Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATIONS, 5
trate ulaiid or
means stricture.
seminal vesicles usually Report ol a Case ol Pulmonary Edema
CompMcatlng Pregnancy.'
As to the various methods of treating By Dr. William L. Kirkpatrick, Pacolet, S. C.
urethral stricture by divulsiou electrolysis,
Definition.— In pulmonary edema there
dilating and cutting, the only cases in is an exudation of serum from the blood
which 1 have gotten satisfactory results j,^ ^:^^ pulmonary alveoli. In other words,
followed the latter operation. After using ^n effusion of some serous fluid into the
electrolysis in fifty-two cases, I alaandoned air-vesticles and interstitial lung-tissue,
the method on account of not getting the .^^^^ condition is scarcely to be regarded as
results looked for and claimed by others.
^^^ independent affection, but as a second-
To get permanent relief from organic ^rv condition, being in many instances asstricture
is to completely sever the fibrous ^o^iated with pulmonary congestion,
bands or tissues witU the knife, and, by £-//,/„/^^,,,_Pulmonarv edema is secondthe
use of the sound, make the cut or stric- ^^ j^ acute and chronic affections and
turedportionoflhe canal heal to the size of p„eumonia, but not with any degree of
the normal urethra.
. constancy, It is not especially liable to
The failures recorded after internal ure- ^^ associated with congestion or with low
throtomy are due to the fact that the strict- ^^ades of inflammation of the lungs. The
ured tissue is not completely severed, or ^^^^^^ ^^^^. ,^g j^^^^j^ i„ jj^g i^njediate
failure to introduce the sound at proper 111- neighborhood of a circumscribed, usually
tervals after the operation. 1 he fact that inflammatory lesion; or general, arising
we frequently find more than one stricture f^^^^ causes similar to those which produce
should not be overlooked, and the operator congestion, or constituting a terminal event
should be careful not to leave a single fi- in states of great debility. The factors
brous band uncut, as the success of the which appear to be instrumental in causing
operation may hinge on this point. ^''e transudation are increased tension in
the Pulmonary vessels, increased fluidity
As a rule, strictures in the penile urethra ' ... of the blood, an abnormal 4iermeability of
arelocatedwithm the first three inches, but
^jjg ^^^^^1 ^^.^^1,^ due to nutritive changes,
it is freciuently the case that constrictions and left ventricular weakness,
are deeper that reciuire cutting. 1 do not The diseases with which edema is most
consider it safe to do an internal urethro- commonly associated are pneumonia; the
..,..,,. , ., cachexias; grave anemia, nephritis in uU
^tomy w.thot perineal drainage deeper than
j^, f„„„,. ^^^.j^ g^.^cific fevers with much
•five inches.
heart weakness; valvular disease; and cere-
It is a fact that, if a strictured urethra is
I)roperlp cut, and the after-treatment carbral
apoplexy or injuries.
Pathology:—This consists of a transudaried
out
tion
( which is as important as
into the alveolar walls interstitial conthe
cut-
.. ,., . ,
., nective tissues, and air cells, and rarely the
,
ting, the urethra can be examined years
process is limited to the interstitial tissue,
afterwards and found free of contractions. For the sake of convenience, two forms
.Vfter internal urethrotomy, the patient may be recognized;
should be required to remain in bed three (A) Collateral Kdevia ilntlammatory
days. The sound can be passed on the
^''^^w^):—This is usually local in charac-
,, . , , , ,, ,• . ,, J, . ter, circumscribing an area of the lung that
third day, and the patient allowed to return j^ effected by pneumonia, abscess, or pult..
his work on the fourth. With a two per monary infarction, and is the result of a
cent solution of cocaine, tJje operation can mild inflammatory process allecting the
be performed with very little pain. Adren- vessel walls. When the condition follows
!>yPostatic congestion the terms "hypostat-
. , ., , , , . , . ,, . ic edema" and splenization" have been
alin used after the operation will, as a rule,
control the hemorrhage. It is advisable to annlied
pass the sound every four or five days until (y) General Pulmonary Edema.—
tlie hemorrhage ceases, then every ten days congestion be not associated, the portions
for three or four months. of the lungs involved by this type look
P^le; when pulmonary congestion is pres-
, . , f . , . , . ent, the lung appears darker than the nor-
In a brief paper of this character, the
various kinds of stricture, their location
anil symptomatology cannot be considered;
^al and the exudate is blood-tinged. The
hing tissue is heavier than in the healthy
but the point I wish to emphasize is that state, owing to the more or less airless coniiilcrnal
urethrotomy is the proper method tHtiou of the alveoli, though it does not
of curing fibrous striclme of the anterior
«Y^ea,r before recent meeting or the Tri-State
urethra. .Medical Society, Charleston, S. C.
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