Operations for retention of urine dependent on stricture of the urethra : a clinical lecture delivered at the Hospital in 1852, and now reprinted from the Medical times and gazette of that year / by John Simon.

  • Simon, Sir John, 1816-1904.
Date:
[1880]
Catalogue details

Licence: Public Domain Mark

Credit: Operations for retention of urine dependent on stricture of the urethra : a clinical lecture delivered at the Hospital in 1852, and now reprinted from the Medical times and gazette of that year / by John Simon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    You will find this operation fully described in Mr. Soutli^s translation of Chelius, and spoken of as the practice of the Borough hospitals for the past thirty or forty years. And, if you wish to see the operation in its most favorable aspect, you cannot do better than observe it in Mr. South^s hands, who has had great experience in the proceeding, and who executes it with all the care and patience which are indispensable for its success. Professor Syme, of Edinburgh, who is a great authority in such matters, speaks of this operation as protracted, un- certain, dangerous, and unsatisfactory.^-’ Looking to its average performance, I must say my experience would justify this censure. It is protracted, for the patient undergoes severe manipulation during a period, of which the mean would be twenty to thirty minutes. It is uncertain, for the division of a stricture or strictures to which one is so imper- fectly guided, cannot be accomplished with facility: nor can one feel sure, under the most favorable circumstances, that one’s scalpel has hit the exact line of a canal contracted (perhaps for an inch of its length) to such narrow dimensions as scarcely, if at all, to admit the smallest catheter.* It is dangerous, because, in addition to the sources of risk just adverted to, large hsemorrhage not unfrequently contributes to exhaust the patient; and further, because in many cases (as where the urethra is contracted throughout its whole spongy portion) a catheter cannot be maintained in the passage, without prolonging that state of pain and irritation which already have set life in jeopardy. And unsatisfactory it must be on all these grounds. For what can be more so, than to conclude a severe and dangerous operation with uncertainty as to whether one has accomplished that very object for which the severity and the danger were encountered? These objections apply to the proceeding as practised by the best—I mean the most careful, operators. In other than good hands, it is a very horrid aflfair : metallic instruments are thrust in all directions; they leave the canal at one * “ Even under the most favorable circumstances, it cannot be otherwise than doubtful whether the stricture be properly divided; that is, whether the incision has passed through the narrow canal in the centre, or through the solid substance on one side.”—.BroeZie on Diseases of Urinary Organs, p. 65.