SURGERY. 
along the a'rethra. The complaint increases 
in violence for about three weeks, and 
then gradually declines ; a discharge often 
Bemainiiig when the other symptoms have 
entirely subsided, and being then ternred a 
gleet. There is litlle power of stoppmg the 
course of the complaint, at least without 
great risk of inducing hernia humoralis ; so 
that the safest plan is to palliate. Occasion- 
al saline pni-ges, abstemious regimen, and 
copious draughts of diluting and mucilagi- 
nous liquors are proper with this view. Sus- 
pension of the testicles is useful as a precau- 
tion against hernia humoralis. Cold appli- 
cations to the penis. After a few days, 
astringent injections may be employed, 
often with the effect of lessening the dura- 
tion of the dLscharge considerably. Zinc, 
vitriol, gr. ijss. in two ounces of water ; or 
bydr. mnriat gr. j. in eight ounces of water 
will do for the beginning ; but their strength 
may be increased. Opium and antimony 
where the symptoms of irritation are very 
considerable ; balsam, copaivae is also very 
useful. 
The ^eet which remains after a gonorrhoea 
is not infectious, although veiy trouble- 
some. Astringent injections may be tried 
for it ; as liydr. mur. gr. ij. in aq. distillat. 
5 viii. or ziiicum vitriol, or cupr. vitriol, in 
larger proportions. Balsam copaivae or 
tinct. cantharid. may be taken internally. 
Chordee is an indammatiun attended 
with extravasation of coagulating lymph 
into the corpus spongiosum urethrae, or 
corpoia cavernosa penis, which renders the 
penis curved in its erect state. Bleeding 
by leeches, fomentations and poultices, 
with the antiphlogistic regimen generally ; 
and afterwards camphorated mercurial oint- 
ment. 
Sympathetic bubo should be treated as 
a case of common inflammation. Affection 
of the bladder may be combated by the 
warm bath, venesection, leeches, and fomen- 
tations to the perineum and bladder, and 
ppiate clysters. 
Phymosis and Paraphymosis. In the 
former the prepuce is so contracted, that it 
cannot be withdrawn over the glans ; while 
in the latter it cannot be drawn forward 
from behind the glans. The irritation of 
chancres, gonorrhoea, &c. is the common 
Cause of these affections j but some per- 
sons are born witlr a phymosis. Frequent 
injections under the prfepuee are necessary 
in phymosis, which need not prevent the use 
of mercury if it is required. If the contrac- 
tion be so great as to confine the matter, 
and absolutely prevent its discharge, tho 
prepuce may be slit open, but not otherwise 
in the inflamed state. When the complaint 
has subsided, and the contraction still re- 
mains, the following operation may be per- 
formed. The surgeon grasps the prepuce 
with a pair ot harelip forceps, leaving out 
as much of the outer fold as he wishes to 
remove, and cutting this away at one stroke 
of the knife. He then slits up the inner 
fold with a crooked bistoury passed in a di- 
rector. 
In paraphymosis die glans can generally 
be returned by pressing the blood out of it, 
after immersion in cold water, and drawing 
forwards the prepuce. Leeches may be ap- 
plied to the glans to diminish its bulk. If 
these means do not succeed, the stricture 
must be cut through. 
Amputation of the penis is necessary in 
cancer of that organ ; but it should be 
done before the glands are affected. One 
stroke of the knife is sufficient for tfie pur- 
pose, after which the bleeding vessels must 
be secured. 
r 
Strictures in tlie urethra are contractions 
of tlie canal ; which may be either tempo- 
rary, w’hen they are called spasmodic j or 
permanent, in which case there is a projecting 
ridge of the membrane, or a contirmed con-' 
traction occupying some length of the canal. 
The latter are also subject to attacks of spasm 
from inflammation, &c. ; and vary in their 
state under different circumstances. If ’ 
there be only a single stricture, it will be 
generally found at the bulb of the urethra ; 
that is, about six and a half or seven inches 
from the mouth of the urethra ; and where 
strictures are situated nearer to the end of 
the penis, there is almost alwa; s one in the 
former part. The symptoms’ of the com- 
plaint are diminished stream of urine, which 
is voided more frequently than is natural, 
and with difficulty ; gleet, nocturnal emis- 
sions, impeded ejection of the seminal 
fluid in coition ; irritability of the bladder, 
which secretes a mucous fluid. Sometimes 
there is a complete paroxysm of fever ; and 
occasionally swelling of the testicle. Stran- 
giiary and total retention of urine are some- 
times the consequence of a stricture, which 
becomes affected with spasm from some oc- 
casional cause. 
Our first object in treating strictures is to 
ascertain the number and situation of the 
contractions. The bougie should be curved 
to the requisite degree (which is necessary 
in all cases where these instruments are in- 
troduced) and oiled before its introduction, 
