TREATMENT OF STRICTURES OF THE URETHRA 
BY 
LAMINARIA DIGITATA AND GALVANISM. 
By ROBERT NEWMAN, M.D., 
NEW YORK. 
A PAPER READ BEFORE THE MEDICAL JOURNAL ASSOCIATION OF NEW YORK. TREATMENT OF. STRICTURES OF THE URETHRA 
BY 
LAMINARIA DIGITATA AND GALVANISM. 
By ROBERT NEWMAN, M.D., 
NEW YORK. 
A PAPER READ BEFORE THE MEDICAL JOURNAL ASSOCIATION OF NEW YORK. 
It is not my intention to speak of the treatment of 
strictures in general. Elaborate works on that subject 
are written by many authorities. Medical literature 
abounds with treatises on this subject. This Society 
has recently listened to valuable papers on Strictures. 
Neither is it my purpose to recommend one particular 
treatment as the best; and to condemn all other. The 
true physician has. no direct panacea for certain dis- 
eases. On the contrary, he always feels the necessity 
for close and accurate observation upon the phenomena 
developed by particular cases, and adapts his treatment 
to. the peculiar needs of each patient. In this way 
each case of stricture requires examination, and the ap- 
plication of its appropriate means of cure. 
There are different kinds of stricture, such as the 
spasmodic, the inflammatory, the traumatic, the granu- 
lar, the fibrous, the cicatricial, the calcareous, etc. It 
would be absurd to suppose all of these varieties could 
be treated alike; although in all cases, our treatment 
has but one common aim, i.e., to restore the urethra to 
its normal state, calibre, and power of healthful action. 
There are many instruments ingeniously devised to se- 
cure this end, and each may find proper employment 
in the peculiarities of the disease, as it develops itself 
in different cases. But the best way to accomplish the 
end must be left to the judgment of the surgeon, and 
I cannot too strongly insist upon the necessity of 
the most careful examination and perfect understand- 
ing of the difficulty before any plan of the treatment 
is instituted. Neglect of this first most important step 
has frequently resulted in very serious complications, 
injurious to the patient. When this has been accom- 
plished, the surgeon may safely pursue any of the es- 
tablished methods, or which is better, depend upon his 
own judgment and experience in making choice of the 
fitting remedies to effect a cure. 
The knowledge through examination is gained by: 
1st. Digital touch, committed to the fingers by trans- 
mission of the exploring instrument. 2d. By exact 
measurement to ascertain the exact locality, length, and 
size of the strictures, and 3d. By ocular inspection 
through the endoscope. The latter will give valuable 
information, and is alone capable of revealing the true 
condition of the parts, which decides the character of 
the stricture. When the tube of the endoscope is 
withdrawn from a urethra, which is sensibly indurated, 
and especially if there be a slight stricture, the canal 
closes behind the end of the instrument with a certain 
abruptness; a circumstance, which is in striking con- 
trast with the gradual way in which the healthy ure- 
thra closes, when similarly manipulated. If the tube 
of the endoscope is arrested by an organic stricture, 
the ocular inspection will show the exact form. Of 
course we see that the calibre is nltrowed. the tissues 
altered and indurated. The real j 
tracted in various ways and forms: it 
ring, but more frequently we see irregular slits in dif- 
ferent directions, oval, round, square, triangular, serra- 
ted, and other irregular shapes. Such strictures are 
not necessarily in the middle, but frequently are seen 
on one side of the focus. If the stricture is so slight, 
that a smaller tube will pass it, then it is necessary to 
examine the lower parts of the urethra, in order to as- 
certain if other strictures are present. In withdraw- 
ing the tube, the peculiar abruptness of the stricture 
upon the instrument can be seen and felt by the guid- 
ing hand. Often another condition will be found. The 
tube is arrested, at the same time the patient complains 
of soreness, even of pain. Then the inspection shows 
that the calibre of the urethra is narrowed by granula- 
tions, which in the centre of the focus are elevated, 
hanging in small red rotulas, with a peculiar shining 
lustre, giving it a strawberry appearance. Below these 
granulations and underneath, the longitudinal fibres 
radiate towards the periphery from little centres, re- 
sembling a contracted pupil. These fibres are less 
regular and distinct than in health, and sometimes are 
even interrupted and indistinct. The cure of the gran- 
ulations by local applications is the only rational one, 
and thereby the stricture will also disappear. In for- 
mer times we were taught, that the introduction of the 
steel sound by its weight presses the granulations until 
they are cured. But such treatment was notoriously 
unsuccessful, and the fallacy of such theory is now 
easily understood. Dr. Otis in his valuable paper says: 
“ We may, then, affirm as a most important axiom, that 
the slightest abnormal encroachment upon the calibre 
of the urethral canal, at any point in its course, is suf- 
ficient to perpetuate a urethral discharge, or even, un- 
der favoring circumstances, to establish it de novo, 
without venereal contact.” I endorse this most heartily 
as an important fact, and may add, that the discharge 
will disappear as soon as the calibre of the urethra is 
restored to its normal size. This is very important in 
the treatment of gleety discharges and strictures. In- 
jections continued for years will not cure a gleet, so 
long as the stricture or the granulations remain. 
