A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 9).

James Copland

Date:: 1834-59

Credit: A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 9). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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$though perfectly healthy, are liable to become ex- cited and irritable, and the individual has no peace until the unnatural secretion is discharged. In such cases the fault lies, not in the bladder, but remotely in the kidneys and assimilating organs. —{Op. at.,?. 366) 8 The use of various fruits, ripe or unripe, es- pecially by children, and even by adults, and dis- orders of digestion and of assimilation, occasion- ed by these or by other causes ; the elimination from the blood of unwholesome substances, con- veyed into it from the organs of digestion, wheth- er subsequently altered or unaltered by the kid- neys ; the excessive use of alkalis, or of these combined with the vegetable acids, and alkaline states of the urine from these or other causes ; and the prolonged use of acids, or of the nitrate of potass, or of the oxide of potassium, or of other diuretics, may severally occasion this complaint 9. b. The irritation of ascarides in the rectum, and morbid states of the urine, caused either by unwholesome food, by unripe fruit, or by impair- ed assimilation, or by spinal affections, or by rick- ets, are the most common causes of this affection in children Mr. Coulson met with cases in chil- dren which were caused by so great a contrac- tion of the orifice of the prepuce as hardly to ad- mit the point of a probe ; circumcision cured the complaint. When irritability of the bladder oc- curs in this class of patients about the periods of dentition, it may generally be imputed to disorder of the digestive organs, and to consecutive altera- tions of the urine. The connexion of irritability with paralysis of the bladder is not unfrequently met with in children (^36) 10. c. Symptomatic irritability of the bladder is much more common than the idiopathic disease. Granular and other organic lesions of the kidneys are generally attended, especially during the night, with frequent and urgent desire to evacuate urine, this excretion being always more or less morbid even from an early period Diseases of the pros- tate gland and of its vicinity, organic, inflamma- tory, or malignant very generally, and strictures of the urethra not unfrequently, are accompanied with this complaint. Indeed, strictly speaking, irritability of the bladder is merely symptomatic, either of disease of some adjoining or some close- ly related organ, or of morbid conditions of the urine ; and this may be the case even in those considered purely nervous, or most devoid of manifest structural change. [Gonorrhoea and masturbation are among the most frequent causes of irritability of the bladder, the irritation being transferred from the urethra to the neck of the bladder ; causing frequent mic- turition, with tenesmus, pain, bloody urine, &c All the stimulating class of diuretics may cause the same difficulty; also those resinous cathartics, like aloes, which act on the lower portion of the intestinal canal. Turpentine, cantharides, and nitrate of potass are the most likely, perhaps, of the diuretics, to irritate the bladder ] 11. iii. The diagnosis of this complaint is often of importance; and nothing tends more to de- termine this than a careful examination of the urine. Irritability of the bladder will not be mis- taken for diabetes, if the quantity and quality of the urine be ascertained. Although irritability is a symptom of inflammation of this viscus, yet it is necessary to ascertain its independence of inflammatory action; and this is to be inferred chiefly from the absence of those local and con- stitutional symptoms characterizing cystitis, ci- ther in an acute or chronic form. The absence of pain in the region of the bladder, and of fre- quency of pulse or of other febrile symptoms, es- pecially towards evening, will indicate the inde- pendence of the recent state of the complaint of acute inflammation ; while the more chronic state of irritability will not be imputed to chronic in- flammation of the bladder, if the constitutional powers of the patient be not very sensibly im- paired by it. The dependence of the complaint upon disease of the prostate gland may readily be ascertained by an examination per rectum. Not only, however, may there be irritability, but also pain of the bladder, without any manifest disease of this viscus ; the mischief being confined to the kidneys, chiefly in the form of calculi of these organs. Instances of this kind are adduced by Morgagni, Prout, Coulson, H. J Johnson, and others, and have come under my own observa- tion. Dr. Prout remarks that, in certain renal affections in particular habits, even where the urine is not very unnatural, the pain is confined chiefly to the neck of the bladder; but where the urine is actually diseased, and especially when it is alkaline, we may be certain that the kidney is functionally, and if the patient be of a scrofu- lous habit, and the case of long standing, very probably organically affected.* 12. iv. Treatment —a. In recent cases, the states of the general health and of the urine will frequently indicate a successful treatment. When the urine is very acid, or scant)-, or furnishes a red sandy deposit, and when the complaint ap- pears in connexion with either gout or rheuma- tism, then bicarbonate of potash may be given, with or without the nitrate of potash, in tonic or bitter infusions or decoctions ; the carbonates of soda and of ammonia being inappropriate, the for- mer owing to its favouring the formation of urate of soda, the latter to its influence in generating urea and uric acid. Mr Coulson states that great relief will sometimes be obtained from cupping on the perineum. This will be more especially the case if any congestion of, or vascular determ- ination to, the prostate gland be present. Liquor potassse, prescribed in bitter infusions, with hen- bane or conium, or with small doses of colchicum, in the gouty or rheumatic/diathesis, is also of great service. Where the potash, in either of the states now mentioned, is not productive of relief, magnesia may be given so as to preserve the bowels in an open state, an occasional dose of equal parts of the compound infusions of gentian and senna being also taken 13 b In cases which manifest a nervous char- acter, or which seem to be results of abuse of the sexual organs, tonics are especially required, ei- ther in combinations already mentioned, or with the mineral acids; as the infusion or decoction of cinchona with the nitro-muriatic acids, and with henbane or conium, or with a few drops of tincture of opium, or with the compound tincture [ This disease has sometimes been mistaken for stone in the bladder. We have known two instances where the operation of lithotomy has been performed without find- ing any calculus in the bladder. Dr. Gross relates a case of a boy four years of age, who had a constant desire to micturate, complained of severe pain in the urethra and neck of the bladder, pulled constantly at the prepuce, and strained violently whenever he voided his urine, which was occasionally tinged with blood. On sound- ing, no stone could be found, and he was cured with al- terative doses of calomel and rhubarb, with earb soda, and in the intervals quinine and Fowler's solution ]$

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