Diseases of the Bladder.—The anatomical description of the bladder will be found in the earlier pages of this work. It may simply be restated:
The bladder is a viscus somewhat similar in structure to the stomach. It is composed of several coats—muscular, nervous, and mucous. Each are liable to diseases peculiar to their several structures. The size of the bladder differs in most persons, and in the sexes.
The female bladder is generally the largest; but the largeness is observable more especially in females who have borne children. The proverbial ability of females to retain their urine longer than men is thus accounted for.
Much mischief is often done by both sexes disobeying the particular “call of nature” to urinate; and the younger branches should have that fact impressed upon them. Ihave known children acquire a severe and obstinate form of irritability of the bladder by retaining their urine too long. Diseases of the bladder are generally the consequences of other complaints, and those complaints have already been enumerated. They may be thus summed up:
Gonorrhœa extending to the bladder, and producing absolutely a clap of the bladder. If the inflammation is not subdued, or does not subside, probably some permanent mischief ensues; at all events, the inflammation extends, and involves other coats than the interior. Accordingly, we have inflammation of the muscular coat, the nervous coat, and, lastly, the peritoneal coat. These terminations, severally, have certain symptoms, and certain names.
There are others, and among them may be named colds, local injuries, hæmorrhoids, excess in drinking particular fluids, sensual indulgences, diseased condition of the kidneys, or long retention or vitiated states of the urine, nervousness, and, lastly, the formation of stone in the bladder. The most common form of bladder ailment is irritability, which is a milder term for inflammation. Then we have absolutely inflammation, and, lastly, loss of power, or paralysis.
Irritability of the Bladder.[3]—The chief indication of disease affecting the bladder is a frequent desire which the patient experiences to pass his water; but that symptom alone does not determine the nature of the complaint. It may be irritable from sympathy with surrounding irritation, and disappear on the subsidence of that irritation. It may constantly be fretting the patient by its contractions, through the urine (owing to some general derangement in the system, being altered in its chemical qualities) exciting the bladder the moment it is secreted therein; or it may be the result of nervous agitation, with or without any actual diseased state of the bladder. These causesshould be understood to regulate the treatment, which of course must be qualified by the provocation, and which the patient, when in doubt, had better leave to the discrimination of his physician.
Paralysis of the Bladder.—The bladder may become, through loss of nervous stimulus, insensible to irritation, and consequently be disobedient to its natural functions. The urine, in these cases, accumulates in large quantities, distends the bladder to its utmost, which it does without pain; and the excess of secretion then dribbles away involuntarily. This state of the bladder is called paralysis, and is an aggravated form of disease, arising from the same causes that establish inflammation, or from some contiguous nervous injury. The treatment of paralysis of the bladder must be intrusted to experienced hands; it consists chiefly of purgatives, stimulative enemata up the rectum, the introduction of the catheter, the cold bath, rest, and general medicinal nervous excitants.
Inflammation of the Bladder.—Cases of acute inflammation of the bladder are of rare occurrence; but they do occur, occasionally prove fatal, and always are productive of much general disturbance, which yields not without vigorous and active treatment. Gonorrhœa is most usually the exciting cause. On the sudden suppression of the urethral discharge, an inflammation sympathetically seizes the testicle, the glands in the groin, or the bladder; and when the latter is the seat of the transference, it may be held as the ratio of the severity of the disease. In inflammation of the bladder, there is a constant desire to pass water, which, when made, is usually in very small quantities, and leaves a sediment. The patient often experiences an insupportable inclination to urinate, with a sensation as though the bladder were ready to burst—whereas there may be little or no urine in it. There is much pain at the root of the penis, and it extends along the perinœum to the rectum, which latter is assailed with almost constant spasms resembling straining. There is considerable thirst, fever, and anxiety; the pulse is full and quick, the tongue furred, and all those symptoms are present that prevail during severe constitutional excitement. The treatment consists of bleeding, leeching, or cupping; relieving the bowels by castor oil and injections; giving mucilaginous drinks, administering opiates, preserving rest, and total abstinence from stimulatingdiet. If these means fail in subduing the inflammation it runs on to ulceration, permitting extravasation of urine occasioning mortification and death; but where they are effectual, the patient is soon left free from complaint. It often happens that the inflammation is not so vigorously treated, or it may be wholly neglected, and yet it may happily resolve itself without proceeding to the extremity narrated; but, unfortunately, it may degenerate into a minor but not less troublesome form, denominated chronic, and which, in fact, is the disease christened “irritability,” and the one, for obvious reasons, as above stated, for which relief is most usually sought, the patient having in vain daily looked for the subsidence of his malady. Having stated that irritability of the bladder must be treated with reference to its cause, it is obvious that more than non-medical discrimination is required. Where it depends upon stricture, the stricture must be first cured; where upon stone in the bladder, the stone must be removed; where upon sympathetic inflammation, the source must be attacked, and so on.
