URETHRA. 



upon the continent in general, the praftice never gained any 

 partifans. The great thing which rendered the plan a fa- 

 vourite one with many furgeons feme time ago, depended 

 upon its alleged fuperiority in radically curing ftriftures, 

 and leaving no chance of a relapfe. We believe, however, 

 that this was only a fuppofition ; for we have feen feveral re- 

 turns of ftrifture after the ufe of cauftic ; and, if the dif- 

 eafe fhould recur rather lefs frequently on the whole, the fuc- 

 cefs may be very well afcribed to the larger fize of the armed 

 bougies ordinarily employed. In fhort, we have no doubt, 

 that common bougies would permanently cure ftriftures 

 quite as well as any armed ones, if care were taken to in- 

 creafe the fize of them in a proper degree, in proportion as 

 the obftruftion gives way. 



For thofe ftriftures, however, which are like what would 

 be produced by tying a piece of packthread round the 

 urethra, we think armed bougies generally anfwer very well. 

 They have alfo been particularly recommended for irritable 

 ftriftures, the irritability of which is faid to be deftroyed 

 with the difeafed part of the canal. There are fome cafes 

 in which no bougie nor catheter, of the fmalleft fize what- 

 ever, can be got through the obftniftion. Here the fur- 

 geon has the choice of ufing the armed bougie ; of exciting 

 ulceration of the ftrifture with the preffure of a common 

 one ; or of imitating the French, and fome of our own fur- 

 geons, in boldly forcing a way through the obftrudiion with 

 a conical catheter, of which we (hall prefently fpeak. 



Treatment of Slridures -with other Bougies, firmed mth the 



Caiiftic Potajfa Mr. Whately confiders flriftures of the 



urethra, not merely as contradled fibres, but as really difeafed 

 portions of the membrane lining that canal. Hence he has 

 propofed a remedy, calculated, as he thinks, both to remove 

 the difeafed affeftion, and to dilate the contradled part, 

 without putting the patient to the inconvenience of wearing 

 a bougie. Such a remedy he thinks cauftic, when it isjudi- 

 cioufly ufed. But his great objeft is to recommend the em- 

 ployment of the cauftic potaffa, or kah purum, in a parti- 

 cular manner, as being, according to his own account, more 

 efficacious, and lefs painful and hazardous, than bougies 

 armed with lunar cauftic. 



Before the cauftic potafla is employed, the urethra ought 

 to be rendered fufficiently capacious to admit a bougie above 

 the fmalleft fize into the bladder ; and the ftriftures, if very 

 irritable, are to have this irritability previoufly leflened by 

 the ufe of common bougies. 



The following is the manner of arming a bougie with this 

 cauftic, according to Mr. Whately's defcription. Put a 

 fmall quantity of the cauftic upon a piece of ftrong paper, 

 and break it with a hammer into little bits, about the fize of 

 large and fmall pin's heads. When thus broken, it fhould 

 be kept for ufe in a phial, clofed with a ground ftopper. 

 The bougie muft have a proper degree of curvature given 

 to it, by drawing it feveral times between the finger and 

 thumb of the left hand, and it ftiould be juft large enough 

 to enter the ftridlure with fome degree of tightnefs. Then 

 let it be palTed gently into the urethra, and when its point 

 flops at the ftrifture, which it almoft always does before it 

 will enter it, make a notch with the finger-nail on the upper 

 portion of the bougie, eraftly half an inch from the extre- 

 mity of the penis. When the bougie is withdrawn, a fmall 

 hole, about the fixteenth part of an inch deep, ftiould be 

 made at the extremity of its rounded end. Some of the 

 broken cauftic fhould then be put upon a piece of paper ; 

