Plate 59.--Figure 3.

Fig. 4, Plate 59.--In this the canal is constricted at the point a, midway between the bulb and glans. A false passage has been made under the urethra by an instrument which passed out of the canal at the point f, anterior to the stricture a, and re-entered the canal at the point c, anterior to the bulb. When a false passage of this kind happens to be made, it will become a permanent outlet for the urine, so long as the stricture remains. For it can be of no avail that we avoid re-opening the anterior perforation by the catheter, so long as the urine prevented from flowing by the natural canal enters the posterior perforation. Measures should be at once taken to remove the stricture.

Plate 59.--Figure 4.

Fig. 5, Plate 59.--The stricture a appears midway between the bulb and glans, the area of the passage through the stricture being sufficient only to admit a bristle to pass. It would seem almost impossible to pass a catheter through a stricture so close as this, unless by a laceration of the part, combined with dilatation.

Plate 59.--Figure 5.

Fig. 6, Plate 59.--Two instruments, a, b, have made false passages beneath the mucous membrane, in a case where no stricture at all existed. The resistance which the instruments encountered in passing out of the canal having been mistaken, no doubt, for that of passing through a close stricture.

Plate 59.--Figure 61.

COMMENTARY ON PLATES 59 & 60. 131

Fig. 7, Plate 59.--A bougie, b b, is seen to perforate the urethra anterior to the stricture c, situated an inch behind the glans, and after traversing the substance of the right corpus cavernosum d, for its whole length, re-enters the neck of the bladder through the body of the prostate.

Plate 59.--Figure 7.

Fig. 8, Plate 59.--A bougie, c c, appears tearing and passing beneath the lining membrane, d d, of the pros­tatic urethra. It is remarked that the origin of a false passage is in general anterior to the stricture. It may, however, occur at any part of the canal in which no stricture exists, if the hand that impels the instrument be not guided by a true knowledge of the form of the urethra; and perhaps the accident happening from this cause is the more general rule of the two.

Plate 59.--Figure 8.

Fig. 9, Plate 59.--Two strictures are represented here, the one, e, close to the bulb d, the other, f, an inch anterior to this part. In the prostate, a b, are seen irregularly shaped abscess pits, communicating with each other, and projecting upwards the floor of this body to such a degree, that the prostatic canal appears nearly obliterated.

Plate 59.--Figure 9.

Fig. 10, Plate 59.--Two bougies, d e, are seen to enter the upper wall of the urethra, c, anterior to the prostate, a b. This accident happens when the handle of a rigid instrument is depressed too soon, with the object of raising its point over the enlarged third lobe of the prostate.

Plate 59.--Figure 10.

Fig. 11, Plate 59.--Two instruments appear trans­fixing the prostate, of which body the three lobes, a, b, c, are much enlarged. The instrument d perfo­rates the third lobe, a; while the instrument e pene­trates the right lobe, c, and the third lobe, a. This accident occurs when instruments not possessing the proper prostatic bend are forcibly pushed forwards against the resistance at the neck of the bladder.

Plate 59.--Figure 11.

Fig. 12, Plate 59.--In this case an instrument, d d, after passing beneath part of the lining membrane, e e, anterior to the bulb, penetrates b, the right lobe of the prostate. A second instrument, c c, penetrates the left lobe. A third smaller instrument, f f, is seen to pass out of the urethra anterior to the prostate, and after transfixing the right vesicula seminalis external to the neck of the bladder, enters this viscus at a point be­hind the prostate. The resistance which the two larger instruments met with in penetrating the pros­tate, made it seem, perhaps, that a tight stricture existed in this situation, to match which the smaller instrument, f f, was afterwards passed in the course marked out.