5 80 Dr. Hamilton’s Account of the 
of the bladder, met there with an obftrudlion not to be 
overcome. Under fuch prefling circumftances no time 
■was to be loft. The patient’s life was in imminent dan- 
ger, either from a rupture, or a gangrene of the bladder. 
The approach of the latter was loon to be apprehended, 
from the hiccup and fmallnefs of the pulfe. There was 
no alternative left ; the bladder mult be fpeedily emptied 
by an aperture fome where, or the patient muft perifti. 
The l'urgeons, therefore, went to prepare their inftru- 
ments for making an opening into the bladder. Re- 
fledting, in their abfence, on the moft eligible method 
of performing the operation, I was in fome degree of 
perplexity ; for 1 did not much approve of any of the 
methods recommended by the belt chirurgical writers; 
either that of making a perforation above the os pubis, 
in the place where the higher operation of lithotomy 
is performed; or that of the puncture in perinao . Whilft 
I was confidering what was to be done, the mother of 
the patient told me, that fhe had feveral times that day 
attempted to give him a clyfter, but had not been able to 
introduce the pipe, by reafon of a large fubftance low in 
the gut near the fundament, which flopped up the paf- 
fage. It immediately occurred to me, that the obftruefting 
body could be nootherthan the diftended bladder, which, 
having filled the pelvis , preffed downwards where there 
was the leaf! refiftance towards the anus , as well as up- 
wards into the abdomen. From this circumftance I was led 
to think, of difeharging the urine by a puncture into the 
bladder, with a trocar introduced by the anus. I con- 
ceived that tliis method would have advantages fuperior 
to 
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