Femina, A Work for Every Woman

by John A. Miller

INFLAMMATION, CATARRH, AND OTHER DISORDERS OF THE BLADDER.

The female bladder is easier approached than that of the male. This is clearly illustrated in the anatomical Plate II, which should be thoroughly studied before this chapter is read.

The bladder lies directly behind the symphysis pubis, above or in front of the vagina. On account of the comparative shortness of the female urethra, to that of the male, the cavity of the bladder is also much more accessible through this channel, and if access through this communication does not suffice, then the interior of the female bladder may be exposed by an incision through the anterior wall of the vagina, but this resource becomes rarely necessary. Formerly we had to content ourselves with external appearances, that were confined to the external anatomy of the urinary canal on the anterior vaginal wall, aided only by a delicate sense of touch. Valuable as these means of examination sometimes were, they were far from satisfactory to either physician or patient. Now we are able to examine with the finger, aided with the eyes, almost the entire lining of the bladder.

Professor Simon, of Heidelberg, was the inventive genius of this improved method of examination, by means of a series of graded specula or hard rubber bougies, which are known by his name. The specula are simply small, smooth, pin-shaped, hard rubber bougies, about three inches in length, beginning with a size that is three-tenths of an inch in diameter, to the largest, which is eight-tenths of an inch in thickness. These are carefully introduced into the urethra, commencing with the smallest size, which is retained for a few minutes and then withdrawn, and the next size inserted, and this continued until the largest one has been inserted, or the required dilatation accomplished, either for the purpose of introducing the finger into the bladder, or exposing its lining membrane for inspection. While this procedure does not fall into the sphere of home treatment, it is of sufficient interest to women in general that they should know what can actually be accomplished by the expert specialist. Were I to review the malformations, or dislocations, of the bladder, or the history of stones in the bladder, or other foreign bodies, that the female specialist is very seldom called upon to treat, I should only worry the patience of the reader with things that she would not readily understand. The same is true of growths and tumors of the bladder, which have principally a scientific interest for the practitioner of medicine, but for the casual reader they are too profound in their details for a clear understanding.

INFLAMMATION.

Inflammation of the bladder is in medical language termed cystitis. It presents itself under two varieties or subdivisions, acute and chronic, depending on the duration, whether recent or protracted.

The disease begins in the mucous membrane, and the acute inflammation comes on suddenly. It rarely occupies the entire mucous surface of the bladder, but usually occurs in irregular spots. Some spots are as large as the palm of the hand, while others are only the size of a ten-cent piece. The parts that are most frequently affected, are the neck of the bladder and its posterior wall, although no portion of its lining membrane is exempt from inflammation.

It rarely happens that the inflammation spreads over the entire extent of the bladder, or that it invades the muscular tissue; if it should complicate the latter, it would involve the peritoneum; this would add a very serious complication, namely, a peritonitis. Cystitis may be due to an extension of gonorrhœal infection from the vagina and urethra, or from other purulent affections. Women who are unable to pass water after confinement, may be liable to the disease from retained urine, decomposing in the bladder and causing inflammation. On the other hand, a filthy catheter used by a midwife or doctor who is careless or ignorant of the necessary antiseptic precautions, and who fails to brush and boil out the catheters, and uses one catheter on different patients, without the precaution of even thoroughly rinsing it, may give rise to dangerous cystitis. The most serious case that I ever have seen was directly traceable to this cause. If impure air gets into the bladder this will also excite cystitis; to prevent that, is to close with the finger the outlet of the catheter that is used for drawing off the urine, when withdrawing the instrument, a precaution seldom observed.

Newly-brewed malt liquors, alcoholic stimulants taken in excess, diuretics of spirits of turpentine and cantharis, or highly-seasoned and rich food, are among the exciting causes; irritating injections into the bladder or vagina, and even cold-water injections into the vagina, must be added as exciting causes of this painful affection. Venereal excesses operate in exciting visceral inflammation, and when the slightest symptoms are felt, prudence and good common sense dictate continence. The first feeling that manifests itself is a dull, heavy, aching sensation, immediately after urinating, and an involuntary inclination to further relieve or empty the bladder by pressing or bearing down. Soon after the first indication to void urine, there is another desire to empty the bladder, and the same symptoms repeat themselves, only in a more aggravated form. The distress of micturition gradually becomes continuous so that during the short intervals between the times that urine is voided, and as the disease progresses, the pain becomes sharper. This is accompanied by a kind of gnawing uneasiness in the region of the whole bladder, which has intermissions, but is greatly increased when the desire to make water is felt. If the disease progresses, the pain is now felt in the neighboring organs and a general constitutional disturbance manifests itself. The patient will now generally have a severe chill; this is followed with heat and thirst and an increase in the pulse. The desire to void urine at shorter intervals becomes more prominent and only drop by drop, accompanied with distressing spasm and a burning sensation along the urinary canal.

The region of the bladder becomes in the advanced stages of inflammation extremely sensitive and tender, and if the peritoneum is involved, even the weight of the bedclothes becomes intolerable. The limbs are drawn up and the body is inclined forward to relieve the tension of the abdominal muscles and their pressure on the bladder.