Lectures on the Principles of Surgical Diagnosis: Especially in Relation to Shock and Visceral Lesions
Authors: F. L. G. Clark
Journal: BMJ (1869)

LECTURE VI (c-1lnc/mlul).-LESIONSOF TIHE PELV-IC VISCERA.Fractures (f t/i' JPlvis antd thzeir ComplIicationzs.-Rup.turIcof Bladder- aliwoa Pb/sl?/f't-cs: considlerations sug-ested thereby.-Ruptmo'e L'ao';'Gatiton Uo-fret/i : Ca uts's a ndI S)ont/ to;ns.-7',-tauatic Lesions ij,f Rcc/um.--S/hock in Pelvic Injurieis, antd ing CertIain AlIol-bia Condfituons f t/ze Perus.-Recapoitnlation.-Indicationzs femzonitorj of DiS S or/I 0; CG1onvaleCSCC eCC.C0onClUsiOnl.character of protection afforded by the pelvis to its contained viscera is more allied to that of tise skull in relation to the brain, than of the abdoomen or chest to the organs occuipying, respectively, regionis.I'he arrangement of the rigid and irregular arch of bone whiclh encloses and forms the walls of the pelvic cavity, is adapted to resist external violenice by its sheer strength ; whilst its large outlets permit the expansion and evacuation of its membranous contents.When these membranous anid muscular organs rise, by their own dis- tension, above the brim of the pelvis, they become obnoxious to injury, from whlich they are comparatively secure whilst within its protecting walls.Ti'lius, in lesionis of the urinary bladder, with rare exceptions, twro conditioins seem to be necessary, namely, distension and extrusion the pelvis, wNhich conjointly favour this result.The usual history these cases is, tllat the patient has been indulging in free libations, neglecting the calls of nature, and then by some accident,-often a quarrel w%vith a booni companion,-the abdomcni is forcibly compressed, and rupture of the bladder is the result.It is somewhat remarkable these injuries are not more frequent than they are; and this circum- is a proof of the natural power of resistance of this membranous Accidlenits in whliich the pelvic bones are crushed, gun-shot wounds, and otlher still less frequent forms of injury, may involve the lint ordinary fractures of the pelvis are very rarely compliby this lesion ; more frequently, though, in my experience, still rarely, its excretory duct, the urethra, is lacerated.Fractures of the pelvis are met with in every variety, from the simplest to the most complex.They are always occasioned by great violence either of momentum or of weight, as in heavy falls, or in pon- derous wlheels passing across its walls.I have the records of numerous cases, some wsitlIoLnt displacement, others including dislocation of frag- ments of bonie, or even of the pelvic symphysis, or of the sacro-iliac synchondrosis of onie or both sides.In the detection of these fractures, the outline of the pclvis should be carefully scanned, inicluding the often broken ischio-pubic ramus.Pressure, alternately with either hand, on anterior spine of each ilium, will usually elicit any mobility whlich may result from loosening of this bone from its attachments.I wi-ould remark, however, that these fractures sometimes escape very careful ex- amination; anid I have long since learned the importance of assuming the possibility of pelvic fracture, where it is suggested by the nature of