THE VALUE OF THE 
LEITER INCANDESCENT-LAMP URETHROSCOPE 
IN THE DIAGNOSIS AND TREATMENT OF 
CHRONIC URETHRAL DISCHARGES. 
BY 
JOHN B. DEAVER, M.D., 
DEMONSTRATOR OF ANATOMY AND LECTURER UPON SURGICAL ANATOMY 
IN THE UNIVERSITY OF PENNSYLVANIA ; ATTENDING SURGEON 
TO THE PHILADELPHIA, GERMAN, ST. MARY’S AND * 
* ST. AGNES’S HOSPITALS. 
FROM 
THE MEDICAL NEWS, 
June 21, 1890. [Reprinted from THE Medical News, June 21, 1890.J 
THE VALUE OF THE 
LEITERINCANDESCENT-LAMP URETHROSCOPE 
IN THE DIAGNOSIS AND TREATMENT OF 
CHRONIC URETHRAL DISCHARGES} 
By JOHN B. DEAVER/M.D., 
DEMONSTRATOR OF ANATOMY AND LEG IURER UPON SURGICAL ANATOMY 
IN THE UNIVERSITY OF PENNSYLVANIA; ATTENDING SURGEON 
TO THE PHILADELPHIA, GERMAN, ST. MARY’S AND 
ST AGNES’S HOSPITALS. 
Having med the Letter incandescent-lamp ure- 
throscope for some time with most gratifying results, 
both in the diagnosis and the treatment of chronic 
urethral discharges, I have felt that it would be of 
interest to present my views upon the advantages 
offered by this instrument, at the same time illus- 
trating my remarks by the citation of a few of the 
many cases I have recorded in my case-book. 
The incandescent-lamp urethroscope made by 
Leiter, of Vienna, consists of three pieces: the 
handle, the lantern, and the urethral canulae or 
tubes. The handle is made of vulcanized rubber 
and has upon its upper end a small incandescent 
lamp, which is connected with the two binding- 
screws projecting from its lower end. 
The light steel spring on the side is the key by 
1 Read before the American Medical Association, Section of 
Surgery, May 21, 1890. 2 
DEAVER, 
which the current is connected and broken. The 
handle fits into the bottom of the lantern. 
Fig. i. 
The lantern is a gutter-shaped box, roofless, hav- 
ing at one end, which I will call the ocular end, an 
obliquely placed concave mirror for the purpose of 
reflecting the light of the lamp along the urethral 
canula or tube, also a movable lens intended for THE LETTER URETHROSCOPE. 
3 
either long- or short-sighted observers. At the 
other end is a nozzle for fitting on the tubes. 
In addition to this are also noticed small per- 
forations in the floor of the lantern immediately 
around the lamp, which are intended to carry off 
the heat. The urethral tubes are of different sizes, 
intended, of course, to be used in different sized 
urethrae. The larger the tube used the more satis- 
Fig. 2. 
Urethroscope ready for use. 
factory will be the examination, and, if necessary, 
I do not hesitate to enlarge the meatus, which in 
most cases we find contracted, and this simple 
division will, in some instances, relieve the patient 
of the trouble which we are trying to learn the 4 
DEAV E R , 
nature of by the urethroscopic examination. The 
nearer the size of the tube approaches the normal 
calibre of the urethra, the less likely are we to over- 
look a fold which may be the seat of a small patch 
of disease. The mirror is to be so adjusted as to 
reflect the light along the tube. 
The construction of this instrument is so simple 
that it very seldom gets out of order. The most 
delicate part is the lamp, which after being used 
some time requires changing, as it is apt to become 
blackened. Changing is done by simply removing 
the handle and loosening the two small screws hold- 
ing the lamp in place, when the lamp is lifted out and 
replaced by another, care being taken to secure 
it by tightening the screws. The handle is then 
replaced and fixed. In adjusting the lamp care 
must be taken to have it at a proper level, other- 
wise there will be insufficient illumination. To 
avoid all annoyance it is best, when inserting the 
handle into the lantern, to light the lamp and test 
the amount of illumination by placing the end of 
the urethral tube, adjusted on the nozzle, against a 
dark surface, when by elevating or depressing the 
handle the proper level can be obtained. 
The two forms of batteries used by me in lighting 
the urethroscope, are the Julian storage system and 
the Grenet or plunge battery. 
