branches a certain amount of knowledge is absolutely necessary before you can conscientiously engage in practice. Learn also to exercise those intellectual powers which have proved to others, and will prove to you, of such eminent service in after life; cultivate the faculty of observation; be ready to take in all that is going on around you, and also exercise yourselves in collecting and arranging the facts which you observe, so that you may be the more able to learn the lessons which they teach; and bearing in mind the circumstances in which you will frequently be called upon to minister, do not neglect those genial qualities which are of so much value on such occasions; strive to cultivate kindness of disposition, gentleness of manner, and the power to sympa. thise with others, combined with a proper degree of firmness -qualities which go so far in making a medical man accept able to his patients.

It is a fact, with but few exceptions, that the position which any one ultimately gains, falls short of that which he has set before himself as the aim of his life; therefore, in order to attain to anything great you must always keep in view some objects that shall be worthy of your efforts. Ambition, if it is of the proper kind, and makes use only of legitimate means, is deserving of all praise, and I would urge upon you all to be ambitious. Place some high model before you, and strive after that. You may not be able to reach it, but at all events you will rise to a better position than if you had no desire to elevate yourselves. And the earlier you begin to do this, the more likely will you be to succeed in gaining your end. As I have already remarked, there is no lack of opportunity for each and every one of you to distinguish himself in our profession, and I trust the day may come when the names of many I see before me now shall be known far and wide, as belonging to men renowned in science or some department of medicine or surgery. Do not imagine this to be impossible. You know not what you can do until you try. Those who have advanced to the foremost ranks were once students like yourselves, and probably had as modest an opinion of their abilities as, I hope, you have; but they kept a grand object in view-they strove after it-they gained it, and you may follow in their footsteps.

In order, however, to achieve anything noble, you must set out with a determination to be patient and persevering, to overcome all difficulties, and strenuously to resist every temptation by which you may be assailed. It is the law in every path of life that difficulties and trials have to be met with. Life is familiarly illustrated by a voyage, during which adverse winds or tempest and storm must sometimes be encountered; or by a journey, which is not always along smooth and pleasant paths, but often across very steep and rugged mountains; or by a battle, with its reverses as well as its successes; and our course is no more exempt from such vicissitudes than is that of others. Difficulties will meet you in your way—obstructions will rise up against you-barriers will intervene to check your footsteps; but resolve to overcome difficulties, to break down obstructions, to surmount barriers, and it can be done. Do not, however, start with the idea that this will be an easy task; it will often require you to call forth all your efforts, and will demand patient and persevering labour. You must not be dispirited if the goal which you have set before yourselves is not speedily reached, for remember that we must be content for a time with the lower stages, if we intend ultimately to gain a high station. It is astonishing what can be accomplished by perseverance in the use of faculties, limited though they may be; it frequently leaves so-called "talent" far in the shade. Our greatest men are often not those possessed of what are termed "brilliant capacities," but those who by quiet, earnest, continuous labour, have removed obstacle after obstacle, until, while benefitting mankind, they have raised themselves to the highest pinnacle of fame. Bear in mind that whatever may be your abilities or opportunities, without your own co-operation they can avail you nothing. Not that the possession of talents is a thing to be despised nay, rather it adds immensely to the responsibility of the possessor. If one of you, having abilities of a high order, which, with proper use, are capable of doing great things for yourself and the world, yet by their neglect, allow one who is much inferior in intellect to surpass you-it will only redound the more to your disgrace and shame. You are wasting God's richest gifts, and a poor account will you one day be able to render of the manner in which you have employed them. To those who are not favoured with unusual mental powers, it is

