But the most frequent malady about the fountain of the urinary secretion, is from calculi in the ureters. The kidneys have few nerves, and therefore not very acute sensation. Calculi or gravel in the strainers of the kidneys, seldom excite much uneasiness until they are forced into the ureters by the current of urine, by exercise, exertions of the body, agitations of a coach, passions of mind, stimulating diet and drink: then they excite atrocious pain, like a stake driven into the back, which is exasperated by certain postures, by every motion of the body, and by a full stomach; together with all the other symptoms common to inflammation, except the fever; to which, however, and to inflammation calculi, often give birth. At the beginning the urine is limpid; afterwards it becomes turbid and fabulous. This is a chronic periodical disease, with intermissions and nephritic exacerbations at uncertain intervals. It is distinguishable from intestinal colick by the pain fixed in the loins, the urinary obstruction, stupor of the leg, and retraction of the testicle.
Inflammation and also Calculus of the Bladder. Of cystitis, the symptoms are acute burning pain in the region of the bladder and perineum, and extending to the loins; tumour, tension, and hardness of the abdomen from the distended bladder, which may be felt between the pubis and navel; and sometimes is turgid to an enormous magnitude; perpetual painful efforts to urine and stool, and the urine either suppressed, or in small quantity; a finger introduced into the anus, or into the female vagina, feels the vesical tumour; or if the inflammation particularly fixes upon the neck of the bladder, the surgical catheter cannot, without immense difficulty, be introduced; and with all these symptoms, symptomatick fever, quick, hard, phlogistic pulse. It is very rapid and dangerous: total suppression within a very few days excites burning fever, lethargy, delirium, convulsions, gangrene: or even after recovery from a violent disease, incontinence of urine may remain for a considerable time.
Of calculus, or stone in the bladder, the symptoms are all dubious, without sounding the bladder with the surgical instrument. It is a chronic disease, slow in accumulation; and is frequently endured many years, without having recourse to lithotomy. The symptoms vary in severity, and recur in exacerbations at uncertain intervals; such are frequent irritation to urine, and difficulty in the evacuation; strangury, tenesmus, pain, and titillation of the glans of the penis, and the urethra, especially after making water; itching of the genitals; sometimes bloody urine after riding, or exercise. If the stone is large, there is a sensation of weight in the region of the pubis and perineum; sudden stoppage of the urine during micturition; sometimes necessity of kneeling, and of a prone posture in endeavouring to evacuate the bladder. A finger introduced into the anus, will sometimes feel the stone; but the sound is the only certain criterion. The size, shape, and number of stones are various: often only one, but sometimes several are extracted by lithotomy. Internal incrustations, and also scirrhus of the bladder, or even internal hemorrhoides, have imposed on medical judgment as cystic calculi.
Inflammation and obstruction of the urethra cannot be thoroughly investigated, without a description of the venereal disease, to which we have not yet arrived; but which there could be no impropriety to introduce amongst this group.
The predisposing and occasional causes of urinary suppression, obstruction, and strangury, whether originating in the kidneys, ureters, bladder, or urethra, are inflammation of the kidney or ureter, calculi or sand in the kidneys or ureters; acrid diureticks; spirituous liquors; plethora, spasm, poisons, severe riding, violent heat and muscular exercise; strains of the lumbar and dorsal muscles; long continued posture in a bent position or supine on the back; inactive sedentary life; wounds, contusions, abscess; defecation and crisis of other diseases by the kidneys; scirrhous, incysted, dropsical, paralytick kidney; gout; inflammation of the bladder or its sphincter, stone in the bladder; the urine too long retained in the bladder, by which it becomes violently stretched, and paralytic; hernia of the bladder; obstructions in the neck of the bladder, or in the urethra; varicous blood vessels; the prostrate glands or seminal vesicles scirrhous, or enlarged; inflammation, caruncles, and stricture in the urethra; the corpus cavernosum thickened; contiguous diseases of the anus, vagina, and womb; hardened feces, hemorrhoides, wounds of the rectum, fistula; ulcers of the womb, obstructed menses, or their retention in the vagina; pregnancy; ulcers and worms in the kidneys, bladder, or urethra, and excretion of acrid pus or membranes, by urine; grumous, extravasated blood in the bladder and urethra; inspissated semen after coition; excess of venery; too acute sensibility of the urethra, defect of mucus; acrid urine; tartarous and astringent wine or drink, food, or medicines; stimulating food and drink; frequent ebriety; terrestrious water; sudden refrigeration of the body; contusion; old age; plethora; lunar, venereal, rheumatick, arthritick, hysterick, scorbutick, dropsy, violent colick, retraction and shrinking of the penis.
