Rupture of the urinary bladder : based on the records of more than 300 cases of the affection / by Walter Rivington.

  • Rivington, Walter, 1835-1897
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: Rupture of the urinary bladder : based on the records of more than 300 cases of the affection / by Walter Rivington. Source: Wellcome Collection.

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    pressure over the abdomen between the umbilicus and pubes, over each iliac fossa, and over the course of the ureters. There was no marked dulness on percussion. No urine had been passed, and the bowels had not acted. The patient did not complain of any continuous desire to micturate, but whenever the desire was felt he experienced pain in the body of the penis. The testicles were retracted. When the finger was introduced into the rectum, and pressiu'e was made on the base of the bladder, much tenderness was apparent. Increased pain followed the passage of the catheter, and the instrument coidd not be made to rotate, nor could it be depressed between the patient's thighs; but subsequently, on varying its position, it seemed to slip in further than usual. Only a small quantity of urine mixed with blood was withdrawn through the instrument. These were the mam local symptoms when I saw the patient with Mr. Chambers on the Thiu'sday evening, and we were both of opinion that they indicated injury to the bladder. There was one additional symptom present, however, which rendered it uncer- tain whether a rupture of the bladder was the only injury from which the patient was suffering. This was the occurrence of vomiting. As the case progressed the vomiting became more urgent, and nothing would relieve it. The obstinacy of this symptom, which is passed over lightly in works on surgery in connexion with ruptured bladder, but emphasized as a symptom of rupture of the intestine, led me to suspect some injury to the bowel as well as to the bladder; but in this I was mistaken. On the following day I found the patient decidedly worse, and we informed his friends that he was in great danger, and would probably succumb in forty-eight hours. From this time, I understand (for I did not again see the patient alive), the symptoms increased in severity, the vomiting and pain being most urgent and distressing. The pain came on in violent paroxysms, extending over the whole abdomen. Cold sweats fol- lowed, and death took place about three p.m. on Sunday, October 29th. Fortunately we were able to inspect the abdomen. On open- ing the abdomen there was some, but by no means marked, evidence of peritonitis. The recto-vesical pouch was filled with a blood- stained fluid. The bladder was firmly contracted, and lay at the bottom of the pelvis. A rent, -(vhich in a bladder half filled would be about two inches in length, was seen at the upper and posterior aspect. The edges of the rent were sloughy. There can be no doubt, I think, that the bladder was quite full at the time of the accident. The patient had been drinking freely. He was of a very stout build, with a prominent abdomen. He simply fell flat on his face (his nose was bruised), and the bladder gave way at a point exactly opposite the surface on which the force of the con- cussion was received. He lived four days after the accident. The treatment consisted mainly in the administration of opium and morphia, and the regular introduction of the catheter. A year afterwards I met with my second case. Case 2.—Charles R , nineteen years of age, was admitted into the London Hospital on the evening of October 28th, 1872. c 2
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