184.- Retention of Urine.
DEFINITION.- Inability to empty bladder of urine.
DIAGNOSIS.- Retention is liable to be confounded with Suppression of urine; but in the latter condition the kidneys are the seat of the disease, and do not secrete the urine; in Retention, the urine is secreted, but the fault is in the bladder, its sphincter, or in the course of the urethra, in which there may be some cause of obstruction, as Stricture, diseased prostate, etc. Suppression may be easily distinguished from Retention, for in the latter disease the bladder is distended with urine, and may be felt so at the lower part of the abdomen; while in Suppression, the bladder is empty and cannot be felt. If it be deemed necessary to introduce the catheter, the diagnosis will be confirmed; in Retention the bladder will be found full, but in suppression empty; the latter condition, however-except in temporary cases, when Terebintha will be rapidly curative-is attended with extreme peril, as the elements of urine accumulate in the blood when the kidneys have fallen into disease, and no longer secrete the urine; the patient becomes uneasy; then drowsy, and soon Coma supervenes.
CAUSES OF RETENTION.- (a) Obstruction to the outflow may be in (1) the penis, such as tight foreskin, bands round the penis; (2) in the urethra-stricture, congestion with spasm, impacted stone, ruptured urethra; (3) in the prostate-hypertrophic enlargement, new growth, inflammation; (4) in bladder-new growth, stone; (5) outside the neck of the bladder – pressure of tumours, etc.
(b) Paralysis, Diseases of spinal cord, injury to brain, hysteria, after operations in region of the perinaeum.
(c) Loss of tone of bladder from over-distention, cystitis, old age.
SPASMODIC STRICTURE.- Retention of urine some times results from Spasm of the compressor urethra muscle, which surrounds the membraneous part of the urethra; the Retention is sudden and complete, although the patient may have been able to urinate a little time before. The exciting causes are-indulgence in drink, holding the urine too long, exposure to cold, etc. Spasmodic Stricture is not likely to occur except in persons already suffering from a slight degree of permanent Stricture, or gleety discharge, or an abnormal condition of the urine.
SYMPTOMS.- Bladder presents a tense swelling in lower part of belly. Pain of a constant character in lower part abdomen and fork.
TREATMENT.- The occurrence of retention is always a serious event, and relief must be given with as little delay as possible.
Aconitum.- Inflammatory symptoms, often in alternation with some other remedy, especially Cantharis.
Camphor.- Spasm at the neck of the bladder, especially if caused by Cantharides( a drop on a piece of loaf-sugar every fifteen minutes for three or four times.)
Cantharis.- Urging to urinate; cutting and tearing pains.
Clematis.- Difficult passage of urine; heat or slight burning, with occasional stitches in the course of the urethra while passing water; Stricture of the urethra after repeated attacks of Gonorrhoea, and in cases temporarily relieved by the introduction of bougies.
Nux Vomica.- Painful ineffectual efforts to urinate, caused by the use of wines or spirits; spasmodic Stricture.
Sulphur.- In alternation with the last remedy, if the patient be troubled with Piles.
Cann., Terebintha, Uva U., Phosphorus-Ac., Belladonna, Iodium, Arsenicum, Chim., are additional remedies often required.
When congestive spasm is the cause, first try hot baths with the medicines mentioned. If these measures fail the passage of a catheter or drawing off of the urine by tapping the bladder is necessary.
External applications.- warm baths, the fomentations-bland drinks, and injections by the rectum, greatly aid the medicines in restoring the functions of the parts, if there be not incurable organic disease. The diet should be sparing, and in some severe cases, restricted to barley-water, rice-water, or other diluents.
185.- Gonorrhoea (Gonorrhoea)-Venereal Disease-The Clap.
DEFINITION.- An inflammation of the lining mucous membrane of the urethra cause by inoculation with a specific virus, the gonococcus.
The word Gonorrhoea means, literally, a flow of semen, and was so named by the older writers, who erroneously regarded the discharge as one of semen. The specific virus contained in the discharge is distinct from the of Syphilis.
