OCR Text |
Show M: or run Boccxn. or we cans'rlc. in this disease, when they say it operates like a wedge merely, and dilates the passage. By the pressure of the bougie, an action is excited in the stricture, and the activity of the vessels adapts the form of the canal to the state of dilatation. The worst attendant on the use of the bougie, however, follows this --it leaves an action in the part on its removal, the tendency of which is to re-produce the disease. And further, I do not; doubt that the bougie remaining wedged in any part of the urethra, may produce that low degree of excitement of the canal which tends to increase the contraction in the stricture, upon which it does not operate by distension. The operator has first to measure accurately, with a common sized bougie, the exact place of the stricture ; then, tak. ing one of a conical form, he marks upon it the depth of the stricture, by comparison with the other. r, a , . "wow ‘.--m H | I‘r‘retré‘xfinz , _. <.-«»‘ .<-.‘ -;_ a. he knows that no lesser obstruction short of the full depth, as marked can be the stricture. He now presses gently, and as- ‘(o the bougie can remain for hours, we can have little expecta~ lion of removing the stricture. If the stricttu‘e retains any degree of the natural elasticity of the canal, we may proceed rapidly to increase the size of the bougie; but when it is firm, a change of structure being a necessary prelude to our success, the pressure must be more gradually increased. When we are operating for a permanent cure with the hougie, and not merely as a previous step to the use of caustic, having gained a fair lodgement, we ought then to use a bou- gie of a uniform thickness, and precisely adapted to the stricture. This will remain (once being introduced) with less trouble and imitation, than one of a wedge kind, or with a pyramidal pointse. It ought not to be concealed, that it. is the practice of some so to press with the point, in using the bougie, as to produce ulceration ; or, what is worse, forcibly to break down the V "WM ' \\ On introducing it, " certains that he has introduced the bougie into the stricture, by its sticking when he slightly attempts to draw it back; and when it gives the feeling of having passed the contraction, he can ascertain the fact, by quitting his hold of the bougie, and observing whether it recoils, and rises a little from the urethra; for it does so when it is bending in the canal, and. not entering the stricture.‘ L'pon withdrawing the bougic, and examining the point, we have to observe whether the end be blunted; in which case either the stricture must be close indeed, or it must have struck on the angle formed in the urethra by the prominent stricture. If the bougie is sharpened or flattened towards the stricture, either with the bougie or with a strong silver probe. Of this practice I profess to know nothing; and I should ima- .1: strongest and firmest (the most condensed) part of the urethra, should be a suthcient interdiction against it. I have had, as yet, little opportunity of judging of the merits of the metallic bougie ; yet my experience enables me to say, that when they can be used, there is less irritation, and less discharge from the urethra: and I have thought that the stricture was more quickly removed than with the c0m~ men bougie. ..._ ..‘.‘~.~ _ 4L... -.‘N4 , ,--.-m . OF THE CAUSTIC- the bougie, at a little distance from its point. " The time that each bougie should remain in the passage, must be determined by the feelings of the patient; for it should never give pain if possible." At first, a few minutes (in an irritable urethra) may be sulticient: and in this case our endeavour should be to subdue the irritability 5 for until \AJHJFK -- -- mm point, it has probably entered the stricture, and we are made certain of this, if there be a defined circular impression round #4" gine that the simple fact of the strictured part being the Tn}: propriety or safety of applying the caustic to the stric- ture in the urethra, is measured by the degree of pain felt on the introduction of the simple bougie. It is to be deterred * In this case, as the bougie has sometimes slipped entirely within the urethra, we will naturally use some little contrivance to retain it in its p13"? 311d at the same time to present it from disappearing altogether. x |