However, it has been stated that other causes may exist—that it may even be a primary disease in itself; and as this treatise professes to be a private mentor to the invalid, I will detail such measures as may be safely adopted for the cure of a complaint as often borne from being trusted to unskilful hands, as from a morbid delicacy in seeking proper and legitimate relief. The ordinary symptoms are, first, an inordinate desire to make water; it flows in small quantities, with pain before, during, and after. The urine has an offensive ammoniacal odor; it deposites a thick, adhesive mucus, of a gray or brown color, sometimes streaked with blood, and of an alkaline character.
In this stage of affairs, rest is indispensable; sedatives and opiates may be given; but alkalies (rarely omitted in prescriptions for incontinence of urine) should not be indiscriminately given, for they only render the urine more alkaline, which occasions it to deposite calcareous flakes, that, if not passed off, accumulate, unite, and lay the foundation of that frightful disease, stone in the bladder. The extract ofconium, orhenbane, combined with mucilage, may be given in doses of three to five grains every six hours. Thetincture of henbane, in doses of afluid-drachm, or thetincture of opium, not exceedingten or fifteendropsat a time, may be given in like manner, and continued for several days, keeping the bowels open with castor oil. The daily or alternate daily use of the hot, general, or hip bath, will afford immense relief. The various preparations ofmorphine,aconitine, and ofhops, possess great power in small and frequent doses. Theuva ursiis a remedy of ancient note, and is often prescribed with advantage; the dose is one scruple to a drachm in milk, or any bland fluid, three times a day, or it may be taken in infusion or decoction, one ounce to a pint of water—that quantity to be drank during the day. Thepareira brava, exhibited in a decoction (by simmering three pints of water, containing half an ounce of the root, down to a pint), may be taken in divided doses of eight or twelve ounces during the day, or in the form of extract, in quantity of a scruple, which equals the above amount of decoction.
Theachillæ millefoliæis an excellent plant, and possesses astonishing astringent powers, often restoring the tone of the bladder to a healthy condition, when all other remedies have failed. A handful of the leaves are to be infused in a pint of boiling water, which, when cool, may be poured off, and given in doses of a cupful three times a day. Any of the preceding sedatives may be given in conjunction with these preparations.
Lime-water taken with milk, as an ordinary drink, is a useful corrective.
Thebuchu(thediosma crenata)—an ounce infused for several hours in a pint of boiling water, and a wineglassful of the cooled liquid administered three or four times a day—has justly obtained some notoriety.
Where all these means prove ineffectual, the injection of sedative and astringent applications often answers the most sanguine expectations; but they should be employed only by professional persons, and even then with great care; as when the disease has been at its height, and they have been used, much inconvenience, and even mischief, has been occasioned. A mild infusion of poppies, or weak gruel, may be thrown in, once or twice a day, in quantities not exceeding two or three ounces at a time, and withdrawn after being suffered to remain thirty or forty seconds. A catheter, with elastic bag, should be the instrument used.
In the more chronic forms, where the urine does notdeposite much mucus, or is tinged with blood, the addition of ten drops (very graduallyincreasing the quantity) of the diluted nitric acid may be made to the fluid injected, repeating or declining the operation, as the effects are discovered to be advantageous or prejudicial.
In an irritable state of the bladder depending on some disease of the kidney, there is a frequent desire to void the urine without there being any, or but very little, urine in the bladder. There is also a severe cutting pain felt about the neck of the bladder, especially after each effort to make water, followed or attended by a “languid” pain in the loins. The urine is often the color of whey, at other times tinged with blood, and deposites, when suffered to remain a while, a purulent sediment. The severe symptoms should be allayed by the same remedies as prescribed in irritable bladder arising from other causes; but the original seat of the disease in this instance demands energetic attention. The various counter-irritants are in great requisition; leeches, blisters, setons, &c.
In addition to the tonics and astringents already advised, an infusion of thewild-carrot seed, made by macerating for a couple of hours one ounce of the seeds bruised in a pint of boiling water (drinking, when cool and strained, the whole of the liquid in divided doses during the day), may be taken with every chance of relief. As in the other infusions, the patient must persevere in the use of this for some time.