A letter addressed to James Syme, esq., Professor of Clinical Surgery, Edinburgh, in refutation of certain statements made both by him and others, his advocates, in relation to a case of stricture of the urethra, in which the operation of perineal section was performed / by Francis Burdett Courtenay.

Courtenay, Francis Burdett, 1811-1886

Date:: 1852

Credit: A letter addressed to James Syme, esq., Professor of Clinical Surgery, Edinburgh, in refutation of certain statements made both by him and others, his advocates, in relation to a case of stricture of the urethra, in which the operation of perineal section was performed / by Francis Burdett Courtenay. 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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treatment to allaying the excessive irritability of the parts. To this end, I ordered six leeches to be applied on the perineum once a week, the hip bath to be used night and morning, mild alterative aperients, and such other general treatment as the state of his health required. This course of treatment was commenced on the 16th of July, and by the 5th of August the patient’s state was so much improved that I commenced the treatment of the local disease. I resolved, at the beginning of the treatment, not to use a small instrument of any kind, or make any attempt to introduce such a one into the strictured portion of the canal, but to pass down to the seat of obstruction first a full-sized bougie, and then, on its withdrawal, a similar sized bougie armed with the Potassa Fusa, keeping it steadily pressed against the obstruc- tion. I also directed the patient to inject an opiate enema an hour before the time fixed for our operations to commence. This treatment was steadily persevered in till the 22nd of September, when I succeeded in passing to the bladder, with perfect ease, a larger sized instrument than had been passed since the commence- ment of the disease. During the whole treatment the patient never had a decided attack of rigors, or suffered from retention. A few days after this, I passed with ease a No. 8 metallic bougie. At the next operation, I had some difficulty in doing so, and there was considerable bleeding after the withdrawal of the instrument. I therefore determined for the future to use flexible catheters, but as they were increased in. size, the heemorrhage also increased. In consequence of this unpleasant symptom, I determined on introducing a catheter and keeping it fixed in for a period of twenty-four hours. This plan was continued, without any inconvenience or untoward symptom, till a No. 11 catheter could be passed. The patient returned home at the end of November. The following Christmas I spent a few days with him at his residence in the country. At this time, although the same sized instrument could be passed, yet it did not go in with- out some pressure being necessary; moreover the urethra was very irritable, and there was at times considerable uneasiness in the perineum. Under these circumstances, I recommended that a somewhat smaller instrument should bo passed, and at longer intervals, once in a fortnight, the hip bath used night and morn-

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