Licence: Public Domain Mark
Credit: The works of John Hunter. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![§. 1. Of the Bleeding from the Urethra. It has been already observed, that when the inflammation is violent, or spreads along the urethra, there is frequently a discharge of blood from the vessels of that part. In such bleeding, the balsam capivi, progressive extension of the inflammation which gradually creeps up the urethra. This extension seldom occurs until the complaint has existed for a fortnight or longer, and, if the cure can be effected within that time, may almost certainly be avoided. The true principles on which the treatment should be conducted will naturally fol- low from these considerations. If the patient be seen on the first access of the disorder, when the discharge has only just appeared, and is small in quantity, before the orifice of the urethra has become turgid, and the passage has become sensible to the stimulus of the urine, the disease may often be entirely arrested by astringent injections, or by internal medicines, which have the property of acting as astringents on the urethra, such as the balsam of copaiba, or cubebs. But such a result can only be obtained when the inflammatory symptoms have scarcely commenced, and are in the slightest possible degree. After the expira- tion of twenty-four hours it is often too late, and generally so at the end of forty-eight hours. When active inflammation is present, the stoppage of the discharge can seldom be effected completely, and scarcely ever permanently. It may be greatly diminished; but this diminution rather aggravates than relieves the inflammation, as it lessens a se- cretion which has the effect of unloading the distended vessels, and the continuance of the inflammation will in a short time inevitably reproduce the discharge as profusely as before. It is to be observed, that it is necessary for the success of this plan that the dis- charge should be entirely stopped. If a single drop remains, it will go on to cause in- flammation, and the disease will hold its ordinary course. Should the malady be in such a state as to render this mode of treatment hopeless, it will be necessary to allow it to run its natural course. A period will arrive when the urethra will become accustomed to the virus, and the inflammation will then sponta- neously subside. In the mean time the surgeon must endeavour to moderate its vio- lence, by the removal of all stimulants which can be avoided. The chief stimulants are the urine and the discharge. The urine must be rendered mild, by neutralising its acidity, and by copious dilution; and the discharge must be moderated by astringent medicines, given in such doses as will only slightly check the increase of the secretion, without occasioning any immediate or sensible diminution in its quantity. Everything should be avoided which would determine to the parts affected. The diet should be light, and rather sparing, and no violent exercise should be taken; but there is no advantage in rigid abstinence or absolute rest, or in any restrictions which would inter- fere with the general health, or materially lower the general tone. However, should the inflammation extend to the parts surrounding the urethra itself, or, as Mr. Hunter expresses it, beyond the specific distance, this rule will not always apply. If there is tenderness and swelling of the perinaeum, or inflammation of the neck of the bladder, a horizontal posture and a careful regimen may be necessary. Yet even here it is better that blood should be abstracted locally and not generally, and that the diet should not be much reduced below the usual standard of health. When the inflammatory symptoms have nearly subsided; when the ardor urinae and chordee have disappeared, when (he orifice of the urethra has lost its red and turgid aspect, and the discharge is less profuse and less purulent, astringents may again be given in full doses, and will generally complete the cure.] VOL. II. P](https://iiif.wellcomecollection.org/image/b21996635_0002_0229.jp2/full/800%2C/0/default.jpg)
