fortunate man who has been operated on that was caused by chancre in the urethra about one-half inch from the meatus. eight times will recover. I shall present him to you on next Saturday at my clinic, when you will be surprised at the good results of antiseptic surgery. Stricture of the Urethra--Diagnosis and Treatment. Read before the Eastern Kansas District Med ical Society, in Osage City, Jan. 14, 1890. BY WM. A. RIGHTER, M. D., TOPEKA. Stricture of the urethra is a disease of the female as well as of the male, and at all periods of life, although men are more liable to it than women. No part of the urethra is exempt from it except the prostatic portion, or if it should be found in this region it would be a very rare occurrence and statistics show by the experience of some authors that they never encountered a stricture in this region. The seat of this disease has been very carefully studied by Sir Henry Thompson, who has availed himself of The causes of stricture of the urethra may the advantage afforded him by the public colbe conveniently arranged in two forms, the lections in London, Edinburg and Paris. The traumatic and the pathological stricture, of number of specimens examined were 270 emwhich the latter is the most frequent. The bracing 320 distinct strictures. Of these 215, term traumatic is applied to that form of stric-or 67 per cent. were situated at the sub-pubic ture which is caused by injury, the pathologi- curvature and its vicinity, or the junction of cal stricture is caused by disease. membraneous and spongy portions and one Injury inflicted upon the urethra internally inch of the canal before, and 3/4 of an inch beor externally, may cause inflammation suffi-hind the triangular ligament; fifty-one, or sixcient to cause stricture. A penetrating wound of the urethra may produce a stricture of the most obstinate variety. The kind of injury that usually produces a traumatic stricture is either a blow, kick or fall upon the perineum, causing a contusion or larceration of the mucous membrane and the subjacent tissues of the urethra. The violent use of a bougie in the hands of an unskilled operator may and has caused stricture of the urethra. Masturbation is a cause of stricture as cited by the experience of S. W. Gross of Philadelphia, at the House of Refuge and the Insane asylum. The most frequent cause of pathological stricture is gonorrhoea, frequent or obstinate attacks of gonorrhoea are more liable to produce stricture than one attack. Inflammatory matter is thrown out more or less, and contraction of the urethra is the result. Urethritis caused by non-specific female discharges, caustic's, strong injections, over indulgence in sexual intercourse are liable to cause stricture. teen per cent. in the centre of the spongy portion; and fifty-four, or seventeen per cent. at the external orifice, and within two and onehalf inches of that point. He found that stricture was the most frequent in the bulbous parts of the spongy portion, and the least frequent of all at the posterior part of the membranous portion. In 226 cases the stricture was single and in 185 of these it occupied the posterior region; in seventeen the middle region, and in twenty-four the anterior region. In eight cases, the canal was obstructed in all of these regions, in ten in the first and second only, in ten in the first and third only, and in thirteen in the second and third regions only. Usually there is only one stricture, but often there are two or three, and many more; Gross, never saw but four in one patient, but Hunter saw six; Lallemand seven; Colto, eight; Lery eleven; and Otis saw fourteen. Although I have had quite an experience in the treatment of stricture of the urethra, three is the greatest number I have encountered. Prof. Gross says that in his experience 90 Strictures are of different varieties. I think per cent. of all urethral strictures are due to the most common form is the linear stricture, gonorrhoea, and I believe it true because all the which presents an appearance as though the strictures that come under my observation have urethra was constricted by a cord. It embeen caused by gonorrhoea except one, and braces the entire circumference of the canal at the point of the stricture, and forms a sort of a partition or septum (which is perforated) as it might be called, thus dividing the urethra, but linear stricture does not always form in this way although it will form in a crescentic fold on one side of the canal. describing all of the symptoms that are produced by stricture of the urethra, but will say that these are not (especially these symptoms I have mentioned,) pathognomonic of stricture, because they may be caused by some other disease; but it devolves upon all of us to make There is another form of stricture formed a correct diagnosis of such cases, and to do by a narrow band extending across the canal that, you must explore the urethra with an and is called a bridle stricture. instrument which