An Account of the Death of the Reverend Dr. Greene, Late Rector of St. George the Martyr in Queen's Square London, and One of the Prebendaries of Worcester, Where He Died of an Hurt Received, as He Was Riding out in the Neighbourhood of That City, Contain'd in a Letter from Tho. Cameron M. D. to the Reverend Charles Lyttelton LL. D. and F. R. S.

VIII. An Account of the Death of the Reverend Dr. Greene, late Rector of St. George the Martyr in Queen's Square London, and one of the Prebendaries of Worcester, where he died of an Hurt received, as he was riding out in the Neighbourhood of that City, contain'd in a Letter from Tho. Cameron M.D. to the Reverend Charles Lyttelton LL.D. and F.R.S. SIR, Read Dec. 10. On Tuesday the 20th of October, 1746-7. about Noon, Dr. Greene's Horse, strong, nimble, and vicious, started under him, at the waving of a Plowman's Whip, and with a quick and violent Jerk, turned quite short, first to the left, and then instantly, and with the same Impe- tuosity, to the right. After galloping a few Paces, the Doctor fell gently off into a Hedge, without receiving any Hurt from the Fall. A Chariot was borrowed, into which he was lifted and brought home; for after this he could never stand. At four that Evening I first saw him, just after he had been blooded. He was very faint, cold all over, and his Pulse scarce perceptible, tho' naturally very strong; the Scrotum so much swell'd, that the Penis was quite absorbed and lost in it, and its Colour a very deep Red. I ordered him a Glass of Wine with a Bit of Bread, for he had eat nothing all that Day. This revived him, and raised his Pulse a little. He then told me, in Answer to the Questions I put, that the Testicles were not hurt; that the twisting of the Horse gave him at that Instant the intolerable Sense of being split asunder. I answer'd, that a violent and sudden Stroke, from the Pummel of the Saddle, upon the Os Pubis, might probably give him that Sensation: He replied, that it did not feel like a Stroke, and still persisted in his first Expression of being split asunder. A warm Fomentation was order'd to be constantly applied, and an Ounce and half of Glauber's Salt, quicken'd with two Grains of Emetic Tartar, to be given in a Quart of Gruel. At Eleven that Night an emollient Glyster was given, the Salts having as yet done nothing. Before Morning he had six large loose Stools; but it gave him exquisite Pain to be lifted upon the Bed-pan. Next Morning, Wednesday, the Swelling was increased, and the Colour deeper. I prescribed an Electuary of Bark and Salt of Amber, to prevent, if possible, the approaching Mortification. The stale Beer Poultice was applied; and that Evening, a Fever coming on, ten Ounces of Blood were taken from his Arm. Next Morning, Thursday, the Salts were repeated without the Emetic Tartar, and he had four Stools. All this while he had made no Water, except about a Spoonful just after he was put into the Chariot. The lower Part of the Belly, where a distended Bladder would certainly point, was not swell'd, tho' the Parts upon the Os Pubis were very much so. The Scrotum increased in Bulk and bad Colour every Hour; and the Inside of the right Thigh Thigh grew very tumid, with great Pain, and a very perceptible Fluctuation in it. These Observations convinced me that the Urine had found a Way into the Parts last-mention'd; tho' indeed I could not account for it, but by supposing that the Urethra had been bruised, even to Laceration, between the Pummel of the Saddle and the Os Pubis, The Surgeon, Mr. Russel, soon came into my Opinion about the Urine, but imagined the Bladder must be burst. This I could not comprehend, nor could he explain; for the Bladder lies out of the Reach of all external Injury from the Causes hitherto assigned in this Case. We agreed however about Three in the Afternoon, Thursday, to make a Puncture into the Scrotum; from whence Urine, manifest to the Smell, issued pretty freely all Night. Next Morning, Friday, a larger Opening was made in the right Thigh with the same Effect. The Parts subsided considerably; but the Pulse rising, Decoctum nitrosum was given with the Bark. This Evening the Hiccup came on, and the Scrotum looked livid. Next Day, Saturday, the common Emulsion, with a little Nitre, and the Extract of Bark with Musk were order'd. But the Hiccup increased, watry Blisters appear'd on the Scrotum, the Voice falter'd, the Head failed, and the Pulse sunk. He grew worse and worse, till he quietly expired on Sunday Morning at Eleven o' Clock. Upon Dissection, we found the Scrotum and Corpora cavernosa Penis mortified; the Osse Pubis wrenched asunder to the Distance of four Inches, and and a Rent in the Bladder, half an Inch in Length, a little above the Neck, and exactly in the middle where the *Osse Pubis* join. This was a very astonishing Sight, and gave me quite a new Idea of the Case; which if any Physician could have discover'd without Inspection, I shall readily allow him more Penetration than I pretend to. We may now however, reason about it, with a little more Certainty than before; and it seems to me, that the Body of the Horse in twisting, acted with the Power of a Lever, to which the Suddeness of the Jerk, added in some measure the Force of Percussion. But all this leaves us still in Wonder at the Effect: For Dr. Greene was a very strong large-boned Man, sixty-four Years of Age, and the uniting Surface of the *Osse Pubis* was considerably broader in him, than either the Surgeon, or I had ever seen in any Subject. I fear I have tired you; but am, *SIR,* *Worcester, Dec. 2.* 1747. Your most obedient humble Servant, Thomas Cameron.