An Address on Two Cases of Uncomplicated Intraperitoneal Rupture of the Urinary Bladder
Authors: J. Coats
Journal: BMJ (1894)

THE subject of rupture of the urinary bladder presents points of interest in many directions.My attention has been called to it by the occurrence of two cases within a short period, which presented many points in common, and, in the conditions found after death, offered some matters of sur- prise both to the clinical observer and to the pathologist.Both of the cases came under the category of uncomplicated intraperitoneal rupture, that is to say, there was no other in- jury or disease which had any direct relation to the rupture, and the whole group of phenomena were simply the result of that accident.I will first relate the cases briefly and then make some remarks on the points of special interest.For the clinical notes in the first case I am indebted to Dr. Oswald, of Gartnavel Asylum, the patient having been an inmate of that institution.CASE I. Notes by Dr. Oswald.-"March 11th, 1893.This morning at 9 A.M. the writer was called to see Mr. D., as he was seriously ill.He was found in bed looking pale and collapsed; his pulse small and 60 at the wrist.His abdomen was slightly distended.There was a clear area round the umbilicus, relative dulness on the right side, and dulness in both flanks, slight in extent.There were no external marks of violence.He had had a bad night; had only slept three hours and a-half, and had been noisy for a time.He rose at 9 A.M., washed and dressed as usual, and at 8 took his porridge.Afterwards he walked from the dining room to the sitting room, and talked for a time with an attendant.At 8.30 he was seen to be sitting with his head on his hands, the elbows on the knees in rather a cramped position, and he half slipped to the floor; but he said he was all right.The attendant saw he was looking very ill.He moaned as he was carried to bed, and lay in bed with his knees drawn up and complained of pain over the lower abdomen. (It may be taken as a fact that there was no violence).The bladder was not unduly distended, but he had not passed water since 1 A.M. His bowels had been freely moved the previous day.Through the day he vomited a good deal, aad was very restless, and his mental condition bad." March 12th.Complains of pain low down in the abdomen.No motion of bowels and no passage of flatus.Passed no water since last night.Soft catheter introduced, and 12 ounces of clear urine drawn off.It is healthy, containing no albumen.Temperature slighily subnormal; 97.60 last night, 980 this morning." March 13th.Sick through the night.Passed about 3 ounces of urine during the night; 10 ounces drawn off this morning.Seen by Dr. H. C.Cameron, who saw no grounds for operative interference.To-night he passed some urine containing some blood."M March 14th.Seems rather better.Pulse 104, and fairly good.Abdo- minal distension is greater, and there is more changing dulness in the flanks.No passage of flatus, no motion of bowels, and no more vomiting."March 15th.Seen again by Dr. H. C. Cameron."March 16th.Died suddenly this morning, rather unexpectedly.He had had two free bowel motions, and seemed rather better, but collapsed and died at 9 A.M. All through, his mental condition was one of sub- acute mania, and his extreme restlessness and incoherency prevented much being done for him."Post-Mortemn Examination.-Iwas asked by the friends of the patient to make a post-mortem examination in this case, and I wrote the following account of the results.The examination, by direction of the friends, was limited to the abdomen.The surface of the body was pale, and there were no marks of injury visible on the abdomen.The wall was incised in several places, to see if there was any haemorrhage in the structures, but none was found.The abdomen contained a large quantity of fluid of a