URINE. 



weight have progreffively increafed, it defcends lower into the 

 vagina, and comprelTcs, in the manner of a wedge, the reftum, 

 which is fituated behind ; while it preflcs tlie neck of the 

 bladder and urethra, which are in front, againil the lymphyfis 

 of the pubes, fometimes in fucli a degree, as entirely to 

 clofe them, and ftop the pafTage of the urine tln-ough 

 them. 



From this account of the progrefs of the gravid uterus, 

 the mechanifm of this fpecies of retention of urine appears 

 fo fimple, and, as it were, natural, that one would expeft to 

 find the diforder frequently happen in the fourth and fifth 

 months of pregnancy ; yet, out of a great number of 

 women who had been delivered in the Hotel-Dieu at Paris, 

 Default did not meet with a fingle one who had been thus 

 affefted. He does not, however, prefume to afTert, that the 

 complaint may not occur ; but he believes, that the manner 

 in which the uterus enlarges mull almoft always proteft tlie 

 neck of the bladder and urethra from compreflion. In faft, 

 fays he, it is well known that the increafe of this vifcus begins 

 at its fundus, and then extends to its body, while the cervix 

 retains its fize and length until the fixth month, when the 

 uterus, being too large to be contained in the leffer pelvis, 

 mounts up above the fuperior aperture. 



As this vifcus is larger at its fundus than its cervix, while 

 fituated within the cavity of the pelvis, it muft rather com- 

 prefs the ureters and body of the bladder than the neck of 

 this organ and the urethra, above which the moll bulky por- 

 tion of the uterus is always fituated, unlefs there be a com- 

 plete prolapfus of this organ. Although moft writers have 

 fpoken of a retention of urine as being often occafioncdby the 

 lodgment of the head of the fiEtus, yet, according to Default, 

 not a fingle inrtance occurred at the Hotel-Dieu, duringeight 

 or ten years, in which fpace of time fifteen or fixteen hundred 

 patients were there delivered. Therefore, without denying 

 altogether the poffibility of the cafe, he conceives himfelt 

 juftified in concluding that it is much lefs common tlian is 

 ufually fuppofed. It is true, fays he, women often complain 

 of a defire to make water when the head of the child continues 

 a long while in the pafTage ; and fuch defire may have led fome 

 carelefs pra6litioners to imagine that it proceeded from a 

 full ilate of the bladder, who ought to have known that any 

 irritation about this organ would caufe the fame kind of fen- 

 fation. 



When the pofition of the head of the child, at the time of 

 its being wedged in the leffer pelvis, is confidered with re- 

 gard to the bladder, it appears that the body of this laft 

 organ and the ureters are more expofed to compreflion than 

 the urethra and neck of the bladder. Default even thought 

 it probable, tliat the urine, far from accumulating in this re- 

 ceptacle, could not defcend into it, and was confined in the 

 ureters. 



This conjefture feemed to Default the more likely, inaf- 

 much as a retention of urine is more frequently a confequcnce 

 of, than an attendant upon, the lodgment of the child's 

 head in the pafFagc. The complaint then comes not from 

 any obftruAion of the meatus urinarius, but from wcakncfs 

 of the bladder, which has fuffered contufion, which fome- 

 times caufes Houghs between the vagina and bladder, and 

 produces urinary fiflulx, always difficult of cure, and often 

 incurable. 



Were, however, a retention of urine to happen at one of 

 the above periods of pregnancy, the diagnofis of it would 

 be obvious enough. The ftate and pofition of the uterus, 

 or the fituation of the head of the infant, could cafily bo 

 afcertaincd by manual examination ; and the patient would be 

 able to fay whether the paifage of urine had been prcyioufly 



free, and whether fhc knows of any other caufe that can im- 

 pede the evacuation. 



Frequent inclination to make water, and none of the urine 

 at the fame time coming away, are, in this cafe, very equivocal 

 figns of a retention ; for, as Default remarks, any irritation 

 of the bladder will caufe the firlt fymptom, and the lafl may 

 depend upon compreflion of the ureters. 



If the complaint were caufed, as is fuppofed, by the pref- 

 fure of the uterus upon the neck of the bladder and the 

 urethra, about the fourth month of pregnancy, we could 

 not expeft the diforder to be permanently relieved before tiie 

 enlarged uterus had rifen out of the pelvis. Until tliis had 

 happened, tlie practitioner could only endeavour to facilitate 

 the evacuation of urine by prefTuig the uterus away from the 

 neck of the bladder and urethra, by introducing his finger 

 fufficiently high behind, and a little on one fide of the fym- 

 phyfis pubis. Should this method fail, it would beneceffary 

 to have recourfe to the catheter. 



Were the retention of urine produced by the child's head, 

 delivery Ihould be expedited by changing the pofition of the 

 head with the forceps, &c. If the labour fhould ilill feem 

 likely to be lingering, the urine ought to be drawn off with 

 a catheter. 



Befides the diftention of the uterus and vagina in pregnancy 

 and parturition, there are other conditions of thele organs 

 which may give rife to a retention of urine. This diforder 

 fometimes arifes from the prefence of various kinds of tu- 

 mours, or colleftions of blood or water in the uterus, or 

 ovary ; and it occafionally proceeds from diftention of the 

 vagina with the menflrual difcharge, the ufe of pefTaries, 

 &c. 



As this laft kind of retention of urine is only fymptomatic, 

 the prognofis muft be more or lefs unfavourable, according 

 as the difeafe, of which it is a fymptom, may happen to be 

 more or lefs ferious. It is of itfelf not very dangerous, be- 

 caufe, by drawing ofl" the urine with a catheter, it is .ilways 

 praAicable to prevent or remove tlie inconveniences which it 

 caufes. But even the ufe of the catlieter is not alw.iys ne- 

 ceffary, efpccially when tlic caufe of the retention of urine 

 is eafily removable, and tlie tone of the bladder is not im- 

 paired. Tliis is generally the cafe when the complaint is in- 

 duced by a peffary, or colleAion of blood in the vagina. 

 In other examples, in which the caufe of the difficulty of 

 making water cannot be immediately obviated, as in feveral 

 cafes of tumours, the catheter muft be employed. In 

 fcirrhous and cancerous difeafes of the uterus, alfo, this in- 

 ftrument is tlie only means of relieving the retention of urine, 

 as nature and art can do little for the removal of the caufe. 

 It ought to be known, however, that, as thefe laft difeafes 

 increafe, an incontinence often fucceeds to a retention of 

 urine, in confequcnce of ulceration taking place between the 

 upper furface of the vagina and the lower part of the 

 bladder. 



lo. Relenlion of Urine from Prejfure nf the Ridum upon lh» 

 Neck of the Bladder. — AbfcefTes in the vicinity of this in- 

 teftine, hemorrhoidal tumours, alvine concretions, and the 

 feirrho-contraftod ftate of the gut, &c. may bring on a re- 

 tention of urine by making prcfl'ure on the neck of the 

 bhidder. The irritation, alio, exifting in ihefe cafes, may 

 tend to produce the complaint by exciting a fpafmodic con- 

 tr.idion of the urethra. Here the relief of the obflruc- 

 tioii of the lu-ine is to be effcded by removing or curing the 

 other diforder, which opemtes as its caufe. If this cannot 

 bo immediately accomplilhed, the catheter muft be ufed, 

 though, in fcveml inftances, it will be better to avoid even 

 the irritation of the catheter, and try the cfTcds of blccd- 



