"November 24th. The temperature had risen to above 100°, pulse 104, and patient began to be restless and disposed to vomit. Tym panites increasing, with abdominal tenderness not only above the line of dulness but below it. A large hypodermic needle inserted in the hypogastrium drew out some bloody fluid with an acid reaction and urinous odor. Nothing distinctive could be felt in the rectum. The patient was etherized and an incision, under sublimate irrigation (1 to 1,000), was made, three and one-half inches long in the median line, midway between the symphysis and umbilicus, until the subperi toneal cellular plane was reached, where a large cavity, containing at least a pint of bloody, undecomposed urine, was found. The finger could be carried its full length behind the symphysis, but nothing could be detected. To effect a more complete diagnosis, as well as to allow of the carrying, if possible, of a drainage-tube from - the hypogastric opening clown and out of the perineum, the patient was placed in the lithotomy position, and on a staff introduced into the bladder a median incision was made, opening the urethra just ante rior to the prostate. The finger passed iu here toward the bladder re vealed a rent running along the left side of the roof of the prostate which was lost in the wall of the bladder itself. Through the supra
pubic incision a large silver catheter was carried, and, aided by the finger in the perineal wound, was caused to pass through the lacer ation of the bladder and to emerge from the lower wound. To the eye of this catheter a thread was attached, and a large rubber drainage tube pulled through as the silver instrument was withdrawn. Each end of the tube was secured by a suture to the skin, and a second , drainage-tube was then passed into the bladder, and its external end also fastened in the perineum. The cavity of the extravasation and the bladder were carefully washed out with a warm sublimate solution of 1 to 2,000, and iodoform gauze was placed over each wound, though so lightly that urine could readily flow through the dressing. The progress of the case was in every way most satisfactory, the patient making a complete recovery, and leaving the hospital on December 24th." Penetration of the bladder by sharp instruments, or by bullets and other projectiles, is occasionally met with in civil as well as in mili tary practice. An unusual instance of this kind is recorded by Mr. Couper.