UUHTHRA. 



quickly as pofTible other elallic gum catlictcrs ol larger fize. 

 The elaftic gum bougie fometimes will not pafs a ftrifture 

 in the membranous part of the urethra, owing to the elaili- 

 city of the inftrument tending to keep its point from af- 

 cending over the ridge in the canal. In fome cafes we have 

 found them on this account not to anfwer, and have been 

 obliged to ufc either a common bougie, or an elaftic catheter 

 containing a wire. 



Treatment •with Bougies armed •with Nitrate of Silver. — The 

 praAice of applying cauilic to Itridlurus was known to 

 Wifeman, who is jultly elleemed the father of Englifli fur- 

 gery. The cauftic which he ufed was the common red 

 precipitate, and he introduced it into the urethra by means 

 of a cannula. It appears that Mr. Hunter was not aware 

 that any propofal of the kind had ever been made by others, 

 when he firlt conceived the projeft of curing ftridlures in 

 the urethra with caulHc. It was only afterwards that he 

 learned what Wifeman had done ; and there can be no 

 doubt, that if the idea had not exilled previoufly, we (hould 

 ftill have derived it from the fertile genius of Mr. Hunter. 

 The inftruments with which he employed cauftic coiififted 

 of a filver cannula and a ililet. One end of the ftilet had 

 a fmall bulb, which tilled up the end of the cannula, and 

 made it pafs more ealily down to the ftriclure. The other 

 end was a port crayon, containing the piece of cauftic 

 which was introduced through tlie cannula, and applied to 

 the ftrifture. The application having been made, the port 

 cray«n was drawn back into the cannula, and the whole 

 taken out of the urethra. 



It is obfervcd by fir Everard Home, that the foregoing 

 method of ufing cauftic was found in pradlice to be liable to 

 a variety of objedlions. No filver cannula could be well 

 adapted to the flexible canal of the urethra. Hence, when 

 the cauftic was applied, and any degree of prefTure exerted, 

 the efleift of the cauftic was ncceflarily produced upon the 

 angle, between the ftridture and fide of the urethra, and not 

 upon the middle of the ftrifture, the part intended to be de- 

 ftroyed. Mr. Hunter not only faw the inconveniences of 

 the cannula, but he adluaUy endeavoured to obviate them 

 by devifing a more Ample and commodious method of ap- 

 plying cauftic accurately to the centre of the ftridture. The 

 following is the improved mode, as explained by fir 

 E. Home : Take a bougie of a fize that can be readily 

 pafTed down to the ftri£iure, and infert a fmall piece of 

 lunar cauftic into the end of it, expofing the furface of the 

 cauftic, but fiirrounding it every where laterally with the 

 fubftance of the bougie. This (hould be done fome little 

 time before it is ufed ; for the materials of which the bougie 

 is compofed become warm and foft by being handled in the 

 infcrtion of the cauftic ; and, therefore, the hold which the 

 bougie has of the cauftic is rendered more fccure by the in- 

 ftrument being allowed to cool and become hardened. 



This bougie is to be oiled, but before pafliiig it, a com- 

 mon bougie of the fame fize is to be introduced down to 

 the ftrifturc, in order to clear the canal, and to mcafure cx- 

 aftly the diftance of the llrifture from the external orifice. 

 This diftance being marked upon the armed bougie, the 

 latter is to be paffed down to the ftrifture as foon as the 

 common one is withdrawn. In its paft^agc the cauftic can 

 fcarcely come into contaft with any part of the ll:iiiigof the 

 urethra, as the point of the bougie, of wiiich the cauftic 

 forms the central part, always moves in the middle line of 

 the canal ; and indeed the qiiickiiefs with which it is con- 

 veyed to the ftridlure muft alfo prevent any injury of the 

 membrane. 



When the armed bougie is in contaft with the flrifturc, 

 it is to be ftcadily retained there, with a moderate degree of 



5 



prefTure at firft, which is to be allerwards diminifhcd, or 

 elfe it would bend the bougie when this becomes foftened 

 by the warmth of the urethra. The time which it it to re- 

 main depends a good deal upon the fenfations of the patient, 

 and the length of time the parts have been difeafed ; but on 

 the firft trial it fhould be lefs than a minuie, as it then com- 

 monly gives greater pain than at any fubfequent application. 

 Every other day is generally as often as the cauftic bougie 

 can be ufed with prudence. However, in obftinate cafcs, 

 fir E. Home has fometimes employed it every day. 



The bougie, which is introduced into the urethra previoufly 

 to the armed one, fliould be made of foft materials, in order 

 that it may mould itfelf to the form of ihe paiTage, and 

 communicate fome information relative to the extent, degree, 

 and pofition of the ftridlure. 



The pain arifing from the application of the nitrate of 

 filver, or lunar cauftic, to ftiittures, is reprefented by fir 

 E. Home as much more moderate than might a priori be ap- 

 prehended- This gentleman has even related inftances, in 

 which the piece of cauftic flipped out of the bougie, and 

 remained in the urethra ; yet without occafioning any very 

 fevere fymptoms. 



In the courfe of the ufe of cauftic bougies, efpecially 

 when the patient is guilty of any imprudence, it is poffible 

 for fome uncommon fymptoms to arife. 



The firft is a fwelliug in the perineum. It is very apt to 

 be brought on when the furgeon is endeavouring to remove 

 that part of the ftriclure whicii is nearcft to the fides of the 

 urethra. The fwelling, which is of confiderable fize, is to- 

 tally different from that which is produced by the irritation 

 of the long continuance of bougies in the paflage, and 

 which ends in an abfcefs. It is entirely caufed by blood ex- 

 travafated in the cellular membrane, and which is readily ab- 

 forbed. The inflammation is alfo flight, and foon fubfides. 

 A fecond effeft of cauftic, in fome particular cafes, is a 

 very profufe hemorrhage. According to fir E. Home, the 

 bleeding never occurs with violence, except when tlie tinc- 

 ture h.is been completely dettroyed. This gentleman has 

 related feveral examples of fuch hemorrhage, and others are 

 on record. See Edinb. Med. and Surg. .lourn. vol. v. 



P-333-. 



A third ill confequence, fometimes induced by the ufe of 

 armed bougies, is llrangury. According to fir E. Home, 

 it is not common for cauftic to produce this effeft. On the 

 contrary, he ftales, that in many inftances it removes it, by 

 taking off' fpafmodic aftion from the ftrifture. Patients, 

 however, who are fubjeft to occafioiial retentions of urine 

 from the ufe of common bougies, are alio not lefs liable to 

 the complaint when they are ufiiig armed ones ; and fome- 

 times they I'uffer in a ftill worfe degree. 



In certain conftitutions, it appears alfo, that the applica- 

 tion of cauftic to a ftrifture brings on an attack of ague. 

 This effed't is faid to be moll common in patients who have 

 paft a good deal of their life in hot climates. It fometimes 

 happens, however, in perlons who have never been out of 

 England. We faw in St. Bartholomew's hofpital, a fevr 

 years .igo, an elderly man who had very bad ftriftures, for 

 which the cauftic was ufed. After the plan had been fol- ' 

 lowed about a fortnight, a ferious fliivering fit came on di- 

 redly after the application of the bougie. The method 

 was difcontinued for a time, and the man's hcalth'got rather 

 better. The cauftic was now ag.iin reforted to, and again 

 a moR violent rigour immediately followed, an. I the febrile 

 difpofition which took place proved fatal in a couple of 

 days. 



Caufl:ic bougies ar" ut prefent much lefs employed than 

 they were ten or fifteen years ago. In France, however, and 



upon 



