778 
the impression made on the point of the 
bougie. 
The author next relates several very 
interesting cases of strictures requiring 
an unusual number of applications of the 
caustic for their removal. He attributes 
this to a change in the texture of the ori- 
ginal stricture, and a supposed complica- 
tion of action and re-action between old 
and new strictures. In one of the cases 
the caustic had been applied during six 
years no less than 486 times. The final 
success was considerable and * probably 
would be compleat, and a just observa- 
tion is added which will apply to many 
of these excessively tedious cases. 
«In 1803 this patient continued free from 
any relapse, but was under the necessity of 
passing a bougie daily, and leaving it in the 
urethra for half an hour, to keep the canal in. 
a state of tranquillity ; for he found that when 
he omitted to do so, occasional symptoms 
of irritation came on, 
«*On contemplating the sufferings of the 
patient during so long a period as six years, 
it may be observed, that few men would have 
had the same degree of perseverance, and that 
a cure was hardly worth so dear a price. 
This, however, is not by any means a just 
view of the case, since the whole time he 
was under this treatment he suffered less, 
both in body and mind, from the effects of 
the caustic, than he had done from the symp- 
toms of the disease previous to its bein 
adopted, and the degree of relief he used 
from the immediate effect of the applications 
upon the parts irritated, was more than suf- 
ficient to counterbalance the local pain it pro- 
duced.” 
A very long and very prolix but 
highly valuable case is given by the pa- 
tient himself, a general officer, past the 
middle age, Ss ppm long suffered under 
severe stricture, that had baffled Daran, 
Hunter, and many of the men of pecu- 
liar eminence in diseases of this organ. 
The case is a daily register for’ five 
months of incessant application of caus- 
tic at as short intervals as could possibly 
be allowed of, and attended with the final 
success of making a complete passage 
through a great variety of strictures into 
the bladder. 
After this point was secured, the pa- 
tient recovered to so great a degree as 
to enjoy life very considerably, though 
the power of retaining urine was so much 
impaired as to prevent him from mixing 
freely in society, and a mucous discharge 
from the bladder remained. It is flat- 
tering to the practitioner, after so long 
and assiduous attendance, to have his 
MEDICINE, SURGERY, ANATOMY, &c. 
patient thus describe his feelings and his 
sentiments. : 
«« Now for the bright side of the picture; 
my general health is so much improved, that 
Iam congratulated by all my acquaintance 
upon my appearance. I can 1ide ten miles 
with much satisfaction, and whenever I 
have a call to make water, it passes without 
difficulty. I feel no pain of any kind; in 
short, could I surmount the frequency of 
making water, there would be very few men 
of my age (sixty-five) more robust. This 
amazing change from a life of pain and mi- 
sery I attribute entirely to the operation of 
the caustic. This copy of the journal, which 
I kept during the operation, I give to Mr. 
Home, and hope he will be pleased to consi- 
der it as an acknowledgment of his profes- 
sional abilities, and of my grateful remem- 
brance of their exertion.” 
Four years afterwards this patient 
died. The irritability of the bladder, 
which had never left him, encreased, 
calculous concretions formed, and his 
complicated sufferings put an end to his 
existence. On dissection the cause of 
death was traced to the bladder, but the 
urethra remained sound and uniform 
through its whole extent. 
Our limits will not allow us to exa- 
mine the other cases of disease occasion 
ed by and accompanying stricture. 
A valuable chapter, already published 
in the second volume of the transactions 
of a society for promoting medical and 
chirurgical knowledge, is here very pro- 
perly inserted, containing cases in which 
suppression of urine, in consequence of 
stricture, has required puncturing the 
bladder. 
Some cases are given of strictures in 
the zsophagus, cured by the bougie sim- 
ple, or armed with caustic. The fol- 
lowing valuable diagnostic remarks we 
shall transcribe. Besides the stricture, 
the esophagus is liable to two other dis- 
eases, both of which produce difficulty: 
of swallowing. 
«« One of these is a thickening of the coats 
of the esophagus, which extends to the sur- 
rounding parts, and in the end generally be- 
comes cancerous, or, in other words, an in- 
curable disease: the other is an ulcer on the 
lining of the zsophagus; this last is com- 
monly a little below the seat of the stricture, 
and is upon the posterior part which lies on 
the vertebrae ofthe neck. Both of these pro- 
duce a difficulty in swallowing, and in their. 
early stages are only to be distinguished from 
stricture by an examination with the bougie 5 
when the disease is more advanced, the other. - 
