Supplement to Practical observations on the natural history and cure of lues venerea : containing remarks on the application of the lunar caustic to strictures of the urethra, on the use of sedatives in gonorrhaea, and their dangerous consequences in lues venerea : with a brief enumeration of those effects of mercury which are decisive in the cure of this disease / by John Howard.

Howard, John, -1808.

Date:: 1801

Credit: Supplement to Practical observations on the natural history and cure of lues venerea : containing remarks on the application of the lunar caustic to strictures of the urethra, on the use of sedatives in gonorrhaea, and their dangerous consequences in lues venerea : with a brief enumeration of those effects of mercury which are decisive in the cure of this disease / by John Howard. 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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( 4* ) consider the caustic as an improvement, yet if his object is to destroy the urethra itself as the con- tracted part, in the endeavour to bring such part to the size this membrane is naturally, I cannot view his method in a favourable light; because, there are natural contractions in the urethra, which are most frequently affected with stricture, and these may be relaxed, opened, or enlarged by a bougie ; where is the necessity of removing them by caustic ? For instance, between the bulb and membranous part : of the urethra there is a natural contraction, no doubt for very useful purposes : when stricture takes I place at this spot, is it not much safer to enlarge it | by a bougie, than destroy it by a caustic ? A false route, and superficial ulceration are certainly’pro- ducible by a common bougie, and the latter may be sometimes unavoidable. But whenever this is pro- duced, it is superficial only, and at the stricture, ij there is no absolute destruction of the urethra any- where. Now, if the caustic really acts with consi- derable power, causing loss of substance of the strictured part, probably it may occasion in some instances the adhesion of the sides of the membrane to each other; and if it does, it leaves a new difficul- ty behind. To obviate this, it should be employed with great delicacy, and a common bougie should be introduced so as to prevent such adhesion, as soon after the application of the caustic as possible, i This too is an additional reason for enjoining rest and the most perfect state of quietude afterwards. How careful ought surgeons to be, by large dilution, the injection of oil, and the early introduction of a , bougie, to prevent the possibility of adhesion after the caustic ?—How easily does the abolition of the

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