flowing. A soft flexible catheter should be given in preference to a rigid or semi-rigid one. The best form is the red-rubber catheter.
Stammering micturation.The condition termed by Sir James Paget stammering micturition is frequently seen in young men, more rarely in children and adults. This stammering of the urinary apparatus is analogous to speech stammering, and occurs chiefly in those who are nervous and easily put out. It would seem to be due to incoordination of the sphincter and detrusor of the bladder, the former not relaxing synchronously with the contraction of the detrusor, or vice versa, and is sometimes caused by external irritation, such as preputial adhesions. Occasionally not a drop of urine can be passed, or a little passes and then a sudden stoppage of the flow occurs, and the more the patient strains the worse he becomes, until at last there is complete retention of urine. Very usually such errors in micturition can be cured by the removal of irritating causes, if they exist, and in these cases, as well as in those in which no such cause can be discovered, great care should be taken to avoid those difficulties which have given rise to the patient's worst failures. If at any time he should fail to perform the act of micturition, he ought not to strain, but should quietly wait for a little before making any further effort, after which he will often succeed. Regularity in the times of making water is also of much importance.
Retention of urine.Retention of urine cannot be called a disease of the bladder, but may be the cause of, or result from, bladder disease. It may occur in paralysis of the bladder, or in conditions where the patient is suffering from an illness which blunts the nervous sensibility, e.g., typhoid fever. It is, however, much more commonly due to obstruction in some part of the urinary passage anterior to the bladder, as in stricture of the urethra or enlargement of the prostate. The patient can usually tell when he last passed any urine; but, even when no such information can be obtained, there are signs which lead the surgeon to a correct diagnosis. Thus, the bladder if much distended can be felt as a rounded swelling above the pubes, and it may even have passed to the level of the umbilicus. Percussion of the hypogastrium gives a dull note. When retention of urine occurs and the bladder is over-distended, it is necessary to evacuate its contents as soon as possible. If there is no obstruction to the flow of urine, the retention being due merely to atony or paralysis of the bladder, a flexible soft catheter is passed into the bladder and the water drawn off. But, when there is an obstruction which cannot be overcome, aspiration of the bladder has to be resorted to, the needle of the aspirator being pushed through the abdominal wall into the bladder. The point of puncture in the abdominal wall is in the middle line just above the symphysis pubis. The bladder has been aspirated in this way very many times in the same person without any evil result. But in all cases strict antiseptic precautions must be adopted.(j. c.)
VESOUL, a town of France, chef-lieu of the department of Haute-Saône, is situated 147 miles south-east of Paris by the railway to Mülhausen, at the junction of branch lines to Gray and Besançon, on the river Burgeon, which here receives two tributaries. The isolated conical hill of La Motte (1483 feet), which shelters the town on the north, affords fine views of the Jura and the Vosges Mountains. On the summit is a votive chapel (1854). The chief features of Vesoul are the palace of justice, the church of St George with a fine altar, the promenade with a monument to the gardes mobiles of the department who fell at Belfort in 1870 and 1871, a library of 20,000 volumes, and an archaeological museum. The population in 1881 was 9431 (commune 9553), the corresponding figures for 1886 being 9602 and 9733.
Vesoul, which is first mentioned in the 10th century, was originally a fief of the church of Besaçon. It afterwards passed to the house of Burgundy, and was fortified. The castle was destroyed in the 17th century. The town suffered much during the Wars of Religion and the Thirty Years War. Vesoul belonged temporarily to France after the death of Charles the Bold, was returned to the empire when Charles VIII. broke off his marriage with the daughter of the emperor Maximilian, and again became part of France under Louis XIV. after the peace of Nimeguen.
- ↑ Ad mangonicos quæstus descenderat.