URETHRA. 



but he thought the opinion founded on prejudice ; for he 

 had feen as many (triclures after gonorrhceas, which had been 

 cured without injeftions, as after other cafes, which liad 

 been cured with them. Such modes of accounting for ftric- 

 tures, he obferves, give no explanation of cafes which have 

 not been preceded by gonorrhoea, or the ufe of injeftions. 

 Sir E. Home alfo thinks differently from Mr. Hunter re- 

 fpe&ing injeftions, the injudicious ufe of which he conceives 

 may often caufe ilridtures. StriAures have fometimes been 

 fuppofed to arife from the healing of ulcers in the urethra ; 

 but Mr. Hunter fays, he never faw a fore in this paflage, ex- 

 cept in confequence of a ftrifture, and he therefore does not 

 fubfcribe to the opinion. 



The ftone is fometimes a caufe of flriiSure, and this occa- 

 fjonally happens in infancy. Sir E. Home has met with 

 cafes of this kind in children only fix years of age ; and, 

 from other examples which he has recorded, it would appear, 

 that the difeafe is frequent in calculous patients of more ad- 

 vanced years. 



In the Eaft Indies, and other warm climates, ftridlures 

 are much more readily brought on than in Europe ; and it 

 is thought, that the excelTes, in which the inhabitants of 

 hot countries indulge, have great effeft in promoting the 

 formation of the diforder. 



Striftures have been known to arife from the application 

 of external violence to the perineum ; from the irritation of 

 blifters afFedling the membrane of the urethra ; and from 

 the irritation of a difeafed proftate gland. Cafes, in proof 

 of thefe obfervations, may be perufed in fir E. Home's 

 publication. 



In the treatment of this difeafe, the firft thing is to afcer- 

 tain the precife fituation of the ftrifture neareft the orifice 

 of the urethra. For this purpofe, a common bougie, pro- 

 portioned to the fize of the orifice of this canal, is to be 

 gently introduced. If the bougie eafily enters the pafTage, 

 the furgeon may be well afTured, that, if there be no ob- 

 ftruAion, the fize of the inftrument cannot be too large for 

 the reft of the canal, the orifice of which is naturally Icfs 

 capacious than mod other parts of it. Small bougies, and 

 fuch as are too much pointed, however, are frequently 

 ftopped by the lacuna;, or orifices of the mucous glands, 

 and lead inexperienced furgeons into error. 



In introducing any inftrument properly into the urethra, 

 fome degree of (kill is difplayed. When a bougie or cathe- 

 ter is to be pafied, the furgeon (hould take hold of the penis, 

 by placing the fore-finger and thumb of his left hand on 

 each fide of the prepuce, oppofite the corona glandis : thus 

 he avoids making any prefigure on the paflage into which he 

 is about to pafs the bougie. This being oiled is to be in- 

 troduced at firft a little way; then the furgeon is to draw the 

 penis forward, as it were over it, with the fore-finger and 

 thumb of his left hand, while, at the fame time, he gently 

 and fteadily perfifis in pufhing the inftrument further into 

 the pafTage with his right hand. The bougie itfclf is to be 

 h«ld like a writing pen, and, as it enters the urethra, it 

 ought to be artfully rotated, firll in one direflion, then in 

 the other, in order that its extremity may more certainly 

 cfcapc being entangled in any natural fold of the membrane 

 lining the paflage. 



Having afccrtaincd, by the introduflion of a bougie, the 

 cxiftenqe and fituation of the ftri<?^ure neareft the mouth of 

 the urethra, the next defidrratum is to learn, whether the con- 

 traftion is fuch as would be produced by tying a piece of 

 packthread round the canal ; whether, on the other hand, it 

 occupies a confiderable extent of the paflage ; and, laftly, 

 what is the fize of the bougie which ran be introduced 

 through it. A knowledge of the extent of the ftriAure i» 



