A CASE OF URETHRAL STRICTURE By Surgeon P. M. No. 2082.?Pte. Webb,
Carleton,
(? MALARIAL.)
m.d., a.m.d.
14th Hussars, 27 years of age, with
eight years' service, a man of good muscular development, was admitted to Trimulgherry Station Hospital on the 21st of He March 1883, with symptoms of stricture of the urethra. had suffered from gonorrhoea on two successive occasions, in not He in but since. when on service 1878, Afghanistan, with ague at was three times in hospital during the year 1877 he was twice in hospital with and Meerut ; again during 1S79
the same disease. He never felt any symptoms of stricture until his return to this country, in 1881, from South Africa, whither he had gone with his former regiment, the 15th Hussars, from which he was transferred to the 14th, and arrived with the latter regiment He first began to at this station towards the end of 1881. experience a slight dribbling of urine after each occasion He did not pay much attention to of evacuating the bladder. this at first, but in course of some time the stream of urine became so small and eventually forked, that he was induced to seek medical aid at hospital. A remarkable feature of the case was the occurrence of periodicity in the severity of the ailment. The first attempt to pass a No. 7 catheter with the utmost gentleness, was followed by a little haemorrhage, indicating, some congestion of the mucous membrane as is often found, Further efforts for the introduction of an instruof the part. ment were at that time desisted from, but the patient felt considerable relief in micturition afterwards, and it was ascertained that the seat of stricture was at the bulbous portion of the canal. He was then ordered to be placed in a warm bath, and Tinct. opii was administered, but without the least effect. On the third day, after medicinal Chloroform was also tried. been found unsuccessful, and the stricture treatment had becoming almost impermeable, it was decided to have recourse With much care and patience a No. 1 to the catheter again. was introduced into the bladder without any bleeding, and afterHowever the wards the patient passed urine pretty freely. difficulty returned next day, and a process of dilatation was adopted, commencing with a No. 1 and increasing gradually up to No. 4, which was allowed to remain in for about an hour. Next day the stricture, which had almost entirely disappeared The catheter was not ?gain on that afternoon, returned again. resorted to, but in the evening he had a well-marked paroxysm of intermittent fever, not such as might be confounded with an ordinary rigor, but a distinct fit of ague with properly defined stages, such as he had often had before. The patient was then put on quinine, and the stricture gradually disappeared without any further surgical operation. In reflecting on this case, the writer was reminded of other anomalous affections which he had observed, of a spasmodic nature, which had obeyed laws of periodicity, and which had given way before the administration of quinine, after having obstinately resisted other methods of treatment which seemed and in all of which there had been a more directly indicated, history of malaria. Amongst others was an instance of stridulous breathing coming on every other day, for which sedatives and antispasmodics had proved unavailing, and which lasted for months, until the patient commenced to take quinine, when it slowly disappeared. American authors such as Flint have recognized this feature of certain anomalous affections, observing laws of periodicity, and have recommended the exhibition of quinine to determine It would be interesting to know if any of the the diagnosis. other members of the profession in the more malarial parts of India, have noticed any similar peculiarities which might not be
considered
mere
co-incidences.
Secunderabad, Dcccan, July, 1883.
Carleton,
(? MALARIAL.)
m.d., a.m.d.
14th Hussars, 27 years of age, with
eight years' service, a man of good muscular development, was admitted to Trimulgherry Station Hospital on the 21st of He March 1883, with symptoms of stricture of the urethra. had suffered from gonorrhoea on two successive occasions, in not He in but since. when on service 1878, Afghanistan, with ague at was three times in hospital during the year 1877 he was twice in hospital with and Meerut ; again during 1S79
the same disease. He never felt any symptoms of stricture until his return to this country, in 1881, from South Africa, whither he had gone with his former regiment, the 15th Hussars, from which he was transferred to the 14th, and arrived with the latter regiment He first began to at this station towards the end of 1881. experience a slight dribbling of urine after each occasion He did not pay much attention to of evacuating the bladder. this at first, but in course of some time the stream of urine became so small and eventually forked, that he was induced to seek medical aid at hospital. A remarkable feature of the case was the occurrence of periodicity in the severity of the ailment. The first attempt to pass a No. 7 catheter with the utmost gentleness, was followed by a little haemorrhage, indicating, some congestion of the mucous membrane as is often found, Further efforts for the introduction of an instruof the part. ment were at that time desisted from, but the patient felt considerable relief in micturition afterwards, and it was ascertained that the seat of stricture was at the bulbous portion of the canal. He was then ordered to be placed in a warm bath, and Tinct. opii was administered, but without the least effect. On the third day, after medicinal Chloroform was also tried. been found unsuccessful, and the stricture treatment had becoming almost impermeable, it was decided to have recourse With much care and patience a No. 1 to the catheter again. was introduced into the bladder without any bleeding, and afterHowever the wards the patient passed urine pretty freely. difficulty returned next day, and a process of dilatation was adopted, commencing with a No. 1 and increasing gradually up to No. 4, which was allowed to remain in for about an hour. Next day the stricture, which had almost entirely disappeared The catheter was not ?gain on that afternoon, returned again. resorted to, but in the evening he had a well-marked paroxysm of intermittent fever, not such as might be confounded with an ordinary rigor, but a distinct fit of ague with properly defined stages, such as he had often had before. The patient was then put on quinine, and the stricture gradually disappeared without any further surgical operation. In reflecting on this case, the writer was reminded of other anomalous affections which he had observed, of a spasmodic nature, which had obeyed laws of periodicity, and which had given way before the administration of quinine, after having obstinately resisted other methods of treatment which seemed and in all of which there had been a more directly indicated, history of malaria. Amongst others was an instance of stridulous breathing coming on every other day, for which sedatives and antispasmodics had proved unavailing, and which lasted for months, until the patient commenced to take quinine, when it slowly disappeared. American authors such as Flint have recognized this feature of certain anomalous affections, observing laws of periodicity, and have recommended the exhibition of quinine to determine It would be interesting to know if any of the the diagnosis. other members of the profession in the more malarial parts of India, have noticed any similar peculiarities which might not be
considered
mere
co-incidences.
Secunderabad, Dcccan, July, 1883.
