CHAPTER VII. DISEASES OF THE URINARY ORGANS. THE urinary organs are certainly prone to become diseased in age. The prostate gland is always enlarged, and, the bladder having become weaker, retention, or incontinence of urine, often occur. DISEASE OF THE PROSTATE GLAND. As age advances, at about 50 to 60 years the prostate gland always becomes enlarged, and this chiefly at its middle lobe. The enlargement may be simple, and may not proceed so far as materially to inconvenience the individual, or, in fact, to constitute disease; or it may become abnormally enlarged and indurated, projecting into the bladder, or pressing on the membranous part of the urethra, so as partially or entirely to obstruct the flow of urine. Often when by an effort the urine can be made to flow, the bladder is not emptied, for a sac, which the individual is never able to evacuate, has formed behind the prostate; in this sac a small quantity of urine always remains, and mixed with any mucus which may gravitate to that part, it soon becomes foul and fetid, irritating the inner coat of the bladder, and inducing disease. Whenever then, from enlargement of the prostate, or from any other cause, there is reason to believe that the urine is not fully evacuated by the natural powers, it is highly important that the catheter should be used, so that once in 24 hours at least, the bladder should be fully emptied of its contents. This is a point that requires much watchfulness, for when no difficulty in micturition exists, the bladder being partially emptied with ease, all painful feeling is removed, and it may not be readily suspected that a small portion of urine is always left in the most dependent portion of that organ, and that, being there mixed with mucus, as in some stagnant pool, it soon becomes putrid and baneful. This state of things may be suspected if the bladder feels often much distended, and there is consequently great desire to pass water, yet the quantity cast off be small. In such cases, the last particles are passed with some straining, and contain a slimy matter, or are followed by some thick ropy mucus. The distension of the bladder and the consequent desire to micturate, returns, too, earlier than could have been fairly anticipated. When these symptoms occur, a large catheter should be passed into the bladder immediately after that viscus has been emptied, as much as possible, by the natural powers, and often, by that means, a few ounces of thick, foul urine, mixed with mucus, will be drawn off. If this occur, the nature of the case is evident, and the catheter should be employed once in every day to prevent the formation of disease. In the same manner as the middle lobe of the prostate presses on the urethra, obstructing its canal, so does the body of that gland often project backwards against the rectum, materially impeding its due action, forming a sort of shelf, against which the fæces rest, and thus inducing or increasing constipation, and all the evils which follow in its train. Whenever, then, from the weight felt in the rectum, and the straining required to empty that gut, this condition may be suspected, an examination with the finger will readily detect the fact, and when once known, it is indeed the fault of the individual himself if any evil result; for either by the use of simple enemata, or by mild aperient medicines, the accumulation of hardened fæces in the rectum may be easily avoided. The simple enlargement of the prostate gland in this manner is so frequent a concomitant of age, as scarcely to be considered a disease, yet it is often the cause of much suffering, and gives rise to much disease, which might generally be prevented by reflecting on the nature of the evil, and understanding the simple and easy means of remedying it. A hard substance (the prostate gland) is placed between the two grand outlets of the body, closely embracing the small canal leading from the one, and by projection and pressure narrowing the other; should this gland become much enlarged and indurated, these effects must be augmented, yet no evil will result so long as due care be taken that the effete matters collected in either part shall by natural or artificial means find a ready exit from the body. Simple enlargement and induration of the prostate gland will do but little harm, unless it be allowed to simulate stricture of the rectum and of the urethra, and thus induce disease of the gut or of the bladder. Besides this simple enlargement, the prostate is subject to such other diseases as may occur in similar parts, as inflammation, abscess, scirrhus, calculi, &c., and whenever they do occur, the peculiar situation of the gland will of course aggravate the evils. LITHIC ACID DEPOSIT, GRAVEL, CALCULUS. One of the most common urinary affections of old persons is the deposit of lithic acid, or lithate of ammonia, from the urine on its cooling; it is seen to stain the bottom of the vessel of a red colour: this is one of the consequences of indigestion, and may, in all probability, be traced to faults in diet. Saccharine and farinaceous foods and all such as are likely to pass quickly into acid fermentation, are likely to produce this state; but when the person is otherwise in good health, red deposit in the urine can be scarcely looked upon as an important disease per se, it may be taken as an indication of impaired powers of digestion, and as a valuable guide to the treatment required; but it is really a curative effort of the system to throw off the lithic acid improperly generated the urine at the usual temperature of the body is capable of holding this deposit suspended or dissolved, but it is thrown down as the water cools, in the form of fine impalpable sand, which lines and stains the sides of the vessel. : But although the acid may be thus separated by the kidneys from the blood, it is not at all times thus taken up by the urine, to be by that fluid carried out of the body as excrementitious matter. It sometimes happens that the particles of lithic acid aggregate together and form lithic acid calculi; these may be very small and pass more or less readily through the ureters to the bladder, there they may be retained and aggregate into stones of a larger size, or, under the name of gravel, they may pass through the urethra more or less easily; or, again, the aggregation in the kidneys itself |