(From to retain, and urine).
An Ischury, A Stoppage or Suppression Of Urine.
La Motte distinguishes between a retention and a suppression of urine. In the former, styled strangury, the patient hath frequent calls to make water; but voiding it, if at all, in very small quantities, and with difficulty. In a suppression there is seldom any inclination to discharge any urine; but, if any, the discharge is sudden, and almost involuntary.
In the true ischuria the bladder is full; in the spurious it is empty, for nothing descends from the kidneys.
1. Ischuria renalis, where, some disease of the kidneys having preceded, pain and an uneasy sensation of weight are felt in the region of the kidneys, without any swelling of the hypogastric region, or stimulus to make water.
2. Ischuria ureterica, where, to the same symptoms is added a sense of pain and uneasiness in somc part of the course of the ureters.
3. Ischuria vesicalis, when there is a tumour in 'he hypogastric region, pain at the neck of the bladder, and a frequent inclination to discharge urine.
4. Ischuria urethralis, when there is swelling in the hypogastric region, a frequent desire to discharge urine, and a sense of obstruction in some part of the urethra.
The varieties of each species arc added, and these will sufficiently explain the causes.
Varieties of the ischuria renalis are, ischuria nephri-iica, from inflammation of the kidneys; nephro/itica, from a stone; nephroplethorica, plethora; lunatica, pe-riodica, periodical; nephrospastica, from spasms; neph-relmintica,v/orms; nephrothromboides, coagulated blood; nephropyica, purulence of the kidneys; nephrophlegma-tica, mucus; nephroplegica, paralytic affection; sup-pleta, from some other evacuation supplied.
Varieties of the ischuria ureterica are, ischuria ure-terica, from inflammation of the ureters; ureterolithica, from a stone; ureterothromboides, grumous blood; ure-tero/ihlegmatica, from mucus; ureteropyica, from pus; ureterostomatica, the closing of the inferior orifice of the ureters.
Varieties of the ischuria vesicalis are, ischuria atreta-rum, from the menstrua retained in the vagina, in consequence of an imperforated hymen; cystica, from inflammation of the bladder; cystospastica, a spasm of its sphincter; cystolithica, a stone; cystoplegica, paralytic affection; cystopyyica, purulencc; cystothromboides, gru-mous blood; cystophlegmatica, mucus; cystoproctica, from the rectum swelling, with scybala, calculus, flatus, inflammation, pus,or haemorrhoids; ectopocystica, from a hernia of the bladder; hysterocystica, fron an inverted or retroverted uterus; paradoxa morgagni epistolae; polyurica, from the bladder distended with urine along time retained.
Varieties of the ischuria urethralisare, ischuria aspa-dialis, from closing of the urethra; carunculosa, from caruncles of the urethra; cryptopica, a retraction of the penis within the abdomen; hydrocelodes, from a rupture of the urethra opening into the scrotum; peridesmica, a stricture of the urethra from a ligature; perinaealis, a tumour of the pirinaeum; phymosica, a phymosi; ure-'hrelmintica, worms; urethritica inflammation of the urethra; urethrohymenodes, a membrane impacted in the urethra; urethrolithica, a calculus impacted in the urethra; urethrophlegmatica, mucus stuffing up the urethra; urethromboides, grumous blood; urethropyica, pus.
To these idiopathic ischurias may be added some symptomatic ones, particularly those from general stupor, in consequence of apoplexy or narcotic poisons.
When the suppressed urine is lodged in the bladder, a pain and swelling is observed about the pubes. Relaxation, as a cause, is distinguished from stricture, by the little pain attending the disorder, by the introduction of the catheter, and by the fulness above the pubes.
If inflammation in the kidneys is the cause, some pain and heat may be observed in that region, though in general the kidneys arc insensible. If a stone in the kidneys occasions the complaint, a vomiting is an attendant symptom; if in the bladder, a pain is felt there, recurring by paroxysms with great violence, as well as along the urethra; mucus, or pus, is excreted with pale urine; tenesmus is troublesome, and generally the stone may be felt if the catheter is introduced. If from inflammation in the neck of the bladder, there is pain in the peri-naeum, the slightest discharge of urine gives an intolerable burning sensation; and if a finger is introduced into the anus, and turned towards the bladder, a tumour will be sometimes obvious.
If this disorder is the true ischuria, and violent, tenesmus, coldness of the extremities, vomiting, and a febrile pulse, constantly attend; but if of the spurious kind, there is no tension, but rather a sense of emptiness about the pubes. If it continue above seven days, or if from a wound of the spine, or luxation of its vertebrae, it is highly dangerous. If the smell of urine proceeds from the patient's mouth or nostrils, there is little hope. A hiccough is also an unfavourable symptom; but when no inflammation attends, the urine may be long suppressed, and the discharge again restored should there be no unconquerable obstacle.
The cure must be regulated by the circumstances and the cause of the complaint. If we can ascertain, from the preceding symptoms, that there is no water in either the bladder or ureters, and that the ischuria is truly renal, we must inquire whether it be owing to a palsy of the vessels or to a stone in the pelvis of the kidney. To determine this question, it is requisite to know whether any gravelly concretions have been discharged, or whether vomiting has attended. These will show that the disease is seated in the gland; and though each case occurs in the old and debilitated constitutions, we think the general torpor, the constitutional decay conspicuous in every function, will point out when it arises from palsy of the secretory vessels. In this case we have little room for hope, since this palsy is only one symptom of the general failure of the constitution. Our best chance of success in that case arises from blisters to the loins, the warmest general stimulants, with the most stimulating diuretics, as the ethereal spirit of turpentine. A temporary relief in this way we have obtained; and we have found the efficacy of this last medicine on the diseased part by its producing a discharge of blood, when it has failed in bringing back the secretion of urine. When it has succeeded most effectually, it has procured the discharge only for a short time, and it has then failed entirely. It has been supposed that blisters act from the absorption of the cantharides; but we have never found this medicine efficacious, except when in the bladder. It has never in our hands proved diuretic. In some instances, the secretion of urine has been suppressed in the young and strong without inflammation, or any obvious cause. A case of this kind is recorded by an American physician; and we have met with an instance where no urine was apparently discharged for six weeks; nor was there any vicarious evacuation, except a profuse sweat for a day or two; or the slightest suspicion of imposture, as the patient was in an hospital, and constantly watched. Medicine seemed to give no relief, and the discharge at last gradually returned.