Sauv. gen. 293. Lin. 167. Vog. 129. Sag. 212. Home's Clinical Experiments, sect. xv.

This disease is distinguished into various species, according as the seat of it is in the kidneys, the ureters, the bladder, or the urethra; and hence these species are named renalis, ureterica, vesicalis, and urethralis.

1. Ischuria renalis, or a suppression of urine from an affection of the kidneys, happens but rarely; however, Dr Home in his Clinical Experiments describes such a case. In the end of December 1774, a man of a full habit, aged 35, was seized with shivering, coldness, and severe cough. Three days after, his urine appeared high-coloured, was passed with pain, and in small quantity. About the 8th of January 1775, he was attacked with violent pains in the small of his back, over the whole abdomen, and in the ankles, with pain in the region of the liver when pressed. A general swelling was afterwards observed all over the body, but chiefly in the ankles and abdomen, which last was tense and hard. These were attended with vomiting, bad appetite, and considerable thirst. When he entered the clinical ward (January 21st), the cough, sickness, and vomiting, had gone off, but the suppression of urine remained. The little which he made was passed with his stools, so that Dr Home saw it but once; and then it was pale, and had a white powder at bottom. The pains and swellings, which retained the impression of the finger, continued; he had a headache, and a very slow pulse, beating only 48 strokes in a minute. He had taken a great many diuretic medicines before his admission. The day after his reception, he was seized with a spontaneous diarrhoea, which continued during the remainder of his life. Crystals of tartar were exhibited in doles of half an ounce each morning; at bed-time he took 20 drops of tincture of opium with a scruple of nitre, and continued this course for eight days without any increase of urine. The stronger and heating diuretics were then tried, as an infusion of juniper berries and pills of garlic; but they were attended with no sensible advantage. Whenever the pulse became so strong that he could bear bleeding, eight ounces of blood were taken away, which was fizzy. This was thrice repeated; he appeared easier after each bleeding, his pulse bore it well, and the swellings and other symptoms abated. The heating diuretics, in this state, were given up; and a mixture of vinegar and nitre was substituted in their place, in each dose of which, taken every two hours, there was a scruple of nitre. Fomentations were applied to the region of the kidneys, and camphorated oil was afterwards rubbed on the part. He was ordered the semicupum, which from a deficiency of water in the hospital at that time he got only once; and which then seemed to have a good effect, as he passed a gill of urine when he was in it. Notwithstanding this, however, the disease continually gained ground; he became comatose, delirious, and died ten days after his admission. On dissection, the kidneys were found of an irregular form; some watery vesicles appeared on their surface, containing black gritty particles like fine sand; and the lower part of the right kidney was considerably inflamed. The pylorus, part of the duodenum, and a considerable part of the small intestine, were much inflamed. In the abdomen were found about five pounds of fluid, and in the cavities of the thorax about half a pound. The lungs were a little inflamed, and full of small tubercles on their surface and in their substance; the heart was large, and a polypus in each ventricle. About six ounces of fluid were found in the pericardium; in the brain nothing supernatural appeared, except about an ounce of water in each ventricle.

Dr Home seems to have been at a loss for the remote cause of this suppression of urine, which manifestly had its immediate origin from the kidneys having lost the power of performing their functions. He thinks the inflammation which appeared in the right kidney was scarce sufficient to have occasioned the distemper, as the other would have supplied its place; for which reason also he thinks that the icterus was owing to a general affection of the system; and that it was of an arthritic nature, the patient having been troubled with complaints of that kind for a long time before.

