A Memoir on Stricture of the Urethra. By J. P. Mettauer,
M. D., LL. D., Professor of the Principles and Practice of
Surgery in the Medical Department of Randolph Macon Col-
lege, Virginia.
This monograph embraces an abstract of the personal experience
of one, who has for many years occupied a prominent position in the
medical profession, and who has devoted much time and careful
attention to the study and treatment of stricture of the urethra. Tt
is always gratifying, if not really instructive, to learn the results of the
extended experience and numerous observations of those who have
labored long and zealously in investigating the nature and
ascertaining the most appropriate and successful modes of treating
disease. The subject of which our author treats, is one that is often
exceedingly perplexing io the practitioner and greatly annoying to
the patient; not unfrequently requiring a great deal of patience and
perseverance, as wrell as skill, on the part of the former and a
determined co-operation on the part of the latter. That he has
fully appreciated the many difficulties to be encountered in the
proper management of this disease under the different phases in
which it is seen in a large practice, and has availed himself of all
the resources supplied by extensive reading, by careful observation,
and much sound reflection, is evident from this account of the
modes adopted and followed by him in his practice. After
making some brief remarks respecting the varieties of stricture, he
says, of their location in the urethra—“ about two-thirds of my
cases had their seats at or near the bulb. Fifty-one cases were
attended with contractions at the bulb and anterior extremity of the
prostate, and one hundred and eighteen in which the strictures oc-
cupied the posterior orifice of the fossa navicularis, the bulb and
posterior extremity of the membranous portion of the urethra at the
same time.” In one hundred and eighty-two cases, treated suc-
cessfully, sixteen were of the diaphragmatic variety, and “occurred
at or near the orifices of the fossa navicularis or in the spongy
portion of the urethra beyond the fossa.
The lesions constituting stricture and those consequent to it, as
well as their symptoms, are briefly but clearly described. Much
importance is very justly attached to lesions co-existent with, and
consequent to stricture. The manner in which these are noticed,
evinces a thorough and comprehensive knowledge of the subject of
which the author treats. In exploring the urethra, to ascertain the
seat of the stricture, the recumbent position, especially in difficult
cases, is preferred, and the introduction of the sound with the
convexity towards the symphisis invariably adopted, reversing it if
it be found necessary to carry it beyond the bulb, without removing
it from the urethra. In using the bougie, especially the waxen, to
obtain the exact shape of the stricture, our author 'has found the
erect posture generally preferable. Having gained the stricture,
the bougie is allowed to remain twenty minutes or more before it is
withdrawn. It seems, however, that he has, for some years past,
abandoned for the most part the critical exploration of stricture
“ as a needless refinement in the diagnosis of the disease.” He
says:—“It certainly saves patients some bodily suffering, and not
a little mortification from exposure of their genitals!” There
are some cases, however, which he deems it necessary to explore
thoroughly and with the utmost precision. The bridle variety is of
this class.
In the constitutional treatment of stricture the use of nitro-
muriatic acid, externally and internally, has been found a “most
valuable means of regulating the bowels, after purging once or
twice also a combination of Dover’s powders and ox or swine’s
gall to obtain the same effect, in addition to sleep. Our space will
not allow of a detailed account of the author’s different modes
of operating for the radical cure of stricture, or of the different
instruments which he is in the habit of using, a minute description
of which, accompanied with drawings, has been furnished in
the pamphlet before us.
When more than one stricture exists he is in the habit of dividing
them all before withdrawing the instrument, unless fainting or
sickness of the patient renders it necessary. In some instances the
incisions have been dilated by forcing a metallic bougie of a large
size through the imperfectly divided stricture. This, however, is
deemed a hazardous practice, especially in the hands of inexperi-
enced operators. After the division of a stricture and the introduc-
tion of a tube the patient is placed in bed and required to remain
there, generally, for several days—not less than two, unless the
presence of the tube in the urethra should prove too irritating.
The importance of using the bougie, occasionally, for some months,
or even years, after the operation is strongly urged. Having noted
some of the most important points in our author’s valuable memoir
on stricture of the urethra, sufficient, we trust, to give the reader a
general idea of its character, and induce him to obtain it and
peruse it for himself, we may be allowed to express the hope
that his able pen may be spared many years yet to record for the
benefit of his professional brethren the result of his individual
experience.