Licence: Public Domain Mark
Credit: The works of John Hunter. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![§. 1. Of the Bougie. The bougie, with its application, is perhaps one of the greatest im- provements in surgery which these last thirty or forty years have pro- duced. When I compare the practice of the present day with what it was in the year 1750, I can scarcely be persuaded that I am treating the same disease. I remember when, about that time, I was attending the first hospitals in this city, the common bougies were either a piece of lead*, or a small wax candle; and although the present bougie was known then, yet a due preference was not given to it, or its particular merit understood, as we may see from the publications of that time. Daran was the first who improved the bougie and brought it into ge- neral use. He wrote professedly on the diseases for which it is a cure, and also of the manner of preparing it; but he has introduced so much absurdity in his descriptions of the diseases, the modes of treatment, * When lead was used in place of bougies it has happened that a piece of the end has broken off in the bladder, which has been dissolved by injecting quicksilver. I at first suspected that quicksilver could not come in contact with lead while in water, so as to dissolve it; but upon making the experiment I found it succeeded. the urethra, if sufficiently long continued, may give rise to stricture. It may be con- sequent on stone in the bladder, on disease of the prostate or disease of the bladder, on acid urine, on repeated attacks of strangury occasioned by the application of a series of blisters. But of all sources of irritation which can affect the urethra, the most common and the most severe is gonorrhoea, and hence a large proportion of cases of stricture follow so immediately on this disease as to be justly attributable to it. There are few cases of gonorrhoea in which the stream of urine is not diminished in size, from the ex- istence of some degree of spasmodic contraction in the membranous portion of the canal. If the gonorrhoea lasts long, this spasm may become habitual, and terminate in stricture; and the likelihood of such a result is much increased if the inflammation is not confined to the extremity of the urethra, but extends to the bulb and neck of the bladder. How far injections have a tendency to produce the same effect is more doubtful. When they are successfully used on the first appearance of the discharge, it is probable that, by cutting short the disorder, they rather prevent than promote stricture. But where injections fail, they unquestionably in many cases extend the sphere of the in- flammation, and involve those parts of the urethra which are in the vicinity of the bulb, and are especially liable to this affection. Again, the discharge, as the author has elsewhere observed, relieves the spasm of a stricture. In cases where there exists already spasmodic contraction of the urethra, injections, by diminishing or arresting the discharge, will undoubtedly tend to increase the spasm and to render it permanent. The old opinion was, that a stricture was the cicatrix of an ulcer which existed during a gonorrhoea. This notion the author justly repudiates. But he must not be under- stood to mean that ulceration may not sometimes arise from other causes, and leave behind it a stricture. When the urethra has been lacerated by external violence, as by a blow on the perinEeum, stricture will usually follow, and will in most cases be of a kind which is peculiarly intractable and obstinate.]](https://iiif.wellcomecollection.org/image/b21996635_0002_0253.jp2/full/800%2C/0/default.jpg)
