Consideration and respect for the female is all but universal in the sexual relationships of the animals
below man; it is only at the furthest remove from the “brutes” among civilized men that sexual
“brutality” is at all common.
Bladder rupture, the most consequential event leading to the death of Virginia Rappe, is a rare occurrence when cystitis is the cause. Other variables are needed and cystitis is a wide and generic term. In cases of interstitial cystitis (IC), a type of bladder pain syndrome (BPS), the cause is still unknown. But for a rupture to occur there must be urine retention and bladder distention as well as reduced bladder capacity due to unknown etiology, and so on.
When it happens, the rupture occurs at the vault or the junction of the superior and posterior walls—i.e., the site of Rappe’s injury. The defense in the Arbuckle trials hoped to convince the jury that hers was a rare case, an exotic bladder wall disease or a spontaneous rupture, that happened by chance on September 5, 1921, at a party given by Roscoe Arbuckle and his friends at the St. Francis Hotel. The defense didn’t need to be too exacting about how likely one of those scenarios was — they merely needed to introduce doubt about the theory that Roscoe Arbuckle contributed to the rupture. They also implied that Rappe was sexually promiscuous at an early age and had been pregnant in her early teens, subtly characterizing her as a “fallen woman,” and their client had simply happened upon her in his bedroom after the rupture had occurred due to natural causes.
Arbuckle’s lawyers found physicians in San Francisco for authority and physicians in Chicago who would state for the record that they treated or may have treated Virginia Rappe between 1908 and 1914. Truly exotic conditions, such as tuberculous cystitis weren’t mentioned during the three trials. Because it was never mentioned in the trial transcripts or newspaper coverage, they almost certainly didn’t know that Rappe’s mother, Mabel Rappé, had died of tuberculous lymphadenitis (also known as tuberculous adenitis or by the traditional names scrofula and the “king’s evil”). Having mentioned such a thing would have either strengthened the defense’s argument or further confused jury members who were tasked with distilling a variety of anatomical descriptions and medical conditions in their effort to find the truth.
Tuberculous lymphadenitis is the most common form of the tuberculosis infection that appears outside the lungs, which presents as a swellings and ulcerations in neck from infected lymph glands. Virginia Rappe, as an adolescent, would have been exposed to TB. The third most common is genitourinary tuberculosis, which is often misdiagnosed as a urinary tract infection (UTI) or cystitis. both acute and chronic.
The physicians who examined Rappe’s bladder shortly after her death and later, preserved in formaldehyde for weeks, didn’t see the tell-tale ulceration caused by bladder TB. They only observed what appeared to be a mild form of acute cystitis and that Rappe’s bladder was smaller than a normal human female’s bladder. And, anatomically speaking the tear in her bladder, no wider than a penny, was where it would occur if the rupture was due to a distended bladder.
As one contemporary medical text put it, “Rupture of the bladder usually results from severe crushing accidents”—and this is what Arbuckle’s prosecutors saw as the crime for which they originally wanted Arbuckle tried for murder, not manslaughter. All 264 pounds of him was the murder weapon. He had forced himself on her without her consent and caused her bladder to pop like a balloon.
Occasionally, in the diseased bladder, the pressure of retained urine may cause rupture; rarely this occurs during labor. The initial symptoms are usually as if something gave way inside. If the bladder has been greatly distended, there may be a momentary feeling of relief. Pain in the whole abdominal cavity results. Shock is added, the patient is prostrated and unable to walk. Treatment by surgical means is imperative.
The term “distended bladder” was rarely used by the Arbuckle’s lawyers and prosecutors—even though Rappe, having been locked out of one bathroom in Arbuckle’s three-room suite, had been observed hurriedly walking to the vacant bathroom in Arbuckle’s bedroom—room 1219. The word “urine” also seems to have been studiously avoided during the trials—as if a matter of decorum or to avoid confusion with one of Arbuckle’s prosecutors who bore the homophonic surname of U’Ren. But urine is the bodily fluid on which the Arbuckle case sets sail, so to speak.
Once Rappe disappeared into 1219, Arbuckle followed and closed and locked the door.
In our narrative, we have to accept that the amount of time Rappe and Arbuckle were alone in 1219 is, well, fluid. Arbuckle’s lawyers pared the time down to ten minutes. The prosecution stretched it to as long as forty-five. If one accepts that Virginia Rappe went to 1219 to pee, she was unsuccessful in accomplishing that.
In Arbuckle’s “Good Samaritan” testimony of the first and third trials, he explained that he didn’t seek help for Rappe because she had only vomited, despite the lack of any reported evidence of this other bodily fluid in the room. In his testimony he also never mentions any sexual activity.
But it is implied by the prosecution that Arbuckle assaulted Rappe, that she resisted, and that his weight caused her bladder to rupture. And for that to happen, her bladder had to be nearly full.
Without saying it explicitly, the prosecution’s intention was to show that Arbuckle didn’t give Rappe a chance to use the bathroom—and if he did—nothing came out of her—or not enough. To the prosecution, any surplus of unaccounted-for time was left to the juror’s imagination. The prosecution made no inference that Rappe did anything with Arbuckle that was consensual. They only saw a clumsy rape attempt and a coverup.
In our narrative, we see the possibility for consensual sex, but also non-consensual, and something in between that we will call “business,” for which Rappe expected a quid pro quo in the form of a career boost, a source of income to replace what she lost after her breakup with the comedy director Henry Lehrman. (That he himself had nudged her in the direction of Arbuckle as a benefactor was discussed in the film colony if not in court.) And this brings us to the most indelicate question from the Arbuckle case that, if discussed openly in the lost trial transcripts, never made the family newspapers: Can the weight of a man during intercourse cause his willing or unwilling partner’s bladder to rupture?