2. The icterus ureretis is also a rare disease, unless the obstruction proceeds from a stone or clot of blood stopping up the passage. Gravel or stones, indeed, are very frequently formed in the kidneys; and, by falling into the ureters, occasion an icterus, with violent pain, and symptoms more or less urgent in proportion to the size and shape of the stones. Sometimes it is attended with coldness of the extremities, nausea, vomiting, and spasmodic contraction of the precordialia, a difficulty of making water, constipation of the belly, difficulty of breathing, stupor of the thigh, retraction of the testicle, inquietude, loss of strength, syncope, and convulsion fits. When the violent pain has continued for several days and nights without intermission, and has brought the patient exceeding low, and the suppression of urine is complete, with coldness of the extremities and convulsions of the tendons, death is at hand. Nor is it a good sign when the stone continues long in the ureter; for then the appetite decays, a nausea and retching to vomit supervene, and the patient is consumed with a hectic heat. Sometimes the pain is attended with an inflammation of the stomach and intestines; and sometimes the disease ends in a dropy of the breast, or lethargy, which soon carry off the patient.

The indications of cure are, to exclude the stone as easily as possible, and prevent the breeding of others. If the patient be of a sanguineous temperament, Sydenham recommends to take away ten ounces of blood from the affected side; and then to give the patient a gallon of posset-drink in which two ounces of marshmallow roots have been boiled, injecting at the same time an emollient glyster. After the posset drink has been vomited up, and the clyster returned, give a pretty large dose of an opiate. But if the patient be old or weak, or subject to nervous affections, bleeding may be omitted, especially if his urine at the beginning of the fit be coffee coloured, and mixed with gravel; but as to other things, the cure is the same.—Huxham highly recommends an emollient bath prepared of a decoction of marsh-mallow root, linseed, fenugreek seed, and flowers of chamomile, to which may be added a few white poppy seeds. By the use of this bath he says he has seen the most cruel fit of the gravel suddenly ended, when neither copious bleeding nor opiates had the least effect. Mild diuretics are also of service. Hoffman recommends dulcified spirit of nitre as proper to relax the spasmodic failure. It is to be taken with suitable distilled waters and syrup of poppies; or in broth, with a few spoonfuls of oil of sweet almonds. Turpentine glysters are also accounted very serviceable; and may be prepared with ten ounces of a decoction of chamomile, with half an ounce of turpentine dissolved in the yolk of an egg, and about as much honey. The sal diuretica, or acetic potash, is much esteemed by some, when taken along with an opiate. But when the stone is too big to pass, Arbuthnot recommends a cool and diluent diet to hinder the further growth of it. Whey, infusion of linseed, decoction of marshmallows, and gently resolving diuretics, are also proper. To put a stop to the vomiting, the compound tincture of benzoin, formerly named balsamum traducatum, has sometimes been used with success, when almost every other means have failed.

