When a stone in the pelvis of the kidney is the cause, we can gain nothing by the stimulating diuretics, except impacting the obstruction more firmly. Our best chance, though a slight one, is by anodynes and relaxants, abstaining as much as possible from fluids.

Obstruction in the ureters is felt, as we have said, from fulness in the hypogastric region, without any tension in the bladder. Internal sensations are, however, obscure; nor can we sec how this fulness can be distinguished from flatus or an accumulation of faeces. A stone passing through the ureters generally occasions some numbness in cither leg, and a retraction of one testicle in men, as it passes over the nerves which come down with the spermatic vessels. We know not that a fluid will produce any similar effect; but, unless by this means, it is not easy to perceive how a distention of the ureters can be ascertained. Were it possible to decide, it would not, we fear, greatly assist the practice. To increase the quantity of urine would be to add to the disease. If the suppression arises from a stone in the ureters, the pain will discover the cause, and point out the most effectual remedy, viz. opium; but should there be no pain, sedatives will more probably relieve than any violently forcing means. It is seldom, however, that a total suppression arises from obstructions in the ureters, since it can scarcely take place equally in both; and should one only be obstructed, the kidney on that side would soon lose its power, and its office be supplied on that side where the passage is free.

The most frequent causes of ischuria occur in the bladder. Many of these are mechanical, as when a cal-culus, impacted in the neck, obstructs the discharge; when an inverted or a retroverted uterus drag it backward and raise the orifice; when the head of a child, in its passage, rests on the cervix; when hardened feces, or haemorrhoidal tumours, press on the aperture. All these causes are readily discovered; and the treatment of each depending on them will be considered in other places.

Causes more immediately connected with medical practice are inflammation and spasm. The effects of inflammation we have seen to be suppression of urine, and this is relieved by anodyne clysters, fomentations, warm liniments, and even blisters to the perinaeum. (See Inflammatio Vesicae.) Spasm is in part conquered by the same means; but opium may be more freely employed by the mouth and in clysters. Camphor in clysters promises to be an effectual remedy; but an alarming coma has, in two instances, followed. In this case, and in suppression of urine from many other causes, the action of laxatives will excite the usually corresponding action of the bladder; and walking on a cold wet floor, perhaps dashing water against the legs and thighs, would succeed in procuring a discharge of urine, as it has done the discharge of faeces. Atony of the bladder will sometimes occasion ischuria; but a more common effect is incontinence of urine. When it arises from atony, or a want of the contractile power, the catheter must be frequently employed to prevent the distention increasing the disease; warm stimulants applied to the perinaeum and pubes, and stools procured by stimulating clysters. In this case cantharides must he avoided, for these act chiefly on the neck of the bladder; and the stricture of the sphincter in cases of ischuria from this cause is already greater than the power of the other fibres can overcome. Internally, bark, with aromatics, should be given; but every attempt, either fails or procures only a temporary relief.

Cantharides, and sometimes acrid urine, by increasing this stricture of the sphincter, will produce the obstruction. In this case dilution, by frequent draughts of a warm liquid, warm fomentations to the pubes and perinaeum, with opiates, will generally succeed.

When the urine is totally retained in the bladder the introduction of the catheter immediately, whatever may be the cause, is too common; but whether this-, complaint arises from inflammation or from spasm, this. conduct should carefully be avoided. Mr. Pott observes that the best method of relieving this complaint, parti-cularly when caused by spasm, is by evacuation and anodyne relaxation. The loss of blood, he says, is often necessary; but the quantity, the strength and state of the patient will determine. The intestines must also be emptied by some gentle cathartic; but the most effectual relief will be from the warm bath, or semicu-pium, the application of bladders half filled with hot water to the pubes and perinaeum; and above all other remedies, the injection of clysters, consisting of the decoct, pro enemate and tinct. opii; or if after a due bleeding, and, if necessary, emptying the bowels, a free dose of opium is given, and the patient is seated in a warm bath during twenty minutes or half an hour, repeating this use of the bath more or less, as the case may seem to require, success will very rarely fail to attend; and if, by these means, the urine begins to drop through the urethra, although but a drop in a minute at the first, by persevering steadily and closely, the bladder will be effectually emptied. The great object, he observes, is to appease irritation and pain; and although some time be required in producing the effect, it will amply reward the practitioner's care and the patient's fatigue.

When great pain attends a retention or suppression of urine, the practitioner should first observe whether the kidneys have done their office, and whether in reality there is urine in the bladder; for, if full, it will be felt above the os pubis, and by pressure on it a pain will be excited in the neck of the bladder, or at the end of the penis. It sometimes happens that the bladder will contain a large quantity, without being greatly affected; at other times a very small quantity will produce great inconvenience; and inflammation, with symptoms of irritation, will ensue. Dr. George Fordyce observes, that much of the difficulty and pain from retained urine is from the more or less sudden filling of the bladder or distending it.

A bougie, or a catheter, is, however, often necessary, and the larger sizes of each are more easily introduced than the smaller. It is singular that the introduction of either should be sometimes attended with not only a shivering, but all the consequences of an intermittent paroxysm, viz. heat and sweating. In particular constitutions, this is constantly repeated whenever the operation is attempted; but pathologists have offered no explanation of the source of this singular appearance. The rules for introducing these instruments occur in the article Catherismus, q. v.

If no other method will succeed, a puncture may be made into the bladder, as directed in the article Peri-naeum, puncture of the

Four methods have been proposed by different writers for drawing off the urine; 1. By an opening into the bladder above the os pubis. This plan, however, is confined to those cases in which the bladder is greatly distended. 2. By making a puncture through the peri-naeum into the bladder. 3. By puncturing the bladder laterally, as in the lateral operation for the stone. 4. By puncturing the posterior part of the bladder through the rectum.

Mr. Pott prefers the first method; but this, as we have said, is limited to particular circumstances. There is little ground of preference in either of the others; but we have found no very promising prospect of success from the trials hitherto made. Indeed, the operation is generally deferred till the patient's strength is exhausted, or until the parts from continued distention are hastening rapidly to mortification.

The ischuria urethralis arises from substances obstructing the canal; from inflammation, or from local complaints. The obstructions must be removed by bougies; and caruncles, or the more obstinate strictures, by caustics. Inflammation of the urethra is treated in the usual way; and ischuria, from a retraction of the penis, from inflammation, phymosis, or rupture, can be removed only by removing the causes.

See an instance of this disorder from a retroversion of the uterus, in the London Medical Observations and Inquiries, vol. iv. p. 388, etc. See Pott's Chirurgical Works; Lewis's Translations of Hoffman's Practice of Medicine; Bell's Surgery, vol. ii. p. 171; White's Surgery, p. 374; Memoirs of the Medical Society of London, p. 117.