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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    a large abycess, stretching up behind the bladder and between it and the sacruiii. The incision had been made into this cavity. The urethra was sound and uninjured throughout its entire length. The left sacro-iliac synchondrosis was completely separated, and the left side of the body of the pubis was fractured close to the symphysis. Tlie left ramus of the pubis and ischium was also fractured, and the fracture extended into the acetabulum. The tuberosity of the ischium was completely separated from the body of the bone. The cavity of the left acetabulum contained a quantity of purulent matter, and its lining membrane presented the usual appearances of high inflammation. On the right side of the pelvis the only injury was an oblique fracture of the ramus of the pubis, without any displacement. At the lower margin of the right lobe of the liver there was a small deposit of purulent matter. Other organs were quite healthy. Case II.—George Bell, aged twenty-seven, an engineer, was admitted into ward No. 11 of the Glasgow Royal Infirmary, on the 14th March 1846, at nine and a half p.m. (Dr A. Buchanan was at this time surgeon to the hospital.) Half an hour before his admission the patient was at work beside the steam- engine which he had charge of, when his left foot was caught by the fly¬ wheel, and he was drawn in among the machinery. The foot passed between two spokes, and the whole force of the revolving wheel came upon his leg, which was pressed against the belt, and the engine thus stopped. But before that was effected his right leg had been twisted upwards, and he had received a violent blow at the lower part of his back from the main shaft of the engine. On examination it was found that the patient had suffered a severe compound fracture of both bones of the left leg; which was immediately attended to. He complained much of pain at the right sacro-iliac synchondrosis, especially when the limb of that side was moved, and, with the exception of being able to draw up the leg a little, he had no pow'er of moving it. The posterior part of the right ilium was felt to project more than that of the other side, and it was more moveable on the sacrum, which seemed at a relatively greater depth from the surface of the back. In short, there appeared to be displacement of the sacrum forwards, and of the ilium backwards, on the right side. Patient had an uneasy and ineffectual desire to micturate. Some bloody urine was drawn off by the catheter. His face and surface generally were pale and cold. Pulse quick and feeble. He had been in perfect health up to the time of the accident. Next day the patient was still very uneasy, and evidently feebler. He was unable to micturate by voluntary effort, but felt much relieved by the frequent introduction of the catheter ; on which occasions small quantities of slightly bloody urine were usually evacuated. The evident indications of supporting the failing strength, and allaying the sufferings of the patient, were attended to, but without avail, for next morning he was found sinking fast, and he expired at six p.m. 17th.—On inspection of the fractured leg, it was ascertained that the poste¬ rior tibial artery was sound, but that the peroneal was ruptured. On examining the abdomen, the bladder was found ruptured at its fundus, so as to admit three or four fingers. The rupture was transverse, i. e,, nearly parallel to the transverse diameter of the pelvis, and its edges were clean. A very small quantity of urine was found in the peritoneum ; of which that part which lines the pelvis was much injected. A large quantity of blood was ef¬ fused into the interior of the pelvis, and into the substance of the muscles at the lower part of the abdomen, as well as between them and the peritoneum. The other abdominal organs were healthy. The right ilium was quite separated from the sacrum at the synchondrosis, and the pubic ligaments were also ruptured, so that the os innominatum was thus completely detached from the rest of the pelvis.