This disease is both acute and chronic. The acute inflammation often owes its origin to injuries inflicted on the bladder by the clumsy introduction of instruments, or in the operations of Lithotomy or Lithotrity; to Spanish flies applied in blistering the skin, or to the same drug, or to turpentine, swallowed inwardly. Most frequently it is a consequence of neglected or ill-treated gonorrhoea, or else an aggravation of chronic inflammation.

The symptoms are pain and tenderness of the lower part of the abdomen; a frequent desire to make water, with difficulty and straining, and followed by an increase of the pain; fever, with a mucous sediment in the urine.

Treatment

If the symptoms run high, and the patient is robust, he may lose a little blood from the arm; if not, leeches may be applied to the lower part of the body, or he may be cupped there. Fomentations or a poultice may be applied after the leeches. The bowels may be opened with Castor Oil, or an injection of warm water, warm gruel, or warm linseed oil may be given. And an injection of half a pint of gruel containing a dram of Laudanum may be given at bedtime.

The diet must be light and unstimulating, and spirits and fermented liquors must be prohibited.

When the inflammation has been excited by the poison of Cantharides, (Spanish Fly,) or of turpentine, the danger is generally little, while the distress is great. Urine is passed frequently, in small quantities, with much pain; and sometimes it is mixed with blood. The complaint is usually called strangury. The remedies are absolute rest, frequent drinking of some mucilaginous drinks, as thin water gruel or barley water, to which may be added small quantities of Citrate of Potash ( a dram to a pint,) to diminish the acidity of the urine. Forty drops of Tincture of Henbane may be taken at bedtime.

Chronic Inflammation of the bladder is a frequent remnant of the acute disease. It also is caused very often by the habitual detention of a portion of the urine in the bladder, which is unable to expel the whole of its contents in consequence of some mechanical impediment to their exit, such as an enlarged prostate gland; or in consequence of loss of power in its own muscles; and this loss of power may be of a paralytic character, and depend upon spinal disease; or it may result from some over-stretching of the bladder from its contents not being voided often or soon enough; or it may be simply an incident in the general weakness and decay that creep upon us in old age.

In a bladder which never gets thoroughly emptied, the urine remaining there is apt to undergo decomposition, to become alkaline and irritating to the surface with which it remains in constant contact.

It is not always that the retention in the bladder of a certain quantity of urine leads to these consequences. Sir Henry Thompson remarks that although the bladder has not been completely emptied for months, or even for a year, the urine may still remain clear and healthy. He further states that he has never known enlargement of the prostate gland to take place before the age of fifty-four, and he thinks that a man who escapes it up to sixty-five, will be likely to escape it altogether.

Treatment

If the symptoms are at all severe the patient should keep in bed, or on a sofa. If there is at any time a great aggravation of pain, a little blood may be removed by cupping or by leeches, but as a general rule, all lowering measures are injurious. Pain and irritation are to be allayed by the hip-bath, and by injections containing Laudanum, or by the internal administration of Opium or Bromide of Potassium. The bowels should be kept properly open with Castor Oil, but purging should be avoided, Sir Benjamin Brodie strongly recommended a decoction of Pareira Brava in these affections. The decoction is made by boiling down an ounce of the bruised root in three pints of water, down to a pint. A quarter of a pint to be taken three times a day. Or the following may be taken:

Extract of Pareira Brava................Half an Ounce.

Tincture of Henbane....................Three Drams.

Tincture of Orange Peel................Half an Ounce.

Syrup........................................Half an Ounce.

Water, sufficient to make...............Half a Pint.

Two tablespoonfuls may be taken three times a day.

The diet should consist of boiled mutton, fresh fish, rice, arrowroot, and other substances that are easy of digestion, and not apt to turn sour; with cold, weak brandy and water, or gin and water, or sound sherry.

Irritable Bladder. Many cases described under this title are cases of chronic inflammation. Simple irritability, that is, a frequent disposition to pass the urine, without any disease, may be caused by an irritating state of the urine; or it may be caused by sitting in a cold draught, or it may be the effect of mere nervousness, which is not uncommon in elderly people; or it may be sympathetic disease of the kidney; or of irritation of the lower part of the bowels. Paralysis of the Bladder may be caused by injury or disease of the head or spine; it is often present in Typhus Fever; it may be caused for a time by any severe injury, especially of the legs; it generally remains for a few days after the bladder has been long distended, whether from disease of the prostate gland or from stricture, and it sometimes occurs suddenly to nervous, sedentary people, who, if they let their bladder get filled beyond a certain point, find that they cannot empty it. The symptoms of it are, either retention of urine, the patient cannot make water, or else incontinence of urine, the water dribbles away, without his being able to hold it. It is easy to distinguish retention from, palsy from retention from stricture. The retention from palsy comes on suddenly, and there is no obstacle to the introduction of a catheter. The following may be taken:

Tincture of Muriate of Iron............Three Drams.

Tincture of Spanish Fly.................Three Drams.

Syrup...........................................Half an Ounce.

Water sufficient to make..................Half a Pint.

A tablespoonful may be taken three times a day, in a wineglass-ful of water.

Incontinence-and dribbling of Urine. This is a symptom that requires particular notice; because in nine cases out of ten it happens, not because the patient cannot hold his water, but because he has retention of urine, either from stricture or enlarged prostate, or palsy of the bladder. For it must be noticed that, in either of these cases, as soon as the bladder becomes full, a little urine begins to dribble away, and besides, the patient may perhaps be able to squeeze out a little by straining with his abdominal muscles, and may believe his bladder to be empty, while all the time it is enormously distended. By placing the hand on the lower part of the belly the distended bladder may usually be felt. The urine should be drawn off with a catheter; and the operation should be repeated daily till the bladder has regained a healthy tone.

Hysterical retention of Urine. There is one form of palsy of the bladder which is not unfrequent in hysterical women, and which consists of a deficiency of volition rather than of power. They are not unable to empty the bladder if they try, but they are unable to try. These cases must be treated with purgatives and fetid medicines, both internally and as injections. The following may be taken:

Gum Assafetida...................................One Dram.

Powdered Sulphate of Iron.....................One Dram.

Socotrine Aloes....................................One Dram.

Castile Soap........................................One Dram.

Mix, and divide into 48 pills. Two may be taken three times a day.

Half an Ounce of Assafetida may be dissolved in a quarter of a pint of hot water; this may be then added to half a pint of gruel and used as an injection.

If the catheter is not employed, the patient will generally begin to make water, as soon as she suffers much from distension; but the bladder must not be allowed to go unrelieved too long.

The diet should be nourishing and easily digestible: boiled mutton, poultry, fresh fish, light puddings, and things of that kind. Gentle exercise, and early hours are also advisable.