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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    more than moderately, distended. He had been drinking freely, so that the normal tension of the abdominal wall was relaxed (the muscles were off their guard, so to speak), and that part of the bladder which is in relation to the front of the abdomen consequently all the more exposed to the violence. The injury was followed immediately by collapse, pain in the hypogastrium, and by several fruitless efforts to micturate. After a little while vomiting and hiccup set in, and the abdomen became distended. At length, after several hours, first a little blood, and then some blood-stained urine were voided, but with great difficulty ; while the pain in the abdomen became rnoi'e widely diffused and the distension increased. Added to all this it must be borne in mind that only three-quarters of a pint of urine and blood was dis- charged from the bladder in the first thirty-six hours after the injury; and that when a catheter was introduced, which was done without difficulty, less than four ounces of urine were withdrawn. All surgical writers are agreed that these are the leading symptoms to which rupture of the bladder has given rise; and as, unfortunately, the opportunity of verifying the diag- nosis has been afforded in nearly all cases by the death of the patient, the inference based upon such symptoms in any given case amounts well-nigh to absolute certainty. Further in support of the inference in the present case is the fact that within six days after the injury there was well-marked thickening of the tissues in front of the bladder, and that within six days more there was a free discharge of pus from the bladder. All this indicates that the inflammatory process which was taking place outside the bladder, as evidenced by the thickening felt through the abdominal walls, had gone on to suppuration, and that pus was being poured through the rent into the cavity of the bladder. The next thing to determine was the situation of the rent, because both treatment and prognosis depend to a certain degree upon this. Was it extra-or intra-peritoneal ? Or, in other words, was it in front, at the fundus, posterior wall, or the neck of the bladder ? Rupture at the fundus, or of the posterior wall (unless quite low down), if complete, must