In speaking of gleet and stricture, the cause and 
consequence may be easily confounded. As a rule, the 
first step is an old, uncured, and neglected gonorrhoea. 
A stricture is the consequence, which again is followed 
by gleet: the usual one or two drops every morning 
accumulating and emerging from behind the stricture. 
In considering the treatment of the Organic Stricture, 
the majority of surgeons prefer dilatation. This can be 
done by gradual dilatation, or by rupture. The dilators 2 
and divulsors of Voillemier, Thompson, Holt, Otis, \ 
Reybard, Civiale, etc., etc., have their advocates, and 
may be used in appropriate cases. But according to 
authorities, in most cases a gradual dilatation will be 
preferred. 
Speaking of such strictures, in which the best method 
of treatment is gradual dilatation, it must certainly be 
an improvement, ifruch gradual dilatation can be done 
with rapidity, as well as safety. And this is effected 
by the use of laminaria and galvanism, which we will 
consider to-night. 
laminaria du/ibita, sea tangle, seaweed, is a sea-plant 
growing near the coast, beneath the water. It is found 
in Ireland, Scotland, California, etc. For the treatment 
of stricture these bougies, which I show you here, are 
used. They come in six different sizes; No. 6 corre- 
sponding to a small No. 5 of Tiemann'a gauge, and No. 1 
filling } of No. 1 of the same gauge. In relating to 
numbers hereafter, the comparison is made according 
to Tietnann’s gauge. The following experiments will 
show the dilating power these bougies possess. A 
laminaria bougie, No. 3, was submerged in water, and 
was found to dilate as follows: 
In I hour 5 minutes to No. 6. 
“ 2 hours “ 7. 
“ 4 “ 15 “ “ 10. 
Other experiments, all made in May, 1867, had similar 
results. I present here another specimen, which I 
have submerged in water to-day at 12 o'clock. It has 
remained there seven hours ; it is a No. 6, and is now 
dilated to No. 16. Dry air will contract it again to its 
former size. The grade of expansion depends on the 
moisture surrounding the laminaria. This law must 
he taken into consideration, and certain precautions 
used. Some parts of the urethra, which have more se- 
cretions or more moisture, will dilate such portions of 
the bougie to a greater degree, and that part within the 
bladder, surrounded by urine, will expand to such an 
extent, that it is impossible to withdraw the bougie 
through the parts of the urethra, not so much dilated. 
Such an accident may be detrimental or even dangerous 
to the patient. The failure or success of the operation 
will depend much on the attention and care of the sur- 
geon. If the ordinary precautions are list’d, success 
must follow. The following rules must be observed to 
insure success:— 
1. The bougies must lie made frt>tn an unblemished 
piece of the plant, taken out of the middle, made with 
care and equal in its whole length and size. If there 
is the slightest suspicion of unevenness it should not 
be used. 
