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?3r. ebUiin |!3. Cragin

1859-1918



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THE SURGICAL DISEASES



GENITO - URINARY ORGANS



INCLUDING SYPHILIS



BY

K L. KEYES, A.M., M.D.



PKOFESSOR OF GENITO-URINARY SURGERY, SYPHILOLOGY, AND DERMATOLOGY, IN BELLE%a-E HOS-
PITAL MEDICAL COLLEGE ; CONSULTING SURGEON TO THE CHARITY, THE BELLEVUE,
AND THE SKIN AND CANCER HOSPITALS ; CONSULTING SURGEON TO THE
BUREAU OF OUT-DOOR RELIEF, BELLEVUE HOSPITAL ;
SURGEON TO ST. ELIZABETH HOSPITAL, ETC.



A REVISION OF VAN BUBEN AND REYES'S TEXT-BOOK
UPON THE SAME SUBJECTS



NEW YOEK

D. APPLETON AND COMPANY

1889



Copyright, 1874, 1888,
By D. APPLETON AND C03IPANY.



PEEFAOE.



Time and surgical advance have destroyed in great part the
valne of the original treatise npon v^hich this revision is founded,
making it an unsafe guide as a text-book upon certain subjects.
The original book for which my dear old master and myself were
mutually responsible was issued in 1874, and since that date until
the present time has received no material alteration. The whole
subject of litholapaxy has had its birth snice that date; supra-
pubic cystotomy has been restored to a new life ; the surgery of the
kidney has been constructed anew, and radical changes have been
introduced into the surgery of the tunica vaginalis and that relating
to the treatment of varicocele. Many minor advances have been
made by the profession all along the line followed in this treatise.

To bring the book up to date, therefore, it became necessary to
recast it entirely, and the publishers have found it expedient to
destroy the old stereotyped plates and to set up the entire book
anew in type. There are comparatively few pages in which inter-
polations of more or less importance have not been made.

All the cases have been left out, to give place for new matter,
and several of the chapters (on stone) have been di'opped entirely,
being replaced by others.

In this way it has been possible to add considerable new material
without materially adding to the number of pages. The plan of
the original book has been scrupulously adhered to, and its scope
remains unaltered.

I have missed the kindly counsel and the matm-e judgment of
my friend and teacher, without which the original of this work
would not have been written. His absence from this revision is to
be deplored; but I feel jiistifled in making the revision because
there appears to be a demand for it, and because all the text of the



jy PREFACE.

original work came from my pi'ii except Chaptei-s XIV, XV, XVI,
and XVII — on stone. One of these chapters I have left un-
changed, out of respect to my former pai-tner ; the othei-s have been
rewritten.

The book as it stands is an honest exhibit of my views upon all
the subjects considered.

E, L. Keyes.

1 Park Aveme. New Vokk. Fehruanj, ISSS.



PREFACE TO THE ORIGINAL TREATISE.



The steady growth of the science and art of surgery has in-
volved a corresponding increase in bulk of the text-books in which
its principles and practice are set forth — an increase already sug-
gestive of either a limit in bulk soon to be reached, or the omission
or slurring over of special subjects. In this alternative the prepara-
tion of text-books on special subjects would seem to be the appro-
priate remedy.

The tendency of mankind to aggregate in large and constantly-
increasing cities has led to a corresponding tendency to the growth
of specialists in the different departments of medicine and surgery ;
and the development in large cities of hospitals and schools, and
opportunities for teaching, would seem to render them the natural
repositories of accumulating experience and the sources of advanc-
ing knowledge. It is from city practice and hospital experience,
therefore, that the materials for the preparation of text-books on
special subjects would be naturally sought, and from these sources
the substance of the present work has been mainly derived. Its
object is to present to the student and general practitioner a suc-
cinct account of the nature and treatment of the diseases incident
to the genito-urinary organs as they are encountered in private and
hospital practice by those engaged in their daily and especial study.
The literature of this department of surgery has been carefully
studied with the purpose of reproducing every fact of practical
value. It is hoped that the reader will recognize a conciseness in
the grouping of these facts which will save him the necessity of
reference to the numerous monographs and essays from which they
have been collected.

