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Show 3U 01" PIERCINU THE STRICTURE. or rmacmc TILE srnrcrunn, assisted in its operation by the occasional introduction of the simple bougie*. of urine came with great strength, distending the canal of the Urethra to half an inch in diameter. I trust, that in endeavouring thus to assign the proper cases for the boogie, the lunar caustic, and the alkali, I shall not be accused of an imbecile attempt to accommodate my opinion to that of the several authors who have written on this sub ject. Stricture in the urethra is, in individual cases, attend- ed with so many distinct and peculiar circumstances; it is really so varied in its situation and degree ; and in every in- stance so nice and difficult of cure, that it seems to me to re~ am * ,' humor quire more discrimination than is generally bestowed in the preliminary steps and enquiries, as well as in the adaptations of the methods of cure. As improvements and new suggestions are ofl‘ered us, we require in justice to the public, to be Jealous of our individual partialities ; and in no instance, perhaps, is prejudice so apt to arise in favour of a particular nie~ :hod, merely because it is our own, as in the cure of stricdures. In very obstinate stricture, attended with conti nued and ineffectual straining, and violent paroxysms of fever, threaten ing the total overthrow of the patient's const itution, I have "17'. "MA .a >"+:li.e;‘4§-‘. \l been induced to consent to a more spee dy removal of the obstruction. In the instance to which I allude, there was a callous and intricate fistula in the peri neum, about four inchb es and a half from the extremity of the ure thra, a stricture of at least an inch in length, which was felt l ike a cord through _..v.-- ,_ ...-h~- , v 7." r---:~> "V1",_'__.._ . the integuments of the penis ; and u p to this point the stream 1" ha}, T . I r ' ' snice writing the above, I have ceased to think of produciiwa sloughing of the stricture, by this alkaline caustic but only to produce a in the canal a disposition N , . to dilate‘ under the bougie. 'It is admir ably adapted also to facilitate tl it. introduction of the bousrie int 0 2t Iliti‘l‘OVV htl‘lCtlll'LL flu-1:1, 1:]after trying in vain to intro duce a bougie, we withdraw it and arm 1"11 1 ah, and again (3 1 w 7 A t I ( - . ‘ L 0L mti oduce It, no sooner '7has the alkal ' l ‘ i remained for a fi {3‘ time in the neighbourhood of the stricture, than a soap is made ' . which . titer itiitels the introduction of the ‘ ' bougie through the stricuture But 11 IOU" a 1 t ie bou bio r' glide ' s now' through the stric ' ture, without the I further. "so 0-t" tie i boumi gm. ‘....I: shall not gain ‘ all the advantage. 81 OPERATION. A CANULA of silver was introduced down to the stricture. The patient then made an effort to pass the urine ; and when the urethra was fully distended, a stiletto was introduced into the canula, and carried along the diseased part of the urethra, until it entered the dilated part of the canal. These being withdrawn, a bougie was introduced into the passage. This, however, is a very diflicult operation. To the feeling, nothing is more easy than to hit the lower part of the ca~ nal, but it really is very ditfieult. And when my opinion as to the manner of operating was afterwards taken in a similar case, I advised strongly that the stricture should be pierced from below, by first making an opening into the sound part of the urethra, and then passing the canula and stiletto upwards "out through the urethra, to the point of the penis. I assisted Mr. Lynn of Westminster, in the following case: A stout healthy young man had a stricture within an inch and an half of the extremity of the penis, of a full inch in length, quite firm and impervious to the urine, which passed in a free jet from the side of his penis. It was not a stricture from a common cause, but in consequence of a bruise. A small fistula lacrimalis probe was pushed with great dittirulty down from the point of the urethra through the stricture. The end of this fine probe lying in the sound part of the urethra, was out upon ; then a common trochar and canula was, by the direction of this probe, pushed upwards to the point of the urethra. The stilette of the trochar was then withdrawn ; and an eyed probe, with a large scaton, was introdurn ed through the diseased part of the urethra ; and a catheter passed into the bladder from the incision. The large skein of cotton thread in the upper part of the urethra, produced profuse suppuration, and made a passage large enough for the catheter of the largest size. vor. 1. .u When the "it \Alnlcl‘ " ' Mn: I" {5 |
