Cases of rupture of the urinary bladder, with remarks. / By Eben Watson.

  • Watson, Eben.
Date:
1848
Catalogue details

Licence: Public Domain Mark

Credit: Cases of rupture of the urinary bladder, with remarks. / By Eben Watson. Source: Wellcome Collection.

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    Three days before his admission, when the patient was in the act of leap¬ ing from a cart, which was the foremost .of a line of several, his foot slipped, and he fell to the ground upon his back. While in this position, the wheels of three waggons passed between his legs, and over his left groin and thigh. His chief complaint, after the accident, was of pain in the perineum and above the pubis, with a constant desire but complete inability to pass his urine. The treatment consisted of bleeding from the arm, and by leeches to the parts affected. His bowels were freely moved by medicine. On his admission, he still complained of pain in the perineum ; his coun¬ tenance was anxious, and his respiration rapid ; pulse 113, feeble. There was livid ecchymosis of the skin on the inside of the left thigh and groin, as also of the scrotum and penis. The cellular tissue of the upper part of the thigh, scrotum, and perineum, especially its left side, were much swol¬ len, and communicated such a sensation as if the parts mentioned were dis¬ tended with air and fluid. It was not at this time judged prudent to make such an examination as could enable us to detect fracture of the pelvis ; but this being strongly suspected, perfect repose in the easiest position w^as en- ’oined, fomentations were assiduously applied to the injured parts, a Dover's powder was given, and wine was cautiously administered. The catheter was introduced with ease, and apparently into the bladder. A considerable quan¬ tity of bloody foetid urine flowed by it, and the patient felt much relieved. Next day this state was much the same, but easier, on account of the fre¬ quent introduction of the catheter, by which a very little urine was on each occasion allowed to trickle away. A free incision was made by tbe late Dr Hannay, then surgeon to the hospital, on the left side of the raphe, and at the anterior part of the perineum. Thirty-two ounces of fluid, which had a strong urinous odour, were thus evacuated; and, when the finger was introduced into the wound, the ramus of the pubis <;ould be felt fractured about its middle. The patient is reported to have experienced much relief on the evacuation of this urinous fluid. Pulse still continued quick and feeble, and his other symptoms indicated much general prostration. It is also reported that the sensibility of the lower extremities remained unimpaired. He was ordered 12 oz. of wine and 1 lb. of beef-tea in the day, and to have camphor and opium thrice in the twenty-four hours. On the 15th the hospital report is as follows :—“ Urine flows freely by the wound. Feels and looks relieved. Ends of bone (viz., of pubis, felt through the wound) at a distance from one another, and distinctly moveable. Tongue clean and moist. Pulse 90, improved in strength. Natural movement of bowels. Patient can raise lower part of body in bed. He relishes his wine, has some appetite, and does not vomit.” Next day he was ordered six ounces of whisky, instead of his wine ; but there is no report until the 24th, when it it is said that “ patient has had seve¬ ral rigors, followed by heat of skin. Pulse rapid, small, and weak. Complains of thirst and of weakness only. Bowels free ; tongue moist, and slightly white. Urine flows freely by the wound, and a considerable extent of the ischium is exposed, by sloughing of the cellular tissue.” Dover’s powder at night was substituted for the camphor and opium. Next day (25th) it is reported that there is extensive sloughing of peri¬ neum and over sacrum ; but that, in other respects, the patient is not worse. 27th. Debility and exhaustion increase. Respirations 40 per minute. Pulse scarcely to be felt, and tremulous. He died next morning. 20th. On inspection^ much effused blood was found beneath the pelvic fascia, and in the folds of the mesocolon and mesorectum. The bladder was found ruptured obliquely through the left side of its neck, and below the reflexion of the peritoneum, vvhich constitutes its lateral false ligaments. The coats of the bladder were thickened and inflamed. The rupture was a clean rent through both coats, and admitted three fingers. It opened into what appeared