On account of the general character of the work as a text-book,
it has been impossible to refer very largely to personal authority
and experience, and this has been for the most part avoided except
in reference to mooted points and exceptional or noteworthy phe-
nomena. The extent of the subject-matter treated of, and the ne-
cessit}' for compression, will be regarded, it is hoped, as a sufficient



vi PREFACE TO THE ORIGIXAL TREATISE.

apology for terbcness ami directness of expression or defect in style,
while the circumstance of joint-authorshij) will exjilain any lack of
uniforinity in manner throughont the work, of which the prepara-
tion for the press has devolvetl mainly upon the junior author.

The plan of the work is based upon an anatomical classiiication
of the tissues and organs of which the diseases and deformities form
the subjects of description. This necessitates some repetition and
frequent reference to facts, cases^ or illustrations already given, or
to be given, in connection witii other anatomical divisions of the
geuito - urinary tract. These references are usually made thus:
(Nephralgia), (Plate XX), (Case 45), the page not being specified,
as the constant appearance of signs scattered through a page tends
to confuse the reader. No difficulty need be experienced in turning
to these references promptly, as the parenthetical word, case, or
plate may be found at once credited to its proper page in the gen-
eral index at the end of the book, or in the index to plates, or list
of cases, at its commencement.

The terms of measurement employed are uniformly English,
with the exception of the centimetre and millimetre, which fre-
quently occur in the text. These may be readily reduced to tlicir
equivalent in inches by computation from the subjoined table.*

The subject of syphilis is included, of necessity, in a treatise like
the present. Opportunities for the observation and study of this
disease on a large scale fall mainly to the share of the metropolitan
hospital-surgeon and special practitioner. Although properly be-
longing to the department of Principles of Surgery, there is no
disease falling within the limits of this work concerning which clear
and correct ideas as to nature and treatment will, at the present
time, so seriously influence success in practice.

Chapter YIII, Part If, on " Syphilitic Diseases of the Eye,"
has been kindly furnished, at the request of the authors, by Prof.
II. D. iSToyes, M. D., whose authority on this subject is undisputed.

They beg leave to thank Dr. Eoosa for aid, both ju'rsonally and
through his excellent work " On Diseases of the Ear," in the prep-
aration of Chapter IX, Part II, " On Syphilis of the Ear."

Aclcnowledgments are also due to Dr. Partridge and Dr. Morri-
son-Fiset, of the house-staff of the Charity Hospital, for kind assist-
ance ; and to Dr. L. A. Stimsou for aid in many ways.

* 1 centimetre = 4'433 lines, or "oO^YOS inch ;
1 millimetre = -443 line, or -03937 inch;
or, roudilj, 1 millimetre equals half a line — about one twenty-fifth of an inch.

New York, June, 1S74.



OOETTENTS,



PART I.

DISEASES OF THE GENITO-URINARY ORGANS.



CHAPTER I.

DISEASES OF THE PENIS. PAGE

Anatomy.— Anomalies ; Double Penis; Absence of Penis.— Fracture, Dislocation.— Cutaneous
AfEections.— Tumors.— Cancer.— Amputation of Penis.— The Prepuce ; Circumcision.— Phi-
mosis ; Remote Results of Phimosis.— Paraphimosis.— The Glans Penis ; Herpes Progeni-
talis, Balanitis, and Posthitis, Vegetations, Epithelioma.— The Corpora Cavernosa ; Inflam-
mation, Ossification, Calcification, Gummy Tumor, Circumscribed Chronic Inflammation . 1

CHAPTER II.

DISEASES OF THE URETHRA.

