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Show OI" STRICIURE IN THIS URETHRA. 0F STRICTURE IN THE URETHRA. 69 urine. 2. Total obstruction (a case which I have twice seen), in consequence of a small stone in the urethra, lying behind the stricture, and acting like a valve. 0r, lastly, there may be fistulous openings from the urethra, and a discharge into the CHAPTER III. cellular membrane of the perineum-a very frequent cause of death, but not irremediably so. The practice to be observed in the case of suppression natu~ 0F STRICTURE II THE URETHRA, , bYMPI‘OMSw-In consequence of the stricture in the» urethra, there is a frequent call to make urine, with a strain~ ing to pass it. It flows in a wiry-forked stream, at an unusual~ ly long time after the effort has been made; and after the sensation of passing the urine has ceased, there is an involunta: ry discharge of it. Very frequently a long continued gleet has preceded the disease ; or, at least, all suspicion on the part 4‘13va MUM ‘_...,-¢'.-}-.\Jo-A:'l'fl\"-‘" 3 \\ of the patient of his having such a disease. "7hen the con: traction in the urethra is considerable, and of long continu- ance, there is pain in the loins and hips, which is increased upon straining. The urine only drops away, or flows in a small spiral thready stream, and at very short intervals: and there is deposited in it a mucus sediment. The less frequent accompaniments are involuntary discharge of the urine ; noctur~ nal emissions ; excoriations of the glans; shooting pain in the parineum, with great tenderness; heat of urine, and parox- , - a.- r-‘t‘:"‘ '4.‘(§‘-' L7- .. .s-.‘<-r- ..... ' - :‘_~‘_ r- ysms like the attack of an ague, and swelling of the testicle. Piles, or a descent of the inner coat of the rectum, not untrequenty accompany severe stricture, n hen attende d with Violent straining. The surgeon may mistake for stricture, ]. the action of the accelerator urimr, in a very irritable state of the urethra ; 0r, 2. the obstruction of the bougie, from its point enteri ng one of the lacunze of the urethra; or, 8. an enlargement of the pros- rally calls for our first attention. I shall suppose that the catheter cannot be introduced, and that the obstruction is occasioned, by a stricture aggravated by excess in drinking, or by sudden cold, or a large slough, and much swelling of the parts after the application of the caustic. The dangerous symptoms in this case, are pain and swelling in the lower part of the belly, with heat, thirst, and increased pulse. The most alarming and fatal symptom in continued obstruction of urine, or in a case of diseased bladder, is stupor, proceeding from an affection of the brain, and hickup from the sympathetic alfection of the stomach. If the attack is relieved by occasional dropping on" of the urine, he may die of the irritation. If the obstruction is obstinate, the patient dies by the urine escaping from the bladder into the abdominal cavity. Our only hope in this case is from getting a small bougie passed into the bladder, upon withdrawing which the urine will flow; or the mere introduction of a bougie down to the obstruction, letting it remain there for a little time, and then withdrawing it, will often produce a discharge of mines. If this fail, and if care has been taken not to aggravate and in« crease the obstruction by Violent efforts, we have to endeavour next to correct the state of the system, which has produced this effect. This is to be done by taking blood freely from the arm, and (by leeches) from the perineum ; by fomenting the trate gland, and an obstruction from the awkward management perineum and penis, or setting the patient down in the warm of the catheter, n hen it should turn under the pubes . The danger of stricture is, 1. chiefly inflammation bath, or semicopium ; by giving a smart purge, which very of the bladder; and this isto be dreaded when there is violent pain in the back, and pelvis, and thighs, with much mucus in the '* The bougie in this case seems to act by producing in the urethra the sensation and action which accompanies the flow of urine. 111's begun to flow, it passes more and more freely. After the urine "L \Mnfit‘b -- "" My" MN" |
