AN 
INAUGURAL DISSERTATION 
ON 
PERMANENT STRICTURES 
OF THE 
URETHRA: 
SUBMITTED TO THE PUBLIC EXAMINATION OF THE 
TRUSTEES AND PROFESSORS OF THE COLLEGE 
OF PHYSICIANS AND SURGEONS IN THE 
UNIVERSITY OF THE STATE OF 
NEW-YORK, 
SAMUEL BARD, M. D. President, 
FOR THE DEGREE OF 
DOCTOR OF MEDICINE, 
ON THE IST DAY OB' MAY, lBlj. 
JAMES C. BLISS, 
Licentiate in Medicine and Member of the American ASfculafian Society 
TROY: 
PRINTED BY PARKER AND BLISS. 
April, 1815. TO 
SAMUEL BORROWS, M. D. 
ONE OP THF SURGEONS OF THE NEW-YORK HOSPITAL. 
Sir, 
Permit me to dedicate this Dissertation to 
you, as a teftimony of ray refped for your diftin* 
guiflied profeflional charader; as well as my regard 
for you as a Gentleman, Friend, and Inftrudor. 
JAMES C. BLISS. TO 
DR. ELY BURRITT, 
THIS THESIS IS INSCRIBED 
AS A 
TRIBUTE OF GRATITUDE 
FOR HIS VALUABLE INSTRUCTION IN THE EARLY PART 
OF MY EDUCATION, 
AS WELL AS AN 
EXPRESSION OF ESTEEM 
TOR HIS PRIVATE VIRTUES. 
JAMES C. BLISS. DISSERTATION 
ON PERMANENT 
STRICTURE OF THE URETHRA. 
INTRODUCTORY REMARKS. 
Little was known with regard to the nature of 
Stricture, till the accurate inveftigations of Mr. John 
Hunter were made public. 
This gentleman not only gave us the firft accurate 
account of the affection, but fuggefted one of the moft 
important improvements in its treatment. The bougie 
was known as early as the year 1535, as mentioned 
by Alphondus Ferrus ; but it does not appear that its 
ufe was generally adopted till recommended by Daran. 
Even as late as the year 1750, Mr. Hunter informs us, 
that the common bougie employed in the firft Hofpi- 
tals in London, was either a piece of lead or a fmaU 
wax candle. 
Mr. Hunter has been feconded with much zeal and 
induftry, by his kinfman, Mr. Home, who has given 
to the world one of the moft elaborate and at the fame 
time the beft practical treatife on the difeafe, which 
we poflefs. 8 
Few difeafes have more engaged the attention of 
furgeons, within a few years, than the one now the 
fubjed of remark: hence we have been furnifhed with 
a great number of publications on Stridure, polfefling 
various degrees of merit. 
The bold manner in which the cauftic was firft re- 
commended, gave rife to fome controverfy among fur- 
geons ; and although much ingenuity has been dis- 
played and labour expended, yet little pradical advan- 
tage has refulted from this difcuflluju. 
Although we muft acknowledge much has been 
written recently on this fubjed, deferving little confid- 
eration among the great number of publications which 
have appeared, yet many important obfervations have 
been made, and valuable inferences drawn well entitled 
to the regard of the furgeon. 
Mr. Charles Bell has written an excellent little trea- 
tife on difeafes of the Urethra j and has fuggefted 
fome novel ideas with regard to the nature of Stric- 
ture and its treatment. 
It is proper here, alfo, to mention the excellent pa- 
thological obfervations of Mr. Ramfden, on difeafes 
of the Tefticle, as conneded with primary affedions 
of the Urethra, in which are developed many impor- 
tant fads which had before eluded the obfervation of 
furgeons. 
We are indebted to a furgeon of our own country. 
Dr. Phyfick, of Philadelphia, for the propofed method 
of treating Stridures, under certain circumftances, by 
the ufe of a cutting inftrument: a mode which the 9 
Dodor himfelf has fufficiently put in pradice, in a 
number of inftances. 
Wifeman, firft fuggefted the ufe of cauftic in the 
treatment of Stridure, but it does not appear that it 
was ever employed to any extent, till revived by Mr. 
Hunter, who is juftly entitled to the credit of origin- 
ality, for it does not appear that at the time he pub- 
lilhed the account of his treatment of Stridure by 
cauftic that he was acquainted with the fad, that it 
had before been propofed by Wifeman. 
The introdudion of cauftic in the cure of Stridure, 
was doubtlefs one of the greateft improvements ever 
made in the treatment of this formidable difeafe, and 
Mr. Hunter for this, as well as other improvements 
in furgery, is juftly entitled to the character of a ben- 
efaCtor of mankind. DISSERTATION, See. 
I. THE Urethra is a tube extending from the neck 
of the bladder to the extremity of the glans penis, and 
through the greater part of its courfe runs in the infe- 
rior part of the penis. It ferves the purpofe of con- 
veying the urine from the bladder, and the femen to 
the vagina of the female. 
It is lined by a mucous membrane, fimilar in ftruc- 
ture to the mucous membranes lining other paffages 
of the body. Its fenfibility is exceedingly acute, and 
its fympathies extenfive and remarkable. 
This membrane, from its ftrudure and office, ex- 
periences hidden dilatations, as in the expulfion of the 
urine, &c. and is equally liable to fall into a collapfed 
ftate, when the diftending caufe is removed. In its 
collapfed ftate, like the membranes lining the ftomach, 
bladder, &c. under fimilar circumftances, it falls into 
folds, which projed into the canal. 
It has been obferved, under certain circumftances, 
to poflefs the power of contradion; this power is re- 
markable in inflammation attendant on gonorrhaa *uU 
rulenta, in which difeafe, in fome inftances, the canal 12 
is lb contracted that the urine pafles in a very final! 
ftream or by drops. Every furgeon has been accuf- 
tomed to notice the firm manner in which the bougie 
is frequently embraced, when an attempt is made to 
withdraw it after its introduction into the urethra. 
The ftream of urine, likewife, has long been noticed 
to be contracted when the acrimony of this fluid is in- 
created by the watery parts of the blood being diflipa- 
ted, in warm teafons and in warm climates, by per- 
fpiration. 
From thete faCts has arifen the opinion, that the 
urethra poftefles mufcularity. This opinion was par- 
ticularly advocated by Mr. Hunter. 
It has been urged, that its mufcularity is evinced by 
fpafms occurring in Stricture and under other circum- 
ftances. This contraction, however, is evidently anal- 
ogous to that which takes place in other membranes, 
when aCted upon by a proper ftimulant. 
This is more particularly exemplified in the con- 
traction of the fldn j which, in ftruCture, is more near- 
ly allied to the mucous membranes,, than to any other 
membranes of the body. r 
The particular form of Stricture, has been mention- 
ed as another proof of the exiftence of muteular fibres, 
the canal appearing as if a pack-thread or riband was 
tied around it. 
But there appears to be no reafon why this contrac- 
tion, if it depended upon muteular aCtion, fhould take 
place in one part, and not another. Further, it is a 
well known faCt, that a very great proportion of Stric- 
tures of the urethra, do not confift in a diminution of 13 
the whole circumference of the canal, but are frequent- 
ly confined to a very fmall part of it. Now, it is ve- 
ry evident, that no adion of a tranfverfe or circular 
fibre, would produce fuch an effed. 
The difference of the dream in the evacuation of 
urine, and in the emiflion of femen, has been adduced 
as another evidence of the mufcularity of the urethra. 
