Rupture of the Urinary Bladder

1921

J.H., aged 65, arrived at Queenstown by boat at 7.30 p.m. on 27th April, 1921. He stayed at an hotel, where he was a stranger; had a good tea with a glass of beer. Later obtained half a teaspoonful of sweet spirits of nitre from the proprietor, which he took in a little gin, saying that his water was bad. At 1.30 the proprietor heard groans coming from his room, where he found him lying on the floor, evidently in very great agony, and asking for more nitre. Medical aid was sent for, but the patient had expired just prior to arrival. There was blood coming from the penis.

At post-mortem a ruptured bladder was discovered. A ragged tear about one inch long situated posteriorly above the trigone. All other organs healthy except the mucosa of the stomach, which showed signs of a small healed ulcer. No evidence of poisoning. The pelvic peritoneum was acutely inflamed and of a brilliant scarlet colour, doubtless from the extravasated urine. The prostate was enlarged, inflamed, and contained pus. The bladder mucosa was injected and œdematous, and there was a small uric acid stone the size of a bean embedded in the bladder wall. Ureters were normal and not dilated, nor was the pelvis of the kidney. There were no signs of an injury or external violence on the abdomen. Verdict given that death was due to shock and collapse resulting from acute peritonitis caused by free urine in the abdomen.