URINE. 



from the urethra. As foon as the urine has been drawn off 

 with a catheter, the part of the bladder which is out of the 

 pelvis fubfides.on the patient being put into a pofture m which 

 fuch portion of the bladder is higher than the reft of this 

 organ within the pelvis. The hernial tumour feems then to 

 be compofed of thick membranes, which are foftiih, move- 

 able, but yet incapable of being reduced. It is alfo fome 

 time in enlarging again ; and, after its re-appearance, it 

 prefents the fame fymptoms as before. , , • 



When the retention of urine is confined to the hernia, and 

 the opening, by which this communicates with the pelvis, is 

 free, the tumour is indolent, increafing when the patient 

 empties the other part of the bladder, and fubfiding after 

 the evacuation. As foon, however, as this is finifhed, the 

 patient feels a defire to make water again ; fo that there is a 

 fort of interval in the completion of this funftion. But, 

 ihould the communication with the pelvis not be open 

 enough, the iwelling would be incompreffible, or it could 

 not be made to fubfide without a good deal of force. Were 

 it ftrangulated, the circumftance would be indicated by the 

 tenfion of the fweUing, pain, heat, fever, and hiccough, 

 fucceeded by vomiting. 



The ftrll indication is to difcharge the urine with a cathe- 

 ter, or by compreffmg the hernial tumour ; but thefe expe- 

 dients are only palhative. When the difeafe is recent, and 

 the protruded portion of the bladder fmall and reducible, 

 the part ought to be returned and kept up with a trufs, by 

 which means a perfeft cure may be effefted. When the 

 part is adherent and irreducible, the fwcllmg ought to be 

 emptied, and a fufpenfory bandage made to tit and fupport 

 it. If the hernia were in this way gradually got into the ab- 

 dominal ring again, a trufs would afterwards be requifite. 

 Propofals have been made to endeavour to excite the adhefive 

 inflammation in the cavity of the protruded part of the 

 bladder, by methodical compreflion, gradually increafed, and 

 obliterate the poucli in which the urine is lodged out of the 

 pelvis. Although Default thought the attempt cautioufly 

 made juftitiable, he deemed the refult very uncertain. 



Were the retention of urine accompanied with a ftran- 

 gulated ftate of the protruded bladder, and the contents 

 could not be prefted into the other part of this organ, a 

 punfture of the fwelling with a trocar might be proper. But 

 if there were an enterocele alfo prefent, as often happens, 

 this operation would be attended with rid-: of injuring the 

 inteftine. Hence Default preferred opening the tumour by 

 a careful incifion ; and he even approved of cutting away the 

 protruded cyft, if the communication betwixt it and the reft 

 of the bladder were obliterated. 



8. Retention of Urine catifed by Difplacement of the Vifcera 



of the Pelvis Thefe difplacemcnts, which may occalion a 



retention of urine, are a retroverfion, prolapfus, or inverfion 

 of the uterus, and a prolapfus of the vagina and reftum. 

 When the intimate connexions of the bladder with the uterus 

 and vagina in the female, and with the reftum in the male, 

 are confidercd, it is obvious that thefe latter parts cannot be 

 difplaced without drawing along with them the bladder ; and 

 that in this ftate, whatever may be its contraftile power, it 

 cannot contraft compbtcly upon itfelf, fo as to expel the 

 whole of the urine. To this deficient aftion of the bladder 

 is neceft"arily joined an increale of refiftance on the part of 

 the urethra. The beginning of this canal, being drawn by 

 the bladder, changes its accuftomed direftion, and fuch 

 alteration cannot be made without the fides of the tube 

 being prefled together, and thus a more or lels confiderable 

 obftacle formed to the paffage of the urine. It is in this 

 manner that, in the retroverted uterus, the os tinea-, being 

 carried up above the pubes, drags along with it the pofterior 



lO 



fide of the bladder, which, in its turn, draws after it the 

 commencement of the urethra, pulls it upwards, and in- 

 creafes the curvature which this canal defcribes under the 

 fymphyfis of the pubes, againft which it is forcibly applied* 



In a prolapfus or inverfion of the womb, vagina, and 

 reftum, the back part of the bladder, inftead of being 

 drawn upward and forward, is pulled downward and back- 

 ward, and the curvature of the urethra is totally altered. 

 Below the pubes, the bladder forms a copvexity, and not a 

 large concavity, as in the inftance of a retroverfion of the 

 womb. This pofition of the parts ftiould al^fays be recol- 

 lefted in paffing tlie catheter, as it ftiews what curvature and 

 direftion fliould be given to the inftrument, in order to faci- 

 litate its introduftion. 



The retention of urine, arifing from difplacement of the 

 vifcera, may always be eafily diftinguiftied from the other fpe- 

 cies of tliis diforder. The fymptoms, however, by which 

 it is charaAerized, have been detailed in other articles, to 

 which the reader is referred. See Prolapsus Am, Pro- 

 lapsus Uteri, Vagina, Uterus, Retroverfion of, iSjc. 



Thefe kinds of retention of urine are not frequently fol- 

 lowed by any very bad confequences. It is generally fuffi- 

 cient to reftify the wrong pofition of the bladder, and com- 

 mencement of the urethra, by the redudlion of the difplaced 

 vifcera, and a cme is then a matter of courfe, unlefs the 

 exceflive diftention of the fibres of the bladder has in- 

 duced confiderable weaknefs in the parietes of this organ. 

 When this is the cafe, we muft haverecourfe to the particu- 

 lar means which have been recommended for this caufe of the 

 difeafe. The reduftion of the vifcera ufually conftitutei the 

 firft indication. 



For an account of the manner of doing this, we muft refer 

 to the above-mentioned articles. When the redutlion can- 

 not be immediately accompUftied, or when it fails in direftly 

 relieving the retention of urine and fymptoms depending 

 upon it, the catheter is to be ufed. Frequently, when the 

 urine has been drawn off, the reduftion becomes more 

 eafy ; but fometimes the altered diredlion of the urethra 

 makes the introduftion of the catheter difficult ; nor can 

 fuccefs be obtained, except by accommodating this inftru- 

 ment to the faulty ftate of the canal. For example, in the 

 retroverfion of the uterus, a catheter very much curved an- 

 fwers better than a ftraight one, like that ordinarily ufed for 

 females. 



A curved catheter, fays Default, alfo anfwers in cafes of 

 prolapfus uteri, &c.; but with this difference, that, in a re- 

 troverfion, the concavity of the inftrument muft be turned 

 towards the pubes, but, in the prolapfus, towards the 

 anus. Sometimes the catheter will not pafs unlefs it be ro- 

 tated, as it were ; and fometimes, when a filver catheter 

 cannot in any manner be introduced, one made of elaftic 

 gum, which adapts itfelf better to the curvature of the 

 canal, will readily enter. 



W^ere every effort to reduce the vifcera and get a cathe- 

 ter into the bladder to fail, at the fame time that a rifle of 

 this vifcus burfting prevailed, the operation of punfturing 

 it would become indifpenfably neceffary. See Paracen- 

 tesis of the Bladder. 



9. Retention of Urine from the Preffure of the Uterus, or 



Vagina, on the Neck of the Bladder It is alleged, that in 



pregnancy there are two periods when women are particu- 

 larly liable to a retention of urine ; i>iz. during the fourth 

 month, and at the time of labour. In order to have an ex- 

 aft idea of this cafe, we muft remember that, in the firft 

 months after conception, the uterus continues to lie concealed 

 in the pelvis ; that it does not afcend above this cavity till the 

 fifth month, or later ; that, at this period, as its fize and 



weight 



