The swelling which takes place in the lips of the wound prevents in a great measure the flow of the secretion by the opening; but it is by no means always sufficient to do so, as we would be led to suppose from Larrey's statement. The urine may, and does at times escape by both wounds if the ball has passed out; but from the greater amount of bruising and swelling which takes place at that of entrance, it may fail to appear there, even although it be the more dependent, and flow only from the wound of exit. The early passing and retaining of an elastic catheter is a most important part of the treatment of these cases, as it prevents the urine, in traversing the canal of the wound, from becoming infiltrated among the divided tissues.
Larrey, recognizing the existence of this danger only at the period of BOOM BLADDER. tion of the eschars, did not employ; >r early, but was particular in its use at the period when he thought ivl tol to occur. Moreover, the tact that the slouch is by no means the barrier to infiltration which he supposed it t lie, is now well recognizt U0thftt1 i-nl when its separation is to l.e looked for, we know, cannot be relied on. Tinirritation and straining which the unevacuated urine occasions, may j >ivmaturely force off the slo and allow the urine to become effused, and so the misy be done before we are ready to combat it. Unless the wound implicate the neck of the bladder, the presence of a gum catheter will create but little irritation, should be enjoined from the moment of injury, catheter ri be retained till the urine br to flow by its side. afl i'i of abscesses with th.ir disagreeable and dangerous consequci thus last La the object of; infiltration and us engorgement, had recourse to scarifications, so as to enlarge the wound.:tion of secreek.
This step will, however, be perfectly uncalled for, if the catheter be retained from an early period. Rest, low diet, mucilaginous drii: iy be le. or hip baths, will comprise the rest nnent in the majority of cases. liia suppositories will also be found, un nccs, most us does esca; ssues, its early evacucourse be necessary. The posterior or lower wmmd commonly closes before long op< the catheter be made to remove the urine so soon as it niters the bladder. If the part through which the ball has passed be deep, the external orifice of the wound may close before the rest of the track a result which should be avoided. The position of the bladder, its depth from the surface, its size internally, the want of correspondence which takes place between the external wound and that in its walls, from their contraction after the passage of the ball, make the extraction of a ball by the wound a matter of impossibility, without such an enlargement of the orifice as would be injurious.
If the ball remains in the bladder, it becomes a matter of moment to remove it. Balls, pieces of cloth or bone so introduced, form the nucleus of calculi; so that the sooner they are got quit of the better, provided the immediate irritation and inflammation caused by the wound have subsided. Many cases are now on record in which the bladder has been opened, and calculi, having balls as their nuclei, have been removed. Larrey operated successfully on the fourth day after the introduction of the ball, and mentions a case in which Langenbec succeeded in removing a similar body ten years after its introduction into the bladder. Morand operated twice. Demartjuay mentions a case in which the nucleus was a piece of shell.