Incontinence of Urine, and also Diabetes.
Of incontinence, or eneuresis, authors make three species; one involuntary, without sense or effort; the second involuntary, but with a knowledge of its excretion; the third involuntary, during sleep. The Diabetes was unnoticed in the London bills until the present century; and perhaps its trifling depredations were thrown amongst consumptions. It denotes a chronic discharge of urine beyond the natural quantity, and sometimes exceeding in weight all the fluids and solids taken by aliment: it is generally clear and colourless, but sometimes white and chylous, or unctuous, or, like honey dissolved in water, a yellowish green, and tastes sweet like honey: there is unquenchable thirst, intense heat, flow hectic and emaciation, pain in the loins; increased flow of saliva, voraciousness, or inappetency. It often invades by slow and imperceptible steps, and without any other disorder, until, by long continuance, emaciation is visible, with debility and obscure fever. It is sometimes periodical, and in hystericks symptomatic.
The predisposing and occasional causes of incontinence of urine are, palsy of the sphincter of the bladder, from either too great dilatation and accumulation of urine, or from violent efforts in parturition; debility, old age, excess of venery; fistula, abscess, ulcers, lithotomy, stone, spasm, gout, apoplexy, palsy, external injuries. Also, copious, watery, acrid urine: the bladder irritable from inflammation, ulcers, excoriation, defect of mucus; spasm, relaxation of the sphincter; weakness of the sphincter ani, and accelerator muscles; pregnancy, laborious parturition; compression and irritation of the bladder; habit.—Of diabetes, aqueous tenuity, and also acrimony of the blood; weakness, laxity of the kidneys and renal vessels; the crassamentum of the blood not cohering with the serum; faults in the assimilation of the nutriment, and sanguification; excess of watery drink and ebriety; diureticks; sudden refrigeration of the body, and suppression of perspiration; unusual determination of blood and serum to the kidneys; excess of venery; increase of cutaneous absorption; obstructions of the abdominal viscera; spasm; nervous; habit: often unknown.
Ulcers in the Kidneys and Bladder, and Bloody Urine.
Of ulcers in the kidneys, thick fetid urine, sometimes with mouldered fragments of the kidneys; heat and weight in the loins; hectic emaciation, stupor of the leg, and some other symptoms of nephritis. It is tedious and dangerous. Of ulcer in the bladder, pain in the pelvis and perineum, exasperated at intervals; heat, strangury, dysury; the urine fetid with intermixtures of pus, mucus, and blood; sometimes the rectum also is eroded. Of bloody urine, or hematuria from the kidneys, ureters, bladder, seminal vesicles, or urethra. From the kidneys the hemorrhage is sometimes profuse, and the blood of various colours, according to its solution and stagnation in the bladder; and sometimes coagulated, takes the mould of the urethra: the urine tinges linen dipped into it of a red colour, and the blood is coagulable by heat. There are instances of its periodical flow, like the menses. The predisposing and occasional causes of urinary hemorrhage are the general causes of hemorrhages; calculi in the kidneys or bladder; falls, blows on the loins; violent exertion of the lumbar muscles, riding, exercise; venery; plethora; obstructed evacuations, hemorrhoids, menses; hemorrhoids of the bladder and varicous veins; acrid diureticks; ulcers, symptomatick in scurvy; putrid small pox, and malignant fever.