On the employment of gradual dilating metallic sounds in the treatment of stricture of the urethra / by T. Vincent Jackson.

  • Jackson, T. Vincent.
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: On the employment of gradual dilating metallic sounds in the treatment of stricture of the urethra / by T. Vincent Jackson. 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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    in extend nearly or quite to the mnbelicus, but iu cases of hypertrophy the dullness never extends beyond the mid distance between the pubes and umbelieus, and rarely so far, for with the hypertrophic condition of the vesical walls there is a corresponding diminution in the capacity of the organ, owing in part to the increased thickness of the parietes and also to the power of dilatation beiug lessened. When there is an absence of retention and cystitis, and the existence of the stricture has been of long duration, I have more than once diagnosed hypertrophy of the bladder by the frequent micturition and the impossibility of the urine being retained for a natural period. Previous to exploring the urethra, the mine and the urinary stream must be noted. A very attentive and precise chemical and microscopic examination of the urine in each case will well repay the surgeon, for much is to be learnt by it, and in many cases the hue of treatment to be followed is determined by it. These abnormal changes in the kidneys and bladder are of great importance, and have a direct bearing upon the hue of treatment, and then existence or non-existence shoidd always be ascertained. Desiring a patient suffering from difficult micturition to make water in your presence is always necessary, for not only will it assist the diagnosis before resorting to instruments, but also, when a full explora- tion of the urethra has to be made, the probable size of the instrument that will pass through the stricture may, in most cases, approximately be ascertained. Nearly 100 years since Heister acknowledged the ne- cessity of al\va}rs passing large sized instruments for the purpose of exploring the urethra, for, says he,9 some approve of their being very small or slender, thinking that thereby they have a more easy passage into the bladder. In this they are much mistaken, because the most slender ones are apt rather to catch and stick in the rugse and inequalities of the urethra, which often appear very considerable in old men, so that the whole operation may be thereby frustrated. What Heister taught a century since ought never to be forgotten in practice in the present day, for unless a full sized catheter or sound, as No. 8, is arrested at some point along the canal, the existence of an urethral stricture is never positive or certain. Hester's Surgery, vol. ii. p. 145.
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