of Fkacture of the Pelvis. By T. P. Dublin. ?J. G., aged sixty-five, was admitted into Jervis Street Hospital, under my care, on the 29th of last November, having fallen from a drawing-room window into an area, a distance of about twenty feet. "When I saw him he was lying in bed, unable to move the left leg, which had the appearance of slight shortening and inveroion. On measurement, both limbs were found to be of equal length. No crepitus could be detected, although every effort was made to elicit it. dotation outwards gave great pain; no other movement gave any. There was a fulness in the left groin, and ecchymosis of the scrotum. He had no collapse or constitutional disturbance of any kind. Ordered to remain quiet in bed, and sand-bags to be placed on each side of the limb. The next day the fulness in tlie groin had somewhat subsided, and he was able, with some exertion, to flex the limb. No other symptoms developed themselves until Depember 3rd, when I found, on my morning visit, a decided change for the worse. The tongue bad become brown and coated; the pulse, hitherto not more than 80, had risen to 130, full and bounding. Suspecting, from the above symptoms and the nature of the accident, that there was pelvic injury, I tried to pass a catheter, but failed, owing to an almost impassable stricture and false passage (the former he stated he bad since be was seventeen.) On removing the instrument he passed a fair quantity of urine, of normal colour, and without any tinge of blood. Ordered stimulants, opium, and an enema. From this time he rapidly sank, and died on the morning of the 5th instant. Being obliged to leave town for a few days, the post-mortem examination was kindly performed for me by my colleagues, Drs. Stapleton and Corly. On opening the abdomen, a largo quantity of effused blood was found in the left iliac fossa, underneath the peritoneum in the subserous cellular tissue, extending up under kidney. Sigmoid flexure of the oolon and upper portion of the rectum were largoly distended with flatus. and A fracture was found extending through the acetabulum body of the pubis on left side, another through the thyroid foramen and body of tho pubis on the right side, completely detaching the intermediate portion of bone. Behind there was fracture, with displacement upwards, at the left iliac synchondrosis, which explains the apparent shortening of the limb noticed on admission. There was both a longitudinal and transThe bladder was enormously verse fracture of the sacrum. thickened and contracted. The passage through tho membra-
Remaiikable Case
TTalshe,
September 1,
MILITARY MEDICINE IN EEANCE.
1870.]
portion
of the urethra was almost obiliterated, and the refalse passage apparent. There are, I think, several points of interest connected -with this case, viz., the absence of any collapse or constitutional disturbance after such a number of fractures, as was afterwards revealed at the autopsy; the length of time the patient lived after the inj ury, although an old man; the absence of any nous
mains of
crepitus
a
pain,
or t.lfm rmfwntvla\
?
the latter
only
caused by one movement hollow visCfirn. frnm
t.hfi
(rota-
191
Remaiikable Case
TTalshe,
September 1,
MILITARY MEDICINE IN EEANCE.
1870.]
portion
of the urethra was almost obiliterated, and the refalse passage apparent. There are, I think, several points of interest connected -with this case, viz., the absence of any collapse or constitutional disturbance after such a number of fractures, as was afterwards revealed at the autopsy; the length of time the patient lived after the inj ury, although an old man; the absence of any nous
mains of
crepitus
a
pain,
or t.lfm rmfwntvla\
?
the latter
only
caused by one movement hollow visCfirn. frnm
t.hfi
(rota-
191