a comfort to remember what can be accomplished by work, a evidenced by every stage and grade of existence from th school to the throne. If any of you are feeling disappointe to-day at a want of success in the competitive examinations, let that feeling only prompt you to more strenuous efforts, and a far higher prize must be your reward. To every one of you from the most profound genius to the least talented-I would say, start now at the outset with a determination to conquer, and to raise yourselves to positions of dignity and honour; let that resolve lead to perseverance, not short-lived, but continuous; and for this end, it is well not to be too vigorous at the first. It is not an infrequent thing in a race, to see one competitor rush off far in advance of the others, seeming to have everything his own way; but after a time, his efforts flag, the interval between him and those behind gradually lessens, until he finally drops away altogether; while, perhaps, one, who has for some time been far in the rear, and apparently out of the contest, appears to gain power as he goes on, and his speed increasing, he rapidly gains upon his adversaries, and reaches the goal the winne of the prize. This is not unlike what takes place with some students-they make a most energetic start, but as the session advances, their exertions gradually diminish, until at last they cease entirely, and some quiet plodder wins the day. Begin then not too rashly, but steadily, and you will find that as you go on, your powers will increase, your efforts gain strength, and continuing stedfast to the end, you will at last reap a rich reward. I have told you to aim at a high position, but be not satisfied with merely seeking for this, but strive after it. There are few who do not seek in a certain way to achieve something at all events, i.e., they desire to do so, if they could only succeed without labour; but to strive is another matter -it is to strain every nerve to gain the end in view, and to make every opportunity contribute to its attainment; and it is in that spirit that you must set about your task, if you intend to succeed. Do not lose sight of the fact that in your future life, you will be compelled to practice patience and perseverance, if you wish to exercise your calling with any prospect of success. You may not think so now, but daily experience will hereafter convince you of it, and if you do not begin to cultivate those qualities now, you may find it then a task more difficult than you imagine, causing you to look back upon your past neglect with the deepest regret.

THE opening of the session of this society was celebrated on October 6, when the prizes were distributed by Mr. G. W. Sandford, President. An Introductory Address was also delivered on the occasion by Mr. Henry B. Brady, F.L.S., F.G.S.

The CHAIRMAN observed that, in the interval since the last meeting, another great advance had been made towards enlightened legislation in respect to pharmacy, the greatest step probably since the first recognition by the state in 1841 of the claims of special education as set forth in the charter of incorporation. They were now something more than a mere voluntary association, and stood in the same relation to the government as other professional bodies who held compulsory examining powers. The latest Pharmacy Act was but the consummation of twenty years' steady effort in a fixed direction, and embodied the acceptance of principles which the Pharmaceutical Society was founded to support. The legislature had given them, as a body, a certain monopoly on an educational basis, and Parliament had done all that lay in its power to make pharmacy a profession. It rested with them, and especially with their younger members, to qualify themselves for the enlarged sphere opened to them, and they must look to those who, in the course of nature, might expect to see the new order of things that time must bring to qualify themselves by closer mental training for that higher social position which it would be their own fault if they did not occupy. Amongst the most gratifying features in their recent Parliamentary experience was the absence of opposition on the part of the public, and the general approval with the act had been received by the medical profession. There still existed some remnant of an old jealousy, which sometimes showed itself in the correspondence columns of the medical periodicals, which might be traced to recent parliamentary debates, and even in the proceedings of the Medical Council. The relations be. tween medicine proper and pharmacy had till now been so ill

defined that much forbearance was needed on all sides whilst things were settling into their proper order. Medical practitioners, from time immemorial, had been accustomed to dispense; indeed time was when they only were properly qualified for the purpose, and for the state of things which was desired they must rely on the change that was gradually taking place in medical education, which tended more and more towards physiology and therapeutics, and concerned itself less and less with pharmacy and materia medica. On the other hand, they might fairly claim from the medical profession due consideration, since they were both servants of the public, whose ideas of right and wrong in respect of medical advice could only be reformed by a sort of educational process. Most of all it was for them to show that practice in those branches of medical science to which they were specially devoted might safely be left in their hands, and in the mutual confidence thus established the ground for jealousy would soon disappear. The lecturer then delivered a warm welcome to the new students, and laid down the precept which he considered best calculated to direct and aid them in their studies, advising them to strive earnestly for proficiency in their profession, and to adopt as their watchword "Thorough," or, if they would, take home to themselves that olden injunction of King Solomon, "Whatever thy hand findeth to do, do it with all thy might."