3. The icterus vesicalis may arise from a stone in the bladder; and this indeed is the most common cause of it; but there are certain cases, in which, though the usual quantity of urine, or perhaps more, be passed, the patient dies from the retention of a still greater quantity in the bladder. Of this Dr Home gives the following instances. A man of 58 years of age, of a strong spare habit, and never subject to the gravel, had, during the winter of 1777, a cough with expectoration, which went off in the beginning of 1778. About the 17th of February 1778 he felt some difficulty in passing his urine, and much pain about the region of the bladder. He continued in this way for ten days, after which he became easier on application of some medicines. The abdomen then swelled, and he had pains in his loins and thighs. On the 3d of March he was admitted into the clinical ward; his abdomen was then twisted and tense; and an evident fluctuation was felt, which some that touched him thought was sonorous and produced by wind. A tumor was discovered between the navel and spine of the os ilium on the left side, which gave him much pain, especially when pressed. This tumor became more easily felt after the swelling of the abdomen decreased, seemed round, and very near as large as the head of a child. It appeared very much on the left side, even when the patient lay on the right, and it then became dependent. He passed urine frequently, and rather more than in health, as it was computed at four pints a-day. It was always clear, and of a light colour. His body had a strong disagreeable smell; his skin was dry, belly bound, and his appetite entirely gone, so that he had hardly taken any food for 12 days. His legs swelled slightly for some days in the evening. His pulse was generally regular, sometimes slower than natural, and sometimes a little quicker; being once felt at 64, and another time at 92. He was often feigned, especially after eating or drinking, with hiccupping; which increased and lasted till his death. On the 27th day of his disease, after some doses of squills, the general swelling of his abdomen fell, became much softer, and more distinctly discovered the swelling of the left side. The next day a vomiting came on; he became delirious, and died the day following. The body being opened, it appeared that the tumor which was so distinctly felt on the left side of the abdomen, was owing to a distension of the bladder with urine. Its fundus reached to about the division of the aorta into the the iliacs; it entirely filled the pelvis, and contained between five and six pounds of urine of a pale colour. On examining the external surface, its neck, and the beginning of the urethra, were found to be surrounded with a scirrhouosity, which impeded the evacuation of the urine. The bladder itself was much thickened, but not more in one part than another. The ureters entered naturally; but were much thickened in their upper half near the kidney. The kidneys were somewhat enlarged; particularly the left, which had several watery vesicles on its external surface. These organs were not in their usual situation; but lay close on each side of the spine, and very near the aorta; so that the renal vessels were very short. What was very singular, the lower end of each arose over the spine, and they were united together by their membranes, the aorta passing beneath the union. The bladder had pressed considerably on this part; and the peritoneum covering them was considerably thicker than natural. The lungs adhered everywhere to the pleura, and in some places very firmly: they were of a loose texture and black colour; and the veins of the lower extremities were turgid with blood. It does not appear that this patient got any medicines farther than a few dried squills, which diminished the swellings and brought off much wind. He also got a mixture of musk, and afterwards of opium, for his hiccup; but without success. His disease was mistaken for an affections; and the catheter was not tried; but in another case the use of this instrument was apparently of more service than any internal medicines. This last patient was about 90 years of age, and laboured under symptoms very similar to those already mentioned. When admitted into the clinical ward, he had the hypogastric region swollen, and difficulty of passing his water; but without pain, vomiting, or hiccup. He had lost all appetite; was thirsty, and colitive. His pulse was 110, and weak. In the evening about three English pints of pale clear urine were drawn off by means of the catheter: the next day all the symptoms were gone off or abated. After this he continued to pass some urine, sometimes voluntarily, sometimes involuntarily and insensibly; but so much always remained behind, that his bladder was constantly full, unless when the urine was drawn off, which was done twice every day. The urine was sometimes pale, sometimes of a deep red colour; and once there was some blood mixed with it, which perhaps might have been occasioned by the catheter. About the fifth day the urine was very putrid, with much purulent like matter at the bottom, and was passed with more pain. About the 11th, the putrid smell went off. The next day all the urine passed insensibly except what was drawn off; and an hiccup, though not very severe, had come on. In this way he continued without fever, though frequently troubled with the hiccup, especially during those nights in which the urine had not been drawn off. A month after admission, the bladder, with the assistance of the catheter, was almost entirely, though insensibly evacuated, and the hiccup had left him; he had no other complaint but that of voiding his urine insensibly, the natural effect of a scirrhouous bladder, and which was probably incurable. With this patient the hot bath and mercurials were tried, in order to soften the scirrhouosity of the bladder, but without effect.

