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Show ASCERTAINING THE EXTENT OF THE STRICTURE. 70 often takes 03' both spasm and inflammation ; by large and sep- 'When with a bougie of the largest size we are opposed by a firm stricture, we mark the depth of the stricture on the hou- arate clysters of warm water; and lastly, by a powerful ano- gie, and, withdrawing it, take successive smaller ones, until we dyne in a starch clyster. These failing, the puncture of the bladder is our next resourcese. Supposing that this immediate danger has been subdued, or that the patient first presents himself with only the usual symptoms of stricture, we have first of all to ascertain the place and extent of the disease in the canal. OF SOUNDING THE URl'lTlIRA, TO ASCER TAIN THE PLACE AND EXTENT OF THE STRICIURE. As in a natural state the orifice of the urethra is the narrow est, or rather the least dilateable part, we must, in the first in- stance, adapt the size of the bougic to it. It is a general position, that the larger the bougie, the chance is the less of its ' imam" [4JDUW mum ‘ " meeting with any accidental interruptiont, and consequently there is the better assurance of its stopping at astricture only. \\ >3g+zd't‘m‘#"- muss. Having dipped the bougie in oil, it is introduced a little way into the urethra. Then the penis should be moderately stretched with the left hand, and held steady ; when with an .. "nth-xv. -- ' ~ easy unrestrained motion of the wrist and fingers , the bougie should be introduced. The motion ought not to be too slow, nor on the other hand, the bougie harshly introd uced, otherwise the resistance and size of the urethra is not so easily felt. The stricture is generally at the distance of five inches, six, six and a half, or seven inches from the point of the penisjj. Sometimes there is felt only a degree of hesita tion and difi'icul- . ‘0' ac rec-1'" 13(" .,._.. '1‘" 71 SOU‘NDING THE enemas. ty in the bougie passing the first stricture, while it sticks fast in the seconds. find one which passes the obstruction, when we proceed to examine the whole extent of the canal. Supposing that, disappointed in passing the larger bougie, we introduce a smaller one; if it does not pass, it sometimes, when withdrawn, ml] have the point turned directly backward, in which case most probably it has hit upon the angle made by the stricture (B, plate 11. fig. 7.), and has been directed over the mouth of the opening, so as to be reflected on itself. If it has been pushed against the opening directly, the point will infallibly shew some appearance by its be1113‘ flattened (not blunt and obtuse), or it will be sharpened as in fig. 8. the point having entered into the stricture. The curve B. will be a direction by which we have to make the succeeding effort, as it shews us how the permeable part of the canal is removed from the direct line. When obstruction is felt, which our bougie, with moderate ..i perseverance will not pass, we have next recourse to the soft The soft white Dougie is Used to take an impression of the stricture, in order in some measure to ascertain its degree and extent. It is pushed down to the obstruction, and allowed to remain there until it becomes soft ; and then it is gradual~ ly pressed with a very steady hand into the stricture‘f, where being allowed to remain a little time, it takes the impression of the stricture, and upon withdrawing it, often informs us of some obliquity of the passage, which enables us to pass a bougie curved upon the model of the soft bougie. It teaches us also to apply the caustic with effect. Under fig. 4. we haveastricture represented A. Suppose that the soft bougie B is pressed into the stricture, then the greater a1 chance of mistukc,fi-01n its being wedged in the first stricture, winch feels like the opposition of a second. and attended with more severe consequences on the application of the caustic. the parts. ' We cannot examine the urethra with a conical bougie without perpetur 1 In many patients this operation is impossible, from the painful state 0? \Ainlt‘l‘ - *- .MJm N». , bougie. ' See Offlie Operation omezcturing the Bladder. f The bougie, when very small in the point, is very apt to catch on the lacué nae,and on afold ofthe urethra,when it is makjng the curve under the os pubis. # \Vere I to follow my own experience alo no, I should say that stricture is more generally about five inches from the point of the penis, or even nearer, than in any other point. I have uniformly found the first stricture the nar- rowest, though the deeper ones were more difficult to remove, "at. |