But this difference can be accounted for by the com- 
preffion which the canal differs in the diftended date 
of the cells of the penis, the drong manner in which 
the prepuce embraces the penis at the corona glandis ; 
and the violent and convulfive adion of the ejaculator 
femfnis mufcle. 
That the formation of Stridure, near the bulb of 
the urethra, is influenced by the adion ofthemufcles 
conneded with this part is probably true; as this is 
one of the mod common feats of Stridure and of 
fpafm : but it does not neceffarily follow that the for- 
mation of Stridure depends upon mufcular contrac- 
tion, or even upon fpafm. 
The urethra has a great number of lacunae open™ 
ing into its paffage. They run in a longitudinal direc- 
tion, from behind forwards. There are two near the 
glans penis, more confpicuous than the red. Thefe 
lacunae are frequently fo far enlarged by difeafe, as to 
interrupt the free paffage of the bougie or catheter $ 
the point of the indmment lodging in them. 
From a cad, which Mr. Home made of the ure- 
thra of a man at So years of age, it appears that this 
canal is fevemtwentieths of an inch in diameter in the 14 
aarroweft part, and eleven-twentieths in the widelL 
In a fubjeCt at thirty years, there was fome inconfide- 
rable variation. 
It appears, alfo, from thefe calls, that the paflage k 
moft contracted in thofe parts of the canal molt liable 
to Stricture, viz. at four and a half and feven and a 
half inches from the external orifice. 
11. The older furgeons had formed a very imper- 
feCt and indiftinCt notion, with refpeCt to the real na- 
ture of Stricture. 
They had afcribed it to fungus and caruncles, or 
flelhy tumours fimilar to the polypus of the nofe and 
reCturm 
V 
It was not till the nature of Stricture was more com- 
pletely unfolded by morbid dilfeCtions, that thefe opin- 
ions were abandoned. But notwithllanding thefe 
opinions were relinquilhed, one, perhaps more objec- 
tionable, was embraced by Mr. Hunter 5 which was, 
that the difeafe confilled in a mere contraction of the 
fibres of the lining membrane of the urethra. This 
contraction was fuppofed to be partial, in the firft in- 
fiance, but eventually to become fo confiderable as 
completely to obllruCt the palfage of urine. 
This opinion we do not feel difpofed to admit, for 
the reafons already given. It can hardly be fuppofed 
that a Permanent Stricture can be induced in this ca- 
nal by the contraction of a fingle or a fet of fibres, if 
thefe fibres be endowed with the properties of mufcu- 
larky to which relaxation as well as contraction is ef- 
fential. This fuppofed unyielding tonic fpafm. has no 15 
analogy with any phenomenon exhibited in any other 
part of the body, in health or difeafe. 
We fliould, therefore, hardly be willing to admit, 
even if mufcular fibres were found to exift in this 
membrane, that their contraction could be productive 
of Stricture. This opinion is more particularly in- 
dulged, from taking into confederation the extreme 
degrees of relaxation and tenfion which this mem- 
brane in rapid fucceffion undergoes.* We are by no 
means drove to the neceffity of attributing the forma- 
tion of this difeafe to fuch a caufe, when we refleCt, 
that in the molt healthy ftate of this canal, this mem- 
brane is puckered and thrown into a great number of 
loofe folds, by the corapreffion which the canal fuffere 
from diftenfion of the cells of the penis, when ereCled, 
and the violent aCtion of the mufcles furrounding the 
bulb of the urethra, in the expulfion of the urine and 
femen. 
The real caufe of the fimpleft form of Stricture, 
which gives the idea of the paffage being embraced by 
a cord, appears to be inflammation of the Urethra jf 
caufing a thickening of the internal membrane of this 
paffage. Another confequence of this procefs, and 
one which contributes to the obflruCtion, is an effu- 
fion of lymph exterior to this membrane j by which 
* In the London Medical Review, vol. 3d, a cafe is related of 3 boy, 
aged four years, in whom the urethra was dilated to fuch an extent by 
means of fponge, that it permitted three calculi of the lizc of a largQ 
nutmeg to pafs. They were of an irregular wedge-like fhape, and weigh- 
ed, on an average, from fixty to feventy grains each. 
f This opinion has been advocated by Mr. C, Bclls and other diftin* 
guifbed Surgeons. „* means adhesions take place, the cells of the penis are 
glued together, and a ridge is formed which projects 
into the urethra. The broad or riband Stricture, 
appears to affume this form, by a diminution of the 
canal taking place in the interfpace between two fim- 
ple Strictures, which previoufly exifted. This kind 
of Stricture is alfo induced by inflammations ; and, in 
fome inftances, acquires almofl: a cartilaginous hard- 
nefs, and calls for the moft afliduous perfeverance in 
the ufe of cauftic for its removal. 
The Stricture in which there is a thickening, or 
folding of the internal membrane, forming a ridge in 
the fide of the canal, is obvioufly owing to the fame 
caufe as thofe before mentioned. Two or three of 
this kind are frequently met with in the courfe of the 
urethra, and can, in general, be readily diftinguifhed, 
by the impreflion which they make on the bougie. 
Inflammation and fpafm are frequent concomitants 
of Permanent Stricture of the Urethra. The latter 
probably arifes from the fympathy which ex ills be- 
tween the fphinder ‘vejica: and the lining membrane 
of the paflage. Any caufe which gives rife to irrita- 
tion in the Urethra, will produce fpafm ; as the in- 
troduction of the bougie, the application of cauftic, 
coition, intemperance in drinking, expofure to the vi- 
ciflitudes of iveather, violent exertions, non-compli- 
ance with the calls of nature in evacuating the blad- 
der, &c, &c. 
When from any of thefe caufes fpafm is induced, 
bleeding, the warm bath, and anodynes, generally af- 
ford relief. 17 
As has been before obferved, Stri&ures moft com- 
monly occur about feven inches from the external 
orifice, juft at the point where the membranous part 
of the urethra terminates in the bulb. 
This point, it has been fully afcertained, is the moft 
irritable part of the urethra. We are in poflefTon 
of fadls which lead to the belief that it is the feat of 
fpafm in ftrangury, induced from the application of 
blifters. Another fa£l which proves this part to be 
more peculiarly irritable, is, that it is fympathetically 
affe&ed, if we may be allowed the expreflion, with 
inflammation in gonorrhaa virulenta. Thefe circum- 
ftances, without doubt, give rife to the more frequent 
occurrence of obftru&ions in this part of the canal. 
The next moft frequent feat of the difeafe, is at the 
point where the penis takes its bend from the pubis, 
about four and a half inches from the extremity of 
the glans. 
Why this part fhould be more than commonlyTub- 
led to Stri&ure, is obvious from the circumftance of 
the canal at this point, inftead of being left loofe and 
free, as in other parts of its courfe, being fupported 
by the Ugamentum fufpenforium, by which means an 
acute bend is made, and this part receives the whole 
force of the urine in its expulfion. 
Irritation and inflammation from gonorrhea, or any 
other caufe, extending to this part, is kept up by this 
means, and refults in the formation of Stri&ure. Ob* 
ftru&ions very frequently occur within two or three 
inches of the extremity of the urethra ; the occur- rence of them at this part is doubtlefs owing to its 
being the ufual feat of inflammation in gonorrhaa. 
Befides thofe parts already mentioned. Strictures 
fometimes take place juft at the extremity of the ca- 
nal ; but thefe cafes are comparatively rare. 
