If the bladder, under the direct pressure of the child’s head against the pubic bone, be subjected too long, the same results would naturally follow: the tissues could not regain their vitality, and they would either tear or subsequently slough or mortify, which causes the fistula.
The vagina and bladder, like every other tissue of the body, except that of the brain or nerves, will suffer a great deal of contusion for a short time, but if protracted beyond a reasonable length of time, it will be permanently destroyed or injured.
A urinary fistula is always a serious malady, since it exercises a deleterious influence upon the patient’s health. If the opening is only small, a spontaneous cure may take place, but if it reaches considerable dimensions, it requires to be accurately adapted and stitched together. The best time for the repair of the injury, is six to eight weeks after the receipt of the injury.
Rupture of the female bladder is comparatively rare, for the reason that women are not exposed to the same serious accidents as men; but if women will persist in doing everything that men ought to do for them, the statistics may be reversed. When the bladder is distended and violence is brought to bear on the abdominal walls, corresponding to the region of the filled bladder, a rupture is likely to result. Surgical measures should at once be resorted to, so that the injury can be repaired before inflammation of the peritoneum sets in.
CHAPTER XIII.
ACUTE AND CHRONIC INFLAMMATION OF THE VAGINA.
When speaking of inflammation of the vagina, reference is had to its mucous lining alone. It undoubtedly happens that structures or tissues beneath the mucous covering become involved in the inflammatory action, but this occurs so seldom that it is not of sufficient moment to make it the subject of an inquiry in a practical work.
The mucous membrane of the vagina, like all other mucous surfaces, has its natural secretion for the purpose of lubricating and keeping its surface moist. In a perfectly healthy state, the color of the vaginal mucous membrane is a pale red, this becomes scarlet red upon irritation. In girls who are not irritated or women who have not been abused by sexual excesses nor infected by disease, the normal secretion is just sufficient to preserve the moisture of its surfaces, but not in such an excess as to be noticed as a secretion or discharge outside of the vaginal canal. There is a physiological exception to this normal rule, a few days before and after the menstrual period, when the mucous membrane of the vagina sympathizes with the general congestion of the pelvic organs. The mucous secretion becomes then greatly increased, amounting to a catarrh or flow, this, however, is only transient and subsides with the cessation of the menses. This might with propriety be termed a natural or physiological catarrh.