CHAPTER IV. ON THOSE IN THE BLADDER.
OF the diseases in the bladder no one is mild: the acute
proving fatal by inflammation, wounds, spasm, and acute
fevers; while an ulcer, abcess, paralysis, or a large stone, are
chronic and incurable. For it (
a large stone?) can neither be
broken by a draught, nor by medicine, nor scraped outwardly,
nor cut without danger. For the small ones of the bladder
are to be cut out, but the other proves fatal the same day, or in
a few days, the patients dying from spasms and fevers; or, if
you do not cut him, retention of the urine takes place, and
the patient is consumed slowly with pains, fevers, and wasting.
But if the stone is not very large, there is frequent suppression
of urine; for by falling readily into the neck of the bladder, it
prevents the escape of the urine. Although it be safer to cut
in these cases than for the large stones, still the bladder is cut;
and although one should escape the risk of death, still there is
a constant drain of water; and although this may not be dangerous,
to a freeman the incessant flow of urine is intolerable,
whether he walk or whether he sleep; but is particularly disagreeable
when he walks. The very small ones are commonly
cut without danger. If the stone adhere to the bladder, it
may be detected with care; and, moreover, such cases prove
troublesome from the pain and weight, even when there is no
dysuria, but yet the patient may have difficulty of making
water. You may diagnose all cases of stone by the sediments
of sand in the urine, and, moreover, they have the genital
parts enlarged by handling them; for when they make water,
and there is a stone behind, they are pained, and grasp and
drag the genital parts, as if with the intention of tearing out the
stone along with the bladder. The fundament sympathises by
becoming itchy, and the anus is protruded with the forcing
and straining, from the sensation, as it were, of the passage of
the stone. For the bladder and anus lie close to one another,
and when either suffers, the other suffers likewise. Wherefore,
in inflammations of the rectum, the bladder is affected with
ischuria; and in acute pains of the bladder, the anus passes
nothing, even when the bowels are not much dried up. Such
are the sufferings connected with calculi.
Hemorrhage, although it may not prove fatal very speedily,
yet in the course of time has wasted many patients. But the
clots of blood produced by it are quickly fatal by inducing
ischuria, like as in stones; for even if the blood be thin, of a
bright colour, and not very coagulable, yet the bladder accumulates
it for a length of time, and its heating and boiling (as
it were) coagulates the blood, and thus a thrombus is formed.
Ischuria, then, is most peculiarly fatal. But on these symptoms
there supervene acute pain, acrid heat, a dry tongue, and
from these they die delirious.
If pain come on from a wound, the wound itself is dangerous;
but the sore, even if not fatal at first, becomes incurable
from fever or inflammation; for the bladder is thin, and of
a nervous nature, and such parts do not readily incarnate nor
cicatrise. Moreover, the urine is bilious, acrid, and corrosive.
The ordinary condition of the ulcer is this:--when the bladder
is filled, it is stretched; but when emptied, it contracts: it is
in the condition, then, of a joint in extension and flexion, and
no ulcer in a joint is easy of cure.
The bladder also suppurates from an abscess. The symptoms
of an abscess of the bladder are the same as in other cases; for
the abscess in forming is attended with inflammation, fevers,
and rigors. The dangers are the same. But if it discharges
urine which is thick, white, and not fetid, the ulcers from
them are mild; but if it spread, they pass urine which is feculent,
mixed with pus, and of a bad smell: of such persons the
death is not distant. The urine, indeed, is pungent, and the
evacuation thereof painful, and the pain darts to the extremity
of the member. All things, even those which are opposed to
one another, prove injurious to them; repletion and inanition,
inactivity and exercise, baths and abstinence from baths, food
and abstinence from food, sweet things and acid things; certain
articles being serviceable in certain cases, but proving
injurious in others, not being able to agree in any one.