111. From the view which we have taken of the 
fubjeCt, it is obvious that Stricture may arife from any 
caufe producing inflammation of the urethra. 
One of the moft common caufes, therefore, is gon- 
orrhaa virulent a. This fo commonly gives rife to it, 
that we may venture to afl'ert, that five cafes out of 
fix arife from this difeafe. The effeCts of it are pre- 
cifely fuch as we have defcribed as producing Stric- 
ture. In the firft inftance, a thickening of the mem- 
brane takes place; the inflammation extending deeper 
into the reticular membrane of the penis, an effufion 
of lymph follows, adhefions form, and the Tides of the 
canal are thrown into more immediate contaCt. When 
irritation has once begun, it is kept up; the Stricture 
becomes firmer and more perfeCt, till an almoft total 
interruption to the paflage of urine is induced. 
Another very common caufe of Stricture, is the ufe 
of ftrong injections, or the employment of them at 
an improper period for the cure of gonorrhaa. 
The paflage of calculi through the urethra, which 
from the mechanical violence produced, caufes in- 
flammation, though feldom acknowledged as a caufe 
of Stricture, is doubtlefs much more common than is 
generally admitted. 
Frequent and long continued aCtion of the mufcles 
furrounding the urethra, as in difficult micturition. and in coitu, becomes likewife another fource of Stric- 
ture, from the irritable and inflamed ftate of the ure- 
thra induced thereby. The intemperate ufe of vinous 
and fermented liquors, the mechanical violence done 
to the parts, and the formation of abfcefles in the pe- 
nis, have been frequent caufes of Stricture. 
Deep and foul chancres have in fome inftances 
been followed by Stricture, in confequence of theJ in- 
flammation extending to the lining membrane of the 
urethra. The unnatural vice of felf-pollution, alfo, 
hsemorrhois, and other afie&ions of the rectum, 
may be included among the caufes of this difeafe. 
IV. It has been generally remarked, that the fymp- 
toms of Stri&ure in the firft inftance, give fo little in- 
convenience that they pafs unnoticed by the patient, 
A diminution in the ftream of urine, with more fre- 
quent calls than natural to evacuate the contents of 
the bladder, uneafmefs experienced in the courfe of 
the urethra and at the neck of the bladder, and a 
gleety difcharge from the canal, are among the fymp- 
toms which firft excite the patient’s attention* 
Moft of thefe fymptoms are aggravated by any 
thing which produces irritation in thefe parts i as ex- 
cefles in drinkingviolent exercife, particularly on 
horfeback, or in a carriage; indulgences with wo- 
men 5 difobedience to the calls of nature in evacuat- 
ing the bladder ; an attack of gonorrhea ; expofure 
to cold, See, &e. 
Thefe caufes frequently give rile to fpafm, and a 
total fuppreffion of urine is the confequence. A very 
painful fenfation is fometimes experienced in the courle of the urethra, in the aft of coition, and the 
femen inftead of palling in its proper channel is thrown 
back into the bladder. 
In other inftances, confiderabie fmarting takes 
place, and a difcharge from the urethra follows, 
which is liable to be miftaken for gonorrhea. The 
Stricture becomes more complete, the patient is con- 
tinually harralfed with a delire to pafs urine; which 
is evacuated in a fmall ftream or by drops, and is 
obliged frequently to rife from bed in the courfe of 
the night. 
Violent pain is experienced in the fmall of the back 
and in the loins; uneafmefs in the groins peringeum 
and upper part of the thighs. 
The patient has involuntary emillions of femen; 
and very frequently, from lofs of power in the blad- 
der, has incontinence of urine. The fyftem at large 
partakes of difeafe from fympathy. A paroxifm of 
fever, refemblihg, in every elfential point, an attack 
of intermittent, very frequently occurs in thofe affe£t- 
ed with Stricture. Any flight excels, expofure to vi- 
ciflitudes of weather, undue exertions of body, the 
introduction of a bougie and application of cauftic, 
may all be exciting caufes of a fit. 
Other very common attendants are, derangements 
of the ftomach, want of appetite, naufeae and vomit- 
ing. To thefe may be added, thofe peculiar fenfa- 
tions which are the ufual accompaniments of nervous 
difeafes. V. Strictures of the urethra frequently throw the 
unfortunate patient into the rnofl dangerous and loath- 
fome ftate. 
The portion of the canal between the Sricture and 
bladder becomes dilated, from the circumflance of its 
experiencing, in a greater degree, the expulfive efforts 
of the bladder. Inflammation follows; fometimes fo 
acute as fpeedily to deftroy the patient. Under other 
circumftances, it is more flow in its progrefs: ulcera- 
tion is produced j the urine becomes effufed into the 
furrounding cellular membrane; foul and floughy 
abfceffes form, which burft externally and form fiftu- 
-Im, through which the urine conftantly efcapes. Thefe 
fiflulae are frequently extended by the formation and 
burfling of new abfceffes. 
The patient’s general health, under thefe circum- 
fliances, fuffers to a great degree. He has repeated 
paroxifms of fever, lofs of appetite, profufe fweats, 
great debility, and not unfrequently this complicated 
fuffering is terminated by death. 
In fome inftances, the urine becomes fo extenfively 
effufed into the cellular membrane, that inftead of a 
formation of matter being the confequence, fphacilus 
is immediately induced, and the patient is at once de- 
ftroyed. 
One effeCt of Permanent Stricture, is to increafe 
the thicknefs of the coats of the bladder. This is 
probably, in part, to be afcribed to irritation or a lefs 
degree of inflammation being produced by diftention 
of the bladder, and the frequent efforts which are 
made to pafs urine : but, it appears, in a great meaf ure, owing to the increafe of power requifite for the 
expulfion of the urine, and the confequent increafe of 
the mufcular fibres of this organ. 
When a total obftrudion to the paffage of urine oc- 
curs, great diftendon of the bladder, inflammation and 
fphaciius, are frequent confequences. Ulceration of 
the bladder, in fome inftances, alfo takes place, and is 
accompanied with a difcharge of pus with the urine. 
The ulceration, it appears from diffedions, has extend- 
ed quite through the coats of the bladder, and the 
urine has been effufed into the cavity of the abdomen. 
In other inftances it has not extended through the pe- 
ritoneal coat, but the urine has paffed into the cellular 
fubftance behind this membrane. 
The effeds of ftridure frequently extend beyond 
the bladder. The ureters become much enlarged, 
and at times very much inflamed. The kidneys like- 
wife become diftended and inflamed, by the accumu- 
lation of urine, and the inflammation not unfrequent- 
ly extends to the furrounding cellular membrane. 
The fever confequent to obftrudions in the urethra. 
and accumulation of urine, has frequently terminated 
in effufions on the brain. The fluid thus effufed has 
alfo, in fome inftances, been obferved to have a urin- 
ous fmell. 
VI. Whatever might have been the opinions, exift- 
ing formerly, relative to the treatment of Stridures, 
there can be but one, at prefent,- among the intelli-r 
gent of the profeflion. The bougie and the cauftic 
have rendered the treatment of this difeafe fo fafe, and 
at the fame time fo perfed, that we can not look for any material improvement. Perhaps in no furgical 
difeafe involving fuch important confequences, is the 
treatment more perfeCt and fo much to be relied on. 
