Some observations on the treatment of narrow and irritable stricture of the urethra : read before the Suffolk District Medical Society, May 1858 / by D.D. Slade.

  • Slade, D. D. (Daniel Denison), 1823-1896.
Date:
1858
Catalogue details

Licence: Public Domain Mark

Credit: Some observations on the treatment of narrow and irritable stricture of the urethra : read before the Suffolk District Medical Society, May 1858 / by D.D. Slade. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

    5/8
    grasped. After a few moments' delay, the bougie, in the great ma- jority of cases, may be pushed on into the bladder. This, however, it must be borne in mind, is not always necessary; the mere pre- sence of the instrument at the seat of the obstruction is generally sufficient to overcome the spasmodic action upon which the reten- tion depends. The only difficulty in carrying these delicate instru- ments down to the stricture, is from their becoming entangled in the various lacunae, which, as is well known, are greatly enlarged in this disease. This difficulty, however, can be obviated by mak- ing traction upon the penis, so as to put the mucous membrane upon a stretch-—or, in those cases which will admit of it, making use of the probe-pointed or olive-shaped bougie, of which I shall speak. Where one or more false passages exist, by certain careful rota- tory movements given to the instrument, we shall succeed in en- gaging the poiut within the stricture more speedily and safely with these delicate bougies, than by any other means. For this very purpose, M. Leroy made use of gum-elastic bougies which were bent into the form of a cork-screw, and which he often found ex- tremely useful. Whatever form of instrument may be selected, I cannot too strongly enforce the necessity of using the greatest gentleness in its introduction. Anything like violence or even roughness, will not only give our patient great and unnecessary pain, but will be sure to be followed by an increased spasmodic action of the parts, which will defeat all our efforts. M. Civiale never could say too much on this point, which certainly is the basis of all success in catheterism. Mr. Henry Thompson, of London, has recently suggested a method of protecting the mucous membrane from injury, and of rendering the introduction of small instruments more easy, particu- larly in these very cases of narrow stricture, which on trial will be found very useful. It consists in the simple method of apply- ing the oil to the urethra itself, and very freely, rather than to the instrument. In order to effect this, he says, the nozzle of a common glass syringe, containing from four to six drachms of pure olive oil, should be introduced into the urethra as far as it will go, the ex- ternal meatus being at the same time closed upon the nozzle by the fore-linger and thumb of the left hand, so that none can escape. Gentle pressure being now made upon the piston-rod, the oil gradu- ally finds its way down to the stricture j and if this be very narrow?