A compleat discourse of wounds, both in general and particular whereunto are added the severall fractures of the skull, with their variety of figures : as also a treatise of gunshot-wounds in general / collected and reduced into a new method by John Brown ...

CHAP. LXIX.

Of Wounds of the Bladder.

THE urinary Bladder is a membranous part of the lower belly, the which receiving the Serum from the Kidneys doth retain it in it for a while. It is seated in the Hypogastrium between two coats of the Perito∣naeum, in the cavity which is efformed by the bones of the Os Sacrum, Coxendix and Pubis. It consisteth of a threefold membrane. It hath a longish and globous or pyramidal figure. It hath one cavity perviated with three Foramens, two at its neck, and one at the end of the U∣reter entring it. It receiveth its Arteries from the Hypo∣gastrical Arteries passing into the sides of its neck, carry∣ing blood to it for its nutriment. It admits Nerves from the sixth pair, and the marrow of the Spina Dorsi. It's di∣vided into a neck and a bottom, its bottom lies upwards, its neck downwards, and is the lower and narrower part thereof. Its neck is constituted of many Fibres chiefly transverse and orbicular encompassing the whole body of the bladder here constituting a Sphincter Muscle, con∣stringing the neck of the bladder, so as the urine might not involuntarily fall out. Having given you this short draught of the bladder by Anatomy, we are next to en∣quire into its wounds, where first we are to enquire of the signs hereof.

* 1.1 Celsus lib. 5. cap. 26. writes these as Signs hereof, the urine doth come bloody and sparingly. If the body of the bladder be wounded, the urine doth fall into the ca∣vity of the Abdomen, and the pain will communicate it self to the Testicles and Inguens. The Stomach is here∣with affected, a vehement pain doth accompany the

Chest, and anxiety with cold Convulsions and death follows. Wounds happening in the neck of the bladder are to be cured as we see by daily experience in Litho∣tomy, or extraction of the Stone from thence. Wounds also in the lateral parts thereof happening about the Groin are also curable, in such as are young and of a healthful constitution. Hipp. writes that wounds in the membranous parts of the bladder are incurable, Aphor. 18. sect. 6.

* 1.2 As to its cure. Things outwardly to be applied may properly be accounted these. As, to three parts of Turpen∣tine to add one of oyl of St. Johns-wort, and over this to apply Empl. Diapalm. Cyprus Turpentine with the yolk of an Egg mixt together with a little Vernish is al∣so good here. In such wounds as happen so opportune∣ly that we may come at them, falling upon the fleshy part thereof, you may here proceed by injections put through the urinary passage, such as are these two Decoctions. ℞. Hord. mundat. Rosar. rubr. Centaur. min. an. M. ss. vini * 1.3vigr. auster. q. s. pro Decocto. To which add in the end Rhodomel. ℥ij. And use this. Or R. Cydonior. incisor. n. * 1.4iiij. Equiset. Sumach. Bacc. Myrtill. an. ℥iij. Rosar. rubr. pug. ij. Balaust. ℥ss. coquantur in aqu. pluvial. lb 16. ad 3. partis consumpt. coletur, colatur•• solv. Syr. è Rosis sic. Mel. Rosar. an. ℥vj. Syr. Myrtin. ℥iij. Gum. Tragac. ℥iij. of which let him drink and nothing else for ten days. If you desire a more drying injection take this. ℞ Rad. Consolid. major. Centuar. fol. Oliv. * 1.5Myrtillor. an. q. s. Amyl. ℥iss. aqu. chalybeat. q. s. pro decocto, fine addendo Mell. Rosar. ℥ij. pro usu. If it be too sharp add a little milk hereto, all these to be applied warm, and so as they may beget no wind.

* 1.6 Glandorp. Obs. 38. fol. 176. writes of a Souldier who having received a wound upon the Os Pubis, and being thrown backwards hereupon, the urine flew out copi∣ously. That night he was correpted with pain in his head.

Convenient things being ordered him, the third day he died, the body being opened the bladder was seen wounded in that part in which the Urachus is inserted.

* 1.7 Riverius Obs. 5. morbor. infrequentium fol. 75. writes of one who being shot by a bullet through the urinary passage, this wound penetrating the bladder, and the right side of the Os sacrum, so that he urined by the back part of his wound, the urinary passage being only hurt, yet he was restored to his former health, first by applying a defensative, then with arming the Tents with Basilicon mixt with the yolk of an Egg, afterwards with Ʋnguent. de Resina, and lastly with Sarcoticks and Epou∣loticks.

* 1.8 Felix Wirtz Anno 1581. in the month of September, a Mariner, had a Knife struck into the right side of his Abdomen four transverse fingers above the Pudenda, so as the urine did wholly pass through the wound, the which afterwards was well cured, by prescribing Clysters first, then the wound was not dressed with Tents arm∣ed, but applying over it a consolidating medicine, over which was applied a gummy plaster. Inwardly did he dayly twice in a day take a decoction of Orpine, which is excellent here in these wounds, abstaining from hot meats, contenting himself with little drink, and lying in his bed downwards. By which observing he in three days had his urine flowed out by the Urethra, and was af∣terwards perfectly healed.

* 1.9 Casparus Bauhinus in Append. ad Rouset. de Partn Caesareo writes of a Fisherman who had his urine speedi∣ly suppressed, the which would not by any remedies or by the Catheter be removed, hence did arise a great Tu∣mour of his belly, and he was come even to the last of danger: he being advised with, orders incision hereof whereby might be found out the cause of this his sup∣pression. When therefore Incision was first made in the Inguen, as there it is their way of cutting, the Lithotomist

in separating the carnosity which was the more protense by reason of the bladder being thus distended by the u∣rine, did open it, and the wound was produced, and the urine spun out with a great force, whereby the Patient was soon at ease. The Testicle in the same side being ta∣kenout, the wound continued its passage by the wound. The wound being healed, a Fistula remained in the regi∣on of the Groin, through which a short Catheter being sent, the which he generally carried about him, within a small while his water passed without any detriment, and no longer did he urine through his yard. At this se∣ction Platerus and Bauhinus were present amongst the rest.

Notes

• * 1.1

  Signs and Pre∣sages.
• * 1.2

  Cure.
• * 1.3

  Decoction.
• * 1.4

  A vulnerary potion.
• * 1.5

  Injection.
• * 1.6

  History.
• * 1.7

  Another.
• * 1.8

  Another.
• * 1.9

  Another.