2. That part of the bougie which will occupy the 
portion of the urethra below the last stricture, and 
particularly that part of the bougie which enters the 
bladder, must be varnished previously. Mastich var- 
nish can be used. If the varnish is applied just before 
using, the laminaria may dilate a little, but if several 
coats are applied and allowed to dry. no expansion can 
take place. 
3. As any oily substance hinders the expansion, no 
oil must be used. The bougie before introduction must 
be placed in cold water, until it gets a soft, velvet-like 
touch. 
4. The bladder must be emptied before the operation, 
to avoid uneasiness and overdisteution. 
5. The urethra ought to be injected with water, to 
relax the parts and favor the moisture for rapid dilata- 
tion. 
6. The measure of the urethra and seat of strictures 
must be carefully taken, notes made, and the bougie 
prepared accordingly. 
7. The bougie, when ready, must be introduced at 
once, straight, without hesitation, twiatiug, or reeling 
in it* passage ; otherwise it will cause pain, or, as dilata- 
tion goes on immediately, it will uot reach the desired 
depth. 
8. After insertion, the bougie must be left alone, and 
not meddled with, or tried to move. 
9. It must be left inside undisturbed for two to four 
hours, according to circumstances, consulting the feel- 
ing of the patient. 
10. The patient during this time is left in a recum- 
bent position, and attended or observed by the surgeon. 
11. In removing the bougie, the surgeon takes hold 
of the bougie, and uses firmly and gradually tractions in 
the same direction. 
If some surgeons have failed with laminaria, they 
either have not observed these precautions, or they 
have had imperfect bougies, or selected impracticable 
cases. 
This treatment is most indicated when the stricture 
is very small, almost im[»ermeable, and no time can be 
lost, as the No. 1. bougie of laminaria can be intro- 
duced easier than the usual sounds or catheters. In a 
few hours the patient is relieved, and can micturate 
without difficulty. No bad results can follow, nor will 
it interfere with his attention to business. This latter 
sdvantage is a great consideration, as the treatment 
with divulsors or dilators almost always causes pain, 
sufferings and detention in bed and from business. As 
soon as the stricture is dilated so far that a steel sound 
of a larger calibre can be introduced, the laminaria has 
done its duty, and it is better to abandon its further use. 
and continue with other means. These are either steel 
sounds or galvanism. 
Klfctricity in the treatment of strictures is by no 
means new, and has been reported as far back as 25 
years, or perhaps earlier; but the use of galvanum for 
such purposes is only of recent date, and worked metho- 
dically by Mallez and Tripier. Much confusion of terms 
and ideas arise from want of definite information upon 
the subject of electricity, and the vague and undefined 
results afforded by partial experiment and analysis of 
this imponderable agent in therapeutics It is not sur- 
prising that many false statistical reports, and the con- 
founding of scientific terms go on record; thus the first 
“blistering galvanic battery” was patented in the 
United States about 19 years ago. Now galvanic 
batteries, such as we use at present, are only about 12 
years old, and many improvements since that period 
have been made. So when we read of the use of galvan- 
ism of a prior date, wc may be certain that it is an incor- 
rect statement. I will here mention only one such in- 
stance reported in the Mkdical Record, December 1st, 
1868. The gentleman tells us that he lias cured a stricture 
in 1844 with the “ 1'ike’s galvanic battery,” which he 
carried with him in his carriage. A little reflection will 
show that a galvanic battery could not I*) taken in a 
carriage over country roads on the daily visits of a 
physician. What becomes of the acids in the open 
cells? Next, I know that Pike never made galvanic 
batteries. By accident, I came across the same kind of 
lottery, at the house of a friend, used in the case repre- 
sented above, which fully explains the mistake in the 
report. The inscription proved that it was an electro- 
magnetic machine, made by Benjamin Pike, jr., 294 
Broadway, introduced November, 1843. Therefore IImh 
gentleman bad not used galvanism, but only the Faradic 
current. 
From authorities on thU subject, it seems tliat Malles 
and Tripier deserve the credit for having revived, if 
not originated, the treatm-nt of strictures by galvanism 
methodically, with improved instruments and appliances. 
The suc.-ess in curing a stricture by the galvanic 3 
battery depends mainly upon the chemical effect of! 
absorption of the altered tissues forming the stricture. 
