bladder are
the injuries nearest akin to those we have just considered, but a great
gulf separates them, in so far as the escape of a few drops or even a
considerable quantity of normal urine does not necessarily mean
peritoneal infection. The difference in this particular was very
forcibly demonstrated in my experience, since an uncomplicated
perforation of the bladder in the intra-peritoneal portion of the viscus
proved to be an injury that not infrequently recovered spontaneously, I
believe in a considerable proportion of the cases.

I include only one such case in my list because it was the only example
which happened to be under my personal observation during its whole
course, but from time to time I was shown several others in which the
position of the external apertures and the transient presence of
haematuria left little doubt as to the nature of the injury. The case
recounted above, No. 190, is of especial interest, since the patient
recovered from an injury which involved both the bladder and a fixed
portion of the large intestine in contact with its posterior surface.

In another, No. 194, a transient inflammatory thickening pointed to a
local inflammation of a non-infective character, since no suppuration
ensued, and this may have been a case of extra-peritoneal wound; on the
other hand, the bladder may have entirely escaped injury. In wounds of
the portions of the viscus not clad in peritoneum, as a rule, a very
different prognosis obtains. Two typical cases are related, which I
believe fairly represent the general results which follow when the
bladder is either wounded behind the symphysis or at the base. The first
case, No. 195, exemplifies a very characteristic form of wound when
small-calibred bullets are concerned. The bullet, taking a course more
or less parallel to that of the wall of the viscus, cut a long slit in
its anterior wall. This bullet in its onward passage comminuted the
horizontal ramus of the pubes, and lodged in the thigh. Into the latter
region the greater part of the extravasated urine escaped. I think the
history of this case fully shows that I made a blunder in not performing
a proper exploration, instead of contenting myself with an incision in
the thigh. My only excuse was that the patient at the time I saw him was
in a very collapsed state, and a severe grade of abdominal distension
suggested that septic peritonitis was already in an advanced stage. In
point of fact, the patien