OCR Text |
Show 226 or Pencrvmnc THE BLADDER. or rnncruamc THE BLADDER. it rapidly increases in size, from the urine passing over it ; en way. while it sinks down, and forms a sac, so that if the catheter be introduced, it slips into the bladder, and only grazes over the iy done, and we delay without an acknowledged motive. stone. If a small stone be passing the urethra, where there is no stricture, it will lodge more frequently behind the bulb, or in the very extremity of the urethra, rather than any other part. Where there is phymosis, or stricture of the preputium, calculi sometimes lodge or are formed within the prepuce. OF PUNCTURING THE BLADDER. 22?‘ I shall suppose every thing else has been ineffectual»: I have said that the 6th or 7th day of the obstruction (a1. lowing a pint of water forced away by the urethra) is that, in which the urine generally escapes into the belly, after which all is lost. When this happens, the patient is sensible of something giving way. And during the flowng of the water from the bladder into the cavity of the peritoneum, there is extreme pain and anguish. And now, instead of the hard and regular tumour of the bladder, the belly has become softer, and more generally swelled. The pain has much subsid- ed; but in its place there is more anguish and inexpressible I SHALL suppose that we are assured there is a total ob~ struction of urine; that for two days no urine has passed, while the belly is greatly distended, and that it only remains to be determined what manner of operating shall be followed. ‘ "war-mu m MW um} l v‘. -: Two considerations immediately arise; 1. How long ought we to wait 9 2. What are the circumstances of the case which prescribe to us the particular operation ? - At the end of the second day from the total obstruction, the operation should be prepared fen-While there is life it is not too late: the patient may survive even to the eighth day, without the urine having escaped from the bladder into the abdomen. If there is total obstruction, the fifth, sixth, uneasiness. Previous to the operation we ought to examine by the rectum, having a catheter or bougie at the same time introduced down to the obstruction in the urethra. We have to determine upon the place and manner of operating, and there remains no doubt in my mind of the propriety of doing it by the rectum in preference to puncturing above the pubis or in the perineum. If the occasion of our performing this operation arise from a kick in the perineum, or an injury from falling upon the perineum, or an obstinate narrow stricture aggravated by caustic, we have little to determine further than whether the and seventh days, are those in which the urine may escape swelling, which we feel pressing down the upper part of the from the bladder into the belly. I would puncture on the foufllz day. When the time of the obstruction is not distinctly marl:~ ed, or when we are told that urine has flowed, the signs of danger which are to prescribe our conduct are these-The in~ rectum, be elastic: of this we must be well assured. press it, and we feel that it contains fluidés. clination to make urine has subsided; there is less pain; at intervals, during four days, perhaps, he has passed only a pint of water; the belly is hard as a ball; the bladder is felt rising above the navel; the pulse from 90 to 100; the mouth and lips parched, and the breathing quick. If there follows this an oppression of the faculties, hickup or a low delirium, we may be too late, although the bladder has not give ""0 * I have forgotten whether I could feel with my finger in the rectum, the percussion made on the belly by the hand. 1 l j wow M099" " |