The Journal of Cutaneous Diseases Including Syphilis, 1887, Vol. 5 (Classic Reprint)
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Produktbeschreibung
Excerpt from The Journal of Cutaneous Diseases Including Syphilis, 1887, Vol. 5 The urethral fever attending disturbance of the deep urethra is more often severe, and in a certain proportion of cases lethal. Now, although these facts arc well known and the obvious deduction undisputed, that in cutting anterior stricture there is no excuse, so far as this operation is concerned, for passing any instrument beyond the sinus of the bulb, yet practically I believe that in nearly all, if not all, instances the first sound that enters the urethra after a stricture in its pendulous portion has been cut is made to enter the bladder on one plea or another, either to see whether there is any deeper stricture or ta attempt to test the question of spasm. As a matter of habit, also, it is quite natural to let the first sound enter the bladder. I a in not, in this article, condemning the practice wholly. I have? been accustomed to do it - to sec whether or not the urethra was freely open throughout. My subsequent instrumentation to keep the stricture open is always confined to the limits of the urethra incised, or just beyond; but I raise the question whether in future it will not be better to leave the deep urethra untouched in all cases of anterior urethrotomy until the wound has healed - say until the third week - then to explore the deep urethra, as in an uncut case. I make this suggestion just now, not so much for fear of serious urethral fever, but to test the question of urethral spasm, as will appear further on in my remarks. But that it also has a bearing in relation to the first point was only too clearly demonstrated to me during the past year by an experience which one of my house surgeons in Bellevue had with a common case of anterior urethrotomy done with Dr. Otis´ instrument. The patient was a man of 41, with normal urine, save a little pus; no kidney disease. He had three tight points in the anterior urethra, hut the deepest of them was only two (2) inches from the meatus. These anterior strictures were so small that the shaft of the Otis´ instrument could not pass them, therefore the patient was first treated by having tunnelled steel instruments passed over a filiform bougie at intervals, commencing with No. 8 French tunnelled sound. This treatment was kept up over a month, and the instruments were passed into the bladder. He never had a chill during this treatment or any considerable disturbance. No haste was used in his treatment, and when he had been dilated so that the Otis instrument could pass, lie was cut upon this instrument to 35 French, the house surgeon considering that such an amount of incision was. necessary. Thereupon a number 28 French (17 English) was passed once gently into the bladder to see that the way was open. Six hours later there was a chill followed by high temperature, and death thirty hours after the operation. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.
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