Clinical lecture on rupture of the bladder and its treatment : delivered at the Middlesex Hospital in July, 1879 / by Henry Morris.

  • Morris, Henry.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lecture on rupture of the bladder and its treatment : delivered at the Middlesex Hospital in July, 1879 / by Henry Morris. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    necessarily extend through the peritoneum; in the other situations the peritoneum is usually uninjured, though it may be, and often has been, involved. According to the well-known figures of Dr. Stephen Smith, the posterior wall suffered in fifty out of sixty-five cases, in which the situation of the rent was noted, from which it would seem that the chances are more than three to one that the peritoneum will be injured. This proportion is probably higher than a larger number of cases will support. Thus, from 166 cases collected by Dr. Max Bartels,* the summary notes of which have been translated by Mr. Lyell, I make out the following to have been the results:— Intra-peritoneal, total, 98 ; 94 deaths, and 4 recoveries. Extra-peritoneal, total, 54; 42 deaths, and 12 recoveries. State of peritoneum not mentioned, total, 14; 13 deaths, and 1 recovery. In 84 of the intra-peritoneal cases the rupture was situated as follows :—40 at the fundus, 9 in front near the fundus, 33 posteriorly, and 2 at the side. In 15 cases the rupture was associated with fracture of the pelvis. In 50 of the extra-peritoneal cases the rupture was situated: —19 at the neck, 23 anteriorly, 2 behind, and 6 at the side. In 19 instances the rupture was complicated with fracture of the pelvis; in 8 of which splinters of bone penetrated the bladder, and were either voided with the urine or removed by lithotomy. In 6 of the doubtful cases the pelvis was also fractured, and in 2 of the 6 a splinter penetrated the bladder. It appears evident that when the peritoneum is injured, the fundus or posterior wall, or both, are nearly always the seat of rupture; sometimes the anterior wall and the' fundus are involved. When the peritoneum escapes, the neck ox- anterior wall is the part of the bladder which suffers. This is exactly what would be expected from the anatomical relations of the peritoneum. If the wound be entirely extra-peritoneal, the urine will ‘ Archiv. fur Klin. Chir. vol. xxii. Dr. Max Bartels enumerates 169, but three of these are duplicates.