A CASE OF RUPTURE OF THE BLADDER

T.J. Call
1881 The Lancet  
995 post-partum, or in the common farm of menorrhagia in young girls or adults of more advanced years. Of post-partum haemorrhage one typical case will sutfice, though others might be given. Mrs. K-, aged twenty-eight. Fourth pregnancy. (Ty first attendance on her.) Always has most severe il'oding after delivery. Nov. 1875, delivered of twius; within five minutes a pailful of blood (two to three gallons). Nov. 1876 (three weeks short of twelve months). agam delivered of twins, with similar
more » ... rrha.gf. (All four children still living.) March, 1878, delivered of a living boy. Lombe Atthill's warm-water injedion soon stopped flootling, which was again most severe. Dec. 1880, again delivered of twins (one only alive). When bummoned to Inr this time, onethird of a grain of ergotine and one-sixtieth of a grain of sulphate of strychnine, given every quarter of an hour, had the effect of strengthenmg the uterine contractions, completing the labour expeditiously, and relieving the attendants of the previous dreaded and frightful concomitant-the haemorrhage,-for the placentae were expelled without the slightest bleeding, and the patient was about in little over a week, the last visit being paid on the sixth day. An equally good result was obtained, a month ago, in a primipara with atony of the uterus, delivery being effected by the forceps, when haemorrhage was prevented by similar means. In the treatment of menorrhagia the same remedies are given in like quantities, but three or four times a day, and during the intervals also, together with the arseniate of iron in of a grain doses. A young lady aged sixteen, who had become quite blanched and exhausted by the great drain of blood, which lasted a week and returned in a week (thus she was losing onehalf her time), under the above treatment was restored to health in about five weeks, and another was similarly relieved in seven weeks. A kindred case to the above may here be mentionedviz., haemoptysis in a man in his fifth decade, who recovered under the employment of ergotine and strychnine, after various kinds of treatment had failed. Spondon. THE importance of adequate provision for disease is recognised by all who aim at the mitigation of suffering, and I may say that as regards what I may term surgical diseases, we have in the metropolis and in the provinces numerous and excellent institutions to meet almost every case where operative aid is necessary. The value of the voluntary work done by the surgeons attached to these hospitals can hardly be over-estimated, but the benefits derived are in a certain sense individual. If A breaks his leg, or B is suffering from stone, or C has an ovarian tumour, or D some obscure or malignant disease requiring operation, they will be admitted free of charge to one of the institutions devoted to such cases ; they have the highest skill at their disposal, the best nursing and diet. But such accidents or complications only affect the patients ; their misfortunes are, in a certain sense, personal. The importance of adequate provision for infectious disease is theoretically recognised by all sanitarians, but practically it is only imperfectly appreciated. Infectious diseases are, for the most part, preventable and controllable, so that proper hospital accommodation is an essential element in grappling with them and stamping them out. Hospitals for infectious diseases have more than an individual importance. If A, B, C, or D, in place of suffering from surgical diseases, were so unfortunate as to contract typhus, typhoid, small-pox, scarlatina, &c., the hospital accommodation at their disposal would neither be of the same class nor obtainable on the same easy conditions. In most towns the patient or patient's friends would have to pay a certain sum per week for maintenance, medical attendance, and the rest, in the hospital set apart by the sanitary authorities for infectious diseases. If unable to pay application would have to be made to the relieving officer, when a parish order would be obtained, and the patient admitted free of charge, and attended by a medical officer paid by a board of guardians, the patient in reality paying a penalty, as he is disfranchised by accepting Poor-law aid. This is a serious g.ievance. It violates a rule which h:as been often insisted on-viz., that the relief afforded to the sick in hospitals for infectious diseases should be completely dissevered from any relation with pauperism. It is in the highest degree desirable that our general infirmaries should be maintained ; it is more desirable that we should have hospitals for infectious diseases open on as easy terms, and that every encouragement should be held out to the working classes to avail themselves of this accommodation. It is more than satisfactory that any person who may break his leg in the crowded thoroughfares of the metropolis or in one of our provincial towns should have free hospital attendance of the class now supplied, though such an accident only affects the patient. It is a selfevident truth that it is of greater importance, should the same person be suffering from typhus, typhoid, scarlatina, or small-pox, that he be at once isolated and removed to a hospital, for he not only suffers, but becomes a danger to the household in which _he lives, to his neighbours, and to society generally. I think it cannot be denied that our present hospital accommodation for infectious diseases is defective. The institutions already in existence do not receive the pecuniary support they are entitled to, nor are they sufficiently appreciated by the public. In periods of epidemics there is special activity in providing for the accommodation of infectious diseases ; and in many cases any old empty building is thought good enough for an infectious hospital. The latter is a grave fallacy. A fever hospital should not only be specially and hygienically constructed, but should be made even more cheerful and brighter than an ordinary hospital. There are financial difficulties in the way, but even these must be set aside unless we desire to render abortive the Sanitary Act of late years. We now spend, I may say, some millions upon sanitary work, and we reap a rich harvest by this expenditure. We must not strain at a few extra thousands in order to gather richer fruits. Our medical officers of health cannot grapple satisfactorily with infectious diseases, even with the help of the model clause which requires householders to notify to them infection, unless there is proper hospital accommodation for infectious diseases in their districts. It is my aim in this short paper to prove that hospitals for infectious diseases are more important to the health of the community than general infirmaries. Once this truth is recognised, all difficulties should disappear. C3 Halifax, Yorks. THE interesting editorial article on "Rupture of the Bladder" in THE LANCET of Nov. 12th, 1881, recalls a ease which occurred in the out-patient department of the Alnwick Infirmary during the time I was house-surgeon there in 1858, the history of which I now relate from notes taken at the time. J. R-, a chimney-sweep, between fifty and sixty years of age, had for a long series of years suffered from stricture of the urethra, through which, and only by dint of coaxing, a No. 3 was the largest size of catheter which could be passed. Although this stricture was the cause of frequent complete retention of urine, and at the best of times water could only be made through it in a very feeble stream, he would not consent to have any operation performed for its relief, nor would he attend with sufficient regularity to have it gradually dilated. He was content to go on as he had been doing for over twenty years, and to present himself in the out-patients' room once in every week or two, in order to have his bladder relieved. One afternoon I happened to be passing his house when his wife called me in. I found him walking about the room, evidently in great pain, with no other clothiug on than his shirt, and his bladder enormouslv distended: as. according
doi:10.1016/s0140-6736(02)33489-5 fatcat:p4thbze3ifbr5exybygqc56esi