URETHRA. 



piece of lint in'roduced between the fid«s of tlie pundure, 

 until they are cicatrized. 



In the female fubjeft, the meatus urinarius is fometimes 

 found imperforate, though lefs frequently fo than the vagina. 

 Aa foon as a furgeon is apprifed of the caufe of a young 

 female child not being able to void its urine, he is to divide 

 the membrane which clofes the orifice of the meatus uri- 

 narius. The frequent evacuation of the urine, and the in- 

 troduftion of a fmall doffil of lint, will prevent the fides of 

 the incifion from growing together again. An imperforate 

 urethra in the female fubjeft has been known to give rife to 

 an urinary fiftula at the narel. In this cafe, the retained 

 fl-uid makes its way by the urachus to the umbilicus. The 

 urachus, which in the adult is folid and ligamentous, con- 

 tains in fome fubjefts an inconfiderable cavity, which afcends 

 more or lefs towards the navel. It is conceivable, that in 

 fuch individuals, who are analogous to quadrupeds, in which 

 the urachus is a true canal, the urine may afcend along this 

 procefs to the navel, elevate the (Icin there, and at length 

 makes its way out, and caufe a fiftula in the fame fituation. 

 Even when the urachus is folid, it is poffible that the lining 

 of the bladder may be propelled in this direftion, and pro- 

 trude alfo at the umbilicus, where it may afterwards burft. 

 However it may be, nothing is more certain than the pofli- 

 bihty of the urine afcending along the urachus, and the 

 formation of an urinary fiftula at the navel, in young female 

 children, in whom the urethra is imperforate. Cabrol's 

 twentieth obfervatiou aff^ords a complete proof of the fadt. 

 In a cafe of the fame kind, we could not alfo do better than 

 imitate the praftice, which this praftitioner adopted. It 

 confifted in firft eftabhfliing the natural paflage for the urine 

 by a fuitable incifion, and the ufe of an elaftic gum catheter. 

 A ligature was then applied round the fungous protube- 

 rance at the navel, where the urine had been previoufly dif- 

 charged. Perhaps, however, the latter proceeding would 

 generally be unneceflary, becaufe, unlefs the fiftula had ex- 

 ifted very long, it would fpontaneoufly heal, on the urine 

 finding its natural outlet. 



Ukethra, Orifice of. Mi/placed. In fpeaking of malform- 

 ations of this paflage, it deferves notice that the orifice of 

 the urethra is not always found fituated at the anterior part 

 of the glans. This particular cafe, which is not very un- 

 common, is termed by furgeons hypofpadias. It prefents 

 the following varieties : — Sometimes the orifice of the urethra 

 is below the glans ; fometimes it is very far back, near the 

 crura of the penis, but ftill at the under furface of this organ. 

 There are alfo cafes, in wliich the urethra is found fituated 

 above the corpora cavernofa ; and the malformation ought 

 then to be called epifpadlas. Richerand mentions having 

 feen a remarkable inftance of this defcription in a young 

 confcript. The penis was extremely fliort ; fo much fo, 

 that, at firft view, there feemed to be only the glans, which, 

 in the flaccid ftate of the parts, was the only thing vifible in 

 front of the pubes. Along the upper part of the bafe of 

 the glans there was a fiffure, which extended through the 

 flcin of the dorfum of the penis, refembling a vulva of about 

 an inch in length. The malformation, termed hfptfpadias, 

 caufes no impediment to the evacuation of the urine ; and it 

 is even aflerted, that it does not certainly deprive the indi- 

 vidual of the generative power. The truth of this obferva- 

 ti6n muft depend very much upon the exaft fituation of the 

 orifice of the urethra ; for if it were towards the perineum, 

 impotence muft be the confequence. In this latter kind of 

 cafe alfo, no attempt at a cure would be prafticable ; 

 though, perhaps, when the orifice is near the glans, fome- 

 thing might be done, with a view of forming a continuation 



of the paflage to its proper extent. Such, however, would 

 be the tendency of any new opening to clofe again, that the 

 refult would be very uncertain ; and we believe that the re- 

 cords of furgery evince no fafts in favour of the trial. 



