152 DISEASES OF THE HOESE. 



the course'normal to extrauterine life. Imperfect closure is more fre- 

 quent in males than in females, because of the great length and small 

 caliber of the male urethra and its consequent tendency to obstruction. 

 In the female there may be a discharge of a few drops only at a time, 

 while in the male the urine will be expelled in strong jets coincidently 

 with the contractions of the bladder and walls of the abdomen. 



The first care is to ascertain whether the urethra is pervious by 

 passing a human catheter. This determined, the open urachus may be 

 firmly closed by a stout, waxed thread, carried with a needle through 

 the tissues back of the opening and tied in front of it so as to inclose 

 as little skin as possible. If a portion of the naval string remains, the 

 tying of that may be all sufficient. Jt is important to tie as early as 

 possible so as to avoid inflammation of the navel from contact with 

 the urine. In summer a little carbolic-acid water or tar water may 

 be applied to keep the flies off. 



EVERSION OF THE BLADDER. 



This can occur only in the female. It consists in the turning of the 

 organ outside in through the channel of the urethra, so that it appears 

 as a red, pear-shaped mass hanging from the floor of the vulva and 

 protruding externally between its lips. It may be a mass like the fist, 

 or it may swell up to the size of an infant's head. On examining its 

 upper surface the orifices of the urethra inay be seen, one on each side, 

 a short distance behind the neck, with the urine oozing from them 

 drop by drop. 



This displacement usually supervenes on a flaccid condition of the 

 bladder, the result of paralysis, overdistention, or severe compression 

 during a difficult parturition. 



The protruding organ may be washed with a solution of 1 ounce of 

 laudanum and a teaspoonful of carbolic acid in a quart of water, and 

 returned by pressing a smooth, rounded object into the fundus and 

 directing it into the urethra, while careful pressure is made on the 

 surrounding parts with the other hand. If too large and resistant it 

 may be wound tightly in a strip of bandage about 2 inches broad 

 to express the great mass of blood and exudate and diminish the bulk 

 of the protruded organ so that it can be easily pushed back. This 

 method has the additional advantage of protecting the organ against 

 bruises and lacerations in the effort made to return it. After the 

 •return, straining may be kept in check by giving laudanum (1 to 2 

 ounces) and by applying a truss to press upon the lips of the vulva. 

 (See Eversion of the womb.) The patient should be kept in a stall a 

 few inches lower in front than behind, so that the action of gravity 

 will favor retention. 