4. The ichuria urethralis arises from some tumor obstructing the passage of the urethra, and thus hindering the flow of urine. It is no uncommon distemper, and often follows a gonorrhoea. Dr Home gives us an example of this also.—The patient was a man of 60 years of age, who had laboured under a gonorrhoea six months before, and which was stopped by some medicines in two or three days. He felt soon afterwards, a difficulty in passing his urine, which gradually increased. About 10 days before his admission into the clinical ward, it was attended with pains in the glans, and ardor urinis; he had passed only about eight ounces the day before his admission, and that with very great difficulty; and the hypogastric region was swollen and painful. On introducing the catheter, three pounds of urine were drawn off, by which the pain and swelling were removed. The instrument required force to make it pass the neck of the bladder, and blood followed the operation; and the finger, introduced into the anus, felt a hard tumor about its neck. He was treated with mercurial pills and ointment, by which the swelling about the neck of the bladder soon began to decrease; but at the same time a swelling of the right testicle appeared. He was vomited with four grains of turpith-mineral, the sulphurhas hydrargyri flavus of the present pharmacopoeia, which operated gently; and here Dr Home observes, that though these vomits are little used, from a mistaken notion of their severity, he never saw them operate with more violence than other vomits, or than he could have wished. The swelling diminished in consequence of the emetic and some external applications; and the cure was completed by bleeding and a decoction of mezereon root.

GENUS CXXIV. DYSURIA.

DIFFICULTY OF DISCHARGING URINE.

Dysuria, Sauv. gen. 265, Lin. 57, Vog. 164, Sag. 213.

Stranguria acutiorum.

A difficulty of making water may arise from many different causes; as from some acid matter in the blood, cantharides, for instance: and hence a strangury very often succeeds the application of blisters. In many cases it arises from a compression of some of the neighbouring parts; of the uterus, for instance, in a state of pregnancy. Or it may arise from a spasmodic affection of the bladder, or rather its sphincter; or from an inflammation of these parts, or others near them. Hence the disease is distinguished into so many species, the cure of which is to be attempted by remedies indicated by their different causes.

But the most common, as well as the most dangerous species is that arising from a calculous concretion, or

STONE IN THE BLADDER.

Dysuria calculosa, Sauv. Op. 12.

The signs of a stone in the bladder are, pain, especially about the sphincter; and bloody urine, in consequence Epithesis. quence of riding or being jolted in a carriage; a sense of weight in the perineum; an itchiness of the glans penis; flinty sediment in the urine; and frequent stoppages in making water; a tenesmus also comes on while the urine is discharged: but the most certain sign is, when the stone is felt by the finger introduced into the anus, or by founding.

Causes, &c. It is not easy to say what the particular causes are which occasion the apparently earthy particles of the fluids to run together, and form those calculous concretions which are found in different parts of the body, and especially in the organs for secreting and discharging the urine.

The gout and stone are generally supposed to have some affinity, because gouty people are for the most part afflicted with the gravel. But perhaps this is in part owing to their long confinement, and to lying on the back, which people who labour under the gout are often obliged to submit to; since the want of exercise, and this posture, will naturally favour the stagnation of gross matters in the kidneys: besides, there are many instances of people severely afflicted with the stone for the greatest part of a long life, who have never had the least attack of the gout.

There is, however, good reason for believing, that some farther connection takes place between the two diseases; and when treating of the gout we have already given some account of the opinion of an ingenious anonymous author, who has endeavoured to prove, that both the one and the other depend on a peculiar acid, the concreting, lithic, or uric acid, which is always present in blood; and which may be precipitated from thence by various causes, such as the introduction of other acids, or the like. When thus precipitated, he supposes it to produce the whole phenomena of both diseases. The objections we formerly stated to his theory of gout, do not equally militate against that of calculus; and it is at least certain, from the best chemical analysis, that what are commonly called urinary calculi, and have been considered as entirely an earthy matter, consist principally of acid in a solid state united only with a small proportion of earth or mucus. We may, therefore, whether this hypothesis be altogether well founded or not, justly view lithiasis as depending, in a great measure, on the separation of an acid from the blood.

Whatever may be the particular cause of the disposition to lithiasis, the kidneys appear to be the most likely places for particles to concret or run together, because of the great quantity of blood which passes through the renal arteries, and which comes immediately from the heart, fraught with various newly-received matters, that have not undergone much of the action of the vessels, and therefore cannot as yet be supposed to be thoroughly assimilated.

