Commentaries on the Surgery of the War in Portugal, Spain, France, and the Netherlands / from the battle of Roliça, in 1808, to that of Waterloo, in 1815; with additions relating to those in the Crimea in 1854-55, showing the improvements made during and since that period in the great art and science of surgery on all the subjects to which they relate.

by G. J. Guthrie

12th.—Doing well; wounds closing.

16th.—Bladder resuming its power; discharge of matter from groin very trivial.

Oct. 4th.—Posterior wound closed.

30th.—Wound of groin closed; urine, passed by the natural passage, mixed with pus.

At first it was supposed that only the fundus of the bladder was wounded; but when the collection of matter took place in the right buttock, and a piece of cloth was extracted from it, the urine following, it was evident that both sides of the bladder had been transfixed by the ball; and that, probably, the urine from the commencement had been prevented flowing posteriorly by the intervention of this foreign body. An elastic gum catheter could not be passed into the bladder on account of the piece of bone which had forced its way into the urethra, and from its being obstructed afterward by smaller pieces of bone.

When I saw this gentleman some time afterward, it appeared to me that the purulent discharge from the urethra was not from the inner membrane of the bladder, but was probably caused by some dead bone of the pelvis having a communication with the bladder by a fistulous opening.

A soldier, of the King’s German Legion, was struck, at Waterloo, by a musket-ball, which entered a little way above the pubes, and lodged. The symptoms which immediately followed were by no means severe, although he passed a little bloody urine at first; the external wound closed without difficulty. He complained of pain at the neck of the bladder, and had a great desire to pass urine, with other signs of stone in the bladder, which induced me to pass a sound, when I found that the ball was lying loose in that viscus. On his arrival at the York Hospital, at Chelsea, from Brussels, he became, with the French soldier, whose thigh had been amputated at the hip-joint, an object of great attention. I performed the operation for the removal of the ball in the presence of a large concourse of military and medical persons. It was done in less than two minutes; but the calculus, composed of the triple phosphates, which had formed around the ball, yielded, and broke under the forceps. The pieces were removed separately. The ball, being heavy, fell below the neck of the bladder, which, being healthy, yielded to the pressure, and allowed it to sink on the rectum, where it could not be caught by the forceps, until it had been raised by a finger in the bowel. The bladder was then well washed out, so as to remove all the pieces that might remain, and the man was placed in bed. He was bled once in consequence of some apprehension of pain; but he had not a bad symptom, and rapidly recovered.

The symptoms of irritation did not, however, entirely pass away, as could have been wished, and I began to fear that some small pieces of calculus had been overlooked; when, one morning, after considerable effort, he passed a ring of sandy calcareous matter, which had formed around the orifice of the bladder, and which, being dislodged, had fortunately entered the urethra, along which it was forced by the urine. It was evidently formed of the phosphates in minute portions, which had become agglutinated together, around the meatus of the bladder. This he took with him to Hanover, where it, himself, and the cicatrixes of his wound, and of his operation, attracted great notice. The ball, which was flattened on one side, I kept in a small box, together with the pieces of calculus which were extracted, and showed them annually at my lecture on this subject for many years. One evening, however, I unfortunately left my little box on the table after lecture; and when I recollected, and returned for it, I found that some gentleman had borrowed it, and has not yet returned it. At the battle of Chillianwallah a similar wound took place; the ball formed the nucleus of a calculus, and was removed successfully by a gentleman in the service of the East India Company, whose name I have not been able to learn.

The following case, from Baron Percy, is in point: A young man was wounded by a pistol-shot, which entered just above the os pubis, through the linea alba, wounded the bladder, and lodged. The belly swelled; a tumor formed in the perineum; no urine passed; the bowels were confined, and fever ran high, with a tendency to delirium. Believing that the tumor in the perineum, and the fluctuation he thought he perceived, might be caused by extravasated urine, he punctured it with a trocar, and evacuated a large quantity of bloody urine. This induced him to enlarge the opening, and carry it on to the bladder, through which he brought out the ball, some shirt, and several clots of blood. The man was bled nine times in all; the urine after a time passed in the ordinary way, and the patient slowly recovered.

An officer was wounded near Bayonne, by a musket-ball, on the left side; it passed through the ilium across the pubes, and made its exit through the gluteus maximus of the opposite side, but lower down. Urine flowed through both wounds at first very readily, but none of any moment came by the urethra, from which some blood occasionally oozed. The attempt to pass a catheter failed, although the desire to make water was urgent and painful. After a few days the passage of urine by the external wounds became obstructed, apparently by the sloughs; great pain and misery were experienced; fever ran high; rigors and delirium followed extravasation of urine, and death closed the scene. The mischief here arose from the catheter not having been passed into the bladder, which could not be effected, from the prostatic part of the urethra or the neck of the bladder having been injured.