The commonly received opinion, that the bougie 
operates by dilating a Permanent Stricture like the 
operation of a wedge, is evidently erroneous; nor, 
perhaps, is the opinion that itsfuccefs depends on the 
production of ulceration, lefs exceptionable. Believ- 
ing, as we do, that Permanent Stricture does not de- 
pend upon the contraction of a fmgle or a fet of fibres, 
we cannot, for one moment, fuppofe, that its cure is 
attributable to the dilatation of a contraction which 
never exifted. 
That ulceration, in fome inftances, takes place by 
the ufe of the bougie, and that a cure is by this means 
elfeCted, is without doubt true; and it is equally true, 
that when a cure is thus effected, an unwarrant- 
able and even a hazardous degree of violence muft 
have been employed. 
The fimple faCt appears to be, when the bougie is 
judicioufly employed, that the preffure of the inftru- 
ment caufes an abforption of the new formed fub- 
ftance, between the folds of the lining membrane 
forming the ridge in the canal. The effeCl of pref- 
fure, in promoting abforption, is very remarkable* 
and well illuftrated in anjurifm and in an ulcerated 
leg. In the latter inftance, the luxuriant granulations 
are abforbed, and the remote edges brought into more 
immediate contaCl, by abforption from the cellular 
membrane of the matter producing fwelling ; both of 
which effeCts are brought about by the equal and gen- 24 
tie preffure of a roller bandage. By this mode of 
tiling the inftrument, a very large majority of Stric- 
tures may be overcome; whilll thofe dreadful evils, 
which are the refult of the moll undue and barbarous 
violence, are avoided. It is by ufing the bougie in 
fuch a manner as to produce the effect above men- 
tioned, that the furgeon is freed from the cenfure 
of having made falfe palfages ; of having laid the 
foundation of incurable fiftulas, and of having paved 
the way to a fatal mortification of the parts. It is by 
the adoption irf fuch practice alone, that he can be ac- 
quitted of the imputation of cenfurable ignorance. 
Perhaps in every cafe where a bougie can be palled 
into a Stri&ure, and the irritation is fuch as to be ea- 
fily borne, this inftrument ought to be relied on for 
its removal. 
It is true that this mode of treating Stricture ren- 
ders the cure tedious j and it is equally true, that the 
permanency of the cure is in fome meafure uncertain. 
Yet the prejudices of patients are fo ftrong againft 
the ufe of cauftic, that in general it is better to give 
way to them and adopt this mode of pra&ice, in pre 
ference to giving alarm and exciting unneceflary fears. 
The gum elaftic bougie, in general, may be prefer- 
red, for the cure of Strictures fituate in the part of the 
canal anterior to the bulb of the urethra; but for thofe 
beyond this point the common plafter bougie is pre- 
ferable ; as it more readily takes the curve in the ure- 
thra, and is lefs liable to find for itfell a new palfage. 
As it regards the length of time the bougie Ihould 
be permitted to remain in the urethra, we ought, in 25 
every inftance, to be governed by the degree of irrita- 
tion which is produced, and the fenfibility of the pa- 
tient to its application. It may, in general, be laid 
down as a rule, that the longer the inftrument can be 
retained without material inconvenience, the better. 
The urethra, moll generally, in a fiiort time becomes 
accuftomed to its ftimulus, and the cure advances with 
much more rapidity than when it is applied at long- 
intervals and for a Ihort period of time. 
But whillt the perfevering application of the bougie 
is thus infilled upon, in thofe cafes in which the irri- 
tation in the urethra is flight and the inconvenience 
of the application inconfiderable, yet, whenever much 
pain is excited, followed by inflammation, the further 
ufe of it becomes a queftion. There can be little doubt, 
that in many inftances, it aggravates the difeafe for the 
.cure of which it is employed. 
A pretty accurate opinion can be formed of the na- 
ture of the Stri6lure, by the impreflion made on the 
point of the inftrument, and by the fenfation commu- 
nicated to the finger. If it fhould be one in which 
the diminution is equal throughout the whole circum- 
ference of the canal, the impreflion will correfpond on 
the point of the inftrument. 
In like manner, if but a part of the circumference 
is difeafed, but a part of the circumference of the bou- 
gie will receive the imprelfion. If the Stricture is un~ 
nfually indurated, a fenfation will be communicated to 
the finger as if the inftrument encountered a hard re- 
filling body. This fenfation is fimilar to that which 
would be communicated by the inftrument coming in contact; with a piece of cartilage. This variety of the 
difsafe, if it exift to great extent, is feldom materially 
benefited by the bougie ; it rarely yields but to the 
nfe of cauftic. 
VIII. The application of cauftic, to a part of fuch 
importance as the urethra, is well calculated to excite 
alarm in the minds of thofe unacquainted with its 
operation. This alarm would not probably be leffen- 
cd from obferving the acute fenfibility of this canal., 
and the intimate relation its healthy ftate has with im- 
portant fundions of the body. 
So ftrong have been the prejudices againft this rem- 
edy, that notwithftanding the undeniable teftimony we 
have of its fuperior efficacy, we are not wanting in men. 
Handing high in the profeffion, who would fhrink from 
its employment. 
Like many other new remedies, it has without 
doubt, in many inftances, been abufed. It has like 
nioft new remedies been ufed almoft indifcriminately j 
and we are not to be furprifed that its ufe ftxould in, 
fomc inftances have been attended with injurious con- 
fequences. But this does by no means militate againft 
its general efficacy and value as a remedy. 
Much of the oppofition to it has unqueftionably 
arifen from a miftaken notion relative to its operation, 
as well as a want of experience with regard to its ef- 
feds: Hence, thofe whofe obfervation and experience 
have been moft extendve, have been the mod ftrenu- 
ous advocates for its employment. 
In thofe cafes in which a bougie can not, without 
violence, after perfevering efforts, be pafled through a Stridure,-there can be no doubt that cauftic deferves 
the precedence. The irritation confequent to its ap- 
plication, bears no comparifon to that which follows 
the violence ufually employed in paffing the bougie 
into this kind of Stridure. 
There are cafes in which the fmalleft fixed inftru- 
ment can not even be palled into the Stridure. Un- 
der thefe circumftances, the bougie ought to yield to 
the more efficacious and even fafe application of the 
cauftic. Every praditioner who has had much expe- 
rience in this difeafe has met with cafes in which there 
was an extremely irritable ftate of the ftridured part. 
This peculiar ftate of the canal frequently remains 
obftinately unyielding to the ufe of the moft effica- 
cious remedies ordinarily employed for its relief. The 
ufe of the bougie, under thefe circumftances, aggra- 
vates the affedion to an almoft infupportable degree. 
But this irritation will frequently yield to one or two 
applications of the cauftic, by which means the fenfi- 
bility of the part xis deadened in the fame manner as 
the pain of an extremely irritable ulcer is removed 
by the ufe of the fame remedy.* 
There is yet another kind of Stridure, which can 
be dilated to a certain extent, but which will again re- 
cover itfelf and refill our perfevering efforts with the 
bougie. This form of Stridure requires for its radi- 
cal removal the cauftic. Some remarks on the ope- 
ration of this remedy would not perhaps be improper 
in this place. 
* An ulceration of the cornea which is rendered extremely irritable 
and painful by the conftant of the tears over the part, is alfo re- 
lieved by cauftic. The effect of the cauftic commonly employed, is not. 
to produce a deep and extenfive flough of the parts to 
which it is applied. Its operation is more fuperficial. 
