Proceedings of the Philadelphia County Medical Society - Vol.8 (Session of 1887).

  • Philadelphia County Medical Society
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Proceedings of the Philadelphia County Medical Society - Vol.8 (Session of 1887). Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    BRINTON, Each piece will make two bougies. In preparing them I first cut off the end transversely so as to get rid of any tendency to split. I then round the end by rubbing it lightly on a sheet of emery-paper gummed upon a board. I then make the extremity bulb-shaped. I am told that the bulb is usually produced by the action of a file. This, I think, is objectionable, as it impairs the fibre of the bone, and renders it liable to break or cut when metallic instruments are slid down over it. I make the bulb extremity by placing the end of the whalebone in a groove on the board and shave or scrape it from the end with a very sharp knife. I then shave down the shank and neck in like manner in the opposite direction, until I have formed a conical neck from three to four inches long and of almost capillary thickness as it approaches the bulb. The shaping of the bulbar end demands some . dexterity in handling the knife, and to insure accuracy I do this under a lens of low power. Having shaped the filiform with the knife, it may, if desired, be yet more smoothed by being rubbed laterally on the emery board. In case cylindrical whalebone cannot be obtained from the manufacturers, the irregular strips may be readily rounded by being passed through a watchmaker’s drawplate, or wire gauge. As the filiform whalebone bougie is the guide upon or over which metallic instruments are to be passed, each one should be carefully fitted. This can be done by frequently passing it upward and down- ward through the tunnelled perforation in the beak or extremity of each and every instrument, in conjunction with which it may in future be used. This may seem a small matter, but, in fact, the harmonious action of the guide bougie and its metallic companion has much to do in effecting a ready passage of a strictured point. [The speaker heie illustrated the process of constructing the bougie.] After using one of these instruments, should the neck become bent or twisted, I place it for a moment in hot water and then press it between the leaves of a book. In endeavoring to pass a stricture I make the first attempt with a single whalebone: if it passes, well and good. If it does not go through, I follow it with others, perhaps five or six, until the follicles or folds of the mucous membrane near the stricture are occupied. Then by patiently essaying the inserted filiforms, I almost always succeed in getting beyond the stricture at the first sitting. Sometimes, although very rarely, and in non-urgent cases, if great difficulty be encountered at the first trial, and the patient be frightened and irritable, it may be advisable to desist for the day, and to make a subsequent second attempt. Success at the first trial is, however, the rule, if the