Anatomists who have carefully examined the kidneys in the human subject, particularly M. Berin, inform us, that there are two sets of tubuli uriniferi; the one continued directly from the extremities of the renal artery, and the other springing from that vesicular texture which is conspicuous in the kidneys.

It is in this vesicular part of the kidney that we presume the particles of the concreting matter first stagnate and coalesce; for it is hardly to be supposed, that such solid matters could be allowed to stop in Dyuria, the extremities of the renal arteries, since the blood, and the urine separated from it, must flow through these vessels with great degrees of force and velocity; but in the intermediate vesicles the particles may lie, and there attracting each other, soon come to acquire sensible degrees of magnitude, and thus become sand or gravel. As long as this sand or gravel formed in the vesicular part of the kidney lies quiet, there will be no pain or uneasiness, until the concretions become large enough to press either on the adjoining tubuli, or on the blood-vessels; then a sense of weight, and a kind of obtuse pain in the loins, will be felt. But when the small pieces of concreting matter shall be dilodged and washed off by the force of the circulating fluids, or loosened by some spasmodic action of the moving fibres in these parts, they will in their passage create pain, raise different degrees of inflammation, or perhaps lacerate some blood-vessels, and cause bloody urine. When these little concretions happen to be detained in the pelvis of the kidney, or any other place where a flow of urine continually passes, they soon increase in size, and become calculi, from the constant accretion of particles, which are attracted by the original bit of sand, which thus becomes the nucleus of a stone.

It is an opinion which Hippocrates first advanced, and which has been almost universally adopted by his followers, and has remained till lately uncontroverted, that the stone and gravel are generated by the use of hard water. From the quality, which the waters of certain springs possess, of depositing a large earthy sediment, either in the aqueducts through which they are conveyed, or in the vessels in which they are boiled or preserved, it was conjectured, that in passing through the kidneys, and especially whilst retained in the bladder, they would let fall their groser particles, which by the continued apposition of fresh matter, connected by the animal gluten, and compacted by the muscular action of that organ, would in time form a calculus sufficiently large to produce a train of the most excruciating symptoms. And this reasoning a priori has been supposed to be confirmed by facts and experience; for not to mention the authority of Hippocrates, Dr Litter has observed, that the inhabitants of Paris are peculiarly subject to the stone in the bladder. Nicholas de Blegny has related the history of one who was dissected at Paris, in whom the pylorus, a great part of the duodenum, and the stomach itself, were found incrusted with a stony matter, to the thickness of a finger's breadth. And it is well known, that the water of the river Seine, with which that city is supplied, is so impregnated with calcareous matter, as to incrustate, and in a short time to choke up, the pipes through which it runs. But on the other hand it is objected, that the human calculus is of animal origin, and by chemical analysis appears to bear very little analogy to the stony concretions of water: and though it be allowed, that more persons are cut for the stone in the hospitals at Paris than in most other places; yet upon inquiry it is found, that many of those patients come from different provinces, and from towns and villages far distant from the Seine.

Dr Percival conjectures, that though this disease may chiefly depend upon a peculiar disposition to concrete: In nephritic cases, distilled water would be an excellent substitute for Malvern water, as the following experiment evinces.

Two fragments of the same calculus, nearly of equal weight, were immersed, the one in three ounces of distilled water, the other in three ounces of hard pump-water. The phials were hung up close together in a kitchen-chimney, at a convenient distance from the fire. After 14 days maceration, the calculi were taken out, and carefully dried by a very gentle heat. The former, viz. that which had been immersed in distilled water, was diminished in its weight a grain and a half; the latter had lost only half a grain.

It is the passage of these calculi from the kidneys down into the bladder, which occasions the pain, vomiting, and other symptoms, that constitute what is usually termed a fit of the gravel or stone.

When an inflammation is actually raised, the disease is known by the name of nephritis, and has been already treated of.

