File:Modern surgery, general and operative (1919) (14597795407).jpg

Identifier: modernsurgerygen1919daco (find matches)
Title: Modern surgery, general and operative
Year: 1919 (1910s)
Authors: Da Costa, J. Chalmers (John Chalmers), 1863-1933
Subjects: Surgery, Operative
Publisher: Philadelphia : Saunders
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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e emergence of the instrument is arrestedby a patch of thickening, a granular area, a zone of epithelial proliferation, apapilloma, or a stricture. In fact, anything which lessens the urethral caliberinterferes with the withdrawal of thebougie-a-boule. It does not do to con- Treatment of Chronic Gonorrhea ^505 elude that stricture exists simply because some lessening of caliber is appreciated.The bougie-a-boule finds its chief use in exploring the anterior urethra. Ifintroduced into the deep urethra its emergence will be normally checked as itsshoulder comes against the posterior layer of the triangular ligament. In most cases the diagnosis is only certainly determined by the use of theurethroscope. This instrument has been perfected of recent years and is now anabsolutely essential part of our armamentarium. I have long used Valentinesinstruments (Figs. 984-987). Markss air-dilating urethroscopes (Figs. 988,989) are highly satisfactory. The anterior and posterior urethra can be thor-
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FiG. 9S5.—Valentines urethroscopic tube. oughly examined and with the utmost ease. Before inserting a urethroscopictube place the patient recumbent and cleanse the foreskin, glans, and anteriorurethra as directed in the section on Cystoscopy. Insert a tube which readilypasses the meatus, first cleansing the tube and obturator by burning alcoholupon them. Carry the tube to the anterior layer of the triangular ligament.Withdraw the obturator and insert the light. Turn on the light, mop the ure-thra with bits of cotton wrapped on a stick, and slowly withdraw the tubeexamining the urethra as its walls fall together back of the retractino; tube. Fig. 9S6.—Valentines obturator. After withdrawal of the tube irrigate the anterior urethra. To examine thedeep urethra carry the instrument through the prostatic urethra. Afterthe examination give an intravesical irrigation. When the cause of a discharge is once determined, rational treatment canbe instituted, and to determine the cause the ele

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