THE SALT-CURE OF REICHENHALL. REICHENHALL Owes its existence as a watering place to its salt-springs, one of which, the Edelquelle, is the strongest in Europe. It contains more than 234 per cent. of salt, and has a temperature of 57° F. The baths are of various kinds ordinary warm or tepid baths, douche and vapour baths, and so-called "Wellen sprudel bäder," in which last form the water is forced upwards under pressure into the bath, so as to imitate the effect produced in sea-bathing by the striking of the waves against the body. A "cure "lasts four or six weeks, and comprises from twenty to forty baths, in which the salt-water is sometimes used pure, sometimes mixed either with mother-liquor (which resembles the mother-liquor of Kreuznach), or with the extract of the dwarf Alpine pine, the latter mixture being specially recommended in cases of rheumatic gout. The temper. ture, concentration, duration, and number of the baths are under strict medical supervision. Another mode in which the salt-water is used is that of inha lation, of which two forms are employed. One plan consists in allowing the patient to sit or walk up and down in the immediate neighbourhood of the so-called Gradirhäuser. These erections, which form striking objects in approaching the town, may be described as enormous hedges, forty or fifty feet high, composed of bundles of twigs arranged horizontally, in such a manner, that the surface of the wall is formed by the projecting ends. Their purpose is to afford a large evaporating surface for the concentration of the weaker kinds of saline mater-those containing only a few percentages of salt. The water is conveyed by pipes from the springs to the top of the graduation-hedges, whence it is allowed to trickle slowly over the bundles of twigs into reservoirs. By this process the liquid is brought up to a strength of about 20 per cent., and is then ready to be conveyed into the vats, where the further process of evaporation is accomplished with the aid of heat. The degree in which the air on the lee-side of the graduation hedges is impregnated with salt is surprising. It has been accurately determined by analysis, and has been found to vary at ordinary temperatures from 0.028 grains to 0 052 grains in a litre, or from 0.054 grains to 0.123 grains in a cubic foot, so that the air is considerably richer in suspended saline particles than ordinary sea-air. The second method consists in impregnating the air of a room in which the patient is allowed to sit for a certain number of hours daily, by means of the process of pulverization. For this purpose the liquid is forced by steam power through an iron pipe terminating in a number of minute apertures, from which it issues under a pressure of four atmospheres, in fine jets. Opposite each jet, at a distance of four inches, is a metal ball, by which the stream is converted into invisible spray. The tube stands upright in the middle of the inhaling room, like a post, with the jets and pulverising balls arranged round the top. The air of the room becomes impregnated with moisture and salt, in a degree proportionate to the distance from the pulverizers. Near the post it contains from twenty to forty milligrammes of salt in a litre of air; in the corners of the room not more than four to five. The humidity of the air is far below saturation: it does not exceed 86 per cent.-The Practitioner.

Medical News.

UNIVERSITY OF LONDON.-1868.-First M.B. Examination.-(Entire.)-Pass Examination.

First Division. -Alfred Ashby, Guy's; Ashley William Barrett, London; John Mitchell Bruce (M A. Aberd.,) Aberdeen; Alfred Cotterill, King's College; John Curnow, King's College; Frederic Durham, Guy's; Henry Newell Martin, University College; Rushton Parker, University Richard Clement Lucas, Guy's; Robert Wishart Lyell, King's College; College: Edward Cox Seaton, St. Thomas's; Alfred Shewen, University College; Herbert Alder Smith, St. Bartholomew's; Richard Thoms Second Smith, University College; Hugh Eccles Walker, Guy's. Division.-William Henry Allchin, University College; Edgar George Barnes, St George's; Charles Henry Carter, (B. A.), University College; Alphonso Elkin Cumberbatch, St. Bartholomew's; John De Liefde, Guy's; James Alfred Harris, University of Edinburgh; Robert Haris, Guy's; Richmond Leigh, Liverpool Infirmary School of Medicine; Walter George Lowe, St. Bartholomew's; William Smith Paget, Liverpool School of Medicine; Alfred John Wall, St. Mary's; William Beach Whitmore, King's College. PHYSIOLOGY ONLY.-First Division.-James Reginald Stocker, Guy's. Second Division. Thomas Bridge Bott, University College; Edward Hepburn Seccombe, King's College; Charles Tanfield Vachell, King's College. EXCLUDING PHYSIOLOGY.-First Division. -William Frederick Richardson Burgess, Guy's; Alfred Thoms Gibbings, King's College. Second Division.-Fletcher Beach, King's College; John Thomas Darby, University College; Arthur William Smith, Guy's; John Taylor, (B.), Guy's.

