2.1.7. OP VOLITION. 335 



An inability to empty the bladder frequently occurs to elderly 

 men, and is often fatal. This sometimes arises from their 

 having too long been restrained from making water from acci- 

 dental confinement in public society, or otherwise; whence the 

 bladder has become so far distended as to become paralytic; and 

 not only this, but the neck of the bladder has become contracted 

 so as to resist the introduction of the catheter. In this deplora- 

 ble case it has frequently happened, that the forcible efforts to 

 introduce the catheter have perforated the urethra; and the in- 

 strument has been supposed to pass into the bladder, when it has 

 only passed into the cellular membrane along the side of it; of 

 which I believe I have seen two or three instances; and afterwards 

 the part has become so much inflamed as to render the introduc- 

 tion of the catheter into the bladder impracticable. 



In this situation the patients are in imminent danger, and some 

 have advised a trocar to be introduced into the bladder from the 

 rectum; which I believe is generally followed by an incurable 

 ulcer. One patient whom I saw in this situation, began to make 

 a spoonful of water after six or seven days, and gradually in a 

 few days emptied his bladder to about half its size, and re- 

 covered; but I believe he never afterwards was able completely 

 to evacuate it. 



In this situation I lately advised about two pounds of crude 

 quicksilver to be poured down a glass tube, which was part of a 

 barometer tube, drawn less at one end, and about two feet long, 

 into the urethra, as the patient lay on his back; which I had 

 previously performed upon a horse; this easily passed, as was 

 supposed, into the bladder; on standing erect it did not return, 

 but on kneeling down, and lying horizontally on his hands, the 

 mercury readily returned; and on this account it was believed 

 to have passed into the bladder, as it so easily returned, when the 

 neck of the bladder was lower than the fundus of it. But never- 

 theless as no urine followed the mercury, though the bladder 

 was violently distended, I was led to believe, that the urethra 

 had been perforated by the previous efforts to introduce a cathe- 

 ter and bougie; and that the mercury had passed on the outside 

 of the bladder into the cellular membrane. 



As the urethra is so liable to be perforated by the forcible ef- 

 forts to introduce the catheter, when the bladder is violently dis- 

 tended in this deplorable disease, I should strongly recommend 

 the injection of a pound or two of crude mercury into the ure- 

 thra, to open by its weight the neck of the bladder previous to 

 any violent or very frequent essays with a catheter, whether of 

 aetal or of elastic resin. 



7, Rerti paratysis. Palsy of the rectum. The rectum intes- 



