114 PHILOSOPHICAL TRANSACTIONS. [aNNO J 776. 



immediately occurred to Dr. H. that the obstructing body could be no other 

 than the distended bladder, which, having filled the pelvis, pressed downwards 

 where there was the least resistance towards the anus, as well as upwards into the 

 abdomen. From this circumstance he was led to think of discharging the 

 urine by a puncture into the bladder, with a trocar introduced by the anus. He 

 conceived that this method would have advantages superior to any other he had 

 heard of, for simplicity, ease, and safety. The finger could guide the point of 

 the instrument to the very spot of the bladder to be pierced. The coats of the 

 intestinum rectum and bladder, and the intervening cellular membrane, were all 

 that were to be perforated, and they were now pressed so closely together, that 

 there could be no more art required than in piercing any simple bag of water. 

 When the surgeons (who had gone to fetch their instruments) returned. Dr. H. 

 told them what had occurred to him concerning the descent of the distended 

 bladder (for he had not yet examined it) and its pressing the rectum downwards ; 

 he represented to them the hazard and difficulty attending the operation hitherto 

 in use, and proposed this method of perforating the bladder with a trocar intro- 

 duced by the anus. They readily acknowledged the advantage of such a prac- 

 tice, and agreed to give it the preference. They examined with a finger in ano, 

 and felt a large round tumor, a very little way within the orifice, pressing the 

 anterior side of the rectum downwards, and pushing the anus and perinoeum 

 considerably outwards. The gut itself was loose and empty ; and through its 

 relaxed sides the tumor, which was evidently the bladder, was distinctly felt 

 stretching every way, completely filling the pelvis, and feeling like the mem- 

 branes which contain the waters of a woman in labour, thrust into the dilated 

 vagina. Dr. H. described the manner in which he thought the puncture should 

 be made; and, as he imagined that he could better execute what he had himself 

 conceived than another person, he offered to do it ; which being readily assented 

 to, the ojjeration was performed in the following manner. Having placed the 

 patient on his back on a bed, with his breech projecting a little over the side of 

 it towards the light, and his legs bent into the position ti)ey are placed in for the 

 operation of lithotomy, and held by two assistants, a trocar of the middle size, 

 with its point guarded by the extremity of the fore-finger well oiled, was intro- 

 duced into the anus, till the tip of the finger reached the anterior part of the 

 tumor ; when the finger being a little withdrawn, and the point of the instru- 

 ment brought into contact with the tumor, it was plunged into it, in a direction 

 parallel to the axis of the bladder, in an erect posture ; and the perforator being 

 pulled out, the water immediately followed. A straight catheter was quickly 

 introduced through the canula into the bladder, lest, as it collapsed and shrunk 

 upwards as the water was discharged, the canula should prove too short, for its 

 shell was then close to the anus. The canula was then slipped out of the aper- 