a circumilance that would always be of efticntial ufe to the 

 prr.f ilioiier, if it could be obtained ; beraufe, we prefume, 

 no furgeon, knowing that the obftruflioii and difeafe extend 

 far along the urethra, would ever in fuch a cafe give a pre- 

 ference to the employment of armed bougies. Thofc anne<l 

 with the nitrate of filver could nevc-r be expected to burn 

 their way through a ftrifturc an inch in length ; and if other 

 bougies, armed with the cauftic potafla, are conceived to 

 admit of being applied to fuch a ftrifture with any degree of 

 precifion, or any other real efficacy than what aftually arifes 

 from the mechanical aftion of thefe inftruments themfelves, 

 when pafled through the ftrifture, we confefs that it is more 

 than our obfervations authorize us to believe. We have no 

 hefitation in giving it as our opinion, that, in all cafes ot 

 this defcription, as well as in others, in which two ftriftures 

 are near together, and the intervening part of the canal 

 much contradled, cauftic bougies ought not to be ufed. 



Having afcertained that a common-fizcd bougie will not 

 pafs beyond a particular point of the urethra, we ought to 

 make an impreflion on the inftrument with the finger-nail, 

 clofe to tlie mouth of the uretlira. Then the bougie ftiould 

 be withdrawn, and the furgeon fliould take one of a fmaller 

 fize, which he is to mark with his nail, exaftly at the place 

 correfponding to that of the impreflion on the firft bougie. 

 This fmaller one is to be introduced fufiiciently far to bring 

 its marked part exaSly to the orifice of the urethra, at 

 whicli period the furgeon knows that the extremity of the 

 bougie has juft arrived at the contraftion, which would not 

 allow the firft common-fizcd bougie to pafs. If the fecond 

 bougie cannot be introduced farther than the firft, a iiill 

 fmaller one is to be tried ; but the furgeon ftiould not have 

 recourfe to the fmalleft bougies at once, as the largeft 

 bougie which can be got through the ftridturc ought to be 

 the model of the foft white one, which ftiould now be intro- 

 duced for the purpofe of ftiewing the fiiape and extent of 

 the ftriflure by tlie imprefilons made upon it. If, after the 

 foft bougie has remained a minute or two in the ftrifture, it 

 ftiould be marked with a diftinft circular or femi-circular 

 narrow furrow, on being withdrawn, we have reafon to be- 

 heve, that the ftridure does not occupy much of the 

 extent of the urethra. On the contrary, when tlic impref- 

 fions and irregularities on the foft bougie are extenfivc, it is 

 to be fufprfted that the ftrifture is not confined to a limited 

 point of the canal. At the fame time it muft be acknow- 

 ledged, that it is fomewhat difficult to form a certain judg- 

 ment from the appearances of the bougie, becaufe thefe wjl 

 depend very much upon the force or gentlenefs with which 

 the inftrument is ufed. In particular, it is extremely diffi- 

 cult to learn pofitivcly whether the urethra is diminiflicd in 

 diameter immediately behind the moft contracted part of the 

 ft rifture. Mr. C. Bell propofed the employment of a particvlar 

 fort of probe for determining the extent of ftriftures. " I pro- 

 cured ( fays this gentleman ) a ferics of filver and gold probef , 

 with circular knobs ; the knobs varying from the full fi/c 

 of the urethra to what will jutl pafs the narrowcft ftridturf. 

 By fucceflively introducing fmaller balls, I afcertain the de- 

 gree of ftrifture by the ball which paflcs eafily ; and 1 am 

 lecure of being in the paftage by paffing the probe onward, 

 when it has got beyond the ftrifturc. Then by the flight 

 feeling of reliftance in palling the ball, and in withdrawing 

 it again through the obftjuftion, I afcertain the extent of 

 the contraftion. If the ball of this probe be liable, like 

 the point of the bougie, to enter one of the lacuna;, or, on 

 pafling it, to rub upon its edge, yet, by fcchng whether the 

 lame rcughnefs or difficulty attends the withdrawing of the 

 bulb of the probe as when it pafl"ed downward, we m.iy be 

 aftured whether there be a ilrifture of the canal, or whether 

 3 T 2 the 



