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.

    5/8 (page 5)
    to determine precisely how the blow operated, whether by producing a general concussion of the whole frame, or by causing the bones to impinge directly on the base of the bladder. We think, how¬ ever, that the nature of the accident and its obvious effects, suffi¬ ciently prove the latter supposition to be correct. It will be re¬ membered that the hour at which the accident happened was late in the evening, when the man was about to quit his work for the day, and very probably he had allowed his urine to accumulate in the bladder for some time previously. It is not too much then, we think, to assume that the bladder was fuller distended, when the man received the blow from the main shaft of the engine. This blow immediately detached the ilium from the sacrum on the right side, and ruptured the pubic ligaments, thus separating the os in- nominatum from the rest of the pelvis. Nor was the force of the blow exhausted in producing this separation; for the right margin of the sacrum was at the same time pressed forwards—a position which, owing to the nature of its other connexions, it retained even after death; thus indicating, with perfect certainty, the minimum extent of the indentation. Even apart, therefore, from a consideration of the violence of the blow, and the natural elasticity of the parts, such a change in the bony pelvis as was found after death, was amply sufficient to prove that the sacrum and the margin of the ilium had been brought into direct and violent con¬ tact with the base of the distended bladder. There is, however, reason to think, that had this blow been the immediately efficient cause of the rupture, the rent in the bladder would have corre¬ sponded with the direction of the synchondrosis, and would not have been transverse. There seems to have been another link then in the sequence of events; and the history of the accident probably was, that the blow of the main shaft drove in the bones at the right synchondrosis against the base of the distended bladder, and that thus the violent impulse was communicated to the urine, which, by its rebound, produced the lesion in question. In both of these cases, the accident was of a very severe kind, and the nervous shock proportionately great; but the progress of the cases was by no means such as it would have been had the bladder remained entire. The prominent symptoms in both cases were those occasioned by the lesions of the bladder; and yet their character and course were materially different. As regards the case of the man McCulloch, we, unfortunately, cannot speak with precision of the state into which he was imme¬ diately thrown by the accident, seeing that he was not admitted into the hospital until three days thereafter. But, judging from the severe antiphlogistic treatment which he appears to have re¬ quired, and to have borne, his state must have been one much more acutely inflammatory than that of George Bell. The latter, indeed, never recovered from the nervous prostration caused by the effusion of urine into the peritoneum, combined with the shock of the accident.