Diseases of the urinary organs / [Henry Thompson].

  • Sir Henry Thompson, 1st Baronet
Date:
Between 1860 and 1869]
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the urinary organs / [Henry Thompson]. Source: Wellcome Collection.

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    service. In some cases in which external division of the stricture on a gi-ooved staff is indicated, this operation may be performed in such a manner as to in- clude the fistulous opening in the incision, in which case a successful result may generally be reckoned on. Old chronic perineal fistulse are sometimes better dealt with by tlie galvanic cautery than by any other method. Another obstinate species of fistulous passage, communicating with the prostatic urethra, some- times follows the operation of lithotomy; this also may be often successfully treated by the introduction of an iron wire heated to intensity ; the best means of effecting which is undoubtedly the galvanic current, since it maintains as well as produces the required temperature. A fistulous passage is sometimes j)i'evented from closing by the presence of a small calculus in some part of its course. It may be a small concretion which has escaped from the bladder, or a deposit from unhealthy u.rine while passing through the siniis. Sometimes it occurs in fistula connected with diseased prostate, or with a pro- state which is the subject of calculous formations. Fistula associated with the prostate may, however, exist in the absence of any of these causes; such as those which are sometimes connected with prostatic abscess, and which are generally exceedingly obstinate and irremediable. Fistula is not necessarily a continuous passage from the uretlu'a to the surface; opening from the m'ethra at one end, it may have a blind or csecal extremity: hence blind urinary fistula has been ■described. A small tumour, originally formed by a collection of matter, and having a communication with the urethra, constitutes the general form. Its origin has been variously accounted for; some believing it a result of stricture, others of inflammation of the mucous follicles of the urethra. Until the tumour is opened exter- nally, it will not disappear, when it becomes a fistula of the ordinary kind, requiring treatment already indicated. Urethro-rectal fistulse sometimes occur as a consequence of stric- ture or abscess, and more rarely, perhaps, vesico-rectal. In either case their existence is usually first announced by the passage of liquid in an unusual manner and quantity by the anus ; sometimes by the appearance of feculent matter in the urine or by the lu-etbra. 1 have recently treated a case of urethro-rectal fistula in a gentleman of about twenty years of age, in whom it resulted from acute prostatic abscess following gonorrhoea. The urine passed freely by the anus for some weeks : after trying various means, the use of the catheter, &c., without success, I discovered that by placing him flat on his face during the action of micturition, almost all the urine passed by the urethra. Tins plan was uniformly adopted for three mouths. Urine ceased to pass altogether by rectum in a month, and in two more he could pass it in the upright position without any escape. The fistula has re- mained soundly healed ever since. If such a plan does not succeed, the actual cautery, and particularly that hented by the galvanic cm-rent, affords the best chance of success. It may be applied through the rectum ; a speculum havmg been first introduced, and a full-sized sound carried into the bladder. On the day
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