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incontinence of urine is the result. Both these may arise from injuries done to the spine, or from disease of the spinal marrow, which may prevent the due transmission of the nervous influence; but such cases are not peculiar to any age, whilst in advanced life they most frequently result from over-distension of the bladder. Often from the mind being intensely occupied, sometimes from motives of false delicacy, or from circumstances altogether unavoidable, as temporary confinement in a railroad carriage or elsewhere, the first sensations indicating fulness of the bladder, are disregarded; they become gradually stronger, and are repeated again and again, and are as often resisted; after a time, the violence of the urgency goes off, the bladder gradually yields to the distending force within it, and increases in size, becoming twice or even thrice its usual magnitude, until, when at length the obstacle being removed, the individual attempts to pass water, he finds that he is unable to pass a drop, all straining and endeavour, although painful, is useless, or nearly so; the contractile power of the viscus has been lost by over-distension, and a complete muscular paralysis of the bladder has ensued. Often, when the bladder is thus over-distended up to a certain point, a small portion of water will flow off involuntarily, or may be expelled by the natural
efforts, affording great relief to the fulness, and perhaps deceiving the individual most dangerously as to the nature of his case. Retention of urine from accidental circumstances may perhaps occur at any period of life, but it is most likely to occur in the aged, as, from debility, the muscular fibres more readily yield to a distending force, and when thus much stretched will sooner lose their contractile power: in the same manner, it often arises from general debility of the muscular coat, that the bladder is seldom emptied by the efforts of nature, but that after each attempt at micturition there is still much water left in the organ; when then additions are made from the kidneys, the bladder resisting further distension, but not having power to expel entirely its contents, the sphincter partially gives way, and a constant dribbling of water, drop by drop, or every now and then a sudden and irresistible discharge of small quantities, takes place. This is a most miserable condition, and after it has been long existing is often irremediable; but, how may it be avoided? By remembering its causes, and acting according to the simple dictates of common sense. For all practical purposes, as far as the sufferer is concerned, retention and incontinence of urine in the aged may be considered as one disease; but both consist in a want of power to empty the bladder, arising from over-distension, neglect, or debility. Let the old man then carefully avoid those causes of retention; let him not allow his bladder, under any circumstances or from any causes, to become over-distended: if the tone of the muscular coat be thus lost, it may be indeed difficult to restore it; let not a false delicacy, an interesting or important occupation, the habits of society or the inconvenience of time or place, interfere with the call of nature,—when she gives notice of a necessity to empty the bladder, let that necessity be complied with as speedily as possible, at all risks and inconveniences. In the aged, the golden moment, when the action of the bladder is still obedient to the will, once lost may never be regained. It is of the highest importance to avoid over-distension of the organ, and also to endeavour to empty it completely on each occasion; avoid making water in the horizontal position, as when lying in bed, for it is then very difficult to empty the bladder; a sitting position is more favorable, and perhaps in old or feeble persons is better than the upright posture, as it is easier, and therefore avoids all hurry. In passing water, do not strain or urge, but let it flow naturally; be in no haste, but when the stream has ceased, wait, and perhaps after a few moments it will be renewed, and by such means the viscus may be completely emptied, and its tone preserved. It is
desirable to attempt passing water at stated periods in the day, even although no strong inclination to do so be felt; and whenever about to proceed on a journey, to join society, or attend to business, which may occupy some hours, the aged man should never fail to attempt to pass water as the last of his preparations. When paralysis of the bladder actually exists, it may not be altogether irremediable, whether it arise from general or local debility, or from accidental causes; much may be attempted by medical and surgical means for its removal, and if they fail altogether, the skill of the mechanician will make the evil endurable, but let there not be any delay in applying for relief,— time is of the utmost value, both in enhancing the power of remedial measures, and in avoiding the consequences and dangers of continued over-distension.
DISEASES OE THE SANGUINEOUS SYSTEM.
It would be impossible, in the compass of this short essay, and it is foreign to its purport, to enter into any full account of the diseases of the circulatory system to which age is peculiarly liable; I must therefore content myself with a sketch of the nature and character of the changes which occasionally or inevitably occur, and a view of the conduct necessary to be pursued in consequence. The circulatory system may be said to consist of the blood, and the organs (the heart, arteries, veins, and capillary vessels,) by which it is conveyed throughout the body. The duties of this system are—1st. To receive the fresh supplies brought by the nutritive organs, and to carry them to every part of the body, to restore the waste, and supply the wants of the economy. 2d. To take up by the minute venous branches, and to receive from the absorbent trunks the effete matters from every point of the animal frame, and to convey these excrementa to the various excreting organs, (the kidneys, skin, &c.) to be by them cast off from the system.