Zoonomia/III.A

ARTICLES

OF THE

ADDENDA.

Page 625, line 1, after 'number' please to add, 'except when the patient has naturally a pulse slower than usual in his healthy state.'

Page 197, after line 8, please to add, 'Where the difficulty of breathing is very urgent in the croup, bronchotomy is recommended by Mr. Field.' Memoir of a Medical Society, London, 1773, Vol. IV.

INABILITY TO EMPTY THE BLADDER.

To be introduced at the end of Class III. 2. 1. 6. on Paralysis Vesicæ Urinariæ.

An inability to empty the bladder frequently occurs to elderly men, and is often fatal. This sometimes arises from their having too long been restrained from making water from accidental confinement in public society, or otherwise; whence the bladder has become so far distended as to become paralytic; and not only this, but the neck of the bladder has become contracted so as to resist the introduction of the catheter. In this deplorable case it has frequently happened, that the forcible efforts to introduce the catheter have perforated the urethra; and the instrument has been supposed to pass into the bladder when it has only passed into the cellular membrane along the side of it; of which I believe I have seen two or three instances; and afterwards the part has become so much inflamed as to render the introduction of the catheter into the bladder impracticable.

In this situation the patients are in imminent danger, and some have advised a trocar to be introduced into the bladder from the rectum; which I believe is generally followed by an incurable ulcer. One patient, whom I saw in this situation, began to make a spoonful of water after six or seven days, and gradually in a few days emptied his bladder to about half its size, and recovered; but I believe he never afterwards was able completely to evacuate it.

In this situation I lately advised about two pounds of crude quicksilver to be poured down a glass tube, which was part of a barometer tube, drawn less at one end, and about two feet long, into the urethra, as the patient lay on his back; which I had previously performed upon a horse; this easily passed, as was supposed, into the bladder; on standing erect it did not return, but on kneeling down, and lying horizontally on his hands, the mercury readily returned; and on this account it was believed to have passed into the bladder, as it so easily returned, when the neck of the bladder was lower than the fundus of it. But nevertheless as no urine followed the mercury, though the bladder was violently distended, I was led to believe, that the urethra had been perforated by the previous efforts to introduce a catheter and bougee; and that the mercury had passed on the outside of the bladder into the cellular membrane.

As the urethra is so liable to be perforated by the forcible efforts to introduce the catheter, when the bladder is violently distended in this deplorable disease, I should strongly recommend the injection of a pound or two of crude mercury into the urethra to open by its weight the neck of the bladder previous to any violent or very frequent essays with a catheter whether of metal or of elastic resin.

LINES

TO BE PLACED AT THE END OF

BY A FRIEND.

JAMQUE OPUS EXEGI.

The work is done!—nor Folly's active rage, Nor Envy's self, shall blot the golden page; Time shall admire, his mellowing touch employ, And mend the immortal tablet, not destroy.