As soon as the stone passes through the ureter, and falls into the bladder, the pain and other nephritic symptoms cease; and every thing will remain quiet, either till the stone be carried into the urethra, or until it has remained long enough in the bladder to acquire weight sufficient to create new difficulties.

If a stone happen to be smooth and of a roundish form, it may lie in the bladder and acquire considerable bulk before it can be perceived by the patient; but when it is angular, or has a rugged surface, even though it may be small in size, yet it seldom fails to raise pain, and occasion bloody urine, or the discharge of a slimy fluid, with tenesmus, and difficulty in making water.

There have been various attempts made to dissolve the stone; and there are certainly some articles which have this effect when applied to them out of the body; but the almost total impossibility of getting these conveyed to the kidneys, renders it extremely doubtful whether a solvent ever will be discovered. Of all the articles employed for this purpose, no one perhaps has had greater reputation than fixed alkaline salt in its caustic state, particularly under the form of the lixivium causticum, or aqua potash, as it is now called: but this being of a very acid nature, it requires to be well fleathed by means of some gelatinous or mucilaginous vehicle. Veal-broth is as convenient as any for this purpose; and accordingly it is used by those who make a secret of the caustic alkali as a solvent of calculus.

Mr Blackrie, who has taken much pains in this inquiry, has proved very satisfactorily, that Chittick's nostrum is no other than soap-lees given in veal-broth, which the patients send every day to the doctor, who returns it mixed up with the medicine, in a close vessel secured by a lock.

It is not every case, however, that either requires or will bear a course of the caustic alkali. Some calculi are of that soft and friable nature, that they will dissolve even in common water; and there are cases wherein it appears that the constant use of some very simple decoction or infusion of an insignificant vegetable, has brought away large quantities of earthy matter, in flakes which apparently have been united together in layers to form a stone. Dr Macbride affirms Epistheus fures us, that a decoction of raw coffee, only 30 berries in a quart of water, boiled till it acquired a deep greenish colour, taken morning and evening to the quantity of eight or ten ounces, with ten drops of sweet spirit of nitre, had the powerful effect of bringing away, in the course of about two months, as much earthy matter in flakes as filled a large tea cup. The patient was far advanced in years; and, before he began this decoction, had been reduced to great extremities by the continuance of pain and other distressing symptoms: he was purged occasionally with oleum vicini.

Very lately the alkali in a mild state, and in a different form, has been much used by many calculous patients, and with great advantage, under the form of what is called alkaline aerated water, the aqua supercarbonatis potassii of the present edition of the Edinburgh Pharmacopoeia. For the introduction of this medicine, or at least for its extensive use, we are chiefly indebted to that ingenious physician Dr William Falconer of Bath. He has lately published an account of the Aqua Mephitica Alkalina, or solution of fixed alkaline salt, saturated with fixable air, in calculous disorders; which contains a number of cases strongly supporting the benefit to be derived from it. But whether the good effects obtained in these instances are to be explained from its operating as a solvent of calculus, seems to be extremely doubtful. There are indeed cases in Dr Falconer's treatise, of patients in whom, after using it for a considerable time, no stone could be detected by sounding, although it had been discovered in that way before they began the employment of it. But in many instances, the relief has been so sudden, that it may be concluded, that notwithstanding the ease obtained, the calculus still remained. In such cases, it probably removed from the urine that quality by which it gives to the calculus fresh accretions, producing that roughness of its surface by which it is chiefly capable of acting as a stimulus. For the distressing symptoms resulting from stone are chiefly to be attributed to the inflammatory and spasmodic affections which it induces; and when its surface is least capable of operating as a stimulus, the course will be least considerable. It is therefore not improbable, that this remedy produces relief, by preventing fresh additions being made to the calculus.