Alkalies go to the negative; acids to the positive pole. I 
Consequently Ave use the negative pole to produce the 
effect of absorption, which will act as a caustic alkali 1 
and not produce any cicatrix. 
To regulate the strength of the battery to the strength J 
of the patient is an important point inelectro-therapeu- j 
tics. In all drugs we have an established dose, which we j 
again regulate according to circumstances and the in- j 
dividuality of the patient. Should electricity be given at 
random ? The regular dose in the shape of the strength 
of the current ought to be ascertained, otherAvise the j 
intended remedial effect may be detrimental. Now the I 
question arises, what instrument will best fulfil our pur- j 
pose ? In most of my experiments I have used a 
Stoehrer’s sixteen-cell galvanic battery; but in the use of , 
this very convenient apparatus I have met with some ! 
difficulties, which it was impossible to overcome with- j 
out very complicated auxiliary instruments. This ! 
battery permits grades only by two (2) cells, which, 
increasing or diminishing, is too great a difference, and 
the intensity of the galvanic current, thus altered, is too 
sudden, causing in the patient a nervous irritation, 
shock, and pain. 
The size of the elements in Stoehrer’s battery is far 
too large, and the quantity of electricity thereby gen- | 
erated is too powerful to produce the proper effect; 
consequently the destruction of tissue is too great. 1 
This, again, will cause pain, which patients refuse to 
endure. 
A large surface of battery will cauterize with more 
intensity than any other known caustic. By using the 
necessary amount of electrical current thus generated, 
to enlarge the sphere of action, too much inflammation of 
the surrounding healthy tissues may supervene, and ; 
thus aggravate the disease. No action should ever I 
destroy healthy tissues, the only effort to be made is to ! 
restore the morbid parts to their proper normal condi- 
tion of health ; therefore the concentration of the elec- 1 
trical current should be strictly confined to the diseased 
locality only. 
To this peculiarity of the Stoehrer battery some fail- 
ures are due, and I greet with great satisfaction, and 
exhibit here the neAv galvanic battery invented and 
manufactured by Luis Drescher & Co. 
It is a very handsome, portable instrument, which 
combines elegance with cheapness. It contains 20 
cells, and is sold at the same price as Stoehrer’s 16-cells. 
The great objection to large surfaces is here overcome, 
and in the trials made I found decided advantages in 
the two folloAving points :— 
I. The intensity of the current can be augmented 
gradually cell by cell, without any interruption of the 
current, and the patient will hardly perceive the in- 
crease of intensity which can be used above the power 
of Stoehrer’s battery. 
II. The quantity of electricity is reduced to a point 
sufficient to produce the most intense action on a very 
limited space. 
In treating a stricture, I ahvays first ascertain the 
susceptibility of the patient to the galvanic current. 
Then to the negative pole is attached a metallic con- 
ductor into the urethra down to the stricture. These 
instruments are made from flexible catheters, the end 
of which is a lead or nickel bulb, about a half an inch 
long, connected Avith the battery by a wire running 
through the middle of the catheter. The catheter itself 
acts as an insulator and protector to the other parts of 
the urethra. 
I here exhibit a full set of the catheter-electrodes, a 
complete assortment of all sizes made also by Luis 
Drescher & Co. The insulation is perfect, and the egg- 
shaped form proportionately in length to its diameter. 
As soon as the catheter or the negative pole is connect- 
ed with the battery, the circuit is completed by the 
positive sponge electrode, either placed over the supra- 
pubic region or grasped Avith the palm of the patient’s 
hand. Then the current is very gradually increased 
from one cell upwards, till the patient feels a slight 
pricking, and can tolerate it without pain. 
The galvanic stream must never be so strong as to 
cause pain or burning, otherwise it acts as a galvano- 
cautery, destroys healthy tissues, forms cicatrices, new 
strictures, complicates matters, and the difficulty is in- 
creased. In ending the operation the battery must be 
gradually decreased to cell one (1), and then the cur- 
rent interrupted by removing the electrodes. Failures 
may be due also to too prolonged or too frequent appli- 
cations. Repetition of the application must be made 
at intervals of at least two weeks, or sometimes longer. 
