BLTC Press Titles

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The Count of Monte Cristo

Alexandre Dumas

Paradoxes of the Highest Science

Eliphas Levi

My Man Jeeves

P. G. Wodehouse

The Picture of Dorian Gray

Oscar Wilde

Diseases of the bladder and urethra in women ...

by Alexander Johnston Chalmers Skene


Having in our last lecture discussed the anatomy, function, and some of the malformations of the bladder ;uid urethra, we now pass to a consideration of that t lass of vesical affections known as functional disorders. For a proper understanding of this subject a clear idea of what is meant by the term functional disease or disorder is absolutely necessary.

It has been the rule to class under this head all affections in which no lesion of structure was discoverable in the organs concerned. Although we are still obliged to accept this nomenclature, the progress of pathological knowledge in the past few years has weeded out many of the so-called functional affections ; and as this knowledge advances, and new and efficient means for observation and study arise, we shall be able to root out many more, thus doing away with much of the vagueness and uncertainty in which this class of affections is shrouded. But even with the improved facilities for diagnosis at our command, there are still many diseases in this list . Owing to the obscurity at present surrounding the subject of reflex or sympathetic disorders, i. e., the abnormal condition of an organ or organs, near or distant, affecting the function or nutrition of another organ, we are obliged to put these affections under this name also. Under this head, then, we will consider all affections due to the following conditions:—

ist . Derangements of function in which there is no recognizable organic local lesion. We will here take up the various nervous affections or neuroses of the bladder. We will also introduce, for convenience sake, all abnormalities of vesical function, due to either organic or functional disease of the brain and spinal cord, and to acute and chronic diseases of the general system.

2nd. Diseases of the bladder caused by inflammatory disorders of neighboring organs, such as Metritis, Pelvic Peritonitis, and the like.

3rd. Disorders resulting from uterine displacements or malposition of the bladder itself.

You will please observe that in this arrangement of the subject although a number of structural diseases are brought to your notice, they all stand in a causative relation to the disturbed action of the bladder, the latter being free from any organic lesion, and only disturbed in the discharge of its duty by external, influences.

You must clearly fix in your minds the various manifestations of these functional disorders of the bladder, that you may be able to follow me understanding^ in what I am about to say. They are asfollows:—

1st. Frequent urination—Polyuria.

2nd. Difficult urination and retention—Ischuria.

3rd. Painful urination—Dysuria.

4th. Pain after urination—Vesical Tenesmus

5th. Incontinence of urine—Enuresis.

These deranged actions of the bladder may be due to organic as well as functional diseases, but for the present we will only discuss the functional troubles.

Neuroses, or purely nervous affections of this organ, are rather rare, but that they do exist, there is no doubt, for there are certain conditions that seem to depend on no other known pathological cause. The first and perhaps most important of all this class is. vesical neuralgia.

It is known by a variety of names, each taking as its key-note some peculiar manifestation or symptom, as Irritable Bladder, Cystospasm, Cystoplegia, Neuralgia Vesicae, Tic Douloureux of the Bladder, &c.

You must not confound the term Irritability, so commonly used in speaking of the healthy organ, with the condition known as Irritable Bladder. The former refers to a certain property that the viscus possesses, by means of which it is able to respond to certain stimuli, while the latter refers to an abnormal

condition of sensation, viz., supersensibility or hyperesthesia. One is physiological, the other pathological.

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