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Show 72 ascenmmmc rm: EXTENT or THE srnrerunn. projection of one side of the stricture C has a corresponding indentation in the bougie D, and by withdrawing thebougie with~ out twisting it at all, we learn where the caustic is to be applied. Again, when we are endeavouring to pass a small bougie,' suppose that the point shows a projection, as E, fig. 4., we know that the opening is very small, and to the right side. we accordingly give the smail bougie the curve F, which throws the point into the direction of the orifice of the stricture. Mr. Hunter, with his usual correctness, has said that a l V71: '4abuw "amt" MUM ,..3._a.,,+ :1- cove" -. .‘nE- \\ n"; stricture is of very small extent, and resembles the effect of tying a thread round the canal. But this fact I think has been proceeded upon too blindly. Before the caustic is used, a very accurate survey of the canal should be made. I have now to propose the use of probes, which give, I conceive , much more accurate information of the extent of the strictur e than the bougie. In plate II. fig. 1, 2, 3, we have a series of‘plans, shewing a variety of strictures, and the application of the bow gie and the probes. In fig. 1. there is a strictur e of the com~ mon kind, and in fig. 3. we have the point of the bougie invtroducstl into such a stricture. If this bougie had been of an equal thickness in all its length, it would have passed the stricture with an uniform degree of difficulty. But as it is conical towards the point, it has only entered the stricture , and sticks there; and when softened, it begins to yield and curve in the upper part of the urethra, giving a deceitful sensation of still proceeding. In neither of these cases is any information conveyed to the operator of the extent of the disease. And although very often the contractions are mercl y such as are represented in fig. 1. and 3. yet I am well assured that they are often far from simple ; that there are irregular con- tractions for half an inch or an inch in len gth, in which case it is fifty to one whether , in the common way of introducing of THE BOUOIE. 73 urethra to what will just pass the narrowest stricture. By smocessively introducing smaller balls, I ascertain the degree of stricture by the ball which passes easily, and I am secure of being in the passage by passing the probe onward when it has got beyond the stricture. And by the slight feeling of resistance in passing the ball, and in withdrawing it again through the obstruction, I ascertain the extent of the contrac- tion. If the ball. of this probe be iiable, like the point of the bougie, to enter one of the lacunae, or, pas-ting it, to rub upon the edge, yet, by feeling whether the same roughness or difficulty attends the withdrawing of" the bulb of the probe, as when it passed downward, we may be assured whether there be a stricture and callosity of the canal, or whether the obstruction be not caused merely by the lacunrc ; for as the lac unre present to the orifice of the urethra, their edge cannot catch the probe in the course of its being withdrawn; and consequently, un- less thcre be a disease there is a uniform smoothness in withdrawing the instrument. Again, in fig. 2. there is an irregular hardening of the ure- thra for a considerable extent, along which the probe moves with hesitation and difficulty, while in fig. 1. having passed the obstruction, it moves on with freedom. These balls then ascertain the nature and extent of the stricture. I give importance to this knowledge of the extent of the stricture, because I apprehend that the practice and method of cure is to be varied with the circumstances. Further, with the bougie we are seldom able to ascertain the number and probable obstinacy of the strictures below the first ; while with this instrument, the bait passing the first stricture, we are enabled, from the fineness of the wire, round which the stricture cannot close, to examine the second stricr ture with equal facility as we did the first. the caustic, it follows the course of the natural canal. To ascertain the extent of the stricture, I proc ured a, series of silver and gold probes, with circular knobs (as represented in fig. 1. and‘2.), the knobs varying from the full size of the .03? THE BOUCIE AS A CURE FOIL STRICTUBE- Tire too sanguine favourers of the application of the cans; tie in stricture. have misconstrued the operation of the boogie VOL. I. 1 -LA 4. mini?" . - Ml") N |