The Grenet or plunge battery, which I prefer, is 
made by Mr. Flemming, of Philadelphia, and con- 
sists of a box containing two equal compartments, 
the first of which is occupied by a series of rubber 
cells, one-half filled with the following solution ; 
potassium bichromate, 6 ounces; sulphuric acid, 5 THE LEI TER URETHROSCOPE. 
5 
fluidounces; water, 3 pints. This solution must be 
removed every two or four weeks, according to 
usage. The second compartment contains one 
large cell, the object of which is to catch the drip 
from the plates after their removal from the bichro- 
mate bath, and also to protect them. 
These two compartments are covered by a bed, 
the under surface of which is divided into two equal 
parts, one half being covered by a sheet of rubber, 
to close the cells when not in use, and the other half 
occupied by a number of sets of plates. Each set is 
composed of two carbon and one zinc plate, which 
are fastened to the bed in the usual manner, and so 
connected as to have independent action, the num- 
ber of cells being thrown into circuit as required. 
After using the battery and wishing to discontinue 
the current it is merely necessary to lift out the 
plates, change sides, and deposit them in the one 
large compartment. 
Upon the upper surface of the bed are a number 
of binding-posts corresponding to the number of 
cells employed, and by attaching the cords in a 
proper manner the number of cells desired can be 
brought into circuit. On this surface there is also a 
rheostat, consisting of a rubber plate wrapped with 
silver wire, connected with the cells and having a 
swinging arm which can be moved to any part of 
the plate; the object of the rheostat I will speak of 
later. 
The other form of battery used by me is made by 
Waite & Bartlett, of New York, and consists of a 
carrier or box, containing four large storage-cells, 
each of which is composed of a rubber cup, a series 6 
UEAVER, 
of carbon and lead plates not in contact with each 
other, and contains a dilute solution of sulphuric 
acid which must be replenished from time to time. 
The materials used to connect these cells are narrow 
plates of lead, which are not acted upon by the sul- 
phuric acid solution. The cells each measure two 
volts, and on increasing the voltage it is necessary 
to use a rheostat for reasons mentioned below. 
There are two objections to the general use of the 
storage system. First, it must be charged from a 
dynamo, and second its weight (from 90 to 100 
pounds) renders it inconvenient to carry. 
The objects of using a rheostat are to govern the 
current, to prevent burning out of the lamp, and to 
measure the exact resistance of the lamp. It is a 
well-known fact that the carbons vary greatly in 
different lamps. In some the resistance is high, and 
such only burn when the rheostat is at its minimum ; 
in others the resistance is so low that the lamps will 
not burn with a white light unless when the rheostat 
is at its maximum. 
Manner of Using the Instrument.—In using the 
instrument the position of the patient which I have 
found most satisfactory is the recumbent one, on a 
table or couch of considerable height with the knees 
bent over the edges and slightly separated. The 
largest tube which the meatus will admit is now in- 
troduced, and passed gently through the urethra to 
the bulbo-membranous junction ; unless obstruction 
is met with, when the stylet is withdrawn, the ure- 
throscope adjusted, and the obstructing point exam- 
ined. Great care is to be exercised in passing the 
tube, as it may induce bleeding, thus obstructing the THE LEITER URETHROSCOPE. 
7 
field of vision. Where we are dealing with a much 
inflamed urethra, we will necessarily be annoyed 
more or less by a few drops of blood, and when this 
occurs it can be gently removed by a pledget of 
cotton carried down the tube by the applicator. In 
case the pendulous urethra is found normal I carry 
the tube into the membranous urethra by depressing 
the proximal end, and in this way examine the deep 
urethra. 
Normal Appearance of the Urethra.—When at rest 
the walls of the urethra are closely approximated 
and the lumen varies in shape at different parts of 
the canal. 
Commencing at the bulb and extending to within 
an inch of the meatus, the lumen is transversely 
slightly oval; in the remaining portion it is either 
vertical or triangular, and at the meatus vertical. 
The color of the mucous membranes varies from- a 
pale grayish or pale bluish-pink to a full, bright 
pink; generally it is very similar to the buccal and 
labial mucous membrane in the same individual. 
The brilliancy resembles that of the mouth. On 
slowly withdrawing the urethroscopic tube the walls 
of the urethra will be seen to contract behind it. 
