Odebrecht has, however, in one case demonstrated the existence of a pressure less than that of the atmosphere. Here the fundns vesicle was largely adherent to neighboring portions of the serosa, causing traction upon the bladder, and elongation of the organ. The uterus was adherent to the bladder. Experiments have shown that depressions of the posterior vaginal wall diminish the vesical pressure, since the descending uterus tends to pull the bladder with it. It is to be noted that the introdnction of a finger or a catheter into the rectum has the same effect. The escape of gases and fluids cause the anterior rectal wall to sink towards the pos terior one, the uterus follows, and the consequent traction e,auses a diminution of vesical pressure.
We must then admit that it is possible to have a negative pressure in the bladder; but it can seldom occur, and needs a number of concomitant circumstances to effect it. We may easily see that the examination of the vesical pressure in normal and in abnormal conditions of the bladder may be of great importance; its practise is simple and easy, and does not entail any disagreeable consequences upon the patient.
Finally, the bladder may be examined by percussion and auscultation. As Rutenberg has shown, the organ may be very considerably inflated with air, without there being a tympanitic percussion note above the pubis. " Marked dullness at that place and above it depends upon the amount of fluid in the bladder, upon the position of the organ, and upon the thickness of the abdominal walls. At its greatest distension the dull ness reaches to above the navel, and is melon-shaped. The introduction
of the catheter inay cause the appearance of two auscultatory signs; firstly the clicking noise occasioned by the contact of the metal with a calculus, and secondly the gurgling noise caused by the entrance of air.
When the organ is distended, and it may contain as much as 128 ounces of urine, it may be palpated for through the abdominal walls; and where its walls are diseased and hypertrophied, it may be possible even after complete evacuation to feel its uneven surface from without.
O. Kilstner has constructed a urine thermometer 6.4 inches long, the lower end of which consists of a German silver catheter which contains a small maximum thermometer. This enables us in twelve seconds, during urination, to take the temperature. The instrument may be obtained of Hofmechanicus C. Zeiss, in Jena, for 10 marks; it is to be recommended, especially since catheterization is so frequently necessary in the urethral and vesical diseases of females.
Thus we see that exploration of the female bladder has been greatly perfected in the most recent times. We no longer rely upon external palpation and microscopic and chemical examination of the urine alone. We palpate its internal surface, and examine it closely with the eye; and we are thus enabled to have far better prospects of curing its maladies. These now exploratory methods have already been used for the diagnosis, through the bladder wall of diseases of the organs lying behind it, the uterus, the uterine ligaments, the tubes, and the ovaries. (Noeggerath, Croom.)