Enuresis, involuntary flow of urine. The causes are stony, or paralysis, of the sphincter of the bladder; irritation or compression of the vesica urinaria ; the latter period of pregnancy; taxation of the vertebra. If the disease proceed from atony, the perinzum must be fre quently bathed with cold water ; repeat ed blisters must be applied to it and to the os sacrutn. We should at the same time administer internal tonics and stimu lants, as bark, zinc, and some of the pre parations of iron, tincture of cantharides, and the cold bath. If it be induced bypa ralysis, blisters, electricity, and internal stimulants, must be employed , if from irritation, or compression of the bladder, the cause of it must be discovered, and the proper means of removing it be had recourse to ; and if it be in consequence of the pressure of the gravid uterus, the patient shobld be kept as much as pos sible in a horizontal posture.
Ischuria. Of this disease there are four species ; as affecting the kidneys, ure ters, bladder, or urethra. The first pro ceeds from nephritis, calculi, spasm, gru mous blood, or pus in the pelvis of the kidneys, paralysis, and sometimes inflam mation of the intestines, or mesentery. If the disease arise from the first mention ed cause, which will be readily discovered by a careful attention to the symptoms, it will be removed by the means pointed out when treating of that inflammation : if it be the consequence of calculi, which will be known by the attendant symptoms, which are a frequent desire of making water, often suddenly stopped as it flows in a full stream ; heat and pain soon after the evacuation of it; tenesmus ; an itchi ness of the anus and extremity of the ure thra; colic pains ; costiveness ; nausea ; and frequently vomiting, pain and retrac tion of the testes, and pain or a sense of weight in one or both thighs. Blood-let ting will be requisite, in proportion to the violence of the symptoms of excitement. Laxatives will at the same time be neces sary, and the antiphlogistic regimen must be strictly adhered to. The irritation will be allayed by the • employment of the warm With, fomentation., opiates, watery, farinaceous, and mucilaginous fluids, tur pentine clysters, and stimulating lini ments to the region of the kidneys. If it proceed from a spasmodic affection, opium, xther, hyoscymus, and the warm bath, are the proper remedies. When it arises from grumous blood, or pus, con tained in the pelvis of the kidneys, we must promote the expulsion of them by the warm bath, diluents, opiates, and emollient laxative clysters. If it proceed from paralysis, internal and external stimulants, electricity, and the remedies recommended in the treatment of para lysis, must be employed; and if from the last mentioned cause, the most powerful means of removing such inflammations must be employed with diligence, and those means are pointed out in another place.
In ischury, from complaint in the blad der, there is a suppression of urine, ac companied with a circumscribed tumour of the hypogastrium, and a sense of dis tention in it, and an acute or obtuse pain about the neck of the bladder, attended with a frequent inclination to make water.
When the disease arises from the first mentioned cause, it will be removed by blood-letting, laxatives, emollient laxative clysters, opiates, the warm bath, and fric tion of the hypogastrium, with a strong solution of camphor, in olive oil, and if we do not succeed by those means, we must draw off the urme with the catheter ; and in desperate cases have recourse to puncturing the bladder, either above the pubes, or by passing a trocar into it from the rectum. If the disease arise from
scirrhus of the prostate glands, mercury, hemlock, sarsaparilla, and sea-bathing, should be recommended. If it be the consequence of paralysis, electricity, tinc ture of canthandes, and repeated small blisters will be proper. When it pro ceeds from spasm, opiates must be em ployed internally and externally ; emol lient laxative clysters, the warm bath, and a strong solution of the camphor ; and if the patient be plethoric, it will be advisable to take away some blood. When the disease is caused by over-distention of the bladder, from the too long retention of the urine, cold substances must be ap plied to the hypogastric region, and cold water should be afterwards injected into the bladder. If induced by the presence of grumous blood, pus, or mucus, these are to be removed by tepid injections,di luents, and by the other means recom mended in the treatment of the first spe cies. If ectopia of the bladder be the occasion of it, we must endeavour to bring the parts into their proper situation by the means adapted to their cause. If it arise from calculi, this will be dis covered by there being an uneasy sensa tion at. the orifice of the urethra after making water ; sometimes a dull pain at the neck of the bladder, with a frequent desire of emptying the bladder, and the water often passing drop by drop, or the stream beingsuddenly interrupted ; there will be also a considerable mucous sedi ment, and some degree of tenesmus, and the patient will generally void his urine when in a horizontal position. Under these circumstances, when the pain is con siderable, two drachms of turpentine, in corporated with yolk of egg, and mix ed with half a pint of gruel, with from sixty to a hundred drops of laudanum, should be injected: costiveness most afterwards be obviated by rhubarb, cora bitted with soap, or with small doses of calomel, or the saline cathartics: the uva ursi should be administered in doses of a scruple, or more, three times a day, and the dissolution of the calculus must be attempted by lithontriptics, as a drachm of the vegetable alkali, dissolved in a pint of water supersaturated with carbonic acidgas, three times a day ; Selt zer or soda water may be employed with advantage, or a large spoonful of a mix ture composed of half an ounce of the aqua potasse and six ounces and a half of the aqua calcis, in some mucilaginous liquor, may be given three times a day. When acybalz in the rectum occasion the disease, injections of warm oil, or the internal employment of oil of almonds or castor, with laxative and emollient clys ters, together with dashing the lower ex tremities with cold water, will generally succeed in promoting theirevacuation. If it arise from flatus, we must employ es sential oils and antispasmodics. If it be the consequence of an abcess, which will be discovered by the previous throbbing pain and nature of the discharge, after the bursting of the abscess, the frequent use of warm emollient and oily clyaters will be necessary ; and if it arise in conse quence of the pressure of the gravid ute rus, the urine must be drawn off by means of the catheter, until afterdelivery, when the complaint will cease of course.