One of the most important characteristics of the 
healthiness of the spongy urethra is the evenness 
with which its walls contract behind the retiring 
tube, or expand when it is advanced. A limited 
thickening in a small area will cause them to ap- 
proximate irregularly. A scanty secretion of pus 
will destroy the lustre of the mucous membrane. 
The lumen of the membranous urethra at the site 
of the anterior layer of the triangular ligament is 8 
DEAVER, 
triangular, which is due to the walls being less elas- 
tic than in the spongy portion ; elsewhere it is oval. 
Owing to the presence of the urethral crest (veru 
montanum) the lumen of the prostatic urethra is 
crescent-shaped. 
All chronic discharges of the male urethra have 
been from time immemorial, and still are, known 
by the name “ gleet.” The opinions advanced as 
to the pathological conditions present in gleet in the 
absence of a well-marked stricture have been various, 
and not until recently has the proper aspect been 
given to these cases. The proper understanding of 
these conditions is solely due to the use of the ure- 
throscope, which has been so perfected as to make 
the examination of the urethra, particularly the 
pendulous, membranous, and terminal portion of 
the prostatic, as satisfactory, and in every sense as 
reliable as is the examination of the eye-ground with 
the ophthalmoscope. 
I believe, as does Professor Otis, that in the great 
majority of cases of gleet, one, and in some in- 
stances more than one stricture is present, which 
when situated in the pendulous urethra, the usual 
site, can be most satisfactorily demonstrated by the 
urethra-meter, and that the removal of the stricture 
by dilating internal urethrotomy will cure the greater 
number of such cases. I also believe that the mi- 
nority of cases are not the result of stricture, and can 
be correctly diagnosed, and consequently successfully 
treated, by the use of the urethroscope. It has been 
my experience to see a few cases, where, after a com- 
plete dilating internal urethrotomy, the discharge 
continued, though not to as marked a degree as before THE LEITER URETHROSCOPE. 
9 
the operation, and where cure has promptly followed 
a few applications made to the affected portion of 
the urethra through the urethroscopic tube; also in 
cases where internal urethrotomy is practised I am 
able to hasten the cure by local applications. 
What are the varieties of gleet (meaning any 
chronic urethral discharge) met with and clearly 
demonstrated by those who practise urethroscopy ? 
In my experience with the use of this instrument 
I have been able to demonstrate the following varie- 
ties of chronic urethritis: 
ist. Simple chronic urethritis consisting of three 
different forms ; one where the surface of the ure- 
thra is uniformly livid and moist; a second where, 
in addition to the above, are circumscribed areas 
involving the deeper portion of the urethra (the sub- 
mucosa), resulting in the formation of nodular 
masses, slight, yet easily demonstrated by the ab- 
sence of the normal elasticity of the urethra; and a 
third where there are circumscribed areas presenting 
a granular surface, covered, in many instances, with 
adherent pus and readily bleeding at the slightest 
touch, which is most probably that variety of urethri- 
tis described by some authors as granular. 
2d. Follicular urethritis, where the inflammatory 
process is confined to the simple follicles, or the 
lacuna magna, and in some cases to the ducts of 
Cowper’s glands. 
3d. Ulcerative urethritis, never present except 
when associated with stricture, the treatment of 
which calls for division of the stricture (dilating 
internal urethrotomy), and local applications to the 
ulcer or ulcers made through the urethroscopic tube. DEAVKR, 
It is not uncommon to meet with two or more of 
the above conditions in the same case. 
In the absence of the urethroscope, to ascertain 
the exact pathological condition which is keeping 
up the discharge is, in a large number of these cases 
at least, impossible. I have made the statement 
that, in my judgment, by far the greater number of 
such cases are the result of stricture; but, even so, 
a urethroscopic examination properly made tells us 
the actual condition of the urethra, both behind and 
at the strictured portion. The cases which I will 
now cite demonstrate the advantage of the instru- 
ment in the way of treatment. 
Case I.—J. D., aged thirty-eight years, was ad- 
mitted to the surgical wards of the Philadelphia 
Hospital, in February, 1890, with a purulent dis- 
charge from the urethra, and pain upon micturi- 
tion. History of gonorrhoea for four years, fol- 
lowed by-stricture. Was operated on in the winter 
of 1889, at Bellevue Hospital, by Dr. Keyes. 
