APPLEY, W. L., M.D., of Cochecton, N. J.
ARNOLD, Edmund, M.D., of Yonkers, N. Y.

BARKER, B. Fordyce, M.D., Obstetric Physician to Bellevue Hospital, N. Y.

FETTER, D. F., M.D., of New York.
FINNELL, T. C., M.D., Surgeon to St. Vincent's
Hospital, N. Y.

to Bellevue Hospital, N. Y.

BENNETT, Ezra P., M.D., of Danbury, Conn.
BENNETT, William C., of Danbury, Conn.
BLACKWELL, E., M.D., of New York.
BRADFORD, G. W., of Homer, N. Y.
BROWN, John B., M.D., of Boston, Mass.
BROWNE, Rufus K., M.D., Professor of Physiology
and Microscopic Anatomy in the New York
Medical College, N. Y.

BUMSTEAD, F. J., M.D., Surgeon to St. Luke's
Hospital, N. Y.

BURKE, John, M.D., of New York.

BUTLER, W. H., M.D., of East Saginaw, Mich. CARTWRIGHT, S. S., M.D., of Roxbury, N. Y. CHISHOLM, J. J., M.D., Professor of Surgery in the Medical College of South Carolina, Charleston, S. C.

CHURCH, Wm. Henry, M.D., Surgeon to Bellevue Hospital, N. Y.

CLARK, A., M.D., Professor of Pathology and
Practice of Medicine in the College of Phy-
sicians and Surgeons, N. Y.
CLEVELAND, Wm. K., M.D., of New York.
COOPER, E. S., A.M., M.D., Professor of Anatomy

and Surgery in the Medical Department of the University of the Pacific, San Francisco, Cal. CORSON, William C., M.D., Physician to the New York and Eastern Dispensaries, N. Y. CUSHMAN, A., Pharmaceutist, N. Y. DALTON, John C., M.D., Professor of Physiology and Microscopic Anatomy in the College of Physicians and Surgeons, N. Y. DRAKE, Nelson S., M.D., of Brooklyn, N. Y. ECHEVERRIA, M. Gonzalez, M.D., late Assistant

Physician to the National Hospital for the
Paralysed and Epileptics of London, of New
York.

EDWARDS, F. S., M.D., of New York.
ELLIOT, George T., Jr., M.D., Physician to Belle-

vue Hospital and the Lying-in-Asylum, N. Y.

cine and Medical Pathology in the New
Orleans School of Medicine, New Orleans,
La.

FOUNTAIN, E. J., M.D., of Davenport, Iowa.
FRIEND, A., M.D., Boligee Creek, Ala.

GALT, G. A. D., M.D., of Virginia.
GARDNER, A. K., M.D., Professor of Clinical
Midwifery and Diseases of Females in the
New York Medical College, N. Y.
GREELEY, J. B., M.D., of Nashua, N. H.
HALLET, Alfred, M.D., Physician to the Long

Island College Hospital, Brooklyn, N. Y.
HAMILTON, Frank II., M.D., Professor of Mili-
tary Surgery and the Diseases and Acci-
dents incident to Bones in the Bellevue
Hospital Medical College, N. Y.
HAMMOND, WM. A., M.D., of Baltimore, Md.
HUNT, John W., M.D., late House Surgeon to
Bellevue Hospital, N. Y.

HUNTER, B. P., M.D., of Boligee, Ala. HUTCHISON, J. C., M.D., Professor of Operative

Surgery and Surgical Anatomy in the Long Island College Hospital, Brooklyn, N. Y. ISHAM, Ralph N., M.D., Professor of Surgical Anatomy and Operative Surgery in the Lind University, Chicago, Ill.

JACOBI, A., M.D., Professor of Infantile Patho-
logy and Therapeutics in the New York
Medical College, N. Y.
JONES, H. Webster, M.D., of Chicago, Ill.
KNEELAND, Jonathan, M.D., of South Onondaga,
N. Y.

LALOR, William, Pharmaceutist, N. Y.
LEE, C. A., M.D., Professor of Materia Medica,
N. Y.

LEMMON, R. T., M.D., Castle Craig, Va.
LENTE, Frederic D., M.D., of Cold Spring, N. Y.
LILLY, H. M., M.D., of Fond du Lac, Wisc.
LITTLE, J. L., M.D., House-Surgeon to the N. Y.
Hospital, N. Y.

