ON INCONTINENCE OF URINE.
Althoughthis is not the professional term for the disease I am principally about to speak of, yet under this head will the reader, if he be an invalid laboring under a complaint of this character, seek for a description of his own case. Incontinence of urine implies a loss of the retentive faculty of the bladder; but there is a species of disease where micturition is carried to such an extent, that a patient will attribute his leaky condition to the above cause. Not so, however, is the case; the urine, in thedisease alluded to, is generated or excreted in great quantity, and the bladder merely fulfils its ordinary duty. Of the affection known under the title of incontinence of urine, most persons are aware that it is one of more frequent occurrence in infancy than in adolescence; but the latter is by no means exempt. In childhood it arises, in all probability, from drinking too much, and the bladder becomes, during sleep, overloaded, and runs over; or, perhaps, from the irritability induced by its distension, becomes excited to action, and so empties itself, the drowsy state of the child rendering it insensible to the passing circumstances.
The infirmity soon becomes a habit, which is often rendered worse by the means taken to check it, namely, chastisement, which is highly reprehensible. It is fortunately, however, a disease that wears itself out as the child grows up; and it may at all times be materially mitigated by a little care and attention, such as inducing the child to micturate before going to bed, and even awakening it before the anticipated time when it usually is attacked with the incontinence. The last fluid meal, which should be a spare one, should be taken some hours before retiring to rest; and if the complaint has gained much ascendency, medicines which give tone to the bladder should be taken. I have known the malady successfully removed, in a very short time, by a combination of the sulphate of iron and quinine, and any sedative extract, such as henbane or hops, given in small doses in the form of pills. Female children are more susceptible of the annoyance than males, probably owing to the shortness of the urethra. Every measure tending to give strength to the child should be used, such as cold bathing, fresh air, or a change of the same, especially if residing in the city, to the country. 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. There are many patients who can somewhat control the functions of that organ while awake, but have no power over it when asleep. The treatmentdepends a great deal upon the observance of abstemiousness both in eating and drinking: a perseverance in chalybeate remedies, both taken and administered internally (I have injected the bladder of a person subject to nightly incontinence of urine with various tonic preparations, with very great and permanent relief); the use of the warm bath, whereby the skin is brought into healthier action (for it is generally arid, and parched when much urine is voided), which tends to lessen the duty of the kidneys and urinary system, should be adopted; nor should exercise, thatpabulum vitæof even all feeble persons, be disregarded. It is of the utmost importance for the preservation of health, under all the circumstances in which we may be placed. Escaping from this digression, I now proceed to follow out the idea of the first paragraph of this chapter, to treat of those complaints wherein the urine is voided in excess. There is a disease commonly known by the name of diabetes, wherein the prominent symptom is a continual aptitude to pass urine, and in much greater quantities than the fluid consumed as ordinary drink could supply. This is one form of ailment of this class; but there is another, happily less inimical to life, and which, in the order of its frequency and simplicity, should take precedence. It is that state of health, where the patient is of that leaky habit, that whatever he takes runs through him, and that very quickly too. Of course, such a condition must depend upon a seriously-deranged constitution: hence there is present a perpetual thirst, an entire perversion of the perspiratory function, and a morbid condition of many of the phenomena of life. Where this disease springs up in early years, it becomes a habit proper to existence; and although it may not seriously disturb the economy of the being so as to lessen the duration of one’s stay here, yet it furnishes a source of much solicitude, by depriving us of rest, and shutting us out from society.
The patient (for such he or she may be truly called, and the complaint invades both sexes) appears to have a perpetual fever. Such is the desire for drink, that attested cases record the circumstance of individuals consuming fromonetotwo pailfulsof water in twenty-four hours! and I positively know an instance, at the moment of writing this, of a child, fifteen years of age, consuming during the night, notwithstanding a plentiful supply of liquids during the day, a large jugful (two quarts) of water: thequantity of urine excreted is nearly equivalent. In this case, the perspiration is profuse, and the child enjoys tolerably good health, with the exception of being occasionally nervous and hysterical. The case is under treatment, and the quantity of fluid allowed is being daily diminished. The urine on these occasions is aqueous, very pale, and of little specific gravity; the properties of the urine otherwise are not altered. These cases sometimes exist through life; and if they do not terminate fatally, they ultimately enfeeble the health, and predispose the patient, or, in other words, render him less able to combat with ordinary complaints common to us all, and thereby tend to the break-up of his constitution.