Urethroscopic examination revealed a small ulcer, 
one-eighth of an inch in diameter, on the floor of 
the pendulous urethra immediately in advance of 
the bulbo-membranous junction. A solution of 
silver nitrate, 10 grains to the ounce, was applied 
through the urethroscopic tube by means of the ap- 
plicator. Two more applications, at intervals of 
three days, were made, when the ulcer was entirely 
healed, resulting in the relief of all symptoms. The 
patient was kept under observation for one month, 
when he was discharged cured. This ulcer was evi- 
dently the result of the stricture, but, unlike it, was 
not cured by the internal urethrotomy, which, I 
believe, would often be found to be the case were a THE LEITER URETHROSCOPE, 
careful urethroscopic examination made in many of 
those cases where the discharge is still present. 
Case II.—C. D. ; private patient; came under 
ray care some months since, with a history of gleet 
of two years’ standing. During this time, he says, 
he had several attacks of gonorrhoea immediately 
following connection; these were evidently not 
attacks of true gonorrhoea, but simply aggravations 
of the existing urethritis, the result of the venereal 
act. Examination of the deep urethra with the 
bougie-d-boule and of the pendulous urethra with 
the urethra-meter revealed the absence of stricture. 
This examination was followed by some bleeding. 
Urethroscopic examination revealed chronic urethri- 
tis, with three distinct granular points on the floor 
of the pendulous urethra, inches anterior to the 
bulbo-membranous junction. The granular patch 
nearest the meatus bled freely when touched. 
Four applications of a 20-grain solution of silver 
nitrate were made at intervals of five days. In addb 
tion to the application of silver solution, the patient 
used the following injection four times daily: sulpho- 
carbolate of zinc, 12 grains; sulphate of morphine, 
4 grains; distilled water, 4 ounces. At the end of 
three weeks, all symptoms having subsided, treat- 
ment was suspended. The patient reported two 
weeks later, when a urethroscopic examination 
showed the urethra to be normal. 
Case III.—W. H. ; private patient; came to me 
suffering from a chronic urethral discharge of four 
years’ standing, as a result of a very severe attack of 
gonorrhoea. Three years ago he was examined by 
a genito-urinary specialist, who found a stricture of 
large calibre in the pendulous urethra. This spe- 
cialist cut the stricture by dilating internal urethrot- 
omy, since which time the patient has been passing, 
at stated intervals, a No. 36 (French scale) bougie. 12 
DKAVER, 
During the past three years, the patient states, he 
has had several attacks of gonorrhoea of a mild type, 
but these were evidently attacks of so-called bastard 
gonorrhoea. Examination for stricture showed the 
urethra to be normal throughout. Urethroscopic 
examination of pendulous urethra was negative, ex- 
cept at the point which had been the seat of the 
stricture; here there was an absence of the normal 
elasticity, particularly well marked on the floor. 
Examination of the membranous urethra showed the 
mucous membrane of the anterior part of the floor 
to be dark red and presenting a distinctly granular 
area, bleeding upon the slightest touch. In the 
light of this examination I made instillations, of 
5 minims each, of a 20-grain solution of silver ni- 
trate, six in all, into the deep urethra with the 
Ultzman drop-catheter, at intervals of three days. 
This treatment not proving satisfactory, I brought 
into the field of vision the granular area, and made 
two applications through the urethroscopic tube, 
this sufficing to accomplish the desired end. Some 
weeks since the patient wrote me that he was well. 
Case IV.—G. G. ; private patient; contracted his 
first attack of gonorrhoea in 1883. It ran through 
the three stages, and had all the characteristic symp- 
toms of genuine acute urethritis. The treatment 
consisted of balsam of copaiba internally and various 
injections; it lasted four months. In 1884 he con- 
tracted a second attack, which did not differ from 
the first, excepting that it lasted six months. 
In 1886 he contracted a third attack, which was 
by no means as pronounced as either of the previous. 
He had merely a discharge which differed from that 
of the other attacks in being thinner and whiter. 
The treatment was internal only, and consisted of 
paste of the balsam of copaiba and of cubebs, for two 
weeks. THE LEITER URETHROSCOPE. 
13 
He did not have connection nor did he drink any 
spirituous liquors for one month after the discharge 
stopped ; when having transgressed from the path 
of virtue, upon the day following he had a return of 
the discharge. There was neither pain nor discom- 
fort other than that occasioned by the presence of 
the discharge. He was again treated by balsam of 
copaiba internally and by injections, but not im- 
proving as rapidly as his medical attendant thought 
he should, the systematic passage of steel bougies in 
connection with the above treatment was begun. 
