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.

    68/192 (page 56)
    ment—a result wliicli is often to be noted 1 —renders the catheter highly desirable, ] whether the quantity drawn off be small i or large, transparent or clouded by mucus. 1 Taking into consideration these dif- ( ferent phenomena, which vary so widely ! in different constitutions, you will have no difficulty in arriving at a correct judgment for each individual case, pro- vided you give to each sign or symptom its due importance, and do not rest your decision on any one in particular, unless that one—in regard of quantity, for ex- ample—is sufficiently marked to leave no ground for doubt as to your course. I revert to a fact, already alluded to, which is one of considerable importance, that although the urine may have been quite clear before the catheter was em- ployed, yet in some instances, after its habitual use has been continued for a short period, the secretion becomes cloudy, and the patient is ieverish and unwell. A stage of constitutional derangement, more or less marked, has sometimes to be passed by those persons who, having long ex- perienced difficulty, suddenly change from their usual mode of micturition to the artificial one. It requires some judg- ment, as I have already pointed out, to decide when this change should be made, but having made it, the phenomena de- scribed occur in a few exceptional in- stances ; and this fact you should be aware of, and you should watch the result of the daily catheterism. Sir Benjamin Brodie was the first to remark it, and in his valu- able lectures called attention to the cir- cumstance that patients might even sometimes gradually succumb with sym- ptoms o£ low or irritative fever a few weeks after beginning to use the catheter. Bear- ing this in mind, our mode of proceeding may be advantageously modified in rela- tion to those patients whose amount of residual urine is large. It is then un- desirable to empty the bladder completely on every occasion of catheterism during the first few days. If the patient has been in the habit of retaining perhaps a pint of urine, or even more, after he has made water, it is a serious change for the bladder to be suddenly and completely emptied two or three times a day; the organ soon becomes irritable, the urine is charged with pus, and the patient loses appetite, becomes feverish, and there is sometimes considerable danger to life. The rule under such circumstances is to proceed cautiously. Instead of removing the entire quantity, leave some urine behind; and thus a compromise is made between the exigencies arising in this condition of the bladder and the usually absolute rule that it should be emptied. Draw olf half or only two-thirds of a pint; you will thus relieve the organ partially, and in the course of a week or sooner you may gradually accomplish the entire emptying of the bladder, and all will probably go well. And it conduces greatly to success to permit no outdoor movement to such a patient, but to confine him to his room, in a warm temperature, if the weather be cold, or even to his bed for a few days. The probationary period, while the use of the catheter has to be learned, and the onset of chronic cystitis with constitu- tional disturbance, is to be feared, is more safely passed if absolute rest and quiet are accepted as necessary conditions by the patient. It is only within the last few years that I have pursued this course, and I cannot speak too highly of the results. Nevertheless, very rarely, notwithstanding every precaution, you will find a case in which during this process the tongue grows slowly more red, dry, and con- tracted ; the powers of life gradually fail; the senses become impaired, and the patient sinks. You will always find in such cases, if an autopsy is made, old- standing pyelitis, with dilatation and marked degeneration of the renal struc- ture, and you will know that in no cir- cumstances could the patient have long survived.