As diabetes is mostly a sequence of some previous disturbance of the urinary system, it the more behooves the afflicted to heed the first noticial summons of attack: a handful of water will sometimes quench a mouldering ember that, suffered to rise into a flame, an engineful can not extinguish. I may add, there is no cause so destructive to virility as these drainages from the system through the urethra—an additional reason why they should be attended to upon their first appearance.
Cases where but a small quantity of urine is voided, terminating in suppression, of urine.—The most popular scientific synonymes for complaints are but little understood by men really of education; for, as yet, medical knowledge forms not one of the items of collegiate lore, and few anticipate sickness to render such acumen necessary. The term “Strangury,” from the frequency of its occurrence, is uppermost in most men’s minds; and they use it on all occasions when there happens an interruption to the process of making water. It is oftentimes misapplied. Strangury implies a difficulty in voiding the urine, but it does not include those cases wherein little is voided, because there is little to void. The affection I am now about to make mention of, is of the latter description. I have stated that the urine is subject to a multitude of changes, that the human frame is constituted to exist under a variety of circumstances, and that occurrences are daily happening, wherein its integrity is put to the test. Excesses, termed sensual, and others, which in themselves might destroy life, are counterbalanced by what may be styled the safety-valves of the system. A violent fit of purging, perspiration, or micturition, is often the means of warding off an otherwise fatal blow. The skin, the bowels, and the kidneys, are severally to be acted upon as emergencies demand: instance the specific operations of diet and medicines. The color of the urine is altered by (to give a popular illustration) rhubarb; its odor, by turpentine (taken internally, or from an inhalation of the vapor of them), and by the well-known vegetable asparagus; and its composition by alkaline and other chymicals. The function of cutaneous exhalation is augmented or diminished by warmth or cold; and the action of the bowels is suspended or increased by innumerable substances, forming portions of our daily food.
Analogous to these effects, is the result of certain conditions of ill-health. A patient, laboring under fever or inflammation of any important organ, will scarcely rid himself of a wineglassful of blood-colored urine in the twenty-four hours; and there are many forms of ailments, where the function of separating the urine from the blood, or even the function of supplying the kidneys with that vital fluid, are suspended, partially or entirely. Few of us have escaped attacks of this kind; they are sure to follow long-pursued habits of dissipation, or even occasional displays of it; and they are often the result of accidents over which we have but little control. A patient will complain of a frequent desire to make water; each effort so to do, will be accompanied with excruciating pain. A small quantity, or a few drops only, will dribble away, excoriating the passage as though vinegar was passing over it, and putting on an appearance almost resembling muddy port wine, or a thick solution or suspension of brick dust: there will be present much fever and constitutional disturbance. The patient may have shivering fits, pain round the loins, down the thighs, and over the lower part of the abdomen. He will betray a readiness to submit to anything, although conscious that his bladder is empty, notwithstanding the violent and urgent efforts at straining, which he is continually being called upon to make, as though his bladder were distended, and ready to burst. On passing the catheter (I am supposing a severe case, where retention of urine has at last occurred), not a drop will flow, and the danger of the disease is thereby made apparent. Except very severe measures be adopted, which it would be idle here to lay down, the case is sure to terminate fatally. Instances are recorded, where that event has been retarded upward of a week, during which time the patient voided not one drop of urine.
The absolute cause of the disease is very obscure; but it has a beginning, and to those only who suffer from a long-continued diminution in this natural excretion, and who disregard it, is this picture presented.
The treatment, in advanced stages of the disease, is strictly professional; but the warning of the altered character of a customary evacuation, should not for a moment be disregarded.
Suppression of urine is very different from retention: in the former, there is none to excrete; in the latter, its escape is impeded. In the chapter on stricture, the cause and manner of retention is explained, and the mode of relief laid down, whereby the invalid himself has a remedy at hand; but, in suppression, the resource is neither so ready nor so effectual. It is, therefore, much wiser to notice the first alteration, and to be prompt in seeking the nearest aid. Every practitioner is acquainted with such. Although such are not ever present, even in the most extensive practice, still they do occur; and much as this mode of frightening a patient may be condemned, knowing the frequently existing disinclination toward “laying up,” yet, if it only induce a fellow-mortal to take the tenth instead of the eleventh hour, one life may be saved, and the writer can well submit to the disapproval and contempt of the thoughtless and indifferent.
THE GRAVEL.
Under the head of this disease may be classed all those urinary affections, wherein a sandy deposite is observed, after the urine has stood some time. This sandy excretion varies in its composition, in the quantity voided, and in its continuance: and it is also often separated, for it is held generally in solution in the urine as it comes from the bladder, while in the bladder or in the kidneys; and hence we find gravel in the kidneys, in the bladder, and in the urine. Where it is precipitated, or formed in the kidneys or bladder, it is apt to accumulate, and constitute what is called “Stone” in those organs. As I have just observed, the composition of this gravel differs, and differs also at different times in the same individual, according to circumstances. Stones have been detected that, like the rolling snowball, gather up, as they increase in size, whatever comes in their way; and, accordingly, as the deposites are principally composed of concretions, termed, in chymical phraseology, “Lithates” and “Phosphates,” stones are frequently found to be formed, first of a layer of one covering, then of another, and so on.