standing, and in some instances has existed for years, yet it
may happen that it is only a few months or a year since the
patient's attention has been directed to the disease. This is
very intelligible; for, in conformity with what we observe in
other parts of the body, the bladder has a power of
accommodating itself to a change of circumstances. Its
strength, for a long time, may increase so correctly in
proportion to the increase of the obstacle which opposes the
ejection of its contents that a very considerable period
elapses before the difficulty in making water becomes
cognizable to the patient, or it occasions an annoyance so
trifling as scarcely to excite his attention. This increase of
strength in the bladder frequently renders the formation of
stricture so insidious that the urethra at the affected part
is very narrow before the individual is aware of the existence
of any contraction whatever; the bladder, however, at length
becomes unable to empty itself, and the abdominal muscles and
diaphragm powerfully act as coadjutors, so that each effort to
make water is accompanied by a straining which is very
distressing, and the complete evacuation of the bladder is
often not accomplished even by these combined forces. The
straining which accompanies stricture, and which seems
necessary to evacuate the bladder, although it be occasionally
exceedingly annoying to the patient at the time, is more
important with reference to the results which are its
consequence. I am firmly of opinion that there are a great
number of patients laboring under hernia which has been
produced by no other cause. I must confess that I had seen a
great number of instances of stricture in ruptured patients
before I drew any inference from the observation of their
co-existence." The foregoing observations of Macilwain, made
in 1830, are here reproduced for their clearness of expression
and explanation, as well as to show what injuries can be
produced on the young child afflicted with phimosis. We are,
as surgeons, familiar with the anatomical and pathological
changes there are undergone by the bladde