The Treatment of fractures

9780217400114: The Treatment of fractures

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1900 Excerpt: ... of this treatment--namely treatment of a fractured ramus of pubis and ischium without perineal drainage. A man about fifty years of age, who walked with some difficulty and very awkwardly, and who smelled most outrageously of decomposed urine, came to me for treatment of almost constant dribbling of very acrid and ill-smelling urine, sometimes retention of urine, and always more or less pain in the perineum. He was very weak, pale, and generally ailing. He had almost complete anchylosis of the right hip-joint. Examination showed an impermeable stricture of the urethra at its membraneous portion, but a small passage led out of the urethra towards the right and backwards. There was a large pyriform cyst under the adductor longus muscle just under Scarpa's triangle on the right side, and a gap in the ramus of the pubis, near the arch on this side; there was also an irregular mass of bone below the ramus of the ischium,which seemed to reach far back into the pelvis. After giving the man a little time to recuperate, under anaesthesia I made an exploration of the pelvis by means of a free median perineal section. I could find no prostate gland or only a little thickening where the gland should have been, and though I extended the dissection from the rectum upward, backward, and forward, until I reached the cellular tissue under the recti abdominales muscles, the only vestige of a bladder I found was a little pouch about four centimetres in diameter, in which I could not certainly make out any mucous membrane, and there was no urine in it. I made a continuous passage from the urethra to this little pouch, which was a little higher up than the normal bas fond of the bladder, but occupied about the position of the anterior part of the bladder, if in the normal posi...

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