is capable of locating the Annular stricture involves the surrounding stricture. I have never depended upon the structures much deeper and varies in length. catheter or bougie to locate the stricture, beA stricture of this variety has been observed cause they sometimes produce spasm of the from one end of the urethra to the other. urethra, which is called a spasmodic stricture; This is the variety of stricture that becomes I have therefore, always used Leroy's exploraindurated and extensive hardening caused by tory bulbous bougie, which will never fail to all of the tunics of the urethra becoming in- give you the exact location and the length of volved and the contraction is the greatest at the stricture. After I pass this instrument If any of you have seen one of into the bladder, and then very carefully and these glasses that is contracted in its centre, slowly withdraw it, if there are any stricand which is used for timing a boiling egg, I tures, the bulb of the instrument will be held believe it is called an hour glass, you will have rather firmly behind the obstruction or it will seen an annular stricture. jump over, which sensation can very preceptibly be felt by the operator. A mark may be made upon the instrument with the thumb nail as the strictures are located one after another which can be measured with a rule or tape line after the instrument is withdrawn. This part of the diagnosis must be done very gently as well as deliberately, so as to avoid spasm. or any undue pain or suffering to the patient. its centre. There is a tortuous stricture which causes the canal to be of a different direction instead of being as it should be, thus foiling an attempt to pass any instrument. It may be indurated or not, the passage of an instrument may be completely foiled. There is an impermeable stricture so called, but when the urine passes in drops it is not, strictly, an impermeable stricture. It is given this name because the smallest instrument cannot be passed through it. An impermeable stricture is one that will not permit the passage of urine, is rather rare or we may say uncommon; such a stricture will produce dilatation of the urethra back of the stricture and forms a urinary cyst, which might produce urinary fistula. TREATMENT OBSERVATIONS. In regard to the treatment of stricture of the urethra it has been revolutionized as well as other parts of medicine and surgery. Here antiseptics come into use as well as in general surgery. After the strictures are located a catheter, the size that will enter the meatus to the hindermost stricture should be passed. Attach to it A gleety discharge is usually the first symp- a rubber bulb syringe and wash out the urethra tom the patient notices and he may not have pretty thoroughly with a solution of boracic any other symptom. A narrow stream of acid before attempting to operate. If the urine, a bi-furcated, or a flat stream, or in the hindermost stricture is not more than four and form of a cork screw, a check in the desire, or three-fourths inches from the meatus I introwhile urinating, dribbling. Hyperasthesia of duce a urethratome (Gross) and divide every the urethra, thus causing frequent desire to stricture that has been located. I have dividurinate, and pain with a feeling of weight at ed a stricture on two sides, but once is usually the neck of the bladder, and retention and sufficient; then as large a bougie as the exterincontinence of urine are some of the symp-nal meatus will accommodate is passed every two or three days until pain and soreness has toms. I do not wish to consume too much time in passed away. After about thirty days you may satisfy yourself by another exploration Written for the Medical Journal. that your patient has fully recovered. A stricture of large calibre may be satisfactorily treated by divulsion and followed by the bougie. Knife Wound of the Stomach. GASTRORRAPHY-DEATH-AUTOPSY. I have been in the habit of performing internal urethrotomy for stricture of the urethra October 25, 1889, I was hastily called to see any where in its track; but as you all may J. E. P——, aged 30, who during an altercaknow that if a stricture is beyond four and tion received a knife wound of the abdomen. three-fifths to five inches, is cut or divulsed He was suffering intense pain and vomiting from the inside, chill and fever is the result and I gave him a hypodermic injection of and is termed in these days of enlightenment morphia. He had just ate his dinner and septic absorption, or septicemia. Therefore vomited freely, but there was no trace of external urethrotomy is performed before the blood in the ejecta. As soon as he was easy anterior strictures are operated upon. A he was removed to his home and the wound female catheter is passed into the bladder was examined. The external wound was through the perineal wound, then internal one inch long, urethrotomy is performed upon all anterior extending from the linea alba downward and strictures. After the