An infusion of the seeds of daucus sylvestris sweetened with honey, is another simple and much celebrated remedy; it has been found to give considerable ease in cases where the stomach could not bear any thing of an acrid nature. The leaves of the aqua uris were strongly recommended by the late celebrated De Haen; and this, whatever its way of operating may be, seems to have been productive of good effects in some instances. There is no reason to believe that it has any influence in dissolving calculus; and indeed it seems to be chiefly useful in those instances where ulcerations take place in the urinary passages.

In the Edinburgh Medical Commentaries, vol. iii., we have an account of a method used by the inhabitants of Arabia Petraea for curing the stone, to which they are very much subject, and which the author (an English gentleman of experience and candour) affirms he has seen frequently performed with success. By means of a catheter, they inject into the bladder a weak ley of alkali with the purified fat of a sheep's tail, and a proper quantity of opium, all put together. Their catheters are made of gold; and in performing the operation they introduce them quite into the bladder; so that the composition is safely conveyed to the stone without hurting any other part. But when a stone is situated in the kidney, they have no method of cure.

If this method of curing by injection could be safely practised, it would no doubt have the advantage over that of taking alkalies by the mouth, where the medicine is not only much weakened, but the constitution of the patient runs the risk of being greatly injured. But from some experiments mentioned in the second volume of the Medical Transactions, and still more from the chemical analysis of urinary concretions, lately published by Fourcroy and other modern chemists, it appears that the human calculi are very different from one another in their natures. Some, for instance, will easily yield to an alkaline menstruum, and very little to an acid; while others are found to resist the alkali, and yield to the acid; and some are of such a compact nature, that they yield neither to acids nor alkalies. An attention, however, to the fragments, scales, or films, which the stone may cast off, and also to the contents and sediment of the urine, may lead to the discovery of what solvent is proper, or whether the stone can be dissolved by any. To use either alkalies or acids improperly may be hurtful; though there may be such kinds of calculi as demand the alternate use of acids and alkalies; nay, there may be found calculi of opposite kinds in the same subject.

In such cases as will not allow us to think of dissolving the stony concretions, and where the only object is to palliate and procure ease from time to time, little more can be done than to keep the bowels open occasionally by some gentle cathartic, and wash off as much of the loofe gravelly matter and slime as can be removed by such mild diuretic infusions and decoctions as shall be found to pass freely and fit well on the stomach. Persons afflicted with the stone should be careful in respect of their diet, and studiously avoid all heavy and glutinous food, as well as high sauces that are apt to turn rancid. For the same reason, butter and acids are to be shunned; for these often create heartburning, and every thing that offends the stomach raises the nephritic pain; such is the sympathy that obtains between the digestive and the uroepithelial organs.

There have been surgeons bold enough to entertain an idea of cutting even into the kidney, in order to extract a stone: this, however, except in cases where an abscess has been formed, and nature points out the way, is both very uncertain and very hazardous. But cutting into the bladder for the same purpose, is an ancient and well-known operation, and often crowned with success. A description, however, of this operation belongs to the article SURGERY, to which we refer; and here shall only make this remark, that a surgeon should never begin his operation, until he and his assistants are perfectly satisfied, from actually feeling the stone, that there is one in the bladder; because it has sometimes happened, that when the incision has been made, no stone could be found; and the patient having died in consequence of the operation, and the body... Epithecies, body being opened, it has appeared that the symptoms which occasioned the belief of a stone in the bladder arose from some other cause.

When a dysuria proceeds from any acrimonious matter thrown into the blood, it may be readily cured by bleeding, emollient clysters, cooling and diluting drinks with gum arabic or gum tragacanth, linseed tea, or the warm bath. When it arises from inflammations of the bladder or parts adjoining to it, we are to regard it only as a symptomatic affection; and the remedies used to remove the primary disease will also remove the dysuria. Sometimes it may arise from an ulcer of the bladder; in which case it is generally incurable; a mild nutritious diet will, however, protract the patient's life; and even render that life tolerable, by alleviating symptoms.

Genus CXXV. DYSPERMATISMUS.

Difficult Emission of Semen.