When applied to a fungous excrefence, it appears rath- 
er to operate by ftimulating the abforbent veffels to 
remove the part, than by producing an abfolute de- 
dlrudion in the living principle. 
Its effects are well illuftrated on that kind of ulcer 
which has a furface covered with fpongy and luxuri- 
ant granulations. 
Thefe granulations will rapidly difappear by the ufe 
of cauftic, and a florid healthy furface is prefented, 
ftrongly difpofed to heal. 
In an ulcer of an indolent charader, in which the 
difcharge is thin and gleety, and the granulations lan- 
guid and flabby, by its ftimulating operation it con- 
verts the difeafed part into a Ample purulent ulcer, 
difcharging well formed pus and throwing up healthy 
granulations. 
It would appear, therefore, from thefe fads, that its 
operation does not wholly confift in caufing a deftruc- 
tion of parts, but that it has the peculiar effed of chang- 
ing the difeafed adion, and of promoting the abforp- 
tion of morbidly formed parts. 
The manner of applying this remedy, as commonly 
recommended, is perhaps, generally fpeaking, unex- 
ceptionable. We firft pafs a moderate fized bougie, 
well befmeared with oil, down to the Stridure, and 
mark on the inftrument the diftance of the Stridure 
from the external orifice. After the bougie is with- 29 
drawn we oil the armed inftmment, and having given 
it the proper curve, introduce it into the urethra and 
pafs it fteadily forward till it encounters the Stricture. 
The length of time the cauftic fliould be permitted 
to remain in contact with the Stricture, mull be in- 
fluenced altogether by the fenfibility of the patient to 
its application. In general, half a minute will be fuf- 
ficient; in fome inftances it cannot be retained fo long, 
whilft in other cafes no great inconvenience is experi- 
enced from its being applied a greater length of time. 
Whilft houfe furgeon to the New-York hofpital, I 
had an opportunity of obferving the effe&s of another 
mode of applying cauftic, which was firft fuggefted 
and employed by the diftinguifhed and pra&ical fur- 
geon doctor Richard S. Kiffam, one of the furgeon? 
of that inftitution. 
This method of applying cauftic does not, in princi- 
ple, effentially differ from thofe which have heretofore 
been recommended ; but under certain circumftances 
it appears to poffefs a decided fuperiority. It confifts 
in firft dipping the extremity of a fmall fized gum elaf- 
tic bougie into a faturated folution of cauftic. The 
inftmment is then to be laid afide, for a fliort time- 
that the cauftic may concrete. A canula is after- 
wards introduced into the urethra, and carried down 
to the obftru&ion, and the bougie thus armed is paffed 
through this inftmment into the Stricture. 
In Strictures extending fome diftance in the courft 
of the canal, this manner of employing cauftic prom- 
ifes to be peculiarly ufeful. Many of thde Strictures are remarkably firm and 
indurated, and their cure by the application of cauftic, 
in the common manner, is often tedious and protract- 
ed. This can in a great meafure be obviated by em- 
ploying the bougie dipped in a cauftic folution. 
It pofleffes all the combined advantages of the cauf- 
tic and common bougie, and not only operates in de- 
stroying the ftridure in the fame manner as the com- 
mon armed inftrument, but it alfo acts laterally on the 
ftriCtured part, by which means the difeafe is cured 
with much more facility than when the ordinary me- 
thod is employed. 
The application of the common armed bougie is 
fometimes followed by a total fuppreflion of urine, 
which not only creates material inconvenience, but ii* 
ibme inftances ferious apprehenftons for the fafety of 
the patient.* This effeCt is caufed by the flough which 
is feparated by the cauftic ; and probably, alfo, by the 
eftufed lymph obftrucling the canal. As far as my 
obfervation extends, this effeCt never has nor is likely 
to follow theufe of the bougie, armed with the cauftic 
folution. I think lam further warranted in faying, 
that the irritation which follows the ufe of cauftic 
in this way, is conftderably lefs than what follows that 
of the common armed inftrument. This probably is 
owing to the remedy being applied more extenfively 
to the irritable furface, by which means its fenfibility 
is diminilhed to a greater extent than by a more par- 
tial application of cauftic. There is another mifchiev- 
* See cafe la the appendix. 31 
sdus effect avoided ; which is, the flipping of the caul- 
tic from the bougie into the urethra, during its appli- 
cation. 
This mode of uflng cauftic is more particularly ap- 
plicable to Strictures fituate anterior to the membran- 
ous part of the urethra; but it may be applied be- 
yond this point, without difficulty, if a filver or gum 
elaftic catheter, the extremity of which has been re- 
moved, be uled for a canula. 
A folution of the lunar cauftic may be employed 
for arming the bougie, or the corrofive muriate of 
mercury, both of which folutions fhould be faturated 
in excefs, in order that a concretion may readily take 
place on the inftrument. 
Another cauftic, and one which appears preferable 
to either of the above, is formed by the union of equal 
parts of the corrofive muriate of mercury and water, 
with the additition of fufficient of the muriate of am- 
monia to render the fublimate foluble. By dipping 
the extremity of the inftrument into this folution, a 
fmall quantity remains on it and affumes a cryftalized 
form. 
It perhaps might be objected, that this cauftic would 
probably be productive of too violent effects on fo ir- 
ritable a part as the urethra; but the fmall quantity 
of cauftic which adheres to the inftrument, will effect- 
ually prevent any of thofe bad confequences which 
might be naturally apprehended. 
I feel perfuaded, from the trials which I have made, 
of it, that if it is cautioufly employed it is lefs likely to be followed by inflammation than when the com 
mon mode of applying cauftic is adopted. 
With refpeft to the cauftic potaffi, which has bees; 
fo favorably fpoken of by Mr. Whately, its ufe has 
been fo limited in this country, as hardly to admit of 
an opinion being formed from the experience of our 
own furgeons. Its efficacy, however, has been fully 
tefted by the furgeons of Europe, and it does by no 
means appear to have equalled the expectations form- 
ed of it upon the recommendation of fo refpeCtable 
authority. APPENDIX. 
m 
1 he following cafes are fubjoined more particularly 
for the purpofe of illuftration, than from any peculiar cir- 
cumftances attending them : for this reafon the more prom- 
inent circumftances are briefly noticed, in preference to en- 
tering into a more minute detail. There are feveral, how- 
ever, which may not be wholly uninterefting to thofe whofe 
obfervation has been confined to the cafes which ordinarily 
occur in private pradlice. 
Cafes of Simple Stricture, in which the common Bougie was 
employed. 
Pr D y, aged 59 years, feaman, was admitted 
into the New-York hofpital, Auguft 30, 1814, with Structure 
of the urethra. He had been affefted with the difeafe 15 
years. He voided his urine fome times by drops, at others 
in a forked ftream. 
The ufe of the common bougie was directed night and 
morning for his relief: the employment of the infirument 
was followed by confiderable hemorrhage from the urethra, 
at every application, but no material irritation enfued. 
On the 4th of September, the Strifture was paffed, and 
on the 28th the patient was difcharged. At this time he 
could pals his urine in as full a ftream as ever, although a 
bougie of the largeft fize had not been palled into the bladder. 
J- nR- e, born in Scotland, aged 42 years, was 
received into the New-York hofpital April 12, 1814, with 
Stri&ure, He began to experience difficulty in difcharging 34 
urine nine years before, and for the la ft fix had palled it 
guttatim. 