Anatomy.— Natural Curve of the Urethra.— Proper Curve for Instruments.- Catheterism ; Ob-
stacles to Catheterism in the Healthy Urethra.— Deformities of the Urethra ; Imperforation,
Atresia, Hypospadias, Hermaphrodism, Epispadias.— Urethral and Sexual Hygiene.— Injuries
of the Urethra.— Urethral Fever.- Foreign Bodies.— Polypi 30

CHAPTER in.

DISEASES OF THE URETHRA.

Inflammation.— Causes.— Subdivisions : Gonorrhoea ; Bastard Gonorrhoea ; Urethritis.- Symp-
toms.— Duration.— Course.— Gleet.— Complications of Urethral Inflammation.— Treatment ;
Method of performing Injection ; Abortive Treatment.— Methodic Treatment of Increasing
Stage, including Description of Wrappings ; of Stationary Stage, including Chordee ; of
Decreasing Stage, including Copaibal Erythema.— Gleety Stage ; Treatment of Gleet.— The
Endoscope.— Rare Sequelse of Gonorrhoea 54

CHAPTER IV.

COMPLICATIONS OF GONOERHCEA.

Folliculitis.— Inflammation of Lacuna Magna.— Cowperitis.-Peri-urethritis.— Adenitis.— Lym-
phitis.— Gonorrhoeal Rheumatism ; Hydrarthrosis, inflammatory : affecting Sheaths of Ten-
dons ; Bursas.— Diagnostic Table of Simple and Gonorrhoeal Rheumatism.— Gonorrhoeal
Ophthalmia.— Gonorrhosal Conjunctivitis.— Diagnostic Table of Gonorrhoeal Conjunctivitis
and Gonorrhoeal Ophthalmia 82

CHAPTER V.

STRICTURE OF THE URETHRA.

Definition.— Varieties ; Muscular, Organic— Organic Stricture.— Form.— Xumber.— Seat.— Tlie



Lesion in Stricture.- Causes.— Time of Occurrence of Stricture.— Irritable and Resilient
Stricture



98



viii CONTENTS.



CHAPTER VI.

STRICTURE OF THE I-RETIIRA. PAOR

Instnimcnts and (heir I'sc— Filiform Bougies with Mananivrcs alone, and as Guides.— Bougies.
—Bulbous Bougies.— Catheters.— Sounds.— Scale.— Advantages of Steel Instruments.— In-
struments for Divulsion with Manoeuvres.— Instruments for Internal Urethrotomy with 3Ia-
nanivres.— Perineal Urethrotomy with and without a Guide.- Rectal Puncture.— Supra-pubic
Puncture. — Uieulafoy's Aspirator 109

CHAPTER Vn.

STRICTURE OP THE URETURA.

Diagnosis.— Use of Bulbous Bougie.— Symptoms of Stricture and its Results as affecting the
Urethra, Bladder, Kidneys, Testicles, Rectum, Nerves, etc., including a Consideration of In-
filtration, and the Harmlessness of Healthy Urine in contact with the Tissues.— Causes of
Death from Stricture. — Recapitulation of Symptoms and Effects of Stricture .... 130

CHAPTER VIII.

TRE.\TMEXT OF STRICTUKE OF TUE URETHRA.

With Details for all Complications, and a Recapitulation 146

CHAPTER IX.

DISEASES OF THE PROSTATE.

Anatomy.— Function.— Deformities.— Injuries. — .\trophy.— Hypertrophy.- Bar at the Neck of
the Bladder.— Symptoms and Results of Hypertrophy. — Course of Symptoms from commenc-
ing Irritability up to Retention, Atony, Stone, Uraemia, Death IC9

CHAPTER X.

DISEASES OF THE PROSTATE.

Hypertrophy (continued).— Diagnosis ; Description of Instruments and Manoeuvres cmploj'cd in
their Use.— Examination of Patient.— Methods of retaining Catheters in the Bladder. —Meth-
ods of deciding upon the Character and E.\tent of Prostatic Deformity as affecting the
Course of the Urethra. — Treatment.— Treatment of Complications.— Interna! Remedies in
Prostatic Disease.— Natural Mode of Death due to Hypertrophied Prostate . . .184

CHAPTER XI.

