Dr. R. J. Boyd: A psychiatrist was treating a 27-year-old school teacher for a depressive reaction in a severe hysterical character disorder. In spite of treatments she jumped from a fourth-story window in her third suicidal attempt.
On admission to the hospital, she was alert and responsive. Her neurological examination was normal. Her pulse rate was 120 beats per minute, and her blood pressure was 65/40 mm Hg. The osseous thorax was intact, but harsh, coarse breath sounds were heard in the lung bases bilaterally. Chest films were normal. Tenderness in the left lower abdominal quadrant and absence of bowel sounds were noted. Although two abdominal taps were negative for blood or fluid, a flat plate of the abdomen showed peculiar gas shadows lateral to the rectum. After placement of a Foley catheter into the bladder, clear urine was obtained.
A fractured pelvis and a comminuted open fracture of the