During the first month urine passed freely through the wounds made by the entrance and exit of the ball, and was generally mixed with pus and blood. Fecal matter was frequently discharged through the posterior wound. Some time during the third week he passed several small pieces of bone by the rectum. At the end of the fifth week the wound of exit healed, and for the first time after his injury urine was discharged through the urethra. The wound of entrance gradually closed after five months, but opened again in a few weeks and continued, at varying intervals, alternately closed and open until September, 1865. At this time, on sounding the man, it was found that he had stone; this was removed by lateral operation, and was found to weigh 2 1/4ounces, having for its nucleus a piece of bone about 1/2 inch long. Dougherty reports the operation of lithotomy, in which the calculus removed was formed by incrustations about an iron bullet.
In cases in which there is a fistula of the bladder the subject may live for some time, in some cases passing excrement through the urethra, in others, urine by the anus. These cases seem to have been of particular interest to the older writers, and we find the literature of the last century full of examples.
Benivenius, Borellus, the Ephemerides, Tulpius, Zacutus Lusitanus, and others speak of excrement passing through the penis; and there are many cases of vaginal anus recorded. Langlet cites an instance in which the intestine terminated in the bladder. Arand mentions recovery after atresia of the anus with passage of excrement from the vulva. Bartholinus, the Ephemerides, Fothergill, de la Croix, Riedlin, Weber, and Zacutus Lusitanus mention instances in which gas was passed by the penis and urethra. Camper records such a case from ulcer of the neighboring or connecting intestine; Frank, from cohesion and suppuration of the rectum; Marcellus Donatus, from penetrating ulcer of the rectum; and Petit, from communication of the rectum and bladder in which a cure was effected by the continued use of the catheter for the evacuation of urine.
Flatus through the vagina, vulva, and from the uterus is mentioned by Bartholinus, the Ephemerides, Meckel, Mauriceau, Paullini, Riedlin, Trnka, and many others in the older literature. Dickinson mentions a Burmese male child, four years old, who had an imperforate anus and urethra, but who passed feces and urine successfully through an opening at the base of the glans penis. Dickinson eventually performed a successful operation on this case. Modern literature has many similar instances.
In the older literature it was not uncommon to find accounts of persons passing worms from the bladder, no explanations being given to account for their presence in this organ. Some of these cases were doubtless instances of echinococcus, trichinae, or the result of rectovesical fistula, but Riverius mentions an instance in which, after drinking water containing worms, a person passed worms in the urine. In the old Journal de physique de Rozier is an account of a man of forty-five who enjoyed good health, but who periodically urinated small worms from the bladder. They were described as being about 1 1/2 lines long, and caused no inconvenience. There is also mentioned the case of a woman who voided worms from the bladder. Tupper describes a curious case of a woman of sixty-nine who complained of a severe, stinging pain that completely overcame her after micturition. An ulceration of the neck of the bladder was suspected, and the usual remedies were applied, but without effect. An examination of the urine was negative. On recommendation of her friends the patient, before going to bed, steeped and drank a decoction of knot-grass. During the night she urinated freely, and claimed that she had passed a worm about ten inches long and of the size of a knitting-needle.
It exhibited motions like those of a snake, and was quite lively, living five or six days in water. The case seems quite unaccountable, but there is, of course, a possibility that the animal had already been in the chamber, or that it was passed by the bowel. A rectovaginal or vesical fistula could account for the presence of this worm had it been voided from the bowel;nevertheless the woman adhered to her statement that she had urinated the worm, and, as confirmatory evidence, never complained of pain after passing the animal.
Foreign bodies in the bladder, other than calculi (which will be spoken of in Chapter XV), generally gain entrance through one of the natural passages, as a rule being introduced, either in curiosity or for perverted satisfaction, through the urethra.
Morand mentions an instance in which a long wax taper was introduced into the bladder through the urethra by a man. At the University Hospital, Philadelphia, White has extracted, by median cystotomy, a long wax taper which had been used in masturbation.
The cystoscopic examination in this case was negative, and the man's statements were disbelieved, but the operation was performed, and the taper was found curled up and covered by mucus and folds of the bladder. It is not uncommon for needles, hair-pins, and the like to form nuclei for incrustations. Gross found three caudal vertebrae of a squirrel in the center of a vesical calculus taken from the bladder of a man of thirty-five.
