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Show 76' or run cavsne. OF THE CAUSTIC. where there is fever or much irritability, or when there is an. with one uniform motion down to the stricture, and there it caustic, are an attack of fever like the lit of an ague; high should remain for half a minute ; or, perhaps, three quarters ; irritability of the urethra, lurmorrhagy from the urethra, pli gging up of the ure lira by the slough. I have been particular in describing the manner of ascer- taining the exact place, direction, and extent of the strictu re ; because I am too well assured that it is in this that the gene ral practice is deficient. All kinds and degrees of surgeon s venturing in the sli<.5htcst and in the most desperate cases to try the caustic without discrimination. There are two methods of applying caustic to the urethra. "VI-MA That with lunar caustic, proposed and practised by Mr. Hun: ter,with the improvement and observation of Mr. Home; and that proposed and practised by Mr. W'hate ly, in which he uses the caustic alkali. = ".7 w._..).>.~fi+:vveu.‘4‘~‘~ The lunar caustic is peculiarly well adapted for a stricture of small extent, which is the most general kind of obstruction. It alone must. be used . where there is absolutel y no passing o[ a small bougic prevrously. But there are strictures or diseas~ ed nerroutngs of the canal, extending to half an inch, or an inch in length, and regular in their course. In these cases we must either retain the use of the common bougie, or adopt . that practice recommended to us by Mr. \Vhately: for to at» temp t burrou ing with the armed bougie through the firm strictured part of the canal for so grea t a length, when the , -V"._. 7.7.... misc:- '3 '3'" W- .‘fl"'1'- '"v ‘ the caustic: for as this caustic liquifies, it must lodge chiefly in the angles and wider parts of the canal. The bougie armed with the lunar caustic, is introduced inflammatory gonorrlu‘ea: it is to be avoided, if possible, in very old men. The bad etTects which may be brought on by the use of the swelled testicle, aliection of the stomach with giddiness, and ‘ waif-u." 3'? surreumling,r parts are comparat ively loose is in a high degree dang:1‘oti>; and I‘CScHtldt‘fi more , i think, the efiect of a te‘ uacious adherence to what has been done before, than an open manly conviction of the super iority of the practice. I conceive, on the other hand, that the application of the hall but not, in my opinion more than a minute. After this, the secretions of the urethra are poured out, and the caustic liquifies. I think it, therefore, much better to Withdraw the caustic, and either introduce the same anew, or another bou- gie after a few minutes. This surely is preferable to keeping the caustic in the urethra for three minutes, which some are even in the practice of doing. The bougie for conveying the caustic, should be of a full size ; and the caustic in the centre should complete the circ ular end of the bongie, as in fig. 6. B. The shoulder A, should be full and round, so that it may dilate the canal, and ensure the application of B, to the centre of the strictureit‘. I find in the shops' bougies, of the form of fig. 5. the era tremity being quite flat, and presenting the caustic A,just within the margin. But, as I conceive it, the client of this must be, that the caustic does not touch the centre of the stricture, and cannot enter it in any degree. Nay, rather the point B, is apt to be burnt ; and a lmtgement is formed ther by the side of the stricture, opening the spongy body of the urethra, and attended with hmmorrhagy. A false passage needs but a beginning, for afterwards on that point the bougie will always hit ; and to this form of the bougie I attribute false passages in' some instances'f. If we apply in idea the caustic, fig. 5. to the delineation of the stricture, fig. 2. we shall comprehend the difficulty of makingr way by the caustic through such a length, with any If it shall be thought that this exposure of the caustic may hurt the urethra in its passage down, we have only to give the extremity oi" the hou- purum is not adapted to that case of simple. stricture; ill whic gie a thin coat of mueilage, and allow it to dry. ,ifittgt", ' I as in plate ll. fig. 1. and 3.} is to be touched with urine flows with as much difficulty as before, we are to suspect that a false "53%ng is. forming as in the direction nt‘ihe dotted line. fig. 7" h, a point directly presenting to the extremity of the In the withdrawing of the ‘wugie, the caustic is so coated with mucus, that it does not burn the urethra. Jr \Vhen the caustic and bougie is evidently making progress, and yet the .,-:/ \Nfllf‘ F MINI" |