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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    days. In those instances which do not terminate within a fortnight^ death is usually preceded by suppuration or sloughing of the perivesical cellular tissue. In some cases in which a sub- or retro-peritoneal cavity has been formed, the cavity has been tapped or cut into, and death for a time averted by the evacuation of the urinous and purulent contents; in other such cases the peritoneum has given way, the pent-up fluid has escaped into the abdomen, and fatal peritonitis has been thus set up. The question of treatment is most important. At a recent meeting of the Medico-Chirurgical Society* a discussion was raised on a case of rupture of the bladder brought forward by Mr. Christopher Heath. The advisability of opening the abdomen so as to sponge out the abdominal cavity and free it of all extravasated urine, and then to close the rent in the bladder by means of sutures, was considered. This plan has been adopted by Walter of Pittsburg, by Mr. Willett at St. Bartholomew’s Hospital, and by Mr. Heath at Univer- sity College Hospital, but only Walter’s patient recovered. Another operation, suggested and successfully put into prac- tice by W. J. Walker of Boston, and afterwards by Dr. Erskine Mason, is cystotomy, whereby a free vent for the urine in a depending position is established. Each of these operations is very serious ; and neither ought, in my opinion, to be undertaken, except with a feeling of the greatest cer- tainty as to the nature of the accident, and of the uselessness of all less formidable modes of treatment. Moreover, to my thinking, these are not alternative operations; each is not suitable in the same case, and neither would be anything but harmful in many. For instance, in the case now referred to, if I am right in supposing that the rent was at the front and upper part of the bladder chiefly, though not entirely extra-peritoneal, and that the amount of urine extravasated was small, what would have been the use of abdominal sec- tion or cystotomy ? The wound in the bladder could not have been closed through the abdomen without doing the very thing which increases the mortality of the accident—viz., making the peritoneal cavity communicate with the wound * February 25, lfe79.