fl 



94 SURGERY. 



of the urethra, and pressed steadily, but gently, against any ob- 

 struction. Relaxation of the spasm may also be produced by bleed- 

 in-, warm bath, Dover's powder, laudanum enemala, and cold 

 water upon the genitals. Should all these means fail, and life be 

 endangered, the bladder should be punctured from the rectum. 



Permanent Stricture.— i:\{is is a contraction from permanent in- 

 flammation, plastic deposit having taken place m the submucous 

 cellular tissue. The occasion of this inflammation may be clap, 

 venery, kicks or blows, riding on horseback, acrid urine, drinkings, 

 &c The most frequent sites are at the commencement of the naem- 

 branous portion of the urethra, and also within a few inches ot the 

 glans penis. The extent and degree of contraction vary : some- 

 fimes the stricture is very tight, but limited, as if a thread had been 

 tied around the urethra ; more frequently it is of greater extent, con- 

 tinuin- from a quarter of an inch to several inches. Several 

 strictures may exist at once. Behind the stricture the urethra is 

 enlarged, and serves to catch a calculus. , „ , 



Simptoms.—Th^^e come on gradually : middle-aged men are most 

 liable. Urination is frequent, tedious, and painful : the stream is 

 thin, twisted, or forked. After urination a few drops pass which had 

 collected behind the stricture. Pain in the perineum, thighs and 

 loins; erection is often painful: semen does not escape in coition, 

 but passes into the bladder, and afterwards is voided with the urine; 

 chill and fever constantly occurring, as in ague: a slight discharge is 

 visible at the end of the penis upon rising in the morning ; the testi- 

 cles, rectum, and bowels sympathize, and the general health fails. 



Treatment.— \si. Dilatation by bougies of flexible metal, sil- 

 ver, or sum elastic, of sufficient size, since small bougies are more 

 apt to be entangled than large ones. The natural structures are not 

 to be mistaken for strictures, viz., an enlarged lacuna in the lossa ; 

 spasmodic contraction of the accelerator urin^e muscle ; the trian- 

 gular ligament, and prostate gland. The operations must be fre- 

 quent and cautious until the cure is complete, and even afterwards 

 to prevent return of this disease, which is not uncommon; mdeed 

 there is no certainty that it will not return. 2d. Caustic applied 

 firmly to the stricture; it destroys irritability but is more advan- 

 Leous in stricture near the glans than the bladder. U Punctura. 

 tion.-By means of a lanceted stilet, introduced concealed in a silver 

 canula ; after the division, a catheter is to be introduced 4th. Open- 

 ing the urethra through the perineum, resembling a lithotomy opera- 

 tion; a catheter is then introduced into the bladder, and the wound 

 heals over it. 



FISTULA IN PERIN^O. 



This is usually the result of abscess of the perineum, or a wound. 

 The patient has rigors, fever, and an exquisitely painful promi- 