The foregoing will be illustrated by some cases, which 
are clinical facts. 
Case I.—Stricture cured by Laminaria Bouyies, 
May 13th, 18G7.—A. L. C. of Brooklyn, came to my 
office with the following history : He had contracted a 
gonorrhoea 21 years ago; discharged for some time, 
which was followed by a gleet, and in due time a stric- 
ture was formed; was treated by an eminent surgeon 
with apparent success, but he soon neglected the stric- 
ture. Had another gonorrhoea three months ago; the 
stricture grew worse and troubled him much; some- 
times spasmodic. On examination there were found 
three distinct strictures. Only a sound No. 8 could be 
used for the introduction which reached stricture No. 
1. The other two strictures were found with a sound 
No. 4. In the afternoon a catheter No. 3 was intro- 
duced, and the water drawn off; then a wax bougie 
No. 4 passed nicely. 
Contractions of the bladder were painful and were 
controlled by morphine. 
May 14th. Laminaria bougie No. 2, varnished If inch 
at the end, was introduced four o’clock in the afternoon, 
six inches above the varnished part. Hence the bou- 
gie was introduced 7f inches. The bougie was removed 
at 6 o’clock, having been inside fully 2 hours. Then it 
was found dilated to No. 5. Went home, feeling better 
without any pain or inconvenience. 
May 15tlx. Passes urine freely and since yesterday 
has felt well. 
May 17th. Laminaria bougie No. 4 was left nearly 
three hours. When removed was dilated to No. 8. 
May 19th. Laminaria bougie No. 5 was left three 
hours, on removal was not equally dilated. The stric- 
tures Avere Avell marked by constriction at the bougie, 
varying from 6 to 9. 
R Hydrarg. bichloridi gr. j. 
Extr. belladonnas g. vj. 
Glycerine §j. M. 
To apply on conical bougie No. 6. 
May 21st. Felt well and in gqod spirits. After this 
the strictures were dilated gradually with steel sound 
to No. 12. 
Here we have stricture made tolerably easy within 
2 hours, and dilated to its normal size in 7 days. 
Case IT.—Aggravated Stricture in Prostatic Portion. 
—Laminaria bougie—permanent cure.—Mr. J. R., Hotel 
keeper, came in great agony, suffering from a stricture 
which was so small that it prevented him from passing 
water. The urine dribbled aAvay drop by drop. He 
; had endured the stricture for several years; had treat- 
ment off and on. 
October 14th, 1867. On examination found stricture 
in the prostatic portion. A steel sound No. 11 entered 4 
the meatus and passed on for 64 inches, where it was 
arrested by the stricture. Various instruments were 
tried, none were small enough to pass the stricture. 
At last Minor's instrument was pushed up to the stric- 
ture, and the enclosed cat-gut parsed with great diffi- 
culty into the stricture, but not beyond. 
Oct. 18/A. Dr. Finnell was kind enough to assist me. 
All the usual instruments for the passage of the stric- 
ture were tried in vain ; even the smallest Laminaria 
bougie No. 1 would not enter. After many trials a 
No. I zinc sound entered. 
Oct. 21s/. Zinc sound Nos. 1 and 2. 
Oct. 23d. Zinc sound No. 2. The No. 3 would not 
pass. The Laminaria bougie, No. 1, went easily into 
the bladder. It was left there for two hours. On its 
removal it was found dilated fully to No. 4. 
Nov. 2d. After an absence of nine days, the patient 
returned and reported easy. Is very much improved 
and relieved by passing water freely. Catheter No. 3 
was introduced with a little difficulty. Laminaria bou- 
gie, No. 2, was left for three hours. On removal was 
dilated fully to No. 5. Immediately after he passed 
water easily. 
Nov. 11/A. Patient after each visit left for home, 
which is 44 miles distant from New York. He made 
the journey without experiencing any difficulty. Cathe- 
ter No. 5 passed readily. Sound No. 6, with some dif- 
ficulty, was left inside for eleven minutes. 
