Of the Puncture of the PARINÆUM.
THIS Operation is performed, when the Bladder is under such a Suppression of Urine, as cannot be relieved by any gentler Methods, nor by reason of the Obstruction in its Neck, or the Urethra will admit of the Introduction of a Catheter. The manner of doing it, as described by most Writers, is by pushing a common Trocar from the Place where the external Wound in the old way of cutting is made, into the Cavity of the Bladder, and so procuring the Issue of the Water through the Canula; but others, refining upon this Practice, have ordered an Incision to be carried on from the same Part into the Bladder, and then to insinuate the Canula: But in my Opinion, both the Methods are to be rejected, in favour of an Opening a little above the Os Pubis: For besides, that it is not easy to guide the Instrument thro' the prostate Gland into the Bladder, the Necessity of continuing it, in a Part already very much inflamed and thickened, seldom fails to do Mischief, and even to produce a Mortification.
Some time since, a Gentlewoman complained of a Difficulty in making Water, which she voided by Drops with excessive Pain; and soon after, the urinary Passage became totally obstructed. Having in vain attempted to pass the smallest Catheter I could get, I introduced my Finger into the Vagina, and felt a very hard Tumour about the neck of the Bladder: The Patient had not voided any Water for five Days, and being in the utmost Agony, and as we judged within a few Hours of dying, I put in practice the Incision above the Os Pubis, making the Wound of the Skin about two Inches long, and that of the Bladder about half an Inch: Having emptied by this Means, a prodigious quantity of Water, I kept the Orifice open with a hollow Tent, 'till such time as the Tumour subsided, which, with proper Medicines, it did by degrees; and in about six Weeks, all her Water came the right Way, and some time after, she recovered perfect Health. I have lately practised a Method still more easy both to the Patient and the Operator; which consists only in emptying the Bladder with a common Trocar, and stopping the Canula with a little Cork, which is afterwards to be taken out, as often as the Patient has occasion to urine. The Canula is to be continued in the Bladder, till such time as the Person finds he can void his Urine by the natural Passage.
In this Operation the Abdomen ought to be perforated about two Inches above the Os Pubis; and if the Patient be fat, the Trocar should penetrate two Inches, otherwise, an Inch and a half will be sufficient; this Precaution is of great Importance, for I have seen an Example, where the Trocar being introduced nearer to the Os Pubis, the Extremity of it pressed upon the lower Portion of the Bladder, and in a few Days made a Passage into the Rectum.