There are many persons tipplers, not for the love of the specific liquor, but from being always thirsty; and if we reflect a little, we shall soon find how inclined we are to encourage the habit. Since the introduction of tea into this country, what inordinate quantities of that fluid are consumed by individuals. They must, of course, dispose of it, after having drunk it: the stomach can not retain it, and it escapes either by the skin or kidneys, more usually the latter. It is no uncommon thing for nurses, washerwomen, and other females too, to swallow nine or a dozen cups of tea at a sitting: they declare it is their best meal.
Man is a great deal more careful of the quadruped world than the class he belongs to himself. He will stint his horse drink, who works as much beyond his strength as man does under his own, while he, the driver, will swill till his mouth can scarcely receive another drop. The moral of a volume might doubtlessly be expressed in very few words, but then it would not be a volume, and, consequently, would not be purchased or read; therefore, the proposition herein intended to be presented to the reader would exist unheeded. It is one thing to observe, that we all drink too much, or that too much fluids are hurtful to digestion and other functions, the public require some illustration (which their own reflection would furnish, if they used it), and hence this expense of verbosity to prove the fact. As one of the consequences, then, of too great an indulgence in fluids (I am here speaking of quantity rather than quality), this form of complaint, wherein the patient is perpetually desiring to urinate, is decidedly the result; and, as all complaints have a beginning, this may be considered as the first step toward setting up the severalaffections of the kidneys and bladder hereafter treated upon. How important, then, is the arrest of this practice. Where the inconvenience thus detailed is present, the quantity of fluids must by degrees be diminished, the general state of health must be studied. Dieting and warm-bathing are two sheet-anchors, if properly applied. All remedies tending to afford strength to the urinary system must be had recourse to; and where the bladder loses any of its retentive power, I entertain the greatest benefit from an injection.
The next form of urinary disturbance of a proximate nature to the one just described, is also where the urine is discharged in large quantities; but, unlike the former, excreted in greater abundance than the supply. The character of the fluid is also different; it assumes two appearances, modifications doubtlessly owing to the constitution of the patient and the severity and length of the disease. It is known by the name of diabetes: it is happily a complaint the least frequent of urinary derangements, else, from its obstinacy and difficult management, the slightest urinary disorder would excite much just dread and apprehension.
The forms of the complaint thus vary: In the one instance, there is a deficiency of the animal matter of the urine, namely, the urea, and in the other, a superabundance of it. In the former instance the urine is of a pale color, and transparent, and sometimes like clear water, with a very faint slight odor; whereas, in the latter it is generally of a higher color, and now and then so thick as to resemble brewer’s porter: it is decidedly a disease of great debility. The symptoms are, a wearisomeness and languor of the whole frame, a dry and crimpled state of the skin, a sinking, gnawing pain at the pit of the stomach, the bowels are obstinately bound, while a great thirst always prevails. The body wastes to a mere skeleton, the discharge of urine being almost constant, at least every hour, accompanied with a call that must be immediately obeyed: the leading feature in the composition of the urine, in addition to the varied presence of the urea, is the saccharine matter contained therein. It rarely attacks others than those who have led an irregular life, or else have suffered much from other kinds of sickness.
Diabetes is supposed to depend upon a perverted action of the kidneys; but there is little dispute of its being amalady involving the whole process of animal economization. The quantity of urine got rid of in a day has been known to amount to ten quarts; as the disease continues, the patient becomes much emaciated, the feet swell, and he sinks into a state of low hectic fever; the urine discharged continuing all this time to exceed nearly double the amount of nourishment, liquid or solid, that is taken, has given rise to the idea, that water is absorbed from the atmosphere through the body. The disorder is generally lingering, and, unless conquered, at last fatal. The treatment embraces many remedies—bleeding, emetics, diaphoretics, and sedatives, are mostly employed. It being a complaint involving the necessity of constant professional watchfulness, a more lengthened dissertation upon its peculiarities will but little serve the patient. My own opinion is, that the invalid must look for recovery—presuming the initiatory symptoms have been duly attacked and subdued—to careful diet, fresh air, varied scenery, and cheerful society. Bathing, either vapor or warm, is immensely useful; and, among the cases that have travelled across my path (for patients laboring under diabetes, like any other chronic ailment, generally take the round of the profession), I have seen much and great good achieved by the frequent employment of the bath.