A Stricture was encountered at about five and a half inch- 
es from the extremity of the glans penis. By the affiduous 
employment of the elaftic gum bougie, one of a finall fize 
was pafled through three days after his admiffion. A larger 
inftrument was then ufed, and the fize gradually increaled. 
On the 23d of April he was difeharged from the hofpital. 
Five months after this period he had no return of difficulty 
in evacuating his urine. 
Be H d, born in the ifland of Cape de Verd, 
aged 33 years, feaman, was admitted June 16, 1814, with 
Stricture of the urethra, and fyphilis. The Stricture was fit- 
uate about fix inches from the extremity of the glans. He 
pafled his urine frequently and in a finall ftream ; had pain 
in the loins, &c. He was put on the ufe of the ufual rem- 
edies for the cure of fyphilis, which difeafe he had in the 
form of chancre and bubo. 
After the di (appearance of thefe fymptoms, a finall fized 
gum elaftic bougie was pafled through the Stricture with 
fome difficulty, and from the little irritation which the in- 
ftrument produced, he was able to retain it in the urethra 
almoft uninterruptedly. 
At the time he was difeharged, (July 27,) a bougie of 
large fize could be readily introduced into the bladder, and 
the urine was difeharged in a full ftream. 
J s O’B n, born in Ireland, aged 41 years, waiter, 
was admitted into the New-York hofpital May 4, 1814. 
with Stricture. He contracted gonorrhoea about twelve months 
previoufly, and had experienced difficulty in evacuating his 
urine ever fince that period. He had Stricture fituated about 
two inches from the extremity of the penis. This one could 
be pafled by a finall fized bougie. There was alfo another 
about fix inches from the external orifice. The patient had 35 
pain in the lumbar region, and in the perinseura, a flight 
difcharge from the urethra and fcalding in making water. 
The common bougie was employed in the ufual manner 
for his relief, and on the 19th of May a fmall one was pair- 
ed into the bladder. This inftrument was afterwards ex- 
changed for one of a larger fize, and the patient was fo com- 
pletely relieved, that he was difcharged from the hofpital on 
the 13 th of June. 
J—.—-n H—*—n, aged 26 years, was admitted on the Bth 
of November with Stricture. He had been laboring under 
the difeafe for two or three years. He pafled his urine in 
a very fmall ftream, with much difficulty, and had occafion- 
al attacks of ague with fever. A Stricture was pafled at 
about fix inches from the external orifice, by a moderate 
fized bougie. Its further progrefs was interrupted at about 
feven, by another Stricture. The bougie was feveral times 
pafled into this, by which means the patient was enabled to 
evacuate his urine with freedom. The inftrument, however, 
was never introduced into the bladder. The patient having 
been fo materially relieved, refufed to remain in the houfe 
till a cure could be effected. 
Cafes of Stricture with Fijlula relieved by the Bougie. 
J- n Ps, born in Grenada, aged 27 years, a col- 
ored fervant, was admitted February 5, 1814. The patient, 
at the time of his admiflion, had incontinence of urine. He 
had alfo a fiftulous opening a little anterior to the fcrotum, 
through which the greater part of the urine was difcharged. 
There was confiderable hardnefs and thickening about the 
opening. The fcrotum was fwollen, thickened and hard ; 
and the prepuce had undergone the fame change and pro- 
jected about two inches beyond the glans penis. The patient 
complained of great pain and forenefs of the parts. This 
ftate of parts, it appeared from the patient's own account, 36 
had arifen from the cffullon of urine into the cellular mem- 
brane. He had, with his other fymptoms, great pain in the 
loins and perinaeum. His general health rather impaired. 
On paffing a bougie into the urethra a Stricture was found 
to exift three and a half inches from the external orifice. 
He had been affected with clap fix years before, and began 
to experience difficulty in difeharging his urine fix or eight 
months before his admiffion, attended with frequent and 
urgent defire to evacuate the contents of the bladder. Six 
weeks before he was admitted, the difficulty became fo great 
that the urine could only be palled in drops, and in a Ihort 
time he palled it involuntarily. About three weeks after 
this, ulceration took place, and the urine was difeharged 
through the opening anterior to the ferotum. About this 
time the ferotum and prepuce became fuddenly fwollen, and 
from this period to that of his admiffion into the hofpital, 
he experienced much pain. A fmall fized bougie was palled 
into the Stridure, and direded to be retained as long as the 
fiate of the parts would permit. The ufe of the inftrument 
was continued till the i oth of February, at which time one 
Stridure was overcome : but another was immediately en- 
countered, fo that the fymptoms of the patient were in no 
way relieved. On the 16th of February, he was direded to 
take of the Spir. Terebin. one drachm in an emulfion of 
gum Arabic daily; and a bUller was applied to the perinae- 
um. On the 20th he had not been benefitted by the rem- 
edies direded on the 16th. He complained of confiderable 
pain at the neck of the bladder, which he attributed to his 
medicine. At this time the bougie could be introduced a 
little further. On the 17th of March a fmall fized inftru- 
ment was paffed into the bladder. On the 23d he was able 
to retain his urine half an hour, and but little was difeharg- 
ed by the fiftulous opening. At this time a bougie of con- 
fiderable fizs was palled into the bladder. The fiftulous 37 
opening was completely healed on the pth of April. On 
the 16th of May, three and a half inches of the prepuce 
which had become elongated and converted into a peculiar 
ligamentous fubftance, was cut off. After this period a tu- 
mor made its appearance at the part where the opening had 
previoufly exifted, anterior to the fcrotum. This tumor 
fuppurated and prevented the patient’s being difcharged till 
the sth of Auguft. 
C s K y, born in England, aged 68 years, (hoe- 
maker, was admitted into the New-York hofpital Auguft 5, 
1814, whh fijiulte in perinao, connected with linufes in the 
neighboring parts. The urine was difcharged in confidera- 
ble quantities through the opening, and the patient’s gener- 
al health conftderably impaired. There was a Stri&ure fit- 
uate about four inches from the external orifice. He had 
once been affefted with gonorrhoea. He was firft affected 
with fiftula three years before he was admitted, and it had 
been healed feveral times, and again broken out. After his 
reception the fiftula was freely dilated to give a ready exit to 
the pus and urine. A bougie, alfo, of fmall fize, was palled 
into the Stridhire, and in the courfe of one week, by its cau- 
tious application, the Stricture was overcome. This was 
followed by immediate relief in all the fymptoms of the pa- 
tient ; the fiftula rapidly healed, and he was difcharged on 
the 30th of Auguft. 
Cafes of Stricture •with F'fiula in Peritueo, in •which the common 
armed Jdongie •was employed. 
s J (F, born in Germany, aged 53 years, who 
followed the profeffion of porter, was admitted 17th Decem- 
ber, 1813, with Stricture. In July of the fame year, the 
patient received a very fevere injury in the perinseum, by 
jailing aftride the chime of a calk This injury was follow- 
ed by eftufion of urine, and Houghing of the perinaeum and urethra. The urine was difcharged through an opening m 
perinao two or three weeks after this period, but he was fo 
far recovered as to be difcharged from the hofpital on the 
i oth of September following. The perinaeum was feveral 
times ulcerated after he left the hofpital, but he did not ex- 
perience any material obftruCtion in the paflage of his urine, 
till four days previous to his fecond admiffion. The com- 
mon bougie was firft employed. On the firft of January 
the obftruCtion ftill continued, and the old fijlula in perinao 
had again opened. The cauftic at this time was directed to 
be ufed. The patient was difcharged from the hofpital oft 
the i ith of March, cured of both affections. 
