TABULAR STATISTICS OF ONE HUNDRED CASES OF URETHRAL STRICTURE, TREATED BY ELECTROLYSIS, WITHOUT RELAPSE. BY ROBERT NEWMAN, M. D., Subgeon Northwestern Dispensary, New York ; Permanent Member American Medical Association; Honorary Member Ulster County Medical Society, Etc., Etc. Beprint from NEW ENGLAND MEDICAL MONTHLY. Gould & Stiles, Printers, Bridgeport, Ct. 1885. TABULAR STATISTICS OF ONE HUNDRED CASES OF URETHRAL STRICTURE. TREATED BY ELECTROLYSIS, WITHOUT RELAPSE. BY ROBERT NEWMAN, M. D., Surgeon Northwestern Dispensary, New York ; Permanent Member American Medical Association: Honorary Member Ulster County Medical Society, Etc., Etc. Reprint FROM NEW ENGLAND MEDICAL MONTHLY. Gould it Stiles, Printers, Bridgeport, Ct. 1885. Eepbinted fbom the NEW ENGLAND MEDICAL MONTHLY, August, 1885. TABULAR STATISTICS OF ONE HUNDRED CASES OF URE- THRAL STRICTURE, TREAT- ED BY ELECTROLYSIS WITHOUT RELAPSE. note book, and are, in some sense, consec- utive, i.e., they consist of patients who were treated by electrolysis for urethral strictures from the time of May, 1868, un- til November, 1879, and who were satisfi- ed that they were cured. Of these, only such cases have been enumerated which remained under observation from three and one-half to eleven years, without having suffered a relapse. Therefore, it is obvi- ous that all those patients had to be omit- ted from this list, who did not remain un- der treatment long enough, or were lost sight of. In the following cases we record the time when the patient was seen last, or reliable information obtained that ho was well, without having had any relapse of stricture, and how many years had pass- ed since he had been dismissed as cured. Such information has been obtained either from the patients themselves, or their friends, or through reexaminations con- ducted by the family physician or myself. In many cases 1 personally had the op- portunity to reexamine the patients, and found that the same sized bougie introdu- ced last, no matter how many years ago, passed through the urethra easily, and often even a larger number could be intro- duced with facility. The length of time of these observations was as follows: Three to four years in thirty-two cases ; five to six years in twenty-six cases ; sev- en to nine years in twenty-six cases ; ten years in twelve cases, and eleven years in one case. IIow far the calibre of the ure- thra was enlarged is given under the col- umn, “ Result, and Calibre of Urethra, when Discharged as Cured ”; the first part according to the American scale, and the latter cases are marked according to the BY ROBERT NEWMAN, M. D. Surueon North-Western Dispensary, New York ; Perma- nent Member American Medical Association ; Honorary Memlter Ulster County Medical Society, etc., etc. rpilE tabular statistics of these cases were -■ a part of my paper, entitled “ Elec- trolysis in Surgery,” which was read be- fore the Section in Surgery, at the Ameri- can Medical Association, in Cleveland, June 6th, 1883, and referred for publica- tion, by an unanimous vote. A fire de- stroyed the typo and part of the manuscript, in Chicago. One part was afterwards published in the Journal of the American Medical Association, April 25th, 1885. The present paper is, therefore, a repro- duction of the destroyed manuscript, and not published before. This explanation is deemed necessary for a better under- standing; and is a reason why these sta- tistics appear at this late date. The prin- cipal object of the tabular statement is to show that the one hundred cases treated by electrolysis have not only been dismiss- ed us cured, but have also been kept under observation, and that during a number of years of such observation no relapse has occurred. As these statistics were prepared for the meeting in June, 1S83, and the shortest time of observation after a cure was three and one-half years, it will be seen that no case could have been incorporated in these tables, which came under treatment later than November, 1S79. All these one hundred cases have been taken from mv 4 French scale. Some critics may find fault that the calibre of the urethra has not been enlarged enough, according to their idea, and that a larger instrument would not have passed. My answer is, that I can enlarge the calibre as much as neces- sary ; that in these cases no stricture was found anywhere; that the patients them- selves were well satisfied with their ure- thra ; did not wish to have a larger calibre, even