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Diseases of the Bladder

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DISEASES OF THE BLADDER.

Inflammation of the Bladder (Cystitis) is of the nature of catarrh (p. 214), in which the lining membrane of the bladder becomes congested and swollen and pours out mucus. Breaches in the mucous membrane may occur, leading to ulceration, blood may escape from con gested vessels, and abscesses in the walls may be produced. Irritation of the bladder from the presence of stone, or from the retention of urine, occasions it. The irritation is sometimes due to substances in the blood. Thus poisoning by cantharides, the material of which fly blisters are made, occasions a very painful inflamma tion ; and this may result from absorption from a fly blister placed on some part of the body. Extension of inflammation, such as that of gonorrhoea, excessive drinking, and exposure to cold, are other causes. The disease may be acute or chronic.

The symptoms are frequent passing of water, or constant desire to pass it, not much being expelled at a time, the act being accompanied by tenderness or burning pain. There is also tenderness or pain over the region of the bladder in the lower part of the belly, or in the groins, and in the region of the fundament. Fever may be present. The urine is cloudy with mucus, or contains it in quantity, and blood may be mingled with it and much pus, which forms a heavy dirty- white sediment. In chronic forms the symptoms are less marked, but the urine is more altered and may be offensive to the smell.

Treatment. —Hot fomentations should be applied to the lower part of the belly or between the legs. Warm baths are useful. The bowels should be freely opened by a dose of calomel followed by castor-oil, or by a warm injection. If the pain is severe, 10 to 15 drops of laudanum may be given, at intervals of 2 or 3 hours, to be stopped when the pain is relieved. Plenty of watery drinks should be allowed, barley- water, linseed-tea, &c. The patient should be kept at rest, and only mild diet without stimulants allowed. Should the inflammation be due to the presence of stone or other irritant its removal is, first of all, necessary. In chronic cases it is important that the bladder be thoroughly emptied, and for this purpose the use of the catheter (see APPLI ANCES FOR THE SICK-ROOM, Plate XXX VIII.)

is often necessary. Baths or hot fomentations are useful for relieving pain. The medicines mostly used are infusion of the leaves of buchu, of red bearberry (uvu ursi), of pareira brava, or of the root of dog's grass (Triticum repens). These infusions are made as one makes tea; 1 or 2 ounces of the leaves or root being used to 1 pint of boiling water. The dose is 1 to 4 ounces of the liquid three times daily. The freshly-prepared in fusion is best; but fluid extracts may be obtained from chemists, of which one tea spoonful in water is a dose.

Two comparatively recent drugs are ex tremely useful in such conditions of the bladder, namely urotropin and helmitol. They may be given, one or other, in 10-grain doses in a tumbler of hot water thrice daily, till the urine becomes clear and free from deposit.

If these measures fail to relieve, the bladder should be washed out at regular intervals with antiseptic solutions. This a patient may be taught to do for himself.

Irritability of the bladder is indicated by frequent desire to pass water, the frequency not being due to an excessive quantity of water requiring to be voided. It is often clue to excessive acidity of the urine, to irritation in the bowels, such as piles may induce, or in neighbouring organs, in women to irritation of the womb, in children to the irritation of worms. The irritation may be in the prostate gland at the neck of the bladder. Mere ner vousness may occasion it.

Treatment.—The cause of any irritation should be sought for and removed, if possible. Excessively acid urine may be corrected by alkaline remedies such as citrate of potash (20 grains in water), excessively alkaline urine by 10 drops dilute hydrochloric acid in water, the doses being repeated several times daily as required. Belladonna (a grain of the extract in pill) is useful, specially in nervous cases. If the person is in weak health quinine and iron tonics are called for. Plain diet is neces sary, and all excesses should be avoided. Regu larity of the bowels is of great consequence.

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