In the French language, means a wax candle. The term is applied to a body of a similar shape, introduced into the urethra for removing obstructions. It is likewise known by the terms catheter, candela cerea, vel medicata. A wax candle was formerly employed; and from the name, it seems to be a French invention. It was described previous to (he appearance of syphilis.
In Dr. Swediaur's Pharmacopoeia Syphilitica, bougies are called catheteres, first made of silver, but they are better formed of elastic resin of various sizes. The second he styles catheteres cerei, of elastic resin, or of musical chords, made from the intestines of sheep-the third are cerei medicati, made in the following manner:
Cerae flavae liquefactae i. spermatis ceti, iij. aqua: lythargyri acetati, Ph. Lond. nov. 3 ij. - i: these when mixed together are removed from the fire, and slips of linen cloth are to be dipped in the composition, to be rolled into the form of a wax taper.
The fourth are the cerei medicati, known long before the time of Le Dran.
The great object to be attained by the bougie is mechanical pressure equable on all sides. We do not now expect to gain any advantage by introducing mercury in this way into the system, or to cure any ulceration. The preparation is therefore simple; and the cloths of which they are composed, are chiefly impregnated with wax and oil, rendered somewhat firmer by a proportion of resin. Some saturnine preparation is generally added, as the urethra is in an irritable state, and the mechanical irritation might otherwise increase it.
N n 2
From whatever composition the bougies are made, they must be of different sizes, from the knitting needle to a goose quill. The common ones are made in the following manner. Having spread any quantity of linen rag with the composition that is chosen for the purpose, cut it into slips from six to ten inches long, and from half an inch to an inch broad; then dexterously roll them on a glazed tile into the form of a wax candle. As the end of the bougie which is first introduced into the urethra should be somewhat smaller than the rest, the slips must be rut a little tapering; and when the bougies are rolled up, that side must be outward on which the plaster is spread.
mons. daran, and some others, attributed the action of their bougies to the composition used in forming them. Mr. Sharpe apprehended that their efficacy was chiefly owing to their compression on the affected part; and Mr. Aikin adds, that as bougies of very different compositions succeed equally well in curing the same disorders in the urethra, it is plain that they do not act from any peculiar qualities in their composition, but by means of some common property, probably their mechanical form.
The efficacy of mere compression in many cases of constriction is well known, from the use of sponge tents for dilating parts straitened by cicatrices. If, then, obstructions in the urethra arise from a constriction formed by cicatrised ulcers, or a projection of the spongy substance of the urethra into the canal, we may easily conceive that a gentle continued compression will, in time, overcome the disease. We may also readily account for the inferior efficacy of metallic, whalebone, and leather bougies, from their not having the property of swelling with moisture, and therefore not making an equal compression.
There is no doubt but the mechanical stimulus of a foreign body in such a tender part, though free from disease, must produce in some degree a discharge of matter, and this will be varied according to the chemically stimulating quality of the composition, and the irritable state of the urethra; but it seems an absurdity to apply an uniform cause of distention to the whole length of a canal, with a view of producing extraordinary effects upon a particular part, by means of some powerful quality in the ingredients. That part of the bougie which was in contact with the diseased part is certainly covered with matter; but this circumstance is owing to the greater irritation of the urethra there than in the other parts. To forming bougies of very active materials there certainly exists a very proper objection; because the healthy as well as the diseased parts are exposed to their action, and may themselves become diseased by the application. Surgeons, therefore, have confined themselves to the simple kinds, and such as act chiefly by compression.
Plenck recommended bougies of catgut, which may be easily introduced even into an urethra greatly contracted, as the size is small, the substance is firm, and as it dilates with moisture. They are not, however, convenient; they dilate below the stricture, give great pain when withdrawn, and do not dilate sufficiently on the contracted part.
The elastic resin has been employed for this purpose with great success, as it unites firmness and flexibility, out perhaps it does not swell sufficiently. The resin is moulded on catgut in a way kept secret. They are however, in many cases highly serviceable, though their surface soon becomes rough, and they are expensive.
Mr. Smyth, apothecary, of Tavistock street, has discovered a metallic composition of which he forms bougies, which are allowed to possess properties that these instruments have long wanted, in order to make them complete and efficacious in practice. Bougies formed of this metallic substance are flexible, have a highly polished surface of a silver hue, and possess a sufficient degree of firmness for any force requisite for the passing them in cures of strictures in the urethra. Indeed the short time which they have been employed has convinced practitioners that they exceed any bougies which have yet been invented, and are capable of succeeding in all cases where the use of such an instrument becomes necessary. They are made either solid or hollow, and answer extremely well as catheters; for they not only pass into the bladder with ease, but may also be suffered to continue there for any convenient space of time, and hence produce the most essential benefit. Catheters are also made of the same composition. They certainly do not swell with moisture, but they do not break or bend.
See Sharp's Critical Enquiry, ch. iv. and Aikin's Observations on the external Use of Preparations of Lead. Bell's Surgery, vol. ii. 201, etc. and White's Surgery, 371.