File:Railway surgery - a handbook on the management of injuries (1899) (14756312391).jpg

Identifier: railwaysurgeryha00herr (find matches)
Title: Railway surgery : a handbook on the management of injuries
Year: 1899 (1890s)
Authors: Herrick, Clinton B. (Clinton Bradford), b. 1859
Subjects: Railroad accidents Surgery Emergencies Railroads Wounds and Injuries
Publisher: New York : W. Wood and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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s.Any injury which from the history or external indicationscan be traced to this tract should be at once investigated,and the amount of urine present in the bladder, togetherwith the history of its last evacuation, be carefully noted. 204 RAILWAY SURGERY. In addition to these symptoms and signs, an intraperi-toneal rupture of the kidneys or bladder will soon bemarked by peritonitis. Extraperitoneal rupture of the kidneys will permit the urine to escape in thelumbar region (see Fig.81, PP), in which po-sition it will soon makeitself prominent by afluctuating swelling, orlater by pain, chills, andrise of temperature. Treatment. When the latter con-dition presents itself thetreatment should be animmediate incision overthe swelling, and ifurine is found, it shouldbe freely washed outand drainage instituted,the latter carried downto the structure of thekidney. Such a pack-ing should be given thewound as will cause itto heal from the bottom,or the rent in the organshould be closed bysuture.
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PIG. 81.—Schematic Representation of the Re-lation of the Genito-urinary System to thePeritoneal Cavity. Dotted line representsthe peritoneum. A, Kidney ; U U, ureter ;B, bladder; SP, symphysis pubis; R, rec-tum; PP, post-peritoneal space; P V, pre-vesical spp.ce ; P, perineum. INTERNAL INJURIES. 205 If the conditions point to an intraperitoneal rupture, anincision must be made through the abdominal wall and therent closed. Bladder. The bladder is more liable to be ruptured if full ofurine at the time the accident occurs. If injured extra-peritoneally, the escaping urine may find its way into theprevesical space, filling that, and appearing as a swellingin the cellular tissue of the groin and abdomen (see Fig.81, PV). Or if the rent is perineal, this region will soonshow the presence of the extravasated urine by swellingin that locality, even extending down upon the thighs (seeFig. 81, P). When such a condition as injury to the blad-der is suspected, no matter how slight, the fact w

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