URETHRA. 



the obftruAion be not caufed merely by the lacuna." 

 Oper. Surgery, vol. i. p. 104. 



This author further obferves; that as the lacuna opens 

 in a diredlion towards the orifice of the urethra, its edge 

 cannot catch the probe when this is withdrawn, at which 

 period a uniform fmoothnefs muft be felt, unlefs there be 

 difeafe. When there is an irregular hardening of the 

 urethra for a confiderable extent, the probe is faid to move 

 along it with difSculty ; but no fooner has it pafTed the ob- 

 ftruftion, than it moves on with freedom. Likely as thefe 

 ball-probes for the urethra at firft feem to be to afford de- 

 firable information refpefting tiie fpecies of ftriftnre, they 

 are at prefent not much ufed by furgical praftitioners. In 

 feft, in praftice tliey do not anfwer ; and it is the contrac- 

 tile power of the urethra, or (if others vnll not allow it) it 

 is the aftion of the mufcles contiguous to this pafTage, which 

 fometimes ftops the eafy introduftion of the probe even 

 when there is no permanent ftrifture whatever, and which 

 makes it more difficult to afcertain the nature and extent of 

 the obftruftion than would otherwife be the cafe. 



That great utility in praftice would be derived from being 

 able to learn the nature of the flrifture, muil be as obvious 

 as the faft, that a cauilic bougie is not at all calculated to 

 remove the obftruftion when it is of any extent. Such an 

 ir^ftrument (we mean particularly a lunar cauftic one) could 

 only aft on the anterior part of the contraftion, without 

 prefenting any profpeft of being fufficiently efficacious to 

 burn its way, by repeated applications, through the whole 

 extent of the ftrifturc. Even could we imagine that it had 

 this power, our judgment and common fenfe would revolt at 

 the doftrine of this being the proper plan to be purfued. 

 The common bougie, on the other hand, is introduced 

 thi-ough the whole extent of the ftrifture, and afting like a 

 wedge on every part of it, produces a general dilatation of 

 the obftruAion. Wlien the ftrifture is attended with a coni- 

 cal lefTening of the canal in front of it, a common bougie 

 muit alfo merit a preference. 



Treatnwnt with the common Bougie This inftrument afts 



by producing a mechanical dilatation of the ftrifture. As 

 It operates, however, on bving matter, it either makes the 

 dilated part adapt itfelf to its new pofition, or recede by 

 ulceration. If the cafe is one that will allow even the 

 fmalleft bougie to be introduced through the ftrifture, the 

 cure may be confidered to be within our power. In many 

 cafes in which the ftrifture is confiderable, a great deal of 

 trouble is given by occafional fpafms, which either prevent 

 the introduftion of the bougies altogether, or only allow a 

 very fmall one to pafs. In fuch cafes, Mr. Hunter was 

 fometimes able to make the bougie pafs, by rubbing the 

 perineum with one hand, while he pufhed forward the 

 bougie with the other. He alfo frequently fucceeded by 

 lettmg the bougie remain clofe to the ftrifture a little 

 while, and then pufhing it forward. The fpafm has 

 fometimes been removed by dipping the penis in cold 

 water. 



It is fometimes difBcult to know, whether a fmall bougie 

 has pafTed through a ftrifture, or only bent. In this cafe, a 

 common-fized bougie fhould be previoufly introduced to 

 learn the fituation of the ilrifture ; and, afterwards, when 

 the end of the fmall bougie is known to have reached the 

 obftruftion, the furgeon fhould pufh the inftrument forward 

 very gently, and for a fhort time. If the bougie enters the 

 petris further, he may know whether it has entered the 

 ftrifture by removing the prefTure from the Liougie ; for, if 

 this recoil, it has not paffed, but only bent. After all, 

 however, every praftical furgeon knows, that it is fome- 

 times incorreft to take even fuch a criterion, and a very 



fmall bougie frequently bends, and yet does not afterwards 

 recoil in the leaft. 



When the bougie has paffed a little way through the 

 ftrifture, and remained there a fliort time, we fhould with- 

 draw it, and examine its extremity. If this fhould be flat- 

 tened, grooved, or have its waxen coat pufhed up for fome 

 extent ; or, if there fhould be a circular impreflion on the 

 bougie, or only a dent on one fide made by the ftrifture, we 

 may be fure that the inftrument has paffed as far as thofe 

 appearances and impreffions extend. 



Now it becomes necefTary to introduce another bougie of 

 exaftly the fame fize, and let it remain as long as the patient 

 experiences no particular inconvenience. 



When the end of the firft bougie is blunted, we may be 

 fure that it has not paffed the ftrifture at all. 



The beft time for wearing bougies is when the patient is 

 in bed in the morning, or when he has an opportunity of 

 keeping himfelf perfeftly quiet. The bougie fhould be 

 gradually increafed in fize, as the ftrifture dilates, till the 

 largetl one can eafily pafs, and its ufe fhould be continued 

 for three or four weeks afterwards, in order to habituate the 

 parts to their new ftate. 



It is well known that ftriftures are very liable to return, 

 and hence the treatment with common bougies has been 

 accufed of inefScacy. We have known, however, fome 

 cafes in which the cure lafted many years ; and others in 

 which the ftrifture returned, although cauftic bougies had 

 been employed. One reafon why the difeafe often relapfed 

 in former times was, becaufe furgeons had no correft 

 notions refpefting the naturally capacious diameter of the 

 urethra, and confequently they never increafed the fize of 

 tlie bougie, as far as it ought to have been, in proportion as 

 the difeafe gave way. In the employment of cauftic 

 bougies, on the other hand, furgeons have always preferred 

 large ones ; and, if thefe inftruments ever render the cure 

 more durable, we conceive that the fuccefs is in a great 

 meafure afcribable to this circumftance. 



Common bougies have one advantage over thofe armed 

 with lunar cauftic ; iiiz. that of being fometimes capable of 

 afting upon feveral ftriftures at once, when they are mtro- 

 duced into the urethra ; a thing which is impofQble in the 

 other method. 



Treatment with Elaftic Gum Catheters and Bougies. — Per- 

 haps there is no plan of treating ftriftures in the urethra 

 which is fo mild and unirritating as that with inftruments 

 coated with elaftic gum. It is the common method of 

 treatment followed in France, where cauftic bougies appear 

 to be entirely abandoned. The celebrated Default, vpho 

 had confiderable fuccefs in the treatment of ftriftures, rarely 

 employed any means of cure except an elaftic gum catheter. 

 That this inftrument can frequently be introduced through 

 a ftrifture, even when nothing elfe will pafs, feems well 

 known to every praftitioner in furgery ; for, whether he is 

 an advocate for one method of cure or another, he no fooner 

 fails in his attempts to get through a ftrifture, than he tries 

 what can be done with a gum catheter. It is quite unne- 

 ceffary to dwell long on the mode of curing ftriftures with 

 this inftrument, or the elaftic gum bougie. The cure is ef- 

 fefted on the principle of dilatation ; the very fame prin- 

 ciple on which the common bougie operates. The catheter 

 will fometimes pafs without the ftilet, when it will not dofo 

 with It. This inftrument, being much lefs irritating than a 

 common bougie, can be longer worn without inconvenience, 

 efpecially as the patient can alfo void his urine without 

 taking it out. Indeed, it may be worn feveral days to- 

 gether, if judged advifable ; but we believe it is generally 

 better to withdraw it fooner, and endeavour to get in as 



quickly 



