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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    The latter, although severe, would not, we think, have been ade¬ quate to the effect produced, had not the former concurred with it. The patient in this case lived forty-five hours, and expired without exhibiting the slightest symptom of reaction. Such a termination of the case will not astonish any one, however, who remembers the effect of a foreign fluid in the peritoneum, especially when of an irritating nature, and suddenly introduced, as was the urine in this instance. M’Culloch, the subject of the other case, lived for eighteen days after the accident. The shock” w'hich he received at first, w^as not indeed so severe as that under which the other man sunk, but the injury to the pelvis was much greater. The true explanation of the great difference in this respect between these two cases, is to be found in the fact, that in the latter the urine was not, as in the former, discharged into the peritoneum, but into the muscles beneath it. Inflammation, suppuration, and sloughing ensued; the tendency being towards a natural cure by external opening of the abscess. This effort of nature was duly aided by surgical interfer¬ ence; and there is little doubt in my mind, that this patient would have ultimately recovered, had he not fallen a victim to that mys¬ terious disease phlebitis, which w^as then prevalent in the hospital. The commencement of this disease in McCulloch’s case, is noted in the report of the 24th, up to wdiich time he liad gone on improving. Consequently, at the inspection, it was found that one of those peculiar purulent deposits, characteristic of that disease, existed in the right lobe of the liver, and that a quantity of matter was con¬ tained in the left acetabulum. This case, then, is in many respects similar to that of the child Nicholas Keog, recorded by Dr Harrison in the paper formerly referred to. Regarding this case. Dr H. re¬ marks, that he thinks it might have been saved, had he sufficiently early used free incisions, so as to admit of the escape of the urine, and thus to check the diffuse gangrenous inflammation of w'hich the child ultimately died. In his Pathology and Practice of Surgery, Mr Syme has lately recorded an interesting case of rupture of the neck of the bladder, from direct violence applied above the pubis, and wdthout fracture of the pelvis. The skin w^as freely incised in the place indicated, the patient’s strength was sup¬ ported, and after a critical illness he recovered in about six weeks. This, w^e believe, is one of the only two cases on record, of recovery from rupture of the bladder. The true principle of prognosis in these cases, has been laid down by the same high authority, that ‘‘if the rupture takes place above or within the reflexion of the peritoneum, there cannot be the slightest chance of escape. But if the rent is at the anterior part, so as to discharge the contents of the bladder by a sudden gush into the cellular substance, and con¬ dense it in such a way that only the portion in contact with the urine may be deprived of life, it appears that the patient may be saved by timely incisions.” This latter observation is equally ap-