EXAMINATION FOR HONOURS.-ANATOMY.--First Class.-John Curnow, (Exhibition and Gold Medal), King's College; John Mitchell Bruce, (Gold Medal, worthy of Exhibition). Aberdeen. Second Class.- Alfred Cotterill, King's College; Rushton Parker, University College. Third Class.-Herbert Alder Smith, St. Bartholomew's; Frederic Durham, Guy's; Hugh Eccles Walker, Guy's. ORGANIC CHEMISTRY, AND MATERIA MEDICA AND PHARMACEUTICAL CHEMISTRY.-First Class.-John Curnow (Exhibition and Gold Medal), King's College; Herbert Alder Smith (Gold Medal), St. Bartholomew's; Richard Thomas Smith, University College; Alfrel Shewen, University College: John Mitchell Bruce, Aberdeen; Henry Newell Martin, University College.

ABORTION AS A CAUSE OF INSANITY.-The Superintendent of the Michigan Insane Asylum, in his report just published, says :-" Mental derangement has generally oc curred as a result of local injury, and the serious impairment of general health, directly traceable to the criminal act. In a few cases it has operated as a moral cause; as, for instance, when the unfortunate sufferer has borne a child which has been permitted to remain with her only long enough to show the unhappy mother the priceless value of the gift she had previously refused to accept. In these cases the immediate cause of the insanity is remorse. Unless this most disastrous practice be speedily arrested by the efforts now being used to suppress it, and by more stringent laws, severely punishing all parties implicated, it will materially increase the number of female patients annually presented for treatment."-N. Y. Medical Journal.

PROLAPSUS ANI.-Dr. Schartz, in "Hufeland's Journal," recommends for this affliction a solution of the ext. of nux vomica of the strength of one or two grains to the ounce of distilled water. Of this solution he gives six to ten drops every four hours. This is the dose for very small children; to larger children fifteen drops at the same intervals. Children at the breast two or three drops.-Nashville Journal of Medicine and Surgery.

AN AGED PRIMIPARA.-With respect to childbearing in advanced life, Dr. Cachot, of St. Mary's Hospital, informs us that he delivered in that institution a female of months. The labour in both confinements was tedious, from her first child, at the age of 53 years, and again in sixteen inertia of the uterus, and required the forceps. The mammary glands enlarged, but produced no milk. The children lived in both cases.-Pacific Med. and Surg. Journal.

MINUTE INVESTIGATION OF THE KIDNEY -M. Rendonsky (Virchow's Archiv, bd. 41, 1867) gives the following results of his investigations of the minute structure of the kidney:-1st. The uriniferous tubules are continued into the capsules of the malpighian bodies, or terminate in blind extremities. 2nd. The malpighian capsules are placed on convoluted tubules, lined by nucleated epithelium; other and smaller canals, supplied with transparent epithelium, communicate finally with these tubuli. 3rd. Straight tubuli are connected with some capsules, which, at a short distance from these capsules, show the characters of the convoluted tubuli. 4th. The convoluted and the straight tubes are connected by tubuli, which are lined by transparent (non-nucleated) epithelium; the convoluted tubes are in communication with the capsules, and the straight tubes open into the pelvis of the kidney. 5th. Henle has described canals with transparent epithelium, as continuations of the tubuli uriniferi, which are really blood-vessels,

Lecture.

LECTURES ON STRICTURE.

WITH SPECIAL REFERENCE TO ITS TREATMENT.

BY RAWDON Macnamara,

Vice-President and Professor of Materia Medica in the Royal College of Surgeons of Ireland, and Surgeon to the Meath Hospital.