C ec W———d, born in Africa, was admitted into the 
hofpital Auguft 25, 1814. The patient, at the time of his 
admiffion, had a fiftulous opening in the perinaeum, through 
which the urine constantly efcaped, and he paffed it alfo gut- 
fatim by the natural paflage. He was unable to give any 
fatisfaCtory account of his previous difeafe. A Stricture was 
found to exift five inches from the extremity of the penis. 
A bougie of finall fize was introduced into the Stricture, and 
kept applied for fome time every day. On the fourth day 
the Stricture was paffed j a larger fized inftrument was then 
employed. The fijlula in perinao was healed in a fortnight 
after his admiffion, and he was difcharged from the hofpital 
on the 28th of June. On the 16th of September the pa- 
tient again returned to the hofpital, with fijlula in perinao, 
and difficulty in paffing his urine. With thefe fymptoms 
he alfo had occafional febrile paroxifms. The common bou- 
gie was again reforted to, and was employed for fome time 
with very little advantage: it was then laid afide, and the 
cauftic applied. On its fecond application the principal 
Stricture, fituate at about feven inches from the external or- 
ifice, was pafled. Ihe opening in the perinteum was very 
foon after this clofec!. In October, an ordinary fized cathe- 39 
ler was introduced into the bladder with eafe. By the in- 
cautious ufe of the bougie, by himfelf, after this period, con-. 
Cderable inflammation was produced, which was fucceeded 
by the formation of another fiftulous opening in the perine- 
um. The patient was difcharged from the hofpital on the 
18th of January, 1815, at which time the fiftula had healed 
and he difcharged his urine without difficulty. 
Cafes of Stricture with incontinence of urine, treated hy Caujiic. 
W— —m D n, born in the ftate of Delaware, aged 
39 years, featnan, was admitted 18th of January, 1814. He 
complained of incontinence of urine, and had a gleety dif* 
charge from the urethra. The patient alfo had pain in the 
loins and forenefs of the groins and perinasum, with a fenfe 
of dragging and weaknefs. The progrefs of the bougie was 
flopped at four and a half inches from the extremity of the 
penis. The patient was affe&ed with clap in February, 1813, 
for the cure of which he employed an inje&ion, but with 
very little benefit. The difeafe was attended with violent 
chordee, which (as the patient fuppofed) caufed a rupture of 
the urethra, and was followed by copious hemorrhage. He 
entered on board the frigate United States in the month of 
April; foon after which period the difeharge from the ure- 
thra began to diminiffi, and at the fame time he obferved that 
the ftream of urine was decreafed in fize. In July he had 
an attack of nervous fever ; during which period the diffi- 
culty in difeharging urine was increafed, attended with great 
pain and frequent and urgent calls to evacuate the bladder. 
The bougie was employed a few times at this period, with- 
out any advantage. Soon after he began to pafs his urine 
involuntarily, became much debilitated, and was difeharged 
from the frigate unfit for duty. After his admiffion, the 
common bougie was employed for fome time without afford- 
ing him any relief j from this circumftance it was thought advifable to apply the cauftic. It was accordingly employed* 
and on the third application the Stridture was overcome. 
The pain in the loins, incontinence of urine, and other dif. 
treffiug fymptoms, from this period left him, and he was 
difeharged from the hofpital on the 18th of February. Nine 
months after this period, he had experienced no difficulty 
from his previous difeafe. 
P o By, born in Philadelphia, aged 36 years, fer* 
vant, was admitted nth of February, 1814, with Stridture. 
He had incontinence of urine, pain in the loins and perinae- 
um, and whenever the urine was difeharged by voluntary 
exertions, it was in drops and with violent ftraining. The 
Stridfure was fituate three and a half inches from the ex- 
tremity ot the urethra. He had been affedted with gonor- 
rhoea five or fix times. In March, 1813, he began to expe- 
rience difficulty in paffing his urine, which was difeharged 
in a fmall ftream, whilft his calls to pafs it were very fre- 
quent. His difeafe was alfo attended with an ague and fe- 
ver, as he termed it. Sometime in the following autumn he 
loft the power of retaining his urine altogether. After his 
admiffion, the common bougie was diredted. This inftru- 
ment was employed about a fortnight, without any benefit. 
The cauftic was then diredled to be applied, and after three 
applications he was enabled to retain his urine for a Abort 
time, and palled it in a fmall ftream. By the 19th of March, 
one inch had been gained on the Stridture ; his complaints 
much as before. In April the principal Stridture was pafled ; 
but another prefented at about fix inches from the extremi- 
ty of the canal. The common bougie was employed to over- 
come this obftrudtion. On the 4th of May the patient had 
fuppreffion of urine, which continued about twenty-four 
hours, but which yielded to the ufe of anodynes, warm bath 
and the bougie. Two days afterwards, a fmall inftrument 
was introduced into the bladder, with but little. difficulty. The irritation in the urethra, however, became So great, that 
it required the ufe of the bougie to be fufpended till the 18th, 
On the 20th a pretty large bougie was paffed into the blad- 
der. The patient was difcharged from the houfe on the 
loth of June. 
Cafe of Striflure with mortification of the fcrotumt in confequence 
of the ejfufion of urine. 
W m H s, a coloured man, born in Maflachufetts, 
aged about 50 years, was admitted into the New-York hof* 
pital June 3d, 1814. The patient had Stricture fituate about 
feven inches from the external orifice. He had been twice 
affeCted with clap, had experienced difficulty in paffing his 
urine twelve years, and had been under furgical treatment. 
Two or three days previous to his admiffion, he had more 
than ufual difficulty in paffing his urine, to relieve which he 
employed a bougie himfelf, but did not fucceed in getting it 
into the bladder. The application of the inftrument was 
made with fiich violence as to give great pain, and was fol- 
lowed by hemorrhage. After its introduction there was a 
total fuppreffion of urine, and after {training violently to 
evacuate the bladder, the cellular membrane of the ferotum 
perinaeum, &c. became much dillended with urine, in which 
ftate it was at the time of his admiffion. The patient had 
great pain in the parts, with forenefs to the touch. The ab- 
domen likewife was tenfe and painful on being prefled, and 
he had general febrile fymptoms. The urine, at this time 
was difeharged by drops, by violent exertions. After his 
admiffion the ferotum was freely punCtured with a lancet, 
by which means a very confiderable quantity of urine was 
difeharged from the cellular membrane. A fpirituous lotion 
was directed to be applied to the part, and the bowels open- 
ed by an enema. After this, a fmall bougie was pafled through 
the StriClure, which had the efFeCt of producing a pretty 42 
free flow of urine. Three or four days after his admiflion, 
an extenfive mortification of the fcrotum took place. He 
was then put on the ufe of bark, wine and a nutritious diet, 
and had the ufual local applications to the mortified part. 
The bougie was at the fame time ufed daily, to keep the ure- 
thra pervious. On the 15th of July, the fcrotum was com- 
pletely healed, and he was able at that time to difcharge his 
urine in a full ftream. On the Bth of Auguft he was dif- 
charged from the houfe. 
Cafes of Stricture in which the bougie armed with the caufic fa~ 
lutian, was employed. 
It may be proper to premife, that in the following cafes 
the cauftic employed was formed of equal parts of the corro- 
five muriate of mercury, muriate of ammonia and water. 
