Kleinwachter and Fritsch, in opposition to Winckel, believe that the amount of urine excreted is in proportion to the amount of food in gested. In women who are amply nourished, the quantity of urine is only altered during the first day, when it increases, and then diminishes a trifle the next few days, to increase again a little at the expiration of the puerperium.
, Klemmer, on the contrary, confirms the conclusions of Winckel. Not withstanding food ingested of a very nourishing nature, he has found the mean quantity, during the first few days, to be 63.4 ounces and the speci fic weight 1.019.
It is not unusual for twelve and even twenty-four hours to elapse before the first micturition. We have already mentioned how such distension of the bladder will elevate the uterus, and how, further, it may be at the bottom of colic and after-pains. Of course, the physician should not allow this distensionto occur, but if, at the first visit after delivery, six to eight hours after, urine be found in the bladder, and the patient is unable to pass it, then, if hot applications over the bladder fail in assisting her, the catheter should at once be introduced. In regard to emptying the blad der, we must not believe the statement of the woman that she has done so, but we must assure ourselves by the height of the uterus, and gentle percussion, that this organ is empty. This inability to pass urine ordi
narily passes away at the end of twenty-four hours; at times, however, it persists for three to eight, and, even as in one personal case, to eighteen days. The causes are varied: Certain women cannot pass urine in the dorsal decubitus; at other times the abdominal muscles are weakened by the rapidity or prolongation of labor, and, hence, cannot assist the blad der; again it is the result of the pressure which the festal head exercised on the neck of the bladder, or on the urethra, and the resulting swelling of this canal, or a transient paralysis of the organ. Mattei and Ols hausen would find an explanation in the exaggerated curve of the urethra; Schroeder points out, justly, that there exists not only impossibility to urinate, but absence of desire as well.
The _Nervous System. —This is notably excited. Even the healthy puer pera is very impressionable. We will see, further on, that grave nervous and psychic diseases may develop, and compromise the health of the woman, (puerperal mania, chorea, etc.)