TIME AND ORDER OF THE SYMPTOMS.- The disease usually declares itself in from two to eight days after sexual intercourse with an infected person. There is first experienced a tingling sensation with some degree of heat in the urethra, and at the end of the penis, especially when urinating. The orifice of the urethra soon becomes red, swollen, a nd adhering together by a thin whitish secretion, and, if pressed between the finger and thumb, muco-pus exudes. As the inflammation progresses there are burning or scalding pains on passing water, with increased secretion from the affected part, at first thin, but soon becoming copious, thick, milky, yellow, green, or even bloody. As a rule the penis is red and swollen, and the foreskin oedematous, so that the extremity of the organ is uncovered with difficulty. Not unfrequently the lymphatic glands in the groin are swollen and tender. Distressing sexual symptoms are seldom absent, the inflammatory irritation of the parts inducing increased sexual desire. Painful erections often accompanied by seminal emissions from a characteristic feature of the acutest stage. During this stage, broken rest at night and complications such as are afterwards mentioned are prone to arise. Considering the severity of the local symptoms the general constitution is surprisingly little affected. Apart from slight pallor of the face, loss of appetite, a feeling of malaise, and sometimes at the acme of the inflammation, a trifling rise of temperature, the general condition is hardly impaired.
After the disease has continued for two to three weeks the inflammatory symptoms begin to subside, the secretion becomes thinner and lessened in quantity, until, if all goes well, at the end of five or six weeks the normal and most favorable course, but it is liable to many exceptions, and the course of the disorder may be altered in the following ways (a) by an exacerbation or recurrence of the acute inflammation which not infrequently arises from some indiscretion in diet, more especially the use of alcohol, or from sexual excitement. Such relapses may occur again and again, and not only greatly delay recovery, but are often most potent factors in bringing about extension and in often most potent factors in bringing about extension and in causing the disorder to become chronic. (b) When the condition becomes chronic there is more or less irritation on passing water and a yellow discharge which under unfavourable circumstances may persist for a long time, and then terminate in an obstinate thin, transparent familiar discharge-Gleet. (c) Extension of the inflammation of the ladder, causing cystitis, with frequent desire to micturate, but extreme cystitis, with frequent desire to micturate, but extreme difficulty and pain in doing so. The urine may contain a few drops of blood. There may be complete retention of urine, from spasm of the neck of the bladder, excited by inflammatory irritation. (d) In the male, frequent crooked and painful erections, occurring chiefly during the night-Chordee. This condition is caused by inflammation of the spongy substance of the urethra, making it less elastic, and is present in nearly every case of Gonorrhoea during the inflammatory stage, especially at night. (e) A thickened and constricted condition of the glans penis, and effusion under it, so that the foreskin cannot be retracted-Phimosis. (f) Paraphimosis-inability to draw the foreskin forward after it has been retracted. (g) Inflammation of the lymphatic glands of the groin -Sympathetic bubo. (h) Inflammation of part of the testicles-epididymitis-coming on at a later stage of the disease, when the discharge has nearly ceased, and is probably an extension of the inflammation from the urethra; it is marked by pain, greatly increased when the organs hang unsupported, excessive tenderness, swelling, fever, and often vomiting. (i) Rheumatism (j) Ophthalmia.
CAUSE.- The active agent in the infection is the gonococcus, which can be demonstrated under the microscope in strained smears of the discharge obtained during the acute stage. Rarely a slight urethritis is occasioned by connection with a woman not suffering from gonorrhoea. It is not due to the gonococcus and clears up quickly. Patients most liable to such attacks have a weak constitution, usually a large urethral orifice, and a long narrow prepuce.
TREATMENT.- In the treatment of this disease Homoeopathy offers many advantages; the medicines are safe, pleasant, and effective, sometimes rapidly so; by their instrumentality the patient generally steers clear of all or most of the usual sequelae; and they do not interfere with the usual comfort, occupation, or health.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."