The author has had an opportunity of obferving the ef- 
fects of a folution of the nitrate of filver and of the corrofive 
fublimate, and can fpeak confidently of their efficacy; but 
as has been before obferved, the folution of the triple fait of 
muriate of mercury and ammonia, is preferred. 
N m O d, born in Canada, aged 32 years, car- 
penter, was admitted March Bth, 1814. At the time of his 
admiflion he had incontinence of urine, complained of pain 
in the back and loins ; general health unimpaired. On in- 
troducing a bougie into the urethra, it was flopped by a 
flrifture three inches from the orifice, which could not be 
palled by the fmalleft inftrumcnt. He had been affefled 
with gonorrhoea four of five times. The laft time he had 
the difeafe, it was followed by a dark coloured tumour on 
the dorfum of the penis, which fuppurated, and was opened 
with a lancet. He began to experience difficulty in difcharg- 
ing his urine, immediately after the ulcer on his penis heal- 
ed i and the power of retaining it was loft about two and a 
half years before his admiflion. On the 10th of March, the 43 
armed bougie was introduced, and applied about 
half a minute. The application was attended with confider- 
able pain, and was followed by a fuppreflion of urine and 
diftention of the abdomen. He took a large anodyne at a 
late hour in the night, without any relief in his fymptoms, 
and from his violent efforts to relieve the bladder the urine 
became effufed into the cellular fubftance of the prepuce. 
This was freely punftured to permit the efcape of the effu- 
fed urine, and a fmall fized bougie was palled into the Stric- 
ture, and permitted to remain. In a few minutes the inftru- 
ment was withdrawn, and the urine was afterwards difcharg- 
ed with tolerable freedom. Preventive means having been 
employed, no material inflammation of the penis fupervened. 
The cauftic was again applied feveral times in the courfe of 
the month, and the firft Stricture was overcome. After this 
the common bougie was employed to overcome a Stricture 
of very great firmnefs. This inftrument was exchanged on 
the Bth of May, for the bougie dipped in the cauftic /elu- 
tion. A confiderable quantity of ftringy matter was dif- 
charged with the urine, after the ufe of it. By the 20th, 
after repeated applications of the bougie dipped in the cauftic 
folution, an inftrument could be paffedtwoand a half inches 
further* The ufe of this cauftic was continued till the 30th, 
at which time a bougie could be paffed within a iiiort dif- 
tance of the bladder. On the 2d of June, a common bou- 
gie of confiderable fize was introduced into the bladder 
This inftrument was ufed till the 14th of June, at which 
rime he was difeharged. 
R—d H——n, born in New-York, aged 28 years, lea- 
man, was admitted July Bth, 1814, with gonorrhoea and 
Stricture. The patient had not been free from clap in eight 
months. He had been affe&ed with the difeafe five differ- 
ent times and had experienced difficulty in difeharging urine 
three months. At the time of his admiffion he paffed urine 44 
by drops, and occafionaily in a fmall ftream. He complain* 
ed of pain in the loins, and a fenfe of weaknefs and forenefs 
of the perinaeum. The ufual remedies for gonorrhoea were 
firft employed, and after the fymptoms of this difeafe were 
fubdued, the common bougie was reforted to. By the ap- 
plication of this inftrument, five different Strictures were 
pafied. Another one obftru&ed the paflfage at feven inches 
from the extremity of the penis. The common bougie was 
ufed twenty days to overcome this obftruftion, without ef- 
fect. The bougie armed with the cauftic folution was then 
employed, and after two applications the Stricture was over- 
come. The common bougie was again employed for two 
weeks and the patient was difcharged on the 14th of Sep- 
tember. 
H——h L h, a patient labouring under difeafed liver 
and dropfy, had alfo Stricture of the urethra. The latter 
affe&ion canted much inconvenience. He had frequent and 
urgent calls to make water, and was generally out of bed eve- 
ry half hour for this purpofe. His urine pafied by drops for 
the moft part, but at times in a very finall ftream. The 
bougie was interrupted in its courfe, four inches from the 
extremity of the urethra, by a Stricture. This was pafied 
by the bougie \ but another obftrudled its further progrefs 
at feven inches. An attempt was made to pafs this alfo, by 
jf-fmall fized inftrument, but without fuccefs. The bougie 
armed with the cauftic folution was then ufed, and on the 
fecond application the Stricture was pafled. Confiderable 
hemorrhage followed, but the patient experienced very great 
relief immediately afterwards, and was able to pafs his urine 
with much freedom. After the irritation confequent to the 
ufe of the cauftic had fubfided, a catheter of moderate fize 
\vas introduced into the bladder. 45 
M b B——a, a native of France, aged 20 years, mar- 
iner, was received from the medical department of the houfe 
April 14th, 1814. He had a firm Stridfiire fituate two and 
a half inches from the orifice of the urethra. Cmplained of 
pain and weaknefs in the fmall of the back. He had expe- 
rienced difficulty in palling his urine five or fix years, and 
had been twice affected with gonorrhoea. His urine was dif 
charged by drops, and at times in a very fmall ftream. The 
common bougie was employed for a confiderable length of: 
time without material benefit. In May the bougie dipped in 
the cauftic folution was employed a number of times, with 
the moft decided advantage. Three Strictures were in fuc« 
cellion encountered and palled, On the firft of June the 
bougie could be introduced fix inches, and on the 22d of the 
lame month, another very confiderable Stricture was over- 
come by the above mentioned inftrument, In September a 
large filver catheter could be palled very readily into the 
bladder. 
W W——bb, born in Salem, Maflachufetts, aged 
42 years, feaman, was admitted 16th of Auguft, 1814, with 
fyphilis and a firm Stricture juft at the extremity of the 
urethra. 
He had, according to his own account, been affeCted with 
the venereal difeafe above thirty times, and the glans penis 
had been destroyed by previous chancre. He had experienc- 
ed no very material inconvenience in paffing urine, till a few 
days previous to his admiffion. 
After his chancres had healed, a very finall bougie, arm- 
ed with the cauftic folution, was pafled into the Stricture* 
The application of the cauftic was feveral times repeated, 
till the paflage of a moderate fized bougie could be admitted. 
Two Strictures were afterwards encountered and overcome 
by this inftrument. 46 
The patient was detained in the houfe till the 22d of 
November, on account of an inflamed eye. At this time 
he difcharged his urine with freedom. 
W m B —h, born in Connecticut, aged 27 years, 
feaman, was admitted on the 6th of September, with rheu- 
matifm and Stricture of the urethra. He had experienced 
difficulty in pafling urine about four months. Previous to 
this period he had been affected with fyphilis. A very foul 
chancre behind the corona glandis fo completely deftroyed 
the parts, as to make an opening quite through into the 
urethra, and the urine was difcharged by this opening, as 
well as by the natural palfage, for a fhort time. The pa- 
tient had been affected four or five times with gonorrhoea. 
When he was admitted, the urine was pafled with much 
difficulty in drops, or in a fmall interr*“ptcd ftrcam. 
There was a firm Stricture in a fituation correfponding 
with the corona glandis, in the courfe of the urethra, which 
could not be paffed by the fmalleft bougie. For this reafon. 
an inftrument armed with the cauftic folution was had re- 
courfe to, and on the third application the Stricture was 
pafled. It was afterwards applied twice, by which means a 
moderate fized bougie could be admitted into the canal. 
Three Strictures were afterwards met with in the courfe 
of the urethra, which readily yielded to the common bougie. 
The patient was difcharged from the hofpital on the 29th 
of November, cured of both difeafes.