Surgical essays : the result of clinical observations made at Guy's Hospital / by B. B. Cooper.

  • Cooper, Bransby Blake, 1792-1853.
Date:
1833
Catalogue details

Licence: Public Domain Mark

Credit: Surgical essays : the result of clinical observations made at Guy's Hospital / by B. B. Cooper. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    From the manner in which the bones of the pelvis are covered with soft parts, and from their immobility upon one another, it is frequently very difficult to detect fractures in them. The following plan, will, however, usually lead to sufficient diagnostic marks to judge of the nature of the injury. Since great violence, such as the passage of a heavy- weight, or a fall from a considerable height, is usually the cause of these injuries, producing at the same time exten- sive contusion of the soft parts, such a history, with the follow^ing train of symptoms, would lead to the suspicion of the bones of the pelvis being broken. Upon the patient being directed to move the buttocks only an inch towards either side in his bed, a deep-seated pain will be immediately felt, rendering him utterly incapable of motion ; and at the same time, he expresses a sensation of crepitus, or grating of the bones upon each other, forming a second diagnostic mark. The surgeon should next place the patient in a perfect horizontal posture, and examine if the anterior and superior spinous processes are on a level, and if the lower extremities are of the same length; when a want of symmetry in either of these instances, would necessarily indicate displacement of the bones of the pelvis. I should here recommend, before the surgeon attempts to discover which of the bones of the pelvis has sustained the injury, that he should first pass a catheter into the bladder, to discover whether or not the urethra has been Injured; for in the force necessary to ascertain the seat of injury to the bones, an additional laceration of the urinary apparatus might be inflicted, and which may be avoided, by having ascertained in the passage of the catheter either the safety or injured state of these parts. For should bloody urine, or difficulty of passing the ca- theter, denote fracture of the pubes, the surgeon would immediately fasten the catheter in the bladder, and apply a broad belt tightly around the pelvis, to keep the bones in