Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson.

  • Thompson, Henry, Sir, 1820-1904.
Date:
1882
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Licence: Public Domain Mark

Credit: Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson. Source: Wellcome Collection.

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    apply these questions to the list of diseases before you ? First question—Frequency of passing water. There is no serious affection of the urinary organs, except one or two which I will name hereafter, in which you have not more or less frequency of passing water. Thus the following is an excep- tion : A man may have stricture to a considerable extent; the stream may be rather narrow, and he may not for some years complain of frequency of passing water, although the symptom will appear sooner or later. Now I wish you to observe that I have classified these diseases that we may deal with them more easily. At the head of our list there are the inflammatory diseases—inflammation of the urethra, of the prostate, and of the bladder. In all these you have frequency in passing water. Not necessarily, however, in urethritis, until it reaches the distant part of the canal near the bladder; and this is the second instance of exception which I referred to just noAV. I do not propose to enter upon the subject of urethritis here, as you have frequent opportunities of studying it in the out-patients' room. I am now only referring to this symptom of frequency of passing water as existing more or less in all these diseases at some time or another. Firstly; in Hypertrophy of the Pro- state you have it, and it is remarkable that it is more at night than in the day. Secondly ; in Chronic Prostatitis it is usually present to a small extent; in Cystitis it is, of course, a characteristic symptom. I name these together because they are so intimately connected that the bladder can scarcely be affected without the prostate being more or less involved. Thirdly; in Calculous diseases fre- quent micturition is a prominent symptom, and generally its degree is in proportion to the amount of movement permitted to the patient. Fourthly; Tumours, malignant and non-malignant, are of course attended by the same symptom. Fifthly ; in Pyelitis, and in almost all organic changes of the kidney, in Bright's disease, and in Diabetes, there is frequency of making water. Whenever the natural characters of the urine are altered be- fore it reaches the bladder, the secre- tion produces irritation. This fact is worth dwelling upon for a moment, as it is not uncommonly overlooked. Thus, diluted or watery urine is often regarded as un-irritating; on the con- trary, it is not generally well retained by the bladder. The bladder is, as a rule, never so content as when it contains a urine of average, or more than average, specific gravity. Some persons Avho are nervous, and particularly hysterical pa- tients, will pass urine which is quite pale, almost like natural water, and the bladder is always more or less uncomfortable from it. Of course, in Diabetes, you have not only the character of the urine altered, but the quantity much increased, with frequent micturition as the necessary con- sequence. And I may remark that it is chiefly in renal aff'ections that increase in quantity takes place; while, on the other hand, suppression of urine is always a malady of the kidneys. The second question has reference to Pain. The attainment of precise knowledge relative to the nature and seat of pain, will carry you far on your way towards a diagnosis. In Prostatitis there is usually pain at the extremity of the penis, and felt at the end of passing water—less severe, but resembling somewhat that of stone; as the bladder contracts, when empty, on the tender prostate. In Cystitis the pain is usually before micturition, because the inflamed mucous lining of the bladder will not bear much expansion, and is sensitive on being dis- tended, as all mucous membranes are when inflamed [of which a sore throat is a familiar example] ; and hence the organ frequently endeavours to get rid of its contents. The usual seat of pain is just above the pubes. When cystitis is acute, pain may be felt in the perineum also; but in chronic or subacute cystitis it is supra-pubic, and not at the end but at the beginning of making water, unless the prostate is alfected, and then the tender prostate gives a little pain at the end, as I have just said. In Stricture of the urethra there is often pain about the seat of the obstruc- tion, an idea of which you may obtain by a simple experiment. If, when passing urine with a full stream, you suddenly narrow the passage with your finger so as to diminish the stream to one half or more, you will experience an acute pain.