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40 Medico-Legal J. 71 (1923)
Rupture of the Female Urinary Bladder

handle is hein.journals/medlejo40 and id is 79 raw text is: ORIGINAL ARTICLES

Rupture of the Female Urinary Bladder
By
K. Sellers Kennard, M. D.

Traumatic rupture of the urinary
bladder is a condition which in the
great majority of cases is of surgical
interest only. The injury though of
considerable frequency has its most
obvious legal relations to civil actions
in suits for negligence or of claims
under accident insurance policies or
Compensation Acts and Employers'
Liability statutes. Apparently where
the rupture of the bladder is the sole
competent producing cause of death, it
is of extreme rarity as the result of
criminal acts. When the bladder is
ruptured, most often fractures of the
pelvis as the result of great crushing
force is the cause; or punctured or in-
cised wounds of the abdominal wall
may extend into the bladder and in-
jure it.
But this is not rupture per se, for
that form of bladder rupture which we
desire to note here is produced by force
applied directly to the abdominal wall
and the bladder injury is unaccom-
panied by any other evidence of dis-
ease or of force to related parts. The
mechanics by which a healthy bladder
is ruptured by force applied to the
anterior or lateral lower abdominal
wall is no doubt well understood by the
physician. The writer's views on this
subject were expressed in an article
published in the Medico-Legal Jour-
nal, vol. 38, No. 1, p. 5. The method
there discussed applies equally to the
bladder with the exception that it is
necessary for the bladder to be dis-
tended with fluid, otherwise in the
empty or slightly distended condition
the rules of transmitted force ap-
plicable to other organs would not
strictly apply.
This was done not for the purpose
of any surgical instruction, but pri-
marily for medico-legal interest, for
counsel may be very persistent, and
rightly so, as well as exacting, in his
desire to be informed how and why
some given injury of an internal vis-
cus occurred. The medical testimony
as to how an injury occurred anatom-
ically may have important bearing
upon a case in point, for what chain
of circumstances that are urged for

or against a defendant may be im-
possible or otherwise as causative fac-
Lors of the injury in question.
Putting aside all those instances of
rupture of the bladder occurring by
obvious means and in the presence of
witnesses, or by apparent accidents of
trade, occupation or travel, it is hardly
to be questioned that rupture of the
female urinary bladder is of prime in-
vestigative importance. Hardly is it
secondary in importance to rupture
of the uterus and it seems to the
writer that it may be accepted as a
medico-legal axiom that a case of rup-
ture of the urinary bladder of a
woman, occurring under circumstances
which do not admit of ready explana-
tion either by verbal testimony or ap-
parent   circumstantial  evidence,  is
homicidal per se. The degree of homi-
cide is not in question in this presump-
tion, but homicide as distinguished
from accident or suicide under the cir-
cumstances is the intended use of the
term. These cases are most likely to
fall under constructive murder, at
least in New York (Penal Law, 1044-
sub. 2), which provides that an act
by a person engaged in the commis-
sion of, or in the attempt to commit,
a felony either upon or affecting the
person killed though without design
to effect death is guilty of murder in
the first degree.  (P. vs. Schermer-
horn 203 N. Y. 57, P. vs. Wolter 26
N. Y. Cr. 519), and while it is possi-
ble that excusable homicide by mis-
adventure may explain such an affair,
such causation should be of ready ex-
planation and that most likely by the
party at fault.
More than rupture of the uterus is
rupture of the female bladder pre-
sumptive of homicide, for in the for-
mer the probability exists that manip-
ulations of the woman herself, though
denied, may have caused the injury
and this presumption cannot be ex-
cluded in spite of denial unless the
character and extent of the wound ex-
cludes self-infliction and the circum-
stances of injury admit of possible
solution by investigation. Never could
this be applied to the urinary bladder

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