As the general evacuation of blood is found so beneficial in this disease, it is extremely probable that its frequent topical abstraction, by means of leeches and cupping-glasses, from the lumbar region, would be also eminently advantageous.

The excessive thirst of which diabetic patients often complain, is much ameliorated, and the patients themselves are benefited, by drinking freely of sulphuric acid, copiously diluted with water.

Query. How far might the hydatid, in the right kidney, prove an exciting cause of the disease? Dogs make a very large quantity of urine. The kidneys of a dog I examined a short time since, were full of hydatids. Are these animals particularly subject to this species of animalculæ ?

CHAPTER XXV.

On the Function of the Kidneys.

THE urine is generally regarded as an excrementitious fluid. If it be so, it is the only animal fluid which can be considered as such. All the other secretions answer some purpose after their deposition. The tears lubricate the eye-balls; the synovia facilitates the motions of the joints; the saliva assists digestion, &c. it is difficult therefore to conceive that the secretion of the kidneys can form an exception to this general law of the animal economy.

In the month of October, 1815, I injected rather more than a pint of warm milk and water into the bladder of a patient who had been for some years suffering from an ulceration of the inner membrane of that reservoir. The fluid for a few minutes occasioned uneasiness; an uneasiness which the patient imputed entirely to over-distention. This unpleasant feeling gradually subsided, and

at the expiration of half an hour, he said that he was certain his bladder was perfectly empty. Upon desiring him to allow any fluid that might be in the bladder to pass through the catheter, about two ounces of highly fetid pus mixed with a very small quantity of the milk and water came away.

The removal of the injected fluid could only have been effected by the absorbents. This circumstance gave rise to a suspicion, that the absorbents upon the inner surface of the bladder were destined to reconvey the purer portion of the urine into the system, leaving only the more acrid part to be expelled. What purposes the fluid taken up may answer, it is difficult to determine; it is possible, however, that it may contribute towards the formation of the tears, the saliva, the perspiration; and several other secretions. Of this I feel persuaded, that an infinitely larger quantity of fluid is deposited in the bladder than is expelled from it; and a strong analogy justifies the conclusion, that urine is not purely excrementitious.

I have the kidney and ureter of a patient who died of phthisis. The kidney is free from disease; the ureter is distended with urine to about three times its natural size. The urine it contains is prevented from escaping by an impervious stricture in the ureter. The stricture is placed at the inferior part of the ureter, just before it terminates in the coats of the bladder.

The patient, from whom this preparation was taken, was never known to be labouring under any disease of, or derangement in, the functions of the urinary organs. Had not the absorbents possessed the power of removing the urine from the ureter, as it was secreted from the kidney, the tube must have been ruptured by its excessive accumulation. This case comes strongly in support of the theory I have advanced. Dr. Darwin has insisted upon the existence of what he calls the retrograde motion of the absorbents of the bladder.

ON DISEASES OF THE PELVIC VISCERA.

CHAPTER I.

Affections of the Bladder.

I AM inclined to think that almost all the diseases to which the bladder is liable arise from suffering it to be frequently in a state of extreme distention. Fema les from motives of false delicacy, often entail upon themselves loathsome, painful, and incurable affections of this organ. Inflammation of the bladder; an extreme irritability, and subsequent ulceration of its inner membrane; an incontinence of urine, and an inability to evacuate it; may be generally traced to the foolish habit of retaining it for hours after it ought to have been expelled.

If the urine were discharged whenever it, either by its accumulation or acrimony, excited uneasiness, nuclei for calculous concretions would have no opportunity of forming.

Treatment.

For the removal of inflammation of the bladder we must resort to copious general, and topical blood-letting; fomentations to the hypogastric region; and warm bathing. Distention must be carefully guarded against by the occasional introduction of the catheter.

An irritable state of the inner membrane of the bladder will be much alleviated, and sometimes removed, by the frequent application of leeches to the perinæum and pubes, and by the warm bath. Alcaline Alcaline preparations, exhibited internally, afford great relief. most effcacious medicine of this class is the aqua kali

The

puri (liquor potassæ) in doses of from six to twenty drops, three times a day. The same preparation will be found useful in ulceration of the inner membrane. Much benefit is also to be derived from the injection of tepid milk and water into the bladder.

Incontinence of urine, when depending upon a paralysis of the sphincter muscles of the neck of the bladder, may be sometimes remedied by the application of blisters to the perinæum, pubes, and sacrum, and by the internal exhibition of the tincture of cantharides.

An inability to expel the urine (which appears to depend upon a paralysis of the muscular coat of the bladder, while the sphincter muscles retain their contractile power) requires the same treatment. In addition to these, it will be absolutely necessary to keep the bladder empty by introducing the catheter three or four times every day. A great number of females have been admitted into this Hospital, labouring under this affection of the bladder; and they all attributed it to the practice of improperly retaining its contents.

When calculi form in the bladder of a male, they can only be removed by the operation of lithotomy; in the female, however, before the operation is resorted to, a gradual dilation of the urethra, by means of bougies, ought to be attempted, particularly if it can be ascertained that the stone is of small dimensions. The urethra of the female is capable of very considerable dilation; and if by the means above recommended the removal of the stone can be effected, there will be less danger of a permanent and incurable incontinence of urine, than is incurred by the ordinary operation.

As an inability to retain the urine so generally results from the usual operation upon females, would it not be advisable to operate upon them above the pubes? I am one of the few who still think that the higher operation, as it has been denominated, whether for the male or fe

male, is the best. If the bladder be allowed to become completely distended before the incision is made, there will be but little danger of wounding the peritonæm, and all risk of effusion of urine into the cellular membrane may be effectually guarded against, by keeping an elastic gum-catheter (introduced by the urethra) constantly in the bladder, for a few days after the operation.

As a proof of the practicability of this measure, I shall make an extract from page 121, of the "Sketches of the Medical Schools of Paris," by Mr. John Cross.

"It is astonishing with how little inconvenience patients kept in bed submit to the presence of this instrument (the gum-catheter) in the canal, which is changed every four or six days, for the sake of introducing a larger one; and but for this reason, it might be left in a fortnight or three weeks without being renewed, the only thing requiring attention being the incrustation upon the extremity of the instrument, which sometimes forms in seven or eight days, and at others, not in as many weeks."

If then, in a diseased urethra, an elastic gum-catheter can be retained for many weeks, with how much ease might it be kept in a healthy canal.

CHAPTER II.

On Affections of the Rectum.

To the improper practice of retaining the contents of the rectum, after they have, by accumulation, excited uneasiness, many of the diseases of that intestine may be referred.

The absorbent vessels opening upon the inner surface of the rectum are numerous, and extremely active. If the feculent matter protruded into it by the peristaltic