DISEASES OF TUE PROSTATE.

Congestion.— Parenchymatous Prostatitis.— Terminations : in Resolution, Chronic Prostatitis,
Abscess.— Treatment.— Gonorrhoea! Prostatitis.- Prostatic and Peri-prostatic Abscess.—
Treatment of all Forms of Abscess.— Follicular Prostatitis.- Its Liability to be mistaken for
Stone in the Bladder. — Treatment. — Tubercular Prostatitis. — Cancer of the Prostate. — Pros-
tatic Concretions.— Prostatic Calculi.- Neuralgia of the Prostatic Urethra.— Syphilis of the
Prostate 205

CHAPTER XII.

DISEASES OF TUE BLADDER.

Anatomy. — Anomalies and Deformities, Exstrophy. — Hernia of Bladdcr.—Hypertrophy.— Atro-
phy.— Wounds.-Rupture of the Bladder.— Foreign Bodies.— Retention of Urine. -Inconti-
nence : in Children, in Adults.— Tenesnius.-Chorea.-HKmaturia.-Neuralgia of the Vesi^
cal Neck.— Cause.- Symptoms.— Diagnosis.- Treatment 218

CHAPTER XIII.

DISEASES OF THE BLADDER.

Acute Cystitis.— Gonorrhoeal Cystitis.— Diagnostic Table of Cystitis of the Neck and Prosta-
titis.- Pathological Lesions in Cystitis.— Treatment.— Chronic Catarrh of the Bladder.—
Atony of the Bladder.— Paralysis, Heterologous Deposits, and Tumors in the Bladder-
Walls 243

CHAPTER XIV.

STONE IN THE BLADDER.

Materials of which Calculi are formed.— Causes of Stone, internal and external.— Number.—
Size.— Shape.— Weight.— Degree of Hardness.— Possible Consequences of Stone, including



CONTENTS. jjj

PAOE

Symptoms, Pathology, and Modes of Death.— Symptoms considered in Relation to Dia^o-
sis and Selection of Mode of Cure.— Sounding.— Circumstances prejudicial to a Choice of
Lithotrity 2C3

CHAPTER XV.

TKBATMENT OF STONE OTHEU THAN JtADICAL.

The Preventive Treatment of Stone.— The Electrolytic Treatment of Stone.— The Solvent
Treatment of Stone, General and Local.— The Palliative Treatment of Stone .... 280

CHAPTER XVI.

LITHOLAPAXY.

Modem Improved Lithotrity.— Cases suitable for this Operation.— Instruments? used, and their
Method of Employment.— After-treatment.— Complications.— Litholapaxy in Women.-
Relapse 290

CHAPTER XVII.

LITHOTOMY.

The Lateral Operation.- Cases suitable for it.— Instruments employed.— Operative Method.—
After-treatment.— The Lateral Operation in Children.— The Median Operation.— Cases suit-
able for it.— Operative Method.— Complications of Lithotomy.— Relapse after Lithotomy . 297

CHAPTER XVin.

SUPRA-PUBIC LITHOTOMY.

Cases Suitable for the Operation. — Operative Method.— After-treatment 312

CHAPTER XIX.

DISEASES OF THE URETERS.

Anatomy.— Anomalies.— Chronic Inflammation.— Dilatation.— Stricture.— Wounds . . .310

CHAPTER XX.

DISEASES OF THE KIDNEY.

Anatomy.— Anomalies.— Floating Kidney.— Nephrorraphy.— Injuries.— Suppression of Urine.—
Nephralgia.— Phosphatic Urine.— Oxaluria.— Gravel and Kidney-Stone.— Nephritic Colic—
Nephro-lithotomy.— Pyelitis, Pyelonephritis, and Perinephritic Abscess.— Pyelitis. Patho-
logical Lesions.— Causes.— Calculous Pyelitis.— Perinephritic Abscess,— Treatment of Pyeli-
tis. —Hydronephrosis.— Kidney-Cysts.— Hydatids.— Tubercle.— Cancer.— Other Tumors of
the Kidney.— Nephrotomy.— Nephrectomy.— Syphilis of the Kidney 317

CHAPTER XXI.

