CLASS III. 2.1.7- OF VOLITION. 3 3 5 



An inability to empty the bladder frequently occurs to elder- 

 ly men, and is often fatal. This fometiines arifes from their 

 having too long been reftrained from making water from acci- 

 dental confinement in public fociety, or otherwife j whence the 

 bladder has become fo far diftended as to become paralytic ; and 

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

 fo as to refift the introduction of the catheter. In this deplora- 

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

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

 ftrument has been fuppofed to pafs into the bladder, when it has 

 only pafled into the cellular membrane along the fide of it j of 

 which I believe I have feen two or three inftances 5 and after- 

 wards the part has become fo much inflamed as to render the 

 introduction of the catheter into the bladder impracticable. 



In this fituation the patients are in imminent danger, and 

 fome have advifed 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 faw in this fituation, be- 

 gan to make a fpoonful of water after fix or feven days, aad grad- 

 ually in a few days emptied his bladder to about half its fize, 

 and recovered ; but I believe he never afterwards was able com- 

 pletely to evacuate it. 



In this fituation I lately advifed about two pounds of crude 

 quickfilver to be poured down a glafs tube, which was part of a 

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

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

 previouily performed upon a horfe ; this eafily pafled, as was 

 fuppofed, into the bladder ; on Handing 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 be!: 

 to have pafled into the bladder, as it fo eafily returned, when the 

 neck of the bladder was lower than the fund us of it. But nev- 

 erthelefs as no urine followed the mercury, though the bladder 

 was violently diftended, 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 pafled on the outfide 

 of the bladder into the cellular membrane. 



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

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

 tended in this deplorable difeafe, I thould ftron^ly recommend 

 the injection of a pound or two of crude mer the ure- 



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

 any violent or very frequent eflays with a catheter whether of 

 metal or of elaftic refin. 



7- ReiTiiparaltfis. . Palfy of the rectum. The rectum intef- 



tinum, 