GENTLEMEN,-In the fulfilment of a promise, now of some months standing, I am here to-day to commence a few observations on the difficulties that you will experience in the treatment of stricture, and of some of the diseases allied thereto, and in limine, I may be permitted to observe that, I by no means pretend these observations to be by any means exhaustive of the subject. They are simply intended to be clinical records of what I myself have observed, and are offered to your consideration as the result of some years observation and experience in the treatment of a class of affections, admittedly amongst the most difficult which surgeons are called upon to treat; in a word, as the exposition of the surgical faith which is within me upon these topics; a faith which is based upon numerous cases of many of which you yourselves have been the intelligent observers. Now, I may divide the difficulties to which I alllude into two distinct classes,-first, difficulties which are totally unconnected with the patient, and secondly, those which are connected with the patient. The difficulties which are totally unconnected with the patient are on your side. They belong to the operator, and it is your duty to educate yourselves in such a manner as to overcome these difficulties. Let us consider what these difficulties are. They are, first, difficulties connected with your knowledge of the natural anatomical arrangement of the parts. It is perfectly evident that you must be acquainted with the anatomical relations of the part which you are going to treat; and premising that you have made yourself master of all these details, you have next to educate your hand in every way possible to make yourself familiar with the use of the instruments which you are to employ in the treatment of disease. Now, as to the study of the anatomy of the part, my advice to you is to make yourself familiar with good plates. I dont't want to inculcate the idea that anatomy is to be learned from plates, but in this case you will facilitate your practical anatomical studies if you examine good plates and good drawings of anatomical preparations. Having done this you are prepared to study the anatomical

relations of the parts on the dead subject. I would advise you to lose no opportunity of studying these parts. Then, having learned the whole of the anatomical relations, and having fixed the leading landmarks in your own minds, you should proceed to the further action of passing the instruments on the dead subject. When you go into the dissecting rooms you should always have a catheter, which you should endeavour to pass on the dead subject. You can do him no hurt, and you will thereby educate yourselves to recognise the difficulties that you will have in passing the instrument through the living one. And I say here, seize every opportunity of passing the catheter through the living subject, as by so doing you will educate yourselves for the treatment of disease. Of course you may think that it is because I have devoted so much of my time and study to this subject that I will say it is one of the most important duties that will be required of you hereafter. I can assure you that in the writings of every surgeon of any experience, if you open his works, you will see how thoroughly is recognised the difficulties which attend a bad case of stricture. Every surgeon, whose name is a household word, will tell you that the difficulties which attend the treatment of strictures, are amongst the most embarrassing that attend the every-day duties of a surgeon. You will not be long in practice until you will be called upon to treat some such case as you have witnessed here. But it is not then that you should have educated yourselves. You should have done so long before you were called upon to take charge of the case. It is a remarkable fact that any gentleman who commences practice in town will meet more cases of this sort than those who go to the country. I believe also, that strictures are far more difficult to deal with in town than in the country. But it is possible that even should your lot be cast in the country, you will meet with such cases, and then you will have to act upon your own resources, for possibly you will not be able to call in other surgical assistance. Therefore, I impress upon you the necessity of studying these cases. I have been told by gentlemen in the country that they rarely have cases of stricture, and that they rarely have to pass an instrument; but in the city we know how repeatedly we meet with bad cases of stricture. The only way we can account for this is, by taking into account the healthy life a man leads in the country, contrasted with that which he leads in town. Men are not so likely to contract disease in the country as persons are who live a city life. In towns, unfortunately, and but too frequently, they may lead a dissipated kind of life, but the

peasant leads a far more rational life than the inhabitant of the city. He goes to bed early, and rises early. He lives in country air, and he is employed in toil of a healthy description; whereas, in a town, a person lives a life the very reverse of all this. The townspeople, too, are exposed to temptations to which the country people are not, and they are, therefore, more liable to disease. This is the principal reason why it is that strictures are so rarely met with in country, and so frequently in city practice. But then you may meet a case even in country practice. Although it may be your lot to go to the country, men may go down to your district suffering under bad stricture, and you may be called upon to treat the case. Don't hug yourself with the idea that because you live in the country you won't meet with such cases. Cases also may present themselves to your notice in the country, in which it may be that you will be called upon to relieve a patient of what I I shall presently refer to retention of urine unconnected with stricture. In the town districts we always have numbers of persons to assist us, if we think it necessary; a number of adjuvants also in the treatment of such diseases, such as warm baths, drugs, &c., are at our command in towns. These we may not have in the country. The responsibility there will be all your own, and, therefore, will it be all the more necessary for you to know how to manage these cases.