DISEASES OF THE SCROTUM.

Anatomy.— Injuries.— (Edema.— Emphysema.— Eczema.— Intertrigo.— Pityriasis.— Eczema Mar-
ginatum.— Pruritus Genitalium.— Pediculi Pubis.— Phlegmonous Erysipelas.— Elephantiasis.
—Tumors and Cancer of Scrotum.— Epithelioma 3,53

CHAPTER XXn.

DISEASES OF THE TESTICLE.

Anatomy. — Anomalies. — Cryptorchidism. — Luxation. — Hypertrophy. — Atrophy. — Injuries.
— Hsema tocele.— Hematocele of the Cord.— Free Bodies in the Tunica Vaginalis . . .362

CHAPTER XXin.

DISEASES OF THE TESTICLE.

Hydrocele, acute, chronic— Diagnostic Table of Chronic Hydrocele with Incarcerated Hernia.-
Palliative Treatment.— Radical Treatment.— Congenital Hydrocele.— Diagnostic Table of
Congenital Hydrocele and Hernial Tumor.— True and Spurious Hydrocele of Hernial Sac-
Encysted Hj-drocele of Testis.— Spermatocele.-Spermatic Congestion.— Origin of Sperma-
tocele—Hydrocele of Cord, diffuse, encysted 374



X CONTENTS.

CHAPTER XXIV.

DISEASES or THE TESTICLE. PAOE

Inflammation.— Orchitis.— C.iuscs.- Symptoms.— Pathologlciil Changes.— Prognosis. — Treat-
ment.— Epididymiiis.-Frequency and Date of Appearance in Gouorrha'a.— Causes.— Symp-
toms.— Sterility as a Kesnit of Epididymitis.— Diagnostic Table of Orchitis and Epididy-
mitis.— Treatment of Epididymitis 388

CHAPTER XXV.

DISEASES OF TUE TESTICLE.

Psendo-tubcrcnlar Epididymitis.— Tubercular Testis.— Symptoms.— Pathology.— Treatment

Sypliilitic Epididymitis.— Syphilitic Orchitis ; Interstitial ; Gnmniy.— Cancer.— Sarcoma.—
Diagnostic Table of Syphilitic Testis, Tubercular Testis, Cancer, Sarcoma, including Diag-
nostic Features of Different Fungi.— Castration.— Dermoid Cyst.— Irritable Testis.— Neu-
ralgia Testis 406

CHAPTER XXVI.

MALADIES INVOLVING TUE GENITAL FUKCTION.

Impotence.— True Impotence, its Causes and Treatment.— False Impotence, its Causes and
Treatment. — Sterility.— Masturbation.— Pollution, Nocturnal and Diurnal. — Spermatorrhoea.
—Erotomania.— Satyriasis.-Priapism.— Aspermatism 427

CHAPTER XXVII.

DISEASES OF THE CORD.

Anatomy.— Spasm of Cremaster. — Varicocele, mild, severe 449

CHAPTER XXVIII.

DISEASES OP THE VAS DEFEUENS AND SEMINAL VESICLES.

Anatomy.— Inflammation, acute and chronic 455



PART II.

CHANCROID AND SYPHILIS.



CHAPTER I.

CUANCROID.

Definition.— Transmissibility to Animals.— Cause of Chancroid.- Indefinite Inoculability.— Rela-
tive Frequency.— Methods of Conta£;ion.— Explanation of Apparent Long Period of Incu-
bation. — Situation of Chancroid.— Symi)toins.— Course.— Character of Scar.— Variation of
Chancroid from Tj-pe, in Initial Form, in Shape, in Number, in Size, in Duration, in Pain,
in Condition of Base, in Course (Relapse).— Complication by Vegetations, by Syphilitic
Chancre, by Inflammation, by Gangrene and Gangrenous Phagedena, by PuJtaceous Pha-
gedena, by Bubo, by Lymphangitis.— Diagnosis of Chancroid.— Prognosis .... 400

CHAPTER n.