One intrepid medical journal gave this question at least a terse but intriguing answer. The Urologic and Cutaneous Review 26, no. 4 (1922) featured a short piece that reacts to the outcome of first trial’s hung jury of ten to two for acquittal.
In a recent California manslaughter case, one of the issues raised was whether bladder rupture could result from a force applied external to the abdomen during coitus. At the first trial, the jury disagreed; a hysterical jurywoman [i.e., Mrs. Helen Hubbard] insisting despite every argument on a verdict of guilty. The bladder is so protected by the abdomen that rupture from any but extreme violence producing concussional effects is doubtful and the bladder must also be unhealthy. Concussional effects of this type would produce extreme discolorations. These were not present in this case. The question is a different one where injuries of the bladder by coitus within the vagina occur.* Cases of this type have been repeatedly reported. The evidence against internal violence was so great that external violence was insisted on by the prosecution. (p. 252)
Where does this intriguing brief take us? What is the author saying?
He (or possibly she) sees the human urinary bladder as well protected by bone and surrounding tissue inside the pelvic cavity or arch. But this protection is lost when the organ overdistended. Furthermore, the author only considers “extreme violence,” which would result in extreme abdominal bruising (ecchymosis) if we are reading this correctly. But he seems to only consider the bruises to Rappe’s arm, not those found on her midriff, thighs, and calves. This is probably because the trial testimony didn’t put emphasis on the other discolorations.
Without a solid reference to the Medical Standard, we can’t investigate what is meant by “injuries of the bladder by coitus.” We can only guess what is meant by the “evidence against internal violence.” (There is, indeed, a wealth of veterinary literature from this period about bladder ruptures in female livestock due to coitus that could lend itself to the human act.) The newspaper and extant court reportage are silent on any kind of sex acts performed on Rappe beyond Arbuckle allegedly slipping ice into her vagina to, as he put it, restore her to consciousness. The prosecution only focused on a rape attempt that they discreetly referred to as an “assault,” and used pioneering fingerprint evidence taken by Edward O. Heinrich to show that a struggle occurred as Rappe presumably tried to exit room 1219 through the hallway door.
While the author of the note acknowledges a body of evidence that supports the possibility that coitus can injure a bladder, the meaning of “internal violence” is left to the imagination and left out of the Arbuckle–Rappe paradigm. What he alludes to, however, isn’t the “honeymoon night” of normal, human coitus in 1921, that is, the ventral–ventral or “missionary” position with the requisite gentle massage that leads to, at least, the male climax. Hence, we must look elsewhere for a source of “internal violence” or a combination of external and internal violence or force or pressure.
Rappe’s escort to the Arbuckle party, Maude Delmont, as well as another attendee, said that the party got “rough.” That is to say, some men began to force themselves on women. These men were inebriated and partially clad to facilitate sexual activity. The pornography of the day, if it accurately reflects the norms of the era, rarely shows a man completely undressed. They are even shown in their shoes, stockings, and garters as though they were off to work.
Arbuckle, given his size and assuming his intention was to have a discreet “quickie” without interruption, probably would have favored a dorsal–ventral position or, in other words, doggy-style. If he was considerate to Rappe—whether consensual or submissive to her host, a “good fellow” to use Delmont’s term—such a route would have been tolerable, a small mercy.
But haste and other factors must be considered, especially in regard to Arbuckle. He had been drinking. We know from his wife, Minta Durfee, that he suffered from periodic impotence, erectile dysfunction. Any kind of erection only had a certain duration. Courtship, “spooning,” and foreplay were out of the question given the need for immediate gratification. Thus, Rappe needed something to hang onto to brace herself for intercourse from behind, whether normally or Venus aversa. There was the pedestal sink in the bathroom and possibly the toilet bowl. Two brass beds were in room 1219—with sturdy brass rails to catch any fall as well as provide a bolster. The beds themselves had either bedsprings or box springs, which would have lacked the firmness of modern mattresses and were, of course, noisy. Given the presence of the revelers in room 1220 and the atmosphere of “merrymaking,” the rhythmic report of bedsprings would have invited unwanted interruptions to privacy and the concentration that Arbuckle might have needed. But, again, this presupposes that Arbuckle’s purpose for entering the room was something other than what he described under oath.
The “concussional effects” spoken of above—the pounding, the crush on Rappe and the hard surface underneath her—could have come with sexual climax or the urgency to revive a flagging erection or, given the obstruction of Arbuckle’s paunch, to find and keep inside his “mate” for the duration.
Let’s not laugh at the double entendre here. This could be the real tragedy that Arbuckle’s defense and prosecution had to dance around, that the motion picture industry of 1921 surely didn’t want getting out of room 1219 alive, that had to be put behind them at any cost.
 See, for example, Philip M. Hanno et al. (eds.), Interstitial Cystitis (London: Springer Verlag, 1990).
 Her 1905 death certificate reveals that she used this spelling.
 “Bladder, Diseases of,” Encyclopedia Americana (New York: Encyclopedia American Corporation, 1923), IV:50. Save for treatment, this article agrees with the medical literature of the early twentieth century and to this day.
 The Hathi Digital Library has an almost complete run of the Medical Standard, but we have yet to find what article is cited here.