So far, as to what is connected with yourself, now we shall proceed to consider the difficulties that are connected with the patient. I think the first of these are the difficulties which are connected with the healthiest state of the human constitution. I have here before me a work which is very valuable. I don't know whether it is as great a favourite now as it was in my student days; but it is very valuable and I should recommend it to your notice. It is entitled 'Morton on the Perinæum.' It contains much important matter on this most important anatomical region. The plates here are exceedingly accurate, and they give you a very good idea of the parts you have to treat. You have here also on this black board, diagrams giving you some idea of the anatomy of the region of these parts. Now, first as to the urethra. I don't pretend to go into a minute anatomical description of the urethra. I shall only endeavour to give you a few observations on it, such as will enable you to follow me in my remarks. The urethra is generally described as being nine inches long-be that more or less; we will admit this measurement as being correct in the description we are about to give. This urethra is divided into three principal regions; beginning from the bladder, you have the first inch of it which is called the prostatic portion of the urethra, which terminates an inch from the opening into the bladder. The next is called the membraneous portion of the urethra also about an inch in length, and the remaining seven inches are called the spongy portion of the urethra. You see here the three portions:-the prostatic, the membraneous, and the spongy portions. Where the spongy portion of the urethra is about to terminate, there is a large development of the spongy tissue on the inferior surface, and this is called the bulbous portion of the urethra. This has been occasionally described as a region, so that then it would be divided, commencing from before backwards into the spongy, bulbous, membraneous, and prostatic portions. But the bulbous is nothing more than a portion of the spongy; so that if you divide it into three regions it will do you very well. Here you have the anterior termination, which is called the meatus urinarius. This is always the narrowest portion of the urethra, and of this you may be sure that any instrument which will pass the meatus urinarius, ought to traverse the entire of a healthy urethra into the bladder. You will have to take that as a guage of the size of the instrument that you employ. This is the narrowest portion of the healthy urethra, and in many instances is the chief difficulty you have to encounter in passing a large sized instrument. On the mucous surface of the urethra you have several openings of mucous glands and follicles which are called