strictures have all been to the left, beginning two and one-half inches previously made aseptic, a bougie is passed below the ensiform cartilage. into the bladder, the female catheter of course is removed to allow the bougie to enter, a drainage tube is then inserted into the bladder through the perineal wound which is allowed to remain twenty-four hours. A bougie is then passed every two or three days until the perineal wound is healed which requires not more than two weeks, if the case progresses as you would anticipate. A probe was passed into the wound directed slightly upwards three and one-half inches, followed on its withdrawal by a greasy substance similar to that immediately vomited. I advised an operation as the only course of procedure. Assisted by Drs. Nichols, Smith and Harris the patient was etherized and I operated. First having cleansed the wound and abdomen with a bi-chloride solution, I made an incision Urethral chills are supposed to be caused in the linea alba three inches in length beby septic absorption through the urethral wound. If an internal urethrotomy is perginning two inches below the ensiform cartiformed in the pendulous portion of the urethra lage. Several small pieces of beef-steak were found which had escaped from the stomach during the act of vomiting. the wound will drain well, whereas, in a case of an internal urethrotomy in the deep urethra, the wound will not drain; there follows absorption, chills, fever, etc., and you would say your patient has urethral fever. When at the same time you were not aware of the fact that your patient had septicæmia which would be a very unfortunate occurence. Electricity has been highly lauded in the past few years in the treatment of stricture, but I have never had any confidence in it, therefore I have never tried it, and I am acquainted with a number of men who have! given electricity a thorough trial and abandoning it. The wound in the stomach was found with considerable difficulty and was one and onefourth inches long. Situated two and one-half inches from the cardiac orifice and one and one-half inches from the omental fold. On removing the clotted blood from the wound two small arteries which had been severed be gan bleeding, but were closed by torsion and the wound closed by a continuous carbolized silk ligature (cat gut could not be obtained.) The external wound was closed by six inare terrupted sutures and dusted with iodoform. Do not pour sulphuric ether from one vessel to another near a lighted lamp or gas jet. A hypodermic injection of whisky was given before and after the operation to assist reaction, which was complete. He was nourished per rectum by beef extract and whisky, and sufficient morphia given hypodermically to relieve the pain. The patient was very hope- SOCIETY ful and had a good night's rest. October 26-The pulse ranged about 120 but the temperature was normal. October 27-Morning, temperature 102°, pulse 130. Evening, temperature 99°, pulse 140, slight tympanites; urine drawn. October 28-From four to five a. m. very restless with some delirium. At nine a. m., he revived; the temperature 100°, pulse 140. The evening temperature normal and remained so except once; the 30th it reached 100°. The external wound healed nicely and the sutures were removed. October 29-The pulse and temperature the same as the 28th, but he became unconscious and remained so until death. October 30-The left parotid began to swell increasing rapidly in size, evidently due to septæmia. There was no trace of pus in the wound and realizing that my patient was too weak to stand a second operation nothing further was done. October 31-The right parotid gland began swelling. The urine was voided, pulse 160. November 1-He became maniacal. It required large doses of morphia and constant care to keep him in bed. November 2-He died at 8 a. m., just seven and one-half days after receiving the injury. Autopsy-Bowels distended with gas and slightly adherent to the peritoneum in places. The stomach was distended with gas and water, the wound healing nicely, and sutures intact. The spleen was very friable and adhered to the stomach with patches of pus between. The liver was slightly adhered to the peritoneum in places, and there were several small patches of pus on its upper surface, also at the points of adhesion to the diaphragm. The pus and adhesions on the liver, spleen and diaphragm, were evidently due to the liquid contents of the stomach, which escaped during the act of vomiting. LIBERAL, KANSAS. H. H. SUTHERLAND, SECURE one of the premiums offered by the JOURNAL. PROCEEDINGS. Eastern Kansas District Medical Society. The Eastern Kansas District Medical So ciety met in Dr. Schenck's office, in Osage City, January 14, 1890, at 3 o'clock, p. m. Present-Drs. Minney, Schenck, Righter, Thompson (of Kansas City), Burdick and McClintock. Dr. Minney in the chair. The minutes of the last meeting were read and approved. Drs. F. E. Schenck, of Harveyville, and W. R. Roup, of