Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson.

  • Thompson, Henry, Sir, 1820-1904.
Date:
1882
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Licence: Public Domain Mark

Credit: Clinical lectures on diseases of the urinary organs : delivered at University College Hospital / by Sir Henry Thompson. Source: Wellcome Collection.

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    admire the performance too much. But it is necessary to remark that much pre- paration of the bladder itself is necessary ; that some irritation of the organ must be regarded as a highly probable result—as, indeed, is often unavoidable from the use of this or of any other endoscope. If the urine is bloody or cloudy with mucus, nothing is visible ; the bladder must be washed, and then be partially distended with clear water or with air before the instrument can be applied. If the urine is quite clear no preliminary washing is necessary, and a few ounces should be present in the bladder. Having tested the power of this in- strument myself, I venture to express in cautious terms my views as to its use. First, I do not regard it as likely to help us in cases of difficult stricture or reten- tion of urine. Nor is it required to explore a bladder for any remaining fragments after the operation of lithotrity. On the other hand, there are some morbid conditions the existence of which Ave sometimes suspect, but cannot positively affirm to exist, whose presence may now be ascertained through the agency of the new endoscope. I refer to the identifica- tion of sacculated stone as the cause of persisting and unrelieved symptoms; to the detection of pedunculated growths and of villous disease of the bladder, remov- able by operation; and, lastly, to the investigation of the nature of foreign bodies, other than calculi, which have become lodged there. A precise know- ledge of the nature, size, and position of a foreign body might enable us to devise a safe and certain means of removing it in place of a tentative, uncertain, and hazardous proceeding. All these cases, however, are more or less rare; nevertheless it is our duty to be provided with every resource, whatever it may be, which en- ables us to deal more effectively than heretofore with conditions on the manage- ment of which grave issues depend. It ought to be added, moreover, that the apparatus is complicated, and requires the expenditure of much time, a practical acquaintance with electrical instruments, and great care in Avorking it in order to attain any results. It is impossible to discuss now that large and important department of dia- gnosis which comprehends the various modes of examining the urine. It de- mands a separate and practical demon- stration, to be given at the end of the course. LECTURE II. ON SOME POINTS RELATING TO THE STRUCTURE AND FUNCTIONS OF THE MALE URETHRA. In view of a consideration of the more important affections of the urethra, Avith which I shall naturally commence, I desire to depart from my usual habit a little to-day, and to speak more at length on a topic Avhich I always allude to slightly, but not otherwise, because it is not part of my plan to teach anatomy and physiology here. But I find it necessary to complain of Avhat I Avill speak of as the * too mechanical method' of treating ure- thral diseases, Avhich I think has been obtaining of late in some parts of the Continent, and perhaps in America. What I mean by that Avill appear as we proceed. I always protest against it in this course of lectures, but something more than this appears to me noAv to be desirable. I dislike to be polemical in this or any other subject, the practical side of Avhich is so important; and I would infinitely rather for my OAvn peace and comfort simply tell you Avhat I think you ought to do in relation to various cir- cumstances Avhich come before you, and not also have to point out treatment pur- sued by others Avhich I think you ought to avoid. HoAvever, I have the convic- tion that much of the treatment noAV in vogue is imperfect and less valuable than it might be, since it is founded on views of the urethra itself which are erroneous; or rather, I should say, it originates in a Avant of consideration Avhich appears very