Ir a case of stricture should present itself, in which, in consequence of the existence of false passages, or temporary aggravation from inflammation, or extreme contraction, induration, or tortuosity, you are unable to introduce an instrument into the bladder, what course is then to be pursued? Is treatment by dilatation to be attempted here ? I would answer, yes; as long as the patient can empty his bladder without assistance it is your duty to attempt dilatation. The case is one of increased difficulty and danger, and success may not ultimately crown your efforts; but by bringing to bear upon it all the resources of your art, and by the employment of the requisite amount of tact, gentleness, and intelligent perseverance, in the great majority of cases you will succeed. Keep in view the idea that where urine can escape, an instrument ought also to pass, and, sooner or later, in all probability, it will. Some years ago I assumed the responsibility of the case of a gentleman, past middle age, who had been under treatment for ten years by various surgeons, with impassable stricture, and liable to frequent attacks of retention of urine, and who had positively refused to submit to an operation. For a period of six months I persevered regularly and steadily before I succeeded in introducing an instrument into his bladder, but in six weeks after attaining this success my patient was able to introduce for himself Nos. 11 and 12 steel sounds with very slight difficulty, and these he subsequently emAM. MED. TIMES, VOL. II., No. 1,

ployed for several years, in the enjoyment of very comfortable health. What are the means to be used in such a case? In the first place you must secure entire control of your patient. Confine him to his room, in warm air, and if necessary, to his bed. Insist upon regular, unirritating diet, and if possible, cut off all alcoholic stimulants. Moderate local inflammation by the application of leeches to the perineum, the use of warm baths, and dilute mustard poultices to the hypogastrium nightly. Give diluents freely in the shape of flaxseed tea, or other mucilaginous drinks, and administer from Dj. to 3 ss. of bi-carbonate of potass three times in twenty-four hours, unless a microscopical

examination of the urine should indicate other and more

appropriate medication. And here let me remark that the use of alkalies is not contra-indicated because the urine, as

is

voided, may be alkaline; it frequently possesses its normal rendered alkaline by altered mucus of an inflamed bladacidity as transmitted from the kidneys to the bladder, but der. So much for medicinal means, and they will facilitate greatly the success of your instrumental manipulations. These should be employed at judiciously selected intervals, every two or three days, or longer, according to the degree of tolerance of the urethra. As the instruments to be selected for the treatment of such a case let me recommend again, the very fine French flexible bougies with a tapering point, from No. 1, of the ordinary scale, downwards. Inject the urethra with warm olive oil before introducing them, and give a spiral twist, as recommended by Leroy d'Etiolles, or an 2-shaped bend, to the extremity of the bougie, so that by rotating it between the fingers as you repeatedly and perseveringly withdraw and re-apply it to the face of the stricture, its point will be more likely to enter the opening through which the urine escapes. Be very careful, especially at first, not to prolong your attempts injudiciously; and if unsuccessful, finish by passing a steel sound of good size down to the stricture, and pressing its point very gently against it for a few seconds. If the tapering point of the bougie should enter the stricture and be grasped by it, leave it there for five minutes, and consider that you have gained enough for one visit; at the next you will probably recognise the advantage thus secured. Should your patient be very irritable it may be advisable to insert an opium suppository into the rectum, and this should consist of from one to three grains of the watery extract, with butter of cacao.

The principal danger to be anticipated, whilst pursuing this plan of treatment, is the liability of bringing on an attack of retention of urine before you have secured the power of introducing an instrument at will; and you cannot be too careful to avoid this by extreme gentleness and circumspection, otherwise the necessity of an immediate resort to operation by cutting instruments may be precipitated. Of the measures to be employed in case of retention, and of some other devices to be brought to bear upon an obstinate stricture, I shall speak hereafter. Meanwhile, let me commend to your considerate judgment the means --both medicinal and surgical-which I have just enumerated; by their deliberate and judicious employment you have it in your power to effect a cure in strictures of the most serious character, and they are applicable to the great majority of cases you will meet in practice. Above all, do not permit your patient to undervalue the gravity of his symptoms, and do not commence systematic treatment without fair control over him, otherwise you place yourself in a false position, and risk disappointment, and loss of reputation.

In cases of stricture in which much difficulty and delay have been experienced in getting an instrument into the bladder, and where there is doubt as to the possibility of its re-introduction without additional delay, it is proper, unless contra-indications exist, to leave the instrument in the bladder, and follow out the plan, as already described, of so-called vital dilatation. In most cases the urine will pass readily beside a fine bougie thus left in the bladder; and probably in a few days a catheter may be substituted