Excerpt from The Medical Bulletin, 1885, Vol. 7: A Monthly Journal of Medicine and Surgery
The surgeon then, very properly, made an opening into the bladder, forming an artificial vesico-vaginal fistula. This partly closed up and she sent for me. The story told me was such a pitiable one, that, although I am not much in the habit of visiting, I went to her house in an alley and found her in a wretched condition.
Her face, as well as her story, plainly showed how much she had suffered. I brought her to the hospital and enlarged the opening into the bladder. I afterwards swabbed out the bladder with a solution of nitrate of silver, of the strength of one drachm to the ounce of dis tilled water. My assistant carried out this treatment, applying the nitrate of silver several times. The strength of the solution was gradu ally reduced, and she left the hospital much improved. She finally got so well that I closed up the opening into the bladder. The trouble now is that the dilatation of the urethra has been so great, that she has no control over the urine, which ﬂows away as rapidly as it enters 'the bladder, and produces an excoriation, which is very distressing. I told her frankly that I was not sure that I could cure her, but that I thought that I could help her. The dilatation has involved the whole canal, and all the muscular fibres have been overstretched. The dilatation has been so great that although I narrow the urethra, I am afraid that I shall not gain much retentive power.
This urethra is very badly tom, the lacera tion being posterior; more commonly it is anterior.
When you have a case of nervous bladder, you do not at once go to work and perform the operation. The first thing to do is to treat the case for nervousness. The best treatment is the Rest-treatment, of which I have spoken so often. Put the patient to bed, have her manipulated, use electricity, give a milk diet, and, after a time, she will get a real appetite, and then she can be fed up. Women eat enormously under these circumstances. She grows fat and the cystitis disappears, for it was the evidence of lack of nutrition. As a German physiologist has said, Pain is the cry of a starving nerve for food. By feeding the patient, you will find that this irritable and nervous bladder will become tractable, and, in the great majority of cases, a cure can be effected without an operation. There are some of these cases which cannot be cured, and the same is true of cystitis.
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