Nov. 14/A. Sound No. 6 passed easily. Same man- 
ner laminaria bougie, No. 3. Left for three hours, when 
it was dilated fully to No. 8. This figure represents the 
urethra at this stage, drawn from the appearance of the 
laminaria alter removal. At a will be seen a little con- 
striction. which shows a small stricture; at b begins 
the large stricture, fully six and a half inches from the 
meatus. The duct, ejaculat. are at e, seven and a half 
inches from meatus. 
The penis of this patient is .small, the whole urethra 
measuring only seven and a half inches. As the stric- 
ture is six and a half inches from the meatus, and one 
inch from the duct, ejaculat., it follows that said stric- 
ture is in the prostatic portion. This is a noticeable 
fact, as Sir H. Thompson denies the existence of stric- 
ture* in said locality. The last laminaria bougie was 
introduced eight and one-fourth inches, therefore three- 
fourths inches within the bladder. The lower portion 
was. of course, properly varnished. 
Nov. 19/A. Some soreness about the stricture ; could 
not introduce sound No. 7. 
Nov. 26/A. Sounds 7 and 8. 
During December, in four visits, dilatation was con- 
tinued with steel sounds. 
Jan., 1868. Treatment continued. In four visits 
sound No. 11 passed ea-ily. 
Feb., 1868. Sound No. 12 easily. 
March, 1868. He passes sound No. 11 himself. The 
urethra appears normal, and he was therefore consider- 
ed cured. 
August 2*>/A, I871.# Just 3| years afb-rwards the 
same patient appears again with an acute urethri- 
tis, contracted 2 weeks ago. For several years he has 
not passed any sound. On exploring with a large 
steel sound No. 10, find to my surprise that it slips into 
the bladder with great ease, and that no trace of the 
former stricture is left. 
The urethritis was cured in a few weeks. Have 
seen the patient only recently, explored the urethra 
again, and found him perfectly healthy. 
This case is an important clinical fact. It proves be- 
yond any doubt, that strictures can be cured, and also 
the efficacy of the laminaria bougies, etc. Objections 
may be made to my mode of illustrating this fact, for 
it is said, strictures within the prostatic portion are 
not believed to occur unless it is proven by a post-mor- 
tem. To either I have to say that if such a stricture is 
cured, the post-mortem demonstration of the fact can- 
not he matte, and if a post-mortem examination shows 
a stricture within the prostatic portion it could not 
have been cured. 
Still another case of stricture within the prostatic por- 
tion of the urethra has come under mv observation re- 
cently. The stricture was seven inches from orifice,sound 
12 passed easily, until seat of stricture, A steel sound 
No. 7 could only be pushed through stricture with diffi- 
culty. Galvanic Battery applied, and the bougie No. 
10 with bulb of lead passed gradually into the bladder 
after five minutes’ galvanic current. After this a steel 
sound passed easily. The case is of too recent obser- 
vation, and therefore cannot place it on file as a derid- 
ed success. 
[J/hy 30/A. The patient has been kept under treat- 
ment, and the stricture cured. To-day sound No. 13 
passed easily into the bladder.—R. N.] 
Dr. G. C. Terry presented a specimen of stricture of 
the urethra in the prostatic portion to the Pathological 
Society in 1807, which is another proof that stricture 
can apj>ear in the prostatic portion; in this case it was 
demonstrated by a post-mortem inspection. 
Case III.—Stricture cured by I/am inaria and Gal- 
vanic Hattery.—F. S., after a urethritis had for the last 
eight months a slight discharge of a gray and green- 
ish color. The discharge is very small in quantity, 
but constant 
March 7th, 1871. On examination with a glass 
tube and mirror found a stricture 14 inches from meatus. 
Bougie No. 3 passed the stricture. 
March 8th. Laminaria bougie No. 4 was parsed with 
difficulty, the size being almost too large to pass the 
stricture. 
During the time of pushing it along, the Laminaria 
began to dilate, in consequence of which it could not 
be pushed further than 3J inches from meatus. Was 
left there for 3{ hours. 
