262 peritonitis; inflammation, &c. 
In puncturing in front of the pubes there is very great risk of 
passing the trochar through the intestines, which I am pretty 
certain would have been so in the foregoing case, as they pressed 
up under the bladder to its neck. It naturally may be supposed, 
when the bladder is so much distended, as in this case, that 
it would have pressed the intestines away; but such was not the 
case, as I examined it veiy particularly. Besides, I think that, 
if the bladder could be tapped in front of the pubis, there would 
be great danger in the urine causing considerable irritation at the 
opening from its pendant situation ; and which is well known to 
be the case, even when the perineum has been opened, and which 
part is not near so liable to be so repeatedly irritated with urine 
as that made through the front of the pubes, which must be in 
constant contact with it. 
Again, Mr. Percivall says, that if we puncture the bladder 
through the recti muscles, the trochar will pass behind the peri¬ 
toneal covering, leaving the abdominal cavity uninj ured; but 
from several examinations I conceive that it is impossible to 
avoid passing the trochar through the peritoneum, as I think it 
will be found that the peritoneum is reflected from the abdomi¬ 
nal muscles into the pelvic cavity, and is nearly attached to 
the two ossa innominata, so that it would be impossible to 
pass the trochar without injuring the peritoneum. In operating 
through the rectum these objections, I think, cannot arise, as I 
imagine there would be no danger of the opening of the rectum 
and bladder speedily closing. I do not see any great objection in 
passing a flexible piece of whalebone up the urethra as far as the 
perineum, and so cut down upon it and pass a female catheter 
direct into the bladder. I should even prefer this to puncturing 
in front of the pubes, although I am aware that there is great dif¬ 
ficulty in getting the opening in the perineum to grow up : there 
certainly is a great advantage in puncturing the perineum ; for it 
is a part where we can easily get at, and can at any time introduce 
the catheter, or even leave it in, j ust as we like. Upon the whole, 
therefore, if it should be found that the bladder can be punctured 
above the pubes without injuring the intestines and peritoneum, 
and that the urine does not irritate the aperture, then I should 
say, by all means operate there; but if, after repeated exami¬ 
nations and operations, it should be found not to answer our ex¬ 
pectations, then, I should say, operate through the rectum ; 
and which, in my opinion, is to be preferred, until the above ob¬ 
jections are found not to be well founded. 
These remarks, your readers must be aware, are not founded 
on experience, but from examinations and plausible deductions, 
and I am not aware of any English author having rationally 