CHANCROID.

Prophylactic Treatment.— Local Treatment of Chancroid.— Local Treatment of Phagedena.—
General Treatment of Chancroid. — Bubo ; simple; virulent. — Treatment of Bubo. —
Lymphangitis ; simi)le ; virulent ; syphilitic. — Treatment of Lymphangitis .... 479

CHAPTER III.
sypuiLis.
Nature.- Unity and Duality. — Length of Time required for Absorption of Virus.- Analogy
with Vaccine Virus. — Second Attacks of True Syphilis. — Transmissibility to Animals.-



CONTENTS.



XI



PACK

Incubation of Syphilitic Chancre.— Induration, parchment-like, split-jx^a, diffuse— Ulcer-
ation.— Secretion.— Pain. — Nature of Scar.— Auto- and Iletero-rnoculution.— Vaccinal Syph-
ilis. —Multiple Inoculation. — Fluids capable of transmitting SypliiliH by Inoculation.—
Methods of Transmission of Syphilis. — Duration of Chancre.— Number.— Size.— Situation. —
Form.— Symptoms of Urethral Chancre. — Course of Chancre. —Complications. — "Mixed
Chancre." — Transformation mto Mucous Patch. — Phagedena and Gangrene. — Treat-
ment of Chancre.— Syphilitic Bubo.— Lymphangitis 402

CHAPTER IV.

SYPHILIS.

Diagnostic Table of Syphilitic Chancre, Chancroid, Herpes, and Ulcerated Abrasion.— Of Syphi-
litic Bubo and the Bubo of Chancroid.— Of Svphilitic Lymphangitis, and the Lymphangitis
of Chancroid.— General Syphilis.— Secondary, Tertiary, Malignant, Irregular, and Inter-
mediary Syphilides. —Prognosis of Syphilis. — Duration. —Influence of Gout and Scrofula
upon the Course of Syphilis.— The Ten General Characteristics of Syphilides.— Concomitant
Symptoms of Secondary Syphilis. — Secondary Incubation, Syphilitic Fever, Alopecia,
Indolent Glandular Engorgement, Sore Throat, Analgesia 526

CHAPTER V.

GENERAL TREATMENT OF SYPHILIS.

Hygienic, Tonic, Specific Treatment. — Syphilization. — Treatment of Early Syphilis. —Bad
Effects of Mercury.— Methods of administering Mercury.— Treatment of Late Syphilis.—
Mixed Treatment.— Treatment by the Iodides.— Methods of administering Iodine in Syphi-
lis.— Quantity of Iodide which may be required.— Duration of General Treatment . . . 5.50

CHAPTER VI.

SITIIILIS OF SKIN AND MUCOUS MEMBRANES,

Syphilides, Secondary and Tertiary.— The Secondary Syphilides.— Concomitant Symptoms on
Mucous Membranes 5S3

CHAPTER VII.

SYPHILIS OF SKIN AND MUCOUS MEMBRANES.

The Tertiary Syphilides.— Concomitant Symptoms on Mucoits Membranes COO

CHAPTER Vin.

SYPHILIS OF THE EYE-

The Lachrymal Apparatus. — The Eyelids : Chancre, Mucous Patches, Gummy Tumors, Ptosis. —
The Conjunctiva.— The Sclera.— The Cornea.— The Iris ; Mydriasis ; Iritis, Varieties and
Complications, acquired and hereditary. — Prognosis. — Treatment. — Vitreous Humor, Hya-
litis. — Crystalline Lens, Cataract. — Cyclitis. — Choroiditis, exudative and atrophic. — ^Retini-
tis. — Neuritis Optica. — Paralysis of Muscles.— Periostitis 609

CHAPTER IX.