The medication was continued until the patient’s 
stomach would no longer tolerate the balsam, when 
it was omitted, the bougieing and injections being 
persisted in. Three months from the institution of 
the treatment, the patient remaining abstemious, 
there was still enough discharge to make him despair 
as well as seek other advice. 
In July 1888, I was consulted, and examination 
then showed a slight gleety discharge. Calibre of 
urethra 36 millimetres. Stricture inches within 
the meatus, calibre 34 millimetres. At this time, 
not having a urethroscope with which to make an 
examination of the urethra, I believed the discharge 
was caused by the stricture of large calibre present. 
I advised the passage of solid bougies and injec- 
tion hrou (French formula), hoping in this way to 
restore the normal condition of the urethra. This 
treatment was used faithfully for five months. In 
December there being no longer any discharge I 
stopped passing bougies and discontinued the injec- 
tion, which had been changed from injection hrou, 
several different formulae having been used. I ad- 
vised that a No. 35 solid bougie be procured and 
passed once a week for some time. 
In August, 1889, I was again consulted for an 
epididymitis of left testicle, following'the passage of 14 
DEAVF.R, 
the bougie. This attack of epididymitis confined 
the patient to house for one week, when the dis- 
charge again returned. As soon as the epididymitis 
had cleared up I examined the urethra with urethra- 
meter, finding it trespassed upon to a little less than 
one millimetre at site of original stricture. Exami- 
nation of urine showed presence of a few pus cor- 
puscles and some shreds of mucus. Examination 
of prostate through rectum was negative. Believing 
the cause of the trouble to be chronic inflammation 
of the deep urethra, I used instillations of solution 
of silver nitrate, varying in strength from to to 20 
grains to the ounce, ucing the Gross instrument. 
In a very short time the discharge disappeared, 
only to reappear after taking a glass or two of beer. 
In the fall of 1889, a urethroscopic exnnination 
showed the cause of the trouble to be chronic ure- 
t hritis with granular areas in the membranous urethra. 
Treatment like that I have detailed proved in a 
short time entirely satisfactory. 
The citation of these four cases, I think, is suffi- 
cient to support what I have intended to convey by 
the title of this paper. 
In addition to the value of this instrument in the 
diagnosis and treatment of chronic urethral dis- 
charges, I desire to call attention to what, by its 
use, I believe I have demonstrated to be a cause of 
failure in obtaining cure in a certain number of cases 
of stricture operated upon by divulsion, and which I 
think is an argument in favor of dilating internal 
urethrotomy (the operation I strongly advocate 
where it is feasible), as the cause of failure cannot 
result from the cutting operation, if properly done. 
I refer to tabs or teats of mucous membrane which THE LEI TE R URETHROSCOPE. 
15 
have been separated at the time of the divulsion; and 
by bougieing, the usual after-treatment instituted in 
these cases, the union of these tabs to the surface 
from which they were torn has been prevented. In 
two cases coming under my care recently, I have 
found the following conditions as here shown in the 
diagrams. 
Fig. 3. 
Fig. 4. 
Normal urethra. 
Teat-like prominence of ure- 
thral mucous membrane. 
Fig. 5. 
Fig. 6. 
Same as Fig. 4. Point of 
prominence showing in 
the centre. 
Multiple projections of mu- 
cous membrane into the 
urethra. THE LEITER URETHROSCOPE. 
Fig. 7. 
Multiple small projections into the urethra. Same as Fig. 6; 
tube partly withdrawn. 
This condition, in my judgment, granting that 
all of the strictured area has been removed, is quite 
sufficient to keep up a discharge. 
The routine treatment of cases of chronic urethral 
discharge is by injections, soluble bougies, the sys- 
tematic passage of solid bougies, and internally by 
the administration of stimulating blennorrhagics, 
until the patient’s stomach will no longer tolerate 
them, and with, in many cases, little or no effect. 
It is evident to all that this form of treatment will 
no doubt modify the condition, and will cure a 
few cases. The advantage offered by the method 
advocated in this paper is, that we are with cer- 
tainty able to deal with the diseased point or 
points, it being necessary only in a very few to 
trespass upon the proslatic urethra proper, which 
is always done in the ordinary routine practice 
of introducing the bougie into the bladder, 
thereby exposing the prostate gland to injury, as 
well as endangering the patient to an attack of 
epididymitis. THE MEDICAL NEWS. 
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