SURGERY. 
Tlie surgeon holds the glans penis lightly 
with the fore finger and thumb ef the lett 
hand, just under the corona glandis, and 
introduces the bougie with the right hand, 
carrying it forwards gently, and drawing tlie 
penis upwards, so as to make the urethra 
tense. When he meets with an obstniction, 
he waits a little and tries again. He should 
make a mark with the nail on the bougicj 
opposite to tlie end of the urethra, if he 
cannot pass a stricture ; and then try a 
smaller instrument. The same plan must 
be pursued, until all the contractions are 
ascertained. If he makes this examination 
with a soft white bougie, he may get an 
impression of the stricture by pressing 
gently, which will be of service in the sub- 
sequent treatment. For the cure of the 
complaint common bougies ntay be used ; 
or they may be armed with caustic. 
The common bougie acts mechanically, 
by dilating the contracted portion. The 
largest instrument, that the urethra will ad- 
mit, should be passed into the bladder 
daily, and left there for ten minutes at 
first, gradually lengthening the time. It 
should be secured by tying it to the end of 
the penis. The size of the bougie should 
be increased, as the strictures dilate. 
Where caustic is used, a smalt piece of 
argentum nitratum is inserted in the end of 
a bougie, and surrounded laterally by its 
substance. This is termed an armed bougie. 
In using this method, we ascertain first 
how large a common bougie will pass to the 
stricture, and mark accurately the distance 
of the contraction; then take a caustic 
bougie of the same size, and mark the dis- 
tance on this also. We then carry it pretty 
quickly down to the stricture, against which 
we hold it steadily, at first for a short time 
(less than a minute) but afterwards longer. 
This is to be repeated every other day, and 
to be practised successively with the dif- 
ferent strictures that are met with. Mr. 
Whately has recommended a peculiar 
mode of employing caustic. He breaks a 
piece of kali purura, with a hammer, into 
bits, of which the largest should not exceed 
a pin’s head, and keeps these in a phial with 
a ground stopper. He passes a bougie 
through the stricture, and marks tlie si- 
tuation of the contraction. In the end of 
this he makes a small hole with a pin, in- 
serts a bit of the kali smaller than a pin’s 
head, and covers it with lard. He passes 
this bougie, properly curved, down to the 
Stricture, and lets it rest for a few seconds, 
tliat the kali may dissolve ; he then urges it 
about one-eighth of an inch forward*, 
allows it to rest, and then passes it on about 
as much further. He now withdraws it to 
the beginning of the stricture, and passes it 
through again once or twice. This is to be 
repeated every seven days, the size of the 
bougie being increased as much as the stric- 
ture will admit. Mr. Wliately adopts this 
plan, from supposing that the membrane of 
the urethra is diseased for some extent. 
A new pa.ssage is sometimes formed by 
tire use of bougies. Here all instruments 
should be laid aside, if the circumstances 
admit, to give an opportunity for the parts 
to recover. 
Fistula in perinea. When the urethra is 
very much obstructed, nature often endea- 
vours to procure relief by ulceration on the 
inside of lliat part of the urethra, which is 
between the stricture and tlie bladder. 
Hence the urine insinuates itself into the 
cellular substance of the perineum, scrotum, 
&c. causing suppuration and mortification. 
If the patient survive, the sloughs are de- 
tached, leaving a free communication be- 
tween the uretlira and the external sur- 
face ; and the openings thus produced, by 
which urine is evacuated, are called fistulas 
in perineo. The treatment consists in re- 
moving the stricture, which is the cause of 
the. complaint ; and this must be attempted 
both by the caustic and common bougie. 
If the fistula does not heal, when the urethra 
is perfectly restored to its natural dimen- 
sions, it should be laid open like any other 
sinus, which does not seem disposed to 
heal. A catheter or staff having been 
passed into the bladder, a director is intro- 
duced along the sinus, until it meets the 
former instrument ; then it will be easy to 
divide the sinuses with the crooked knife. 
An elastic catheter should be worn until 
the wound has healed, which should be 
dressed from the bottom. The treatment 
of the complaint, which terminates in a 
fistula in perineo will be considered under 
the next bead. 
Retention of urine. When the evacuation 
of urine is prevented by any particular 
cause, the bladder becomes remarkably- 
distended. Its fundus ascends towards the 
nave), and forms a hard circmnscribed 
swelling above the pubes, wltile the 'lower 
portion of the viscus bulges towards the 
rectum. Violent pain and straining, ten- 
sion of the abdomen, cold sweats, anxiety, 
&c. are attendant symptoms. When the 
cause of the retention does not close the 
urethra, and it has proceeded to a consi- 
