am. This disease, peculiar to old men, is the most perplexing and most fatal cause of obstruction of urine. In fistula in arm, when the disease is in its commencement, and inflammatory, the neck of the bladder is sometimes affected, or the sinuses running forward in the perineum, or by the neck of the bladder, compress the passage, and ob- struct the urine. Here the tension and swelling is to be sub the bladder still increases, and at last the bladder gives way» and the urine is sent abroad in the peritoneum, and Get; dued by bleeding, and anodynes, and fomentations, and the catheter if possible to be avoided. tain death is the consequence. I have seen what is called the ruptured bladder, from INTRODUCTIOX OF THE CATHETER. dis-tension; but I confess that I formed a different opinion of its nature from that which is commonly described. I conceive it to be neither a rupture, for then the bladder In the hands of a dexterons surgeon, the silver catheter is in general preferable to every other. In the introduction of A : vmm mosey; . |