Arvonia, were elected members of the Society, and signed the constitution and by-laws, and paid the initiation fees and one year's dues, $3 in all. Dr. Schenck read a paper on "Pruritus," which will appear in the next number of the JOURNAL. The paper was discussed by all the members present. Dr. Schenck, of Harveyville, in discussing the paper, said he had a case in a blacksmith, of middle age, in which it was always worse in the winter. Dr. Righter reported a case in which the patient had pruritus, confined to the perineum and back part of the scrotum for five years, resisting all treatment so far. Dr. Righter read a paper on "Stricture of the Urethra, Diagnosis and Treatment." Published in this number of the JOURNAL. Dr. Thompson-In many cases electricity is beneficial in passing a catheter in strictures of the urethra. The Doctor spoke at some length on urethral chill and fever following the passing of a bougie or catheter. One case coming under his observation while in the hospital, was that of a man who had retention of urine from traumatic stricture, a catheter was passed with some difficulty, and the bladder was emptied. The man passed his water the next morning, contrary to directions. In one hour he had a chill, the temperature running up to 106°. He had delirium. At 2, p. m., he awoke and spoke rationally, and in one-half hour died. Dr. Burdick reported a case of supra-pubic lithotomy he had witnessed at Guy's Hospital, performed by Dr. Lucas. He said everything. was accomplished by this operation that could be by the old method, and its simplicity and freedom from danger as compared with the former was not to be compared. The report on a new antiseptic, by Dr. Thompson, and a case of malarial keratitis, by Dr. Minney, was read by title. Both will appear in the JOURNAL. Dr. Schenck did the handsome thing of the evening, by feeding the hungry visitors at the Everett House. The attendance at the meeting was small, owing to so much "grippe" in the various portions of the Society's bounds-two or three physicians in Osage City being its victims. Adjourned to meet in Topeka the second Tuesday of April, 1890. J. C. MCCLINTOCK, Academy of Medicine and Surgery. The Academy of Medicine and Surgery, of Topeka, met in regular session January 7, 1890, at 8 o'clock, p. m. Present-Doctor Munn, president; Dr. D. F. Rodgers, secretary, and Drs. H. C. Miner, D. K. Longshore, S. G. Stewart, W. S. Lindsay, J. E. Minney, R. E. McVey, C. A. McGuire and J. C. McClintock. Wilson County Medical Society. The first quarterly meeting for 1890, of the Wilson County Medical Society was held at Fredonia, Kansas, January 14th, 1890, Dr. J. R. Willits presiding. Dr. T. Blakeslee, of Neodosha, and Dr. M. A. Duncan, of Buxton, were elected to membership in the society. Dr. A. N. Perkins, of Fredonia, read a paper on "Cerebral and Abdominal Surgery," in which he discussed at some length improvements in antiseptic methods. Dr. A. C. Flack, of Fredonia, presented a report of a case of acute articular rheumatism in which endocarditis preceded the development of the disease in the joints. Dr. F. M. Wiley, of Fredonia, contributed a paper on "Typho Malarial Fever," in which he attempted to show that the term is unscientific and unnecessary, and should be discarded from our nomenclature. In the discussion which followed, Dr. T. F. C. Dodd stated that he treated a case of typhoid fever in Wilson county in 1872, and it was the opinion of all present that the disease had had no existence in the county previous to that time. The committee on Necrology presented an appropriate report on the death of Dr. R. B. Campfield, a former member of the society, who died at Buffalo, Kansas, November 10, Visitors-Dr. C. H. Mutz, Mrs. Henshaw 1889. The report was adopted and ordered and Mr. Gilbert. The courtesies of the floor were extended to Dr. Mutz. The minutes of the last meeting were read and approved. Dr. H. T. McLaughlin, a graduate of the Iowa Medical College, class of 1881, was proposed for membership, and referred to board of censors. Dr. Theo. W. Peers read a paper on the "History and Diagnosis of Scarlet Fever," which will be published in the next issue of the JOURNAL, with the discussion. to be published in the local papers. Dr. J, R. Willits, retiring president, read an address upon "Hemorrhages." The following officers were elected for the ensuing year: President-A. N. Perkins, M. D. On motion, the society adjourned. In the evening the members of the society with invited guests to the number of about Dr. McClintock will read a paper the next one hundred, assembled at Willit's opera hall, evening, subject to be sent in. Dr. Minney will read a paper on "The Failure of Eyesight, as a Diagnostic Sign During Pregnancy, and its Treatment." D. F. RODGERS, Secretary. where a magnificent banquet had been prepared, and where the evening was spent in feasting and toasting, and pleasant social in tercourse. Although this society has been in existence |