THE FEMALE URETHRA. 221 



the base and sides. In introducing a small instrument, 

 the position of the lacunae must be borne in mind, par- 

 ticularly that of the lacuna magna, on the upper wall of 

 the navicular fossa, as it is liable to intercept its point; 

 and if force be employed, it might pass beneath the mu- 

 cous coat. In cases of difficulty, by passing the finger 

 into the rectum the point of the instrument can be di- 

 rected into the bladder, on account of the close relation 

 of the membranous portion of the urethra and the rec- 

 tum, and the readiness with which the catheter, or sound, 

 can be felt through it. 



Catheterism in the female is a very easy proceeding 

 generally, and the little papillar orifice which is situated 

 about an inch below the clitoris, in the back part of the 

 vestibule, being detected, a straight instrument is readily 

 slipped in without exposing the patient. When any 

 difficulty is experienced, it is owing to some deviation 

 of the canal or of the neck of the bladder, caused by some 

 tumor pressing upon the parts, which are very mobile. 

 Occasionally fecal accumulations in the rectum have 

 been known to prevent micturition, from pressing upon 

 the neck of the bladder, so that in such cases of retention, 

 when there is difficulty or impossiblity of introducing 

 the female catheter, careful vaginal examination must be 

 instituted. 



In lithotomy in the female the vesico- vaginal operation 

 is the best, provided the resulting fistula be properly 

 treated. There is, however, a chance of permanent in- 

 continence of urine, on account of the function of the 

 urethral sphincter being destroyed by the incision into the 

 neck of the bladder having been made too freely. It must 

 be borne in mind that when the bladder is fully contract- 

 ed, the septum between the bladder and vagina is very 



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