objected to continued treatment for such an object, and have ever since enjoy- ed good health for many years without any relapse or inconvenience. The cali- bre of the urethra can be enlarged and restored sufficiently for a cure by the elec- trolytic process, and in cases which have been treated during the last six years, since 1879, the calibre of the strictured portion has been enlarged, in most cases, up to No. 28 French scale, and in others still more. The duration of the strictures, at the time the patients came under treat- ment varied much, and was from less than one year up to twenty-five years dura- tion. The next point of interest is to compare the percentage of single and multiple stric- tures. Nearly one-half of the cases were single strictures, or more exact, 42%; two strictures in one patient were found in 34% of cases ; three strictures in 17% ; four strictures in 5%, and five strictures in 2%. During the latter years I have found as many as six strictures in one patient. These one hundred patients had one hundred and eighty-nine strictures togeth- er, which were situated in all parts of the urethra, from close to the meatus to within eight inches from the meatus. The exact location of these strictures was as fol- lows : Eight strictures were found at one inch or less from the meatus. Twelve strictures were found from one to two inches from the meatus. Thirty-one strictures were found from two to three inches from tho meatus. Twenty-five strictures were found from three to four inches from the meatus. Forty-two strictures were from four to five inches from the meatus. Thirty-seven strictures were from five to six inches from the meatus. Twenty-four strictures were from six to seven inches from the meatus. Ten strictures were from eight to nine inch- es from the meatus. While the analysis of one hundred cases will not warrant a correct conclusion as to the portion of the urethra where most stric- tures occur 5 nevertheless, these observa- tions are interesting, and they are given for what they are worth. Statistics compiled by general practi- tioners may vary somewhat from my ta- bles, because cases which come under my care are particularly severe, having most- ly been sent by other physicians, who can- not bestow the necessary time, or have not the variety of instruments needed. The general belief is, that most stric- tures are found in the spongy portion of the urethra, and the majority of these, within three inches from the meatus. My experience is, that strictures appear in ev- ery portion of the urethra, and from our tables of one hundred cases, the greatest number were situated from four to five inches from the meatus; about ten per cent, were in the membranous, and nearly five per cent, in the prostatic portion ; some of the latter were of traumatic ori- gin. Seances.—From one to ten operations, in some cases even more, were necessary for a cure, from which one may draw tho conclusion that the average number of seances was five to six for each case. Time.—The treatment in each case averaged two to three months. Lonff in- tervals between the seances, and iveak cur- rents arc rules to which I still adhere, and which I cannot impress too strong to ope- rators, as most important points in these operations. 5 Observations.—The length of time patients were under observation, after they were dismissed as cured, was from three to eleven years, which brings the average time to from six to seven years in each case. For other information, I refer to my former papers, some of which have ap- peared in this valuable journal, in which I have given accounts of the theory and practice of Electrolysis in surgery, and particularly in the treatment of urethral stricture ; many cases in detail, as also a ten year’s experience of cases and sequels. As these tabular statistics speak for them- selves, I conclude without any further comment. G8 West 35th St., New York, June, 1885. 6 No. Patient’s Initials. Residence, When first seen. Age. Cause, Duration, and Complications of Stricture. How many Stric- tures found. Distan e from Meatus in inches. Ameri* can size. No. IHEA1MEN T. Result and Calibre of Urethra when dis- charged. Last heard from after discharged as cured. Time of obser- vation without a relapse. How many seances. Average inter- vals. Time of. 1 L. C., Vermont, May, 1868. 36 Traumatic, 13 yrs. Internal Urethrotomy. 3 3 4£ 8 7 6 5 Days. 8 August 31, to October, 1874. American. Cured. 