372 HEALTH AND DISEASE 



attempt to remove them. The orifices of the ureters, by which the urine 

 enters the bladder, may be found when carefully sought on the upper 

 and anterior part of the protruding viscus, and these will set at rest any 

 doubt as to the nature of the tumour. When labour pains are excited, 

 little jets of urine are seen in some instances spurting out of them from 

 the upper part of the extruded organ (fig. 166). 



Without inversion the bladder may escape through a rupture in the 

 vaginal wall, and continue to fill with urine, which, being unable to escape 

 through the usual channel, rapidly adds to the bulk of the tumour and 

 to the difficulty of its replacement. The muscular layer alone of the 



vaginal wall may be ruptured, and in such case the bladder will be felt 

 through the mucous membrane. 



Treatment. — Before making any examination of the extruded organ, 

 our hands and implements should be rendei'ed aseptic. Having dressed 

 the bladder, we proceed with gentle but continuous force to push it back 

 into the vagina, seeking there for the meatus upon the floor of the passage, 

 and gradually directing it into place with the fingers or by means of the 

 smooth rounded end of a short stick, which should be first freely dressed 

 with carbolized oil. 



The congestion and tumefaction which result from long exposure 

 render the ta.sk of replacement more difficult, and the greatest caution 

 will be required in manipulating the viscus lest the swollen and softened 

 mucous membrane be torn. It may be needful to reduce the oongestion 

 by the application of warm flannels before reposition is attempted. The 