As diabetes is mostly a sequence of some previous disturbance of the urinary system, it the more behooves the afflicted to heed the first noticial summons of attack: a handful of water will sometimes quench a mouldering ember that, suffered to rise into a flame, an engineful can not extinguish. I may add, there is no cause so destructive to virility as these drainages from the system through the urethra—an additional reason why they should be attended to upon their first appearance.
Cases where but a small quantity of urine is voided, terminating in suppression, of urine.—The most popular scientific synonymes for complaints are but little understood by men really of education; for, as yet, medical knowledge forms not one of the items of collegiate lore, and few anticipate sickness to render such acumen necessary. The term “Strangury,” from the frequency of its occurrence, is uppermost in most men’s minds; and they use it on all occasions when there happens an interruption to the process of making water. It is oftentimes misapplied. Strangury implies a difficulty in voiding the urine, but it does not includethose cases wherein little is voided, because there is little to void. The affection I am now about to make mention of, is of the latter description. I have stated that the urine is subject to a multitude of changes, that the human frame is constituted to exist under a variety of circumstances, and that occurrences are daily happening, wherein its integrity is put to the test. Excesses, termed sensual, and others, which in themselves might destroy life, are counterbalanced by what may be styled thesafety-valvesof the system. A violent fit of purging, perspiration, or micturition, is often the means of warding off an otherwise fatal blow. The skin, the bowels, and the kidneys, are severally to be acted upon as emergencies demand: instance the specific operations of diet and medicines. The color of the urine is altered by (to give a popular illustration)rhubarb; its odor, byturpentine(taken internally, or from an inhalation of the vapor of them), and by the well-known vegetableasparagus; and its composition by alkaline and other chymicals. The function of cutaneous exhalation is augmented or diminished by warmth or cold; and the action of the bowels is suspended or increased by innumerable substances, forming portions of our daily food.
Analogous to these effects, is the result of certain conditions of ill-health. A patient, laboring under fever or inflammation of any important organ, will scarcely rid himself of a wineglassful of blood-colored urine in the twenty-four hours; and there are many forms of ailments, where the function of separating the urine from the blood, or even the function of supplying the kidneys with that vital fluid, are suspended, partially or entirely. Few of us have escaped attacks of this kind; they are sure to follow long-pursued habits of dissipation, or even occasional displays of it; and they are often the result of accidents over which we have but little control. A patient will complain of a frequent desire to make water; each effort so to do, will be accompanied with excruciating pain. A small quantity, or a few drops only, will dribble away, excoriating the passage as though vinegar was passing over it, and putting on an appearance almost resembling muddy port wine, or a thick solution or suspension of brick dust: there will be present much fever and constitutional disturbance. The patient may have shivering fits, pain round the loins, down the thighs, and over the lower part of theabdomen. He will betray a readiness to submit to anything, although conscious that his bladder is empty, notwithstanding the violent and urgent efforts at straining, which he is continually being called upon to make, as though his bladder were distended, and ready to burst. On passing the catheter (I am supposing a severe case, where retention of urine has at last occurred), not a drop will flow, and the danger of the disease is thereby made apparent. Except very severe measures be adopted, which it would be idle here to lay down, the case is sure to terminate fatally. Instances are recorded, where that event has been retarded upward of a week, during which time the patient voided not one drop of urine.
The absolute cause of the disease is very obscure; but it has a beginning, and to those only who suffer from a long-continued diminution in this natural excretion, and who disregard it, is this picture presented.
The treatment, in advanced stages of the disease, is strictly professional; but the warning of the altered character of a customary evacuation, should not for a moment be disregarded.
Suppression of urine is very different from retention: in the former, there is none to excrete; in the latter, its escape is impeded. In the chapter on stricture, the cause and manner of retention is explained, and the mode of relief laid down, whereby the invalid himself has a remedy at hand; but, in suppression, the resource is neither so ready nor so effectual. It is, therefore, much wiser to notice the first alteration, and to be prompt in seeking the nearest aid. Every practitioner is acquainted with such. Although such are not ever present, even in the most extensive practice, still they do occur; and much as this mode of frightening a patient may be condemned, knowing the frequently existing disinclination toward “laying up,” yet, if it only induce a fellow-mortal to take the tenth instead of the eleventh hour, one life may be saved, and the writer can well submit to the disapproval and contempt of the thoughtless and indifferent.