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Show 78 am. wniirnn's cansrxe. likelihood of keeping in the tract of the canal. It is in such cases that we should operate on the principle of Mr. Whately's improvement. In using the canstic bougie, we have to proceed thus : we take a bougie of the common kind, which we know to be adapted to the urethra; but the extremity of which will not pass the stricture. We take a caustic bougic of the same size and form; we oil them, and lay them by us, for if kept in the hand they lose their firmness. Then taking the glans penis in the hand, the simple bougie is introduced with a slow uniform motion, until it meets the stricture. Having ascortained its relation to the stricture, it is withdrawn; and the l .~,.,~.~»~ ‘ 'muw . W'p-aqw. , 14E"; llWIA \\ 5 , ion" ' armed or caustic bougie introduced with a like motion of the wrist and fingers, until it is opposed by the stricture ; then it is gently pressed. 1V6 note the commencement of the burning pain, and retain it for half a minute after. The contractions of the urethra, which extend for some length in the canal, are, for the most part, accompanied with ‘ .~ 3397"" €~"='" fistula in the perineum; but whether they are or not, they are always very diflicuit of cure. We ought, in the first in- .i._ .i‘i\"-1'- -A ' _ A.,«;-..ve.. , - .3." F11... -._‘~£. , A 79 rnon'Lut CONTRACTIONS. stance, to endeavour by the introduction of the smaller bougie, to procure some alleviation of the distress and difliculty of passing the urine. There is often an inequality and obliquity in the course of these strictures, which is considerably reL lieved by the use of a small bougie, even when the urethra is not actually enlarged by the bougie. From what follows, of the use of the caustic, as recommended by Mr. "'hately, there will appear a necessity for the stricture being permea~ ble to a bougie, before we attempt a perfect cure ; and, indeed. the great nicety in the treatment of stricture is in the intro duction of small bougies during this first stage of the cure. OF Till-3 APPLICATION OF THE CAUSTIC IN A LIQFID FORM, TO THE LONG CONTRACTIONS AND C ALLOSITIES OF THE URE'IHRA- is a little opened, and there is then introduced into it a piece of the HALI PURUM: in size about half a pin's head. This caus- tic is not intended to touch the urethra, but to melt and flow from the little opening when in contact with the stricture. Having previously marked on this bougie the precise depth at: which the stricture lies from the urethra, it is introduced down to the stricture, and there allowed to remain until the caustic shall have dissolved. The point of the bougie is then passed slowly through the stricture, so as to come in contact with its whole surface. The bougie is to be thus passed through the stricture several times, and the operation repeat, ed at the distance of some daysas. In this operation we proceed gradually; accommodating the severity of the application to the obstinacy of the disease, and to the degree of sensibility or irritability in the part, or in the constitution; and the superiority of the method consists in this, that no false passage can be made. There are certainly objections to this method of applying the kali, which are to he opposed only by the greater danger of applying the lunar caustic in strictures of great length. The caustic is here applied in a liquid form, and rubbed into the stricture; but when we run a black or inky fluid into n. canal, where do we find it lurking? In the hollows and de- pressions-in the rugre ; not on the point of any natural or accidental eminence. 50 must the dissolved alkali in this operation pass beyond the prominent points of the stricture, insinuate itself into angles, and affect more powerfully the wider parts of the canal than the stricture itself. This it certainly must do in short strictures; and it will be applied without af- fecting the natural part of the canal, only in strictures of some length, in which it may be allowed to dissolve and exert its ac- tivity. I cannot help saying, though contrary to the opinion of Air. Whately, that during the use of this caustic, it will be * The immediate edicts of this caustic is :1 slight scalding sensation in A BOUC IE is taken of a size whic h will pass the stricturE, and of a consistence rather firmer than common. The end of it making waiter, and a gleety discharge from the unthratbr a day or two,- "7551(1)! A" .J» \Mn'x‘m .. - Mun I" we. |