Dyspermatismus, Sauv. gen. 260. Sterilitas, Lin. 171. Sag. 211. Agenesis, Vog. 283.

This impediment proceeds generally from obstructions in the urethra, either by tumors in itself, or in the cavernous bodies of the penis; in which case the treatment is the same as in the itchuria urethralis; sometimes it is owing to a kind of epileptic fit which seizes the man in the venereal act; and sometimes the semen, when ejected from the proper receptacles, is again absorbed, or flows into the bladder, and is expelled along with the urine. The last case is very difficult, or even impossible, to cure; as proceeding from scirrhus, or other indoluble tumors of the verumontanum, or the neighbouring parts. It is also, in general, incurable. In some it proceeds merely from too violent an erection; in which case emollient and relaxing medicines will be of service; and we have an example of a cure performed by means of these in the first volume of the Edinburgh Medical Essays.

Genus CXXVI. AMENORRHoea.

Suppression of the Menses.

Amenorrhoea, Vog. 130. Dysmenorrhoea, Lin. 168. Sag. 218.

This obstruction, with many other symptoms, as dyspepsia, yellowish or greenish colour of the skin, unusual appetites, &c., constitutes the chlorosis already treated of, a disease which seldom or never appears without a suppression of the menses. In Dr Hume's Clinical Experiments we find the virtues of several emmenagogues set forth in the following manner. Chalybeates seldom or never succeeded: they were always found more useful in diminishing the evacuation when too violent, than in restoring it when deficient. The tincture of black hellebore proved successful only in one of nine or ten cases, though given to the length of four tea-spoonfuls a-day, which is double the quantity recommended by Dr Mead. Compression of the crural artery, recommended by Dr Hamilton in the Physical and Literary Essays, vol. ii. proved successful only in one of six cases. From the effects produced by this compression, it has the strongest appearance of loading the uterus with blood; from the sensations of the patient it produces the same effects as the approach of the menstres, and has every appearance in its favour; yet does not succeed. Dr Hume supposes that the uterus is most frequently in too plethoric and inflammatory a state; in which case, this remedy will do more hurt than in a state of inanition; however, he owns, that in the case in which it did succeed, the patient was plethoric and inflammatory. Venefication is recommended as an excellent remedy; the doctor gives three instances of its success, and says he could give many more. It acts by removing the plethoric state of the uterus, relaxing the fibres, and giving the vessels full play; so that their action overcomes all resistance, and the evacuation takes place. It is of no great moment from whence the blood is taken: the saphenous vein has been supposed to empty the uterus most; but it is difficult to get the proper quantity from it, and the quantity of the discharge cannot be so well measured. The powder of lavine is a most powerful remedy; and proved successful in three cases out of four in which it was tried. It was given to the quantity of half a dram twice a-day. It is a strong topical stimulus, and seems improper in plethoric habits. Madder-root, according to Dr Hume, is a very powerful medicine in this disease; and proved successful in 14 out of 19 cases in which it was tried, being sometimes exhibited in the quantity of two scruples, or a dram, four times a-day. It has scarcely any sensible effects; never quickens the pulse, or excites inflammatory symptoms: on the contrary, the heat, thirst, and other complaints abate; and sometimes these symptoms are removed, though the disease be not cured; but when it succeeds, the menses appear from the third to the 12th day.

We have now considered all those diseases enumerated in Dr Cullen's Nosology, the cure of which is to be attempted chiefly by internal medicines. The other genera either require particular manual operations, or a very considerable use of external applications; and therefore more properly fall under the article Surgery. To this, therefore, we shall refer the genera which fall under the three last orders of the clas of locales, viz. the tumores, ectopias, and dialytes; and we shall add, by way of Appendix, a few observations on some important affections to which Dr Cullen has not given a place in his system, or which practitioners in general are not agreed in referring to any one particular genus which he has mentioned.

APPENDIX.