SYPHILIS OF THE EAR.

Syphilis as affecting the External, Middle, and Internal Ear 631

CHAPTER X.

STPHILIS OF SPECIAL TISSUES AND ORGANS.

Syphilis of the Nails.— Dactylitis.— Syphilis of Tendons, Sheaths of Tendons, and Aponeuro-
ses.— Syphilis of Muscle.— Syphilis of Joints.— Sj-philis of Bone.— Syphilis of Cartilage —
Syphilis of Lymphatic Glands.— Syphilis of the Mammary Gland 633

CHAPTER XI.

VISCERAL STPHILIS.

Syphilis of the Vascular System.- Syphilis of the Respiratory System.— Syphilis of the Di-
gestive System, including the Tongue and the Great Abdominal Glands.— Syphilis of the
Peritonaeum, Thyroid, and Tliymus.— Syphilis of the Geuito-Urinary System . . . .647



xii CONTENTS.

CHAPTER XII.
STrnrLi9 of the nervous system. paqb
The Lesions : Symptoms, Prognosis, Treatment.— Genoral Cliaraeteristics of Nervous Symp-
toms in nil Cases.— Syphilis of x\u- Hrain.— Syphilis' of the Cord.— Syphilis of Special
Nerves . . " COS

CHAPTER XIII.

INHEUITED SYPHILIS.

Inheritance from either Parent, the other remaining sound.— Abortion due to Syphilis.— Date of
Appearance of Symptoms.— Symptoms.— Visceral Syphilis.— The Syphilitic Countenance-
Treatment of Inherited Syphilis C79



LIST OF ILLUSTEATIOI^S.



FIGUnE PAGE

1. Transverse section of penis (flaccid) 2

2. Transverse section of penis (erect) 2

3. Forceps for circumcision 12

4. Method of reducing paraphimosis 18

5. Method of reducing paraphimosis 19

6. Method of reducing paraphimosis 19

7. Diagram of the urethra 31

8. Lacuna magna 32

9. Vertical section through glans and fossa navicularis 32

10. Transverse section of spongy urethra 32

1 1. Transverse section of prostatic urethra 32

12. Proper curve for conical urethral instruments {o, b) 34

13. Faulty curve («, 6) 34

14. Proper curve 34

15. Passing the sound, first position 35

16. Passing the sound, second position 36

17. Passing the sound, third position 36

18. Passing the sound, fourth position 37

19. Conical-pointed, hard-rubber syringe 65

20. Conical-pointed glass tip for syringe 66

21. Keif'er's hard-rubber syringe nozzle 67

22. Soft-rubber universal injector 67

23. Rubber-capped glass pipette 69

24. Syringe for deep urethral injections 78

25. Linear stricture of the urethra 102

26. Annular stricture of the urethra 102

27. Soft catheter for introduction on two-foot guide 110

28. Soft catheter, with screw-tipped guide 110

29. Tips of whalebone guides 110

30. Banks's whalebone bougies Ill

31. False passages in the urethra Ill

32. Olivary bougies, properly made {A) 112

32. Olivary bougies, improperly made {B) 112

33. Head of bulbous bougie 113

34. Otis's urethrometer 113

35. Silver catheter - 114

36. Bumstead's catheter, with whalebone guide 114

37. Conicity of steel sounds 115

38. Conical tunneled sound = , 115

39. American and French scales 116

40. Thompson's rapid dilator 118



xiv LIST OF ILLUSTRATIONS.

FIGUUE PAGE

41. Civialo's uretlivotonie 120

42. lliiisonncuve's uictbrotonu', Buinstiad's modification 121

43. Maisonneuve's urethrotome, Voillemior's moditicatiou 121

44. Otis's dilating urethrotome 122

45. Blunt grooved staff for perineal section 123

46. Blunt grooved staff for perineal section, with guide 1 28



Online LibraryE. L. (Edward Lawrence) KeyesThe surgical diseases of the genito-urinary organs including syphilis → online text (page 1 of 83)