The dilatation from meatus a to siricture b wa» 
round, and equally expanded to No. 7, the stricture it- 
self was well marked, constricted and dilated only to 
No. 6. The other side lieyond stricture, the Isiugie 
was flattened, and ddated to No. 8. He left rny office 
immediately afterward, very comfortable and without 
pain. 
March 20th. Sound No. 7 pa-sed stricture easily. 
Sanies discharge of serum and a little blood, but had 
no pain. 
March 21s/. Bougie No. 8 would not pas* the stric- 
ture. Galvanic battery applied. Positive pole covered 
with s|>onge in hand. A bougie with a lead bulb at 
the end attached to the negative pole was introduced 
into the urethra and arrested at the stricture. 
A constant stream was then applied with 10 cells for 
2J minutes, when the bougie passed freely through the 
stricture, and was arrested by a second stricture at 
inches. 
Aftrd 3d. Bougie No. 9 passed tightly. Galvanic 
battery bougie passed through both strictures, 10 cell* 
for 5 minutes. The bougie passed the first stricture 
after 2\ minutes, the second oj inche« after 4 mir:ute* 
April 10/A. Urethra still sore but no indurations 
felt. Sound No. 10 paused ea-ily. 
April 18/A. {Examination with glass tube and mir- 
ror cannot discover any granulations or sores. Bound 
No. 11 enters. 
April 27/A. Sound 11 and 12 passes. 
May 8/A. {Examination with endoscope reveal* only 
healthy tissue. Dismissed as cured. 5 
Jan., 1872, was again seen and found in good health. 
Case IV.—Stricture cured by Galvanic Battery.—H. 
W. B., Merchant, married. Had a gonorrhoea two 
years ago. Urethra discharged for several months, 
after which he had gleety discharges off and on. Has 
now some sanies discharge, and sometimes a burning 
sensation on micturition. 
Sept. 14th, 1871. Endoscopic examination. 
Small tube met with some constrictions in the ure- 
thra, and was arrested at 5 inches. 
On inspection the urethra was found a little thick- 
ened and red. The stricture could distinctly be seen 
as an irregular slit diagonally from right to left. Very 
slight points of granulation springing up almost below 
the stricture. 
Sept. 25th. Sound No. 9 passed with difficulty, and 
was arrested at 5 inches. G-alvanic battery 10 cells. 
From negative pole, the bougie No. 10, with a nickel 
point, was introduced into the urethra, constant stream 
for 24 minutes, passed the stricture easily. 
Oct. 24th. Galvanic battery as before—bougie No. 
11, nickel end, after which sound No. 12 was intro- 
duced. Patient was ordered to use sound No. 11 
once a week. 
Jan. 18th, 1872. Saw the patient again, and found 
him well. Sound No. 12 passed. 
Case V.—Stricture.— Cause of the failure of Galvanic 
Battery and Laminaria.—A case is added in which the 
galvanic battery and laminaria did not cure the stricture, 
but on the contrary made it worse. The cause of the 
failure, however, was explained, and I relate it with 
the intention of showing how important it is to make 
a correct diagnosis. Injudicious selection of cases for 
the operation, and a false diagnosis, will necessarily be 
followed by failure. 
B. A. came to my office last fall with an acute 
urethritis, which was cured by mild injection within 
about three weeks, after which a steel bougie No. 
12 passed easily into the bladder. 
Two months afterwards he appeared, and complained 
■of the breaking out of a slight discharge ; on examina- 
tion found a stricture at 4| inches. Galvanic battery 
was applied twice at intervals of two weeks. Each 
time the negative-metallic electrode Nos. 10 and 11 
passed into the bladder. On each succeeding visit, 
however, the stricture was worse. The stricture was 
so small that an endoscopic examination was impos- 
sible. Light thrown by a mirror through a glass tube 
shows only healthy tissue, mucous lining had a natural 
color, orifice and walls normal, no discharge to be seen. 
Cause of stricture unaccountable. Laminaria bougie 
No. 5, varnished at the end for one inch, was intro- 
duced 7 inches from meatus at 2:40, p. m., left there for 
three hours, and after removal found to my surprise 
bougie dilated only to No. 7. A large quantity sanies 
discharge followed the bougie from the urethra, which 
was characteristic of chancre. 
