Mode of using the Instrument. Suppose we wish to measure the long axis of an object, such as M N in Fig. III., we so arrange it on the stage that the cross in the field will, when the eyepiece is rotated, touch first the extremity M, and then the other extremity N. The arc A a, traversed by the pointer, is read off from Fig. III. D d B the brass scale. The chord of the corresponding arc of the imaginary dotted circle is the measure of M N. Its length may be calculated with the greatest ease by the help of the ordinary logarithmic tables of sines. In comparing chords, we use the sines of half their including arcs, as in the example which is appended :— EXAMPLE.-See Fig. III. M N. Num. 0467861 Millim. 2.6701166 In like manner the length of any other chords of the dotted circle may be easily determined;1 and a table-if required-drawn up, 1 It is, however, unnecessary to carry these calculations beyond the fourth or fifth decimal place; for the unavoidable errors of observation render the apparent accuracy of the sixth and seventh places quite illusory. 1 from which the measure corresponding to each degree of the scale can, by mere inspection, be at once ascertained. When the eyepiece rotates smoothly in the tube of the microscope, and a magnifying power of 500 or 600 diameters is used, measurements may be made with such an instrument with the utmost nicety. Welcker recommends that the top of the tube of the microscope should terminate in a hollow cone, into which is received a conical collar, supporting the pointer, and slipt on immediately beneath the milled rim of the eyepiece. The errors of manipulation should hardly exceed 40,000th of an inch,—a degree of exactitude scarcely attainable by the cobweb screw-micrometer. An instrument constructed for me, by Mr James Bryson of Edinburgh, on the plan above described, has been tried against a finelyfinished screw-micrometer, and found to perform with very great accuracy. ARTICLE V.-Case of Stricture of the Urethra treated by External Incision. By JAMES SYME, Esq., Professor of Clinical Surgery in the University of Edinburgh. (Read before the Medico-Chirurgical Society of Edinburgh, 19th March 1851.) In the billet of business for our last meeting, there was announced a case of "Perineal Section," by Mr Miller. Not being aware that he had ever performed the operation to which this foolish title has been applied, and naturally feeling desirous to know what part in the question at issue in regard to the treatment of stricture was to be taken by the Professor of Surgery, I regretted that circumstances prevented me from being present, especially when I afterwards learned that the case read was not Mr Miller's, but one of my own,-the whole responsibility of which rested upon myself. It appeared that the patient had written out a statement of his case, which was read to the Society without my sanction or knowledge; and having reason to believe, from what different members told me, that a very erroneous impression has thus been made, I applied to the secretary, who is usually supplied with the papers produced at meetings, for making out his abstract, which is recorded in the "minutes." Mr Miller not having given the case for this purpose, and being applied to on my own account, referred me to the patient, who, in reply to the request which I then transmitted, sent me the following letter: "March 10, 1851. "DEAR SIR,-In compliance with your request, I readily transmit for your perusal the statement which I drew up of the circumstances attendant upon the operation which I underwent last year. Mr Miller could not, except with my sanction, have parted with the paper, it being a privileged communication; and being drawn up by an unprofessional person, and in untechnical language, prob ably might not bear strict criticism, although it faithfully represents my own ideas upon the subject. "I beg you will understand that it is committed to you confidentially, and neither for publication nor public critique.—I am, &c. "Professor Syme." Considering the constitution and objects of the Medico-Chirurgical Society, I regard the precedent which would be established by allowing this procedure on the part of Mr Miller to pass unnoticed, as of the most dangerous character. Any man, not belonging to the medical profession, and not even acquainted with its language, might thus, without subjecting himself to criticism or censure, communicate to a body of practitioners, associated for their mutual improvement, his own fancies,-no matter how absurd, and calculated to produce the most erroneous impression in regard to modes of treatment, however beneficial they may have been to himself, or valuable for the relief of others. Nothing, in my opinion, could tend more to destroy the confidence existing between medical men and their patients, or impede the establishment of sound principles of practice, than the toleration of such a system. I, therefore, consider it right to express my entire disapprobation of this novelty in professional conduct, and will now read to the Society a statement of the case, for which they may hold me responsible. In the end of January 1850, Mr Miller asked me to operate upon a gentleman, who had long suffered from stricture of the urethra, and seemed likely to perish from it, unless relieved. He was somewhat under forty years of age, during nearly twenty of which the disease had existed,-being at first attended with slight inconvenience, and having gradually become more troublesome, until at length it had affected his health and comfort in the most serious degree. In the first instance, he had been treated for several years by a surgeon in London, who employed wax bougies. He then came under the care of Mr Liston, who, during four years, vainly tried to dilate the contraction, which lay at the fore part of the bulb, by means of metallic instruments, never being able to get beyond No. 7, and instead of affording relief by their use, generally inducing an increase of irritation, with, on one occasion, a serious threatening of complete obstruction. After this, Mr Miller had tried to afford relief in the same way; but with no better success, and hence had been led to advise the operation I have recommended for such obstinate cases. On the 31st of January, at four o'clock in the afternoon of a winter day, I first saw the patient, having been asked to examine him then under the influence of chloroform, and, if I deemed it expedient, thereafter to proceed with the operation. Having passed a small grooved director through the stricture, I divided it by external incision, and placed a catheter in the bladder. Everything went on most favourably for the next two days, and I then removed the catheter. On the following day, I was called to see a case in Northumberland, and consequently did not revisit the patient until the fourth day after the operation, when I found him with a smiling countenance, clean tongue, soft quiet pulse, moist skin, and plentiful discharge of urine; but