URETHRA. 



lliidures in the urethra on the 'principle of actual force. 

 We cannot explain this matter to the reader better than by 

 quoting what Mr. Crofs, an intelligent forgeon at Norwich, 

 who lately vitited the hofpitals of Paris, has faid upon the 

 fubje<ft. « When I firft went to La Charite, (fays this 

 gentleman,) out of fifty-three male patients in the furgical 

 ward, there were five cafes of ftridlure of the urethra, and 

 three or four of difeafes of the telticles. In the treatment 

 of the former complaint, the cauftic bougie is not ufed in 

 any of the hofpitals, and it was cenfured by all the furgeons 

 I met with, as ' a "very dangerous and harjh remedy,' which 

 I believe moft of them have never given a trial to. It ap- 

 pears to me, however, that the Parifian method of treating 

 many cafes of llrifture in the urethra is not more mild than 

 the ufe of the cauftic." Mr. Crofs then recites a cafe 

 which he faw in La Charite. A man who had had for a long 

 while a permanent (Iriclure, had been repeatedly treated for it. 

 There was difficulty of makiug water, but not complete re- 

 tention. Unfuccefsful attempts were made, for feveraldays, 

 to pafs an inftrument into the bladder by gentle means. The 

 patient was ftill able to void his urine, although with great 

 pain and difficulty. M. Roux took, a conical iilver catheter, 

 with a very flight curvature, and an extremity almoft pointed, 

 and by force regularly applied, he made his way into the 

 bladder in fpite of all oppofition. He took care to keep 

 the inftrument central, and to judge of the direftion of die 

 point by the lateral rings. The rule mentioned by M. Roux, 

 for commencing the great depreffion of the outer extremity 

 of the inftrument, was when, by the finger in the reftum, 

 he could feel the point to have reached the apex of the prof- 

 tate. He gave great pain to the patient, but fucceeded in 

 getting the inftrument into the bladder. The urine in the 

 bladder was not fuffered to flow out immediately, the cathe- 

 ter being left in the urethra, and its end plugged up with a 

 piece of wood. Mr. Crofs well obferves, that M. Roux 

 afted very judicioufly in direfting the catheter to be kept dc- 

 prefled between the thighs, becaufe from its fhortncfs, and 

 the fmallnefs of its curvature, the bringing of the outer 

 extremity of the inftrument up to the abdomen would have 

 drawn the other extremity out of the bladder. 



Three or four days are the time M. Roux commonly keeps 

 the conical catheter in the paffage ; but this patient fuffered 

 fo intolerably, that it was taken out at the end of four and 

 twenty hours. An claftic gum catheter, of rather a fmall fize, 

 was immediately introduced without difficulty ; its extremity 

 faftened to the abdomen ; and its orifice plugged up, in order 

 that the urine might be allowed to flow only at certain pe- 

 riods. The next day the patient was comparatively cafy. 

 On the fourth day there was a fwelling of the tefticle, fcro- 

 tum, and perineum. A poultice was applied, and the claftic 

 catheter continued. In four days more the fwelling of the 

 parts had fubfided, and the poultice was no longer neceflary. 

 A fre/h gum catheter of a larger fize was introduced. Suffice 

 it here to add, that in about fix weeks a catheter of the 

 largeft fize could be introduced. 



Another cafe, fays Mr. Crofs, went on lofs favourably. 

 The foncL- con'tque had been employed, and a gum catlieter 



introduced ; but in lefs than a week the patient, believing 

 he could make water without the inftrument, took it out 

 himfelf. The next day, an cffufion of urine in the fcrotum 

 had taken place, and the fluid was freely let out by two long 

 incifions. The claftic catheter, however, could not be in- 

 troduced again. The urine now came away in drops from 

 the urethra. The free incifions in the fcrotum prevented 

 Houghing ; but the patient, who was very weak, and in 

 bad health, died in a few days. It was, obfervcs Mr. 



Crofs, an inveterate cafe of llridurc, and tlie patient would 

 probably have died under any treatment. DiffeAion (hewed 

 a difeafed bladder, whofc coats were above half an inch in 

 thicknefs ; a cartilaginous ftrifturc and extenfive finufcs 

 communicating with the once-membranous part of the 

 urethra. 



" The effefting of a fpeedy cure, in bad cafes of ftric- 

 ture," is the argument advanced by the French furgeons 

 for the ufe of the conical catheter, where that of elaftic gum 

 cannot be introduced without its affiftance. They tell ui, 

 fays Mr. Crofs, even of bad cafes being cured, or greatly 

 relieved, in a month or fix weeks ; and certainly in one cafe, 

 under M. Roux, a catheter of the largeft fize could be re- 

 ceived by the urethra, a month from the introdudion of the 

 conical catheter. 



M. Roux afl"ured Mr. Crofs, that he had never feen any 

 inflammation or irritation from this treatment, which was not 

 readily managed and fubdued. In his clinical lefture, how- 

 ever, he mentioned two fatal cafes, which he had witnefled, 

 and examined after death. In one of thefe, on taking out 

 the fonde conlque d' argent the third or fourth day after its 

 introduAion, the furgeon could not introduce the gum 

 catheter : in attempting to do which, faid M. Roux, another 

 paifage feemed to have been made. Extravafation of the 

 urine, floughing, and death enfued. The fecond cafe was 

 fomewhat fimilar ; peritoneal inflammation was the im- 

 mediate caufe of its fatal termination, the inftrument hav- 

 ing pafted between the pubes and anterior part of the 

 bladder. 



Whoever defires more information refpefting this violent 

 mode of treating ftriftures, muft confult Mr. Crofs's pub- 

 lication. Enough, we conceive, has been faid to prove 

 that it is a dangerous plan, which can only be juftifiable in 

 the moft inveterate and obftinate cafes. It feems that, in 

 fiich examples, the late John Hunter alfo ufed the filver 

 catheter with confiderable force ; and the praftice of Mr. 

 Pearfon and of Cooper is likewife cited, as a fanAion of this 

 bold mode of proceeding. The French even fometimes 

 prefer this way of punfturing the bladder, the catheter be- 

 ing forced through the proftate gland ; and we have heard of 

 one or two diftinguiflied furgeons in this country, who never 

 perform any of the ordinary methods of punifturing the 

 bladder, but invariably fuccecd in getting a catheter into 

 that organ, by forcing the inftrument forward through the 

 proftate gland. See Hunter's Treatife on the Venereal 

 Difeafe. Whately's improved Plan of treating Striftures. 

 Firft Lines of Surgery, edit. 3. Sir E. Home's Praftical 

 Obf. on Striftures. C. Bell's Letters on Dif. of the 

 Urethra. Crofs's Sketches of the Medical Schools of 

 Paris, &c. 



Urethra, Imperforate. Children, when firft born, are 

 fometimes incapable of making water, in confequence of the 

 prepuce or urethra being imperforate. In the firft cafe, 

 the nurfe takes notice that the child's linen is not wet, and 

 the extremity of the penis prcfents a foft, oblong, ftiining, 

 tranfparcnt tumour, occafioned by the colledlion of the urine 

 between the prepuce and the glans. Relief is to be given 



by making an incifion into the anterior and inferior part of 

 the fwelling, and thus opening the prepuce. The frefli-cut 

 furfaces are then to be kept apart with a doffil of lint, until 

 healed. When the prepuce is very long, it is even recom- 

 mended to cut off a piece of it, in order to remove all rifle 

 of a phymofis. 



When the inability to evacuate the urine depends upon an 

 imperforate ftatc of the canal of the inethra, the membrane 

 which clofco its orificc'is to be opened with a lancet, and a 



piece 