The patient was immediately put under consti- 
tutional treatment, and recovered in a few weeks. I 
conclude that the patient when first seen had only 
Gonorrhoea, which was cured. Afterwards the sy- 
philis developed, and a chancre appeared within the 
urethra, causing the pseudo-stricture, which was not 
recognized at first. The case is instructive, and shows 
one of the reasons of failure, in the treatment of stric- 
ture with galvanism and laminaria. 
These cases I believe will suffice to illustrate the effi- 
cacy of galvanism and laminaria in the cure of stricture. 
This method is not sufficiently understood and adopted. 
From my experience I discovered that the following 
rules ought to be observed in its application. 
1. Before the operation, the susceptibility to electricity 
of the patient should first be ascertained, and the 
strength of the battery arranged accordingly. 
2. The current should never be made so strong as to 
cause pain, or prolonged too long, but proportioned to 
the strength of the patient. 
3. The poles must be placed first, and then the cur- 
rent introduced. Shocks and interruption of current 
should be avoided. 
4. Repetitions of the operation must be done at inter- 
vals of at least fourteen days, or better four weeks. 
5. Mild currents, continued and repeated, work better 
than strong currents, which, if given only through the 
metal, cause pain, and may destroy tissues, without 
curing the strictures. 
This electrolytic procedure must not be confounded 
with galvano-caustic, which is used for the amputation 
of tumors, etc., and the immediate destruction of abnor- 
mal growths. 
I cannot finish this paper without alluding to the val- 
uable article of Dr. B. L. Keys, a gentleman well fitted 
for the investigation of this intricate question. The 
doctor has worked with skill and perseverance, and de- 
tailed his experiments with a clear precision and evident 
honesty of purpose. He reports in the N. Y Med. 
Journal, December, 1871, among others, ten cases of 
stricture treated by electrolysis. I perused this report 
with pleasure, as I believe it is the first, if not the only 
one given in America, respecting the use of galvanism 
in strictures. 
The author may possibly be too sanguine in his ex- 
pectation, or too easily discouraged in consequence of 
these large expectations tempting him to condemn the 
method altogether, forgetting that a class of charity pa- 
tients are the poorest kind from whom we can predi- 
cate the result of experimental treatment. Most of 
these are broken down in constitution, and from pov- 
erty and other causes incapable of aiding the cares and 
wishes of the physician. We cannot but observe in 
this report some very important complications that 
would have great weight at the time of treatment in 
characterizing the nature of the result obtained. For 
example, Case 2 was suffering from secondary syphilis; 
Case 6 had swollen testicle; 7, the urethra feels out- 
side like a fibrous cord, and in Case 9, internal urethro- 
tomy had been performed. Certainly all the conditions 
were unfavorable for a good result. Notwithstanding 
all this, the resume of the ten cases ought to give satis- 
faction : 
One unsuccessful—Case 9. 
Five patients refused further treatment, and disap- 
peared—Cases 1, 4, 6, 7, 8. 
Four successful—Cases 2, 3, 5, 10. 
Total, 10. 
The only really unsuccessful case, 9, may be due to 
the former internal urethrotomy. Next, it is unjust to 
condemn the method, because five patients have disap- 
peared, and could “ not be followed sufficiently long to 
make such an observation valuable.” And last, we find 
an undoubted success in four cases. In Case 2, notwith- 
standing the complication of syphilis, the stricture was 
dilated in one sitting from 9 to No. 12. In Case 3, from 
a filiform bougie the progress was made to No. 8, and 
in Cases 5 and 10, after treatment, sound No. 15 passed. 
Certainly a good result, and no reason to complain. 
Considering all circumstances, I must profess myself 
well satisfied with the result obtained by the use of 
galvanism in strictures, and hope the profession will give 
more attention to the subject, and that many interest- 
ing reports may be given us, which will enable us to 
add so confidently important a remedial agent to our 
repertoire. 
New York, 145 West Forty-Seventh Street.}