There is another ferious malformation of the urethra, 

 which confifts in a preternatural ftiortnefs of it. The canal 

 does indeed extend to the glans penis, where it terminates in 

 the ufual way ; but its aftual length does not correfpond 

 with that of the corpora cavernofa. Hence, a permanent 

 curvature of the penis is produced, and the perfetEl ereftiou 

 of this organ is hindered. The cafe is faid to be entirely 

 incurable. 



Urethra, Calculi lodged in. Stones of moderate fize 

 may efcape from the bladder, and, lodging in diff"erent parts 

 of the urethra, may occafion great pain, and a difiiculty of 

 making water. An inftance has been recently publiftied, in 

 which a ftone in the urethra was miftaken for a ftrifture, 

 and the cauftic aftually applied. (See Marcet on Calculous 

 Diforders, p. 9.) Whatever may be their fituation in this 

 canal, their evacuation ought to be promoted by all fuch 

 means as tend to relax the paflage ; as bleeding, the warm 

 bath, fomentations to the perineum, diuretic drinks, and 

 the injeftion of oil into the paflage. Thefe means are to be 

 affifted by the gentle and fliilfuUy direfted prefliire of the 

 fingers, applied juft behind the foreign body. When a 

 very fmall calculus is fufpefted to be in the bladder, and it 

 will not pafs through the uretlua, M. Delpech has lately 

 propofed dilating the paflage as much as poflible with elaftic 

 gum catheters ; and when the largeft inftrument can be in- 

 troduced, he thinks a good chance of the calculus being 

 voided might be obtained, by fuddenly withdrawing the 

 large catheter, and defiring the patient to void his urine as 

 forcibly as poflible. Particular forceps have likewife been 

 conftrufted for the extraftion of calculi from the urethra ; 

 but they feldom anfwer, except when the foreign body is 

 near the orifice, and would foon efcape of itfelf. A to- 

 bacco clyfter has been known to effeft. the difcharge of a 

 calculus from the urethra. See Edinb. Med. Surg. Journ. 

 vol. xii. p. 373. 



When all the foregoing proceedings are ineffeftual, and 

 the patient fuffers a good deal of pain and inconvenience, it 

 becomes the duty of the furgeon to cut down to the calculus, 

 and extraft it. The patient fliould then wear an elaftic gum 

 catheter for a few days, until the opening is healed. The 

 vn-iter of this article was once confulted by a gentleman's 

 coachman, who had contrived to let a large head-drefs pin 

 flip a confiderable way into the urethra, fo that he could 

 not get it out again. The point of the inftrument, in faft, 

 was more than three inches from the orifice of the urethra. 

 Its extraftion was eafily accompliftied, by puftiing its point 

 through the urethra, when it was taken hold of, and with- 

 drawn as far as it could be in this manner. The head of 

 the pin was then puftied towards the mouth of the canal, 

 and the whole inftrument extradled. 



Urethra, Falfe Pajfage in. One of the greateft evils, 

 arifing from the unfliiltul and too violent ufe of catheters, 

 bougies, and other inilruments, is the formation of a new or 

 falfe paflage, by the rupture of the urethra. Whenever an 

 inftrument is afterwards introduced, it does not follow the 

 courfe of the urethra, but enters the ruptured opening. 

 Thus, the difficulty of curing the ftrifture, if there be one, 

 is ferioufly increafed, becaufe the furgeon can hardly ever 

 get the bougie to reach it again ; and if his objeft is to pafs 

 an inftrument into the bladder, he is equally fruftrated. 

 Nothing feems more likely to caufe a falfe paflage, than the 

 violent ufe of the conical filver catheter, in cafes of bad 



fl.iifturt6 ! 