lacunæ. These little black spots which you see on these diagrams are what are the so-called lacunæ of the urethra. There is one larger than the rest situated about an inch and a half from the external orifice upon the upper surface of the urethra which is called the lacuna magna. It is evident that the mouths of these lacunæ are presenting towards the orifice of the urethra and may possibly entangle our instruments. This is the second difficulty. In passing a small instrument into the urethra you may entangle the end of it in the mouths of one of these lacunæ and especially in that of the lacuna magna and so have its course retarded, After a little practical education you will be able to recognise that you are going into one of these. If you forcibly push through them you may lacerate the walls of the urethra, and so make a false passage. If, in passing a small sized instrument, you experience any resistance about this point, your duty is to withdraw it a little, vary its direction, and then possibly you may override this difficulty. This lacuna magna is mentioned in every work on anatomy; but there is another lacuna which is not mentioned in any work on anatomy that I know of, but which I have very frequently met with myself. I think it necessary to draw your attention to it. It is a lacuna which is on the lower surface of the urethra, and about half an inch further back than the lacuna magna, I have got into it very frequently in passing an instrument so as to avoid going into the lacuna magna. You may ask me how did I do so, and I don't know how to explain it to you except that in trying to avoid the lacuna magna, I have dropped from Scylla into Charybdis; but I have frequently got into it, and I now warn you of its existence. The majority of these lacunæ are on the under surface of the urethra, hence you are properly advised to keep the instrument rather towards the upper wall of the urethra in passing it in, for there are fewer of these lacunæ, once the lacuna magna is passed, on the upper surface. The majority of them are all on the under surface, and to avoid them you are to keep close to the upper surface. Avoiding thus these lacure we may go down from six to seven inches fully through the healthy urethra without experiencing much difficulty, and then we come to the sinus of the bulb. When you come to that point, you will experience another difficulty, and that is situated in the triangular ligament. In this diagram you see the triangular ligament and an opening in it; this opening is about an inch below the symphisis pubis, and is for the purpose of allowing the urethra to pass through. On arriving at this point, you can readily perceive how by either unduly elevating or depressing the beak of your instrument you may hitch it against the fold of ligament and so impede its further progress. If at this point you find any difficulty, withdraw the instrument a little, change its direction, and its onward progress into the bladder in a healthy urethra will no longer be impeded. That difficulty having been got over, the next thing you come against is the prostate gland, which, in an aged person especially, is a difficulty to the passing of the instrument, and, finally, at the entrance into the bladder, we meet with a ridge or elevation that occasionally impedes the entrance of the instrument, a difficulty, however, which can readily be overcome by depressing to a corresponding degree the handle of the instrument. In addition to these natural impediments to the passage of an instrument through the urethra, may also be mentioned the openings of the ducts of the prostate gland, which, in rare instances, are found so preternaturally dilated as to admit the entrance of a small sized catheter; and also the Sims' pocularis, a slight depression upon the surface of the verumontarium, within the margins of which may be observed the openings of the common ejaculatory ducts. In this latter position, however, the difficulty which we shall experience is not so much of a mechanical character, as due to the severe pain which the passage of the instrument as it traverses this region, even in the hands of the gentlest manipulator, occasionally gives rise; this pain occurs most frequently in patients who have been in the habit of inordinately in

all.

dulging in sexual excesses, or in the pernicious habit of masturbation. So far for the natural anatomical complications of the parts; it is absolutely impossible, if you are not acquainted with these, that you can with safety to your patient introduce any instrument. Presuming that a case has arisen for passing the catheter, how are you to do it. Here one simple rule above all others is to be observed. The patient comes to you to have an instrument passed. Take a large sized instrument, and if he says, "Oh, Sir, that instrument is too large," never mind him. Take a large sized instrument, No. 9 or 10 of Weiss' guage, and even if he has stricture you will be able to take soundings. Some people will come to you to be operated upon, fancying that they have stricture, who really have no such disease, and presuming them to have a normally healthy urethra, by using a large sized instrument you escape all these dangers; and in fact almost all those difficulties are avoided by using a large sized instrument. Having consulted with your patient, the next step to be considered is, as to the position in which you will place him while passing the instrument. Some people invariably place the patient in a standing position, others lying down. My advice to you is not to adopt any invariable rule at If any person weds himself to any particular line of conduct he will get into a habit, outside of which he will experience some difficulty. Put the patient into the recumbent, or erect position as it suits his case. You cannot get a patient in fever to stand up, you must operate upon him lying down. A great deal depends upon the position in which you have your patient. You should never dream of passing the instrument in the erect position unless he is propped up in some way. You can put your patient against the wall if he is to be standing up, so that he may have a point d'appui. You will let him lean up against the wall with his feet about a foot asunder, and about eight inches from the wall, so that you place him in a kind of slanting position, the buttocks leaning against the wall, and in that way you get him at nearly as possible in the best and most favourable position for the passing of the instrument. If it be the first time that the patient is having the instru ment passed, I am supposing even that there is no disease at all, be sure to have a chair convenient, for over and over again, at the sight of the instrument in the surgeon's hands, the very idea of having an instrument passed has produced such an impression as to make him faint; you will know that he is going to faint by the tottering of his knees, and you must then put him seated on a chair, or better still, lying on a sofa. You must remember the danger of his fainting, and see that no harm happens him. Your own observation will justify this statement, that the mental impression in anticipation of the operation has been sufficient to produce this effect. Some practitioners have rests fixed in the walls of their studies for the purpose of facilitating the introduction of the instrument into the urethra. They have padded pieces of wood coming out from the wall, in order that they may be placed under the armpits of the patients; some of them have others lower down, also to be grasped by the patient's hands, but these are refinements we are scarcely called upon to have. So much for the erect posture, now for your own position. Sit down before the patient; avoid also that stage trick, the trying to introduce the instrument with one hand; use both hands, and remember it is a nice trick to pass the instrument, and you have a right to give every fair play to your patient. I think it is taking a great liberty with a man not to do otherwise; to take the catheter, pass it under the penis, toss it up, and try to catch it in the meatus, is a juggler's trick unworthy of a surgeon seriously intent upon discharging his duty by his patient. What you are to do is this: take the penis in your left hand, hold it gently and put the instrument in, having first seen that the instrument is of the same temperature as that portion of the body, and properly oiled. If it be below the right temperature, you can bring the instrument up to the required temperature by rubbing it in some wollen cloth, or dipping it in hot water. You are next to see that it is