14 April 10, 18S2, by letter. 8 years 2 C. A. S., St. Louis, July, 1875. 34 Venereal excesses, Gonorrhoea, Impotence, Incipient Paresis. 4 28., New March, 1871. 26 Gonorrhoea, 1 year. 1 1* 6 9 S 3 months. Well. 12 April, 1SS1. 10 years 13 No. Patient's Initials. Residence, When first seen. Age. Cause. Duration. and Compli- cations of Stricture. How many Htric- tures found. Distan e from Meatus in inches. French siie, No. How many seances. T K Average inter- vals. EATMENT. r- Time of. Result and Calibre of Urethra when discharged. Last heard from after discharged as cured. Time of olmer- vation without a relapse. 74 W. H., Newburgh, October, 1871. 29 Gleet, Cystitis, Granulations, 4 years. 1 5 15 3 20 2 months. French. Well. 23 November, 1SS0. 9 years 75 A. K., New York, August, 1872. 39 Gonorrhoea, Strong injections, 4 years. 2 3i 4 3 16 7 10 3 months. Well. 25 December, 1SS0. Si years 76 N. S., Jersey City, August, 1S72. 30 Gleet, 3i years. 2 23 6 17 5 7 5 weeks. Well. 23 September, 1SS0. 8 years 77 J. B., New York, September, 1S72. 26 Gonorrhoea, Gravel, 3 years. 1 5i 17 6 12 2£ months. Well. 24 December, 1SS2. 10 years 78 C. M., Port Jervis, October, 1882. 29 Gonorrhoea, 2£ years. 1 43 18 4 20 3 months. Well. 24 December, 1882. 10 years 79 A. D., Jersey City, November, 1872. 25 Urethritis, Trau- matic, 2 years. 1 3 14 6 10 2 months. Well. 23 November, 1881. 9 years 80 G. T., New Yrork, December, 1872. 4S Gleet, Cystitis, 6 years. 2 H H 12 8 8 9 wreeks. Well. 23 December, 1S80. 8 years 81 T. A., New YTork, September, 1876, 27 Gonorrhoea, Reten- tion, 6 years. 4 i* H 6 7| 10 0 7 20 5 months. Well. 26 May, 18S3. 6-i years S2 C. W., New7 York, October, 1S76. 23 Gleet, General Paresis. 2 3 5 14 5 6 6 weeks. Well. 23 December, 1SS0. Then went west. 4 years 83 L. M., New York, January, 1877. 32 Gonorrhoea, 12 years. 1 H 15 3 12 1 month. Well. 24 May, 1SS3. 6 years 14 No. Patient’s Initials, Residence, When first seen. Agre. I How iDistan’e French size. No. TREATMENT. Result and Calibre of Urethra when discharged. Last heard from after discharged as cured. Time of obser- vation without a relapse. cause. Duration and Complications of Stricture. many Stric- tures found. from Meatus in inches. How many seances. Average inter- vals. Time of. 84 M. S., New York, February, 1877. 29 Gonorrhoea, Granulations, 9 years. 3 3* 4 6 16 11 7 Days. 13 3 months. French. Well. 23 December, 1S82. 5k years S5 . J. T. S., Washington, May, 1877. 24 Strong injections, 7 years. 3 3 4i 5 17 6 Long and irreg’lar 4 months. Well. 24 December, 1882. 5£ }Tears 86 S. M., New York, June, 1S77. 28 Gonorrhoea, 3 years. 1 54 15 5 7 1 month. Well. 23 December, 1882. 5 years 87 O. M., Philadelphia, July, 1S77. 34 Gleet, Impotence. 2 44 64 16 11 7 12 3 months. Well. 23 July, 1882. 5 years SS S. Y., Jersey City, July, 1S77. 43 Gleet, 10 years. Yen. Rheuma- tism. 1 5| 16 5 7 1 month. Well. 23 August, 1880. Then left for Europe. 3 years 89 W. B., New York, July, 1877. 29 Gonorrhoea, 6 years. 1 6f 15 6 8 l£ month. Well. 23 October, 1S82. 5 years 90 G. R., New York, August, 1877. 51 Gleet, 3 years. 1 7 17 3 12 1 month. Well. 24 November, 1881. 4 years 91 M. E., New August, 1879. 31 Gonon hoea, 10 years. 2 3 6-7 17 0 4 7 1 month. Well. 20 Septemb’r, 1S82. 3 years 92 J. S. C., Rome, August, 1S79. 50 Gonorrh oea, 12 years. 2 3 54 17 4 12 2 months. Well. 28 June, 1883. 4 years 93 L. H., New Y"ork, August, 1S79. 45 Gonorrhoea, Venereal excesses, S years. 4 24 3 44 5£ 20 4 Long and irreg'lar 4 months. Well. 25 May, 1S83. 34 years 15 94 G. W., Connecticut, September, 1879. 25 Gonorrhoea, Cystitis. 1 3 20 2 2 4 days. Well. 24 May, 1SS3. 34 years 95 C. D., Brooklyn, September, 1S79. 58 Gonorrhoea, 25 years. 5 13 44 5 7 12 0 8 20 5 months. Well. 28 May, 1S83. 3.J years 96 S. B., New Jersey, October, 1879. 46 Gonorrhoea, Incontinence, 20 years. 4 4 6 7 8 9 4 12 2 months. Well. 24 May, 1883. 34 years 97 T. T., New York, October, 1S79. 62 Successive Gonor- rhoea, Retention, 15 years. 4 H 5 6 8 12 0 4 10 14 months. 20 Feels so com- fortable, and has neglected further treatment. May, 1883. 34 years 98 S. T., New York, October, 1S79. 42 Gonorrhoea, 19 years. 2 3* ef 13 7 15 3£ months. Well. 25 June, 1883. 34 years 99 J. M., Home, Ootober, 1879. 34 Gonorrhoea, 10 years. 2 3* 5 17 3 25 2\ months. Well. 23 June, 1S83. 34 years A. N., Bridgeport, 100 November, 1879. 32 Gonorrhoea, 10 years. 1 5 0 3 8 1 month. Well. 20 Promised to come back, but felt well enough. June, 1S83. 34 years