HOME’S PRACTICAL OBSERVATIONS ON STRICTURES IN THE URETHRA, &e. 
been in use now for eight years, a sufficient 
time is elapsed to. admit of some conclusion 
being drawn respecting the consequences 
which are produced by it, and the permanency 
of fts effects ; and so great has been the num- 
ber of those who have submitted to it, that, 
notwithstanding the many difficulties which 
still attend the subject, the following con- 
clusions are given as formed upon a very €x- 
tensive series of observations. 
<© That it does not dispose the parts to take 
on any other disease is sufficiently establish- 
ed, as there is no one instance within my ob- 
servation in which that has been the case. 
«That the parts recover themselves after 
the use of caustic, and acquire the natural 
smooth surface they originally possessed in 
eommon with the rest of the urethra, is also 
completely ascertained. 
«< That removing the strictures restores the 
parts to all their natural functions has been 
proved by the effect.on patients in a married 
state, who had for years palliated the symp- 
toms by means of bougies, and during that 
period had not begot children ; but who were 
afterwards capable of doing so during the 
same marriage. 
«© These are the essential points which 
could not. be determined by any reasoning, 
and were therefore only to be ascertained by 
experience.” 
Several causes of what may be called 
spurious stricture, or temporary obstruc- 
tion of the urethra, are related, all of 
which have been mistaken for true stric- 
* ture, and occasionally have exposed the 
sufferers to the use of the caustic, where- 
by extreme mischief has been produced 
and the practice itself brought into dis- 
_eredit. A most calamitous case is re- 
Jated of inflammation of the bladder pro- 
ducing permanent obstruction ef urine 
and constant pain, which had so much 
the appearance of stricture as to induce 
the surgeon to apply caustic several 
times, and with temporary relief to the 
strangury. ‘The latter part of the case 
is so instructive, that wé must relate it 
in the author’s words. 
«In this state he came to town, and put 
himself under my care.. He was now very 
much emaciated, and appeared to be in a state 
beyond recovery, independently of the state 
of the complaint in his bladder. Upon exa- 
“mining the urethra by a bougie, this couid 
not be passed beyond the bulb of the urethra ; 
1 could not, however, procure any impression 
upon the point of it, so as to satisfy my 
mind of the real state of the part He re- 
quested me to use the caustic, as the only 
means of giving him ease, from the distress- 
mg pain he had at the glans penis ; and ‘upon 
applying it, he found himself next day easier. 
1 made several attempts to get an impression 
777 
of the stricture upon the bougie, but in vain ; 
and always applied the eaustic, to give my 
patient a temporary relief. After using the 
bougie four or five times, I passed a silver 
catheter, of a size larger than the bougie I 
had used, and found it went with perfeet ease 
into the bladder. This explained to me the 
present state of the case ; and I informed the 
patient, that there was now no stricture, the 
passage was perfectly open, and the whole of 
the remaining disease was in the internal 
membrane of the bladder, and therefore the 
only object was to enable the parts to re- 
cover themselves by soothing dhictn: and to 
strengthen the constitution by nourishment. 
He became, however, weaker and weaker, 
and in the course of three months died. 
«« During this period he had frequent ri- 
gors and cold sweats, which are common at- 
tendants upon diseases of the bladder; but 
the symptoms of which he died were wast- 
ing of flesh, loathing of food, occasional 
sickness, without his being aware of his gra~ 
dual decay. At last he was so weak as scarcely 
to bear being moved. He had his faculties 
perfectly clear, and his recollection complete, 
till within a few hours of his death. 
«‘ Upon inspecting the parts after death, 
it appeared that there had been no stricture 
in any part-of the urethra. The internal 
membrane of the bladder was in a state of 
ulceration, particularly the lower part, where 
the ureters enter into it, except a line not 
broader than the eighth of an inch, extending 
from each ureter to the middle line, where 
the two streams would unite. The orifices 
_ of the ureters were in a state of ulceration, 
and inflammation had extended itself along 
the internal surface of the left ureter to the 
kidney, the pelvis and infundibula of which 
were in a state of ulceration. 
«<The use of the caustic had made five 
different holes through the membrane of the 
urethra, of the size of the end of a com- 
mon bougie, ata small distance from each 
other ; a large abscess had formed between 
the perineum and buttock, into which the 
urine escaped by these orifices. The imme- 
diate cause of his death, I should believe, 
was the state of the kidney, having seen two 
other cases in which a diseased state of the 
pelvis of the kidney produced similar symp- 
toms.” , 
A more instructive warning against the 
rash application of the caustic could 
hardly have been found ; and notwith- 
standing the original disease of the blad- 
der and kidney, we can hardly refuse to 
attribute a very large share of the fatal 
event to the caustic itself, the dreadful 
effects of which Mr. H. has so candidly 
related. 
In such cases as these it does not ap- 
pear that the author has'any other cri- 
terion of the existence of stricture than 