properly oiled. You cannot oil it too much. Have it thoroughly lubricated, and of the same temperature as the part, and you have done a great deal towards effecting an entrance for the instrument. You should always pass it in most gently-upon this point I shall have occasion in a future lecture to speak more forcibly. You introduce it into the meatus urinarius, and in passing it will place your hand below, in this way. You have remarked that I introduce it by placing the handle towards the left groin, inasmuch as you get more room in this way. According as you slip it in, you bring the handle round towards the mesial line, keeping it still close to the abdominal wall, until the beak approaches the opening in the triangular ligament, and then depress gently, and so continuing, at last the instrument will gently glide into the bladder. You are not to imagine that this procedure is intended for the tour de maitre. This consisted in keeping the hand down at the commencement of the operation between the patient's legs. Then you introduce the catheter so, until you get to the triangular ligament, when you give it a sweep around to the mesial line, and the idea was that in the turn round you slipped it into the bladder. This was nothing but a stage trick, and I think that in trying to effect the tour de maitre many a false passage has been made. Well, I will presume that you have gotten the instrument down towards the opening in the triangular ligament, and the handle goes down between the patient's thighs, and as you depress it, the instrument does not go in. We are here now at the triangular ligament, and this diagram represents the opening in it. It is evident that the beak of the instrument may be hitched against its lower margin, the most frequent source of the impediment to its ingress, or against its upper margin; in either case withdraw the instrument slightly and alternately depress, or elevate the handle, and its passage through this portion of the urethra will be secured. It is evident that if you bring the handle of the catheter down in this way, you turn up its beak, and so change its axis, that you bring the beak of the instrument up by the very act of depressing its handle, and vice versa, and so it slips on into the bladder. You thus avoid all that natural difficulty of the triangular ligament; and the prostatic difficulty, which you will subsequently meet with, will also be overcome by depressing the handle of the instrument; this, however, is a subject to which I shall yet have more particularly to allude. As a general rule, it is always better at this point to depress the handle of the instrument, and so avoid the inferior margin of the triangular ligament, and by the same manoeuvre you avoid the prostate gland. So much now for passing the instrument in the erect position, remembering always, on the first occasion of passing the instrument, the danger of the patient's fainting. The next position is in the recumbent posture. Here you take great care to have the patient lying evenly on his back. It is evident that if you have him placed more on one side than another you endanger the chance of passing the instrument. You put him lying evenly on his back. These trifling details may appear to you to be unimportant. An old writer has said, "these things may be trifles, but trifles make perfection, and that is no trifle." Put the patient lying evenly on his back; then, with the left hand, lay hold of the penis and introduce the catheter in the way I have described to you in the last posture. There is one great advantage in the recumbent posture-that even if he faint you can take advantage of his faint; you can introduce the instrument, and leave it in until he recovers. Another advantage accrues from the habit of practising catheterization upon the patient in the recumbent posture, and it is this: that it is the posture in which, in many cases of diseasefever, for instance the instrument perforce must be passed, and so you become familiar with that which you hereafter must practise. So that it becomes all-important for you to familiarize yourselves with it, before being called upon to discharge this duty. In either of these ways, all cases where the urethra is healthy may be easily treated.

There is a third way, which is a mixture of the recum