 and a bit, fmaller than the fmajleft pin's head, is to be fe- 

 Icfted for the firft application. Let this be inferted into the 

 hole of the bougie with a pocket-knife, and pufhcd into it 

 with the blunt end of a pin, fo as to place the cauftic rather 



below the margin of the hole. In order to prevent the po- 

 taffa from coming out, the hole is then to be contrafted a 

 little with the finger, and the remaining vacancy is to be 

 filled viith hog's-lard. The bougie, being then oiled, is to be 

 palTed, with the curvature upward, to the anterior pai-t of 

 the ftrifture, the fituation of which has been afcertained be- 

 forehand, and the bougie marked as already explained. The 

 inftrument fhould reil there for a few feconds, for the pur- 

 pofe of letting the cauftic begin to diffolve. It fhould then 

 be very gently pulhed forward, about one-eighth of an inch, 

 when there muft be another flop for a fecond or two. The 

 bougie fhould next be carried forward in the fame gentle 

 manner, till it has got through the ftrifture. After this, it 

 fhould be immediately withdrawn, by a very gentle motion, 

 to the part at which it was firft made to reft awhile. It is 

 next to be very flowly paffed through the ftrifture a fecond 

 time ; but vnthout letting the bougie ftop in its paffage. If 

 pain or faintnefs arife, the operation is now to end, and the 

 bougie is to be immediately withdrawn ; but if no fuch 

 effefts be produced, the inftrument may be paffed and with- 

 drawn once or twice more. 



Mr. Whately direfts the application to be repeated once 

 every feven days ; and if the ftrifture be found dilated, the 

 bougie muft be proportionally increafed in fize every time. 

 The piece of cauftic, in no cafes whatever, ought to be 

 larger than a common pin's head. 



By proceeding in the way above related, Mr. Whately 

 conceives that the cauftic will be equally difFufed over every 

 part of the ftriftured furface, and that the application will 

 only abrade the membrane of the ftrifture, without pro- 

 ducing a flough. 



It deferves notice, that this method of treatment feems 

 httle adapted to ftriftures, which are confined, as it were, to 

 a pomt of the urethra ; the cafes which are alfo the moft fre- 

 quent, if we are to credit the authority of Mr. Hunter. 

 The poffibihty of applying the cauftic accurately to the 

 place intended has always appeared to us doubtful ; and, 

 indeed, notwithftanding there are fome good furgeons, who 

 occafionally try the plan and think it anfwers, we arc inclined 

 to afcribe more to the paffage of the bougie itfelf than to 

 any effeft of the little bit of cauftic on the ftrifture. 



Treatment of StriSures with metallic Bougies. — For fome 

 years paft, a new plan has prevailed of treating ftriftures in 

 the urethra with bougies, compofedof a foft, flexible metal. 

 The iuftruments alfohave a highly pohftied furface,of a filvery 

 hue ; and as the diameter of fome of them is confiderable, they 

 poffefs a fufficient degree of firmnefs, both for introduftion, 

 and for retaining the curve of the patient's urethra. This 

 laft circumftance, indeed, is conCdered by fome praftitioners 

 a great advantage, exclufively belonging to metallic bougies. 

 Hence, as foon as they have received the curvature which is 

 judged to fuit the patient beft, they are carefully preferved 

 in this form throughout the cure, and are kept in a cafe 

 which alfo has a bent ihape. Formerly, we have heard of 

 objeftions to thefe inftruments, on the ground of their being 

 hable to break in the urethra ; but, although they are now 

 often ufed, we have not been acquainted latterly with fuch an 

 accident. Perhaps this is to be imputed to their prefent 

 compofition, which is firmer and lefs flexible than it ufed to 

 be fome years ago. Many patients bear the employment of 

 metallic bougies better than any others. It feems only ne- 

 ceffary to add, that they effeft a cure on the principle of di- 

 latation, like common bougies. 



Treatment of StriHures with a conical Silver Catheter. — It 

 is remarkable that the French furgeons, who have always ob- 

 jefted to the ufe of armed bougies, which appear to them too 

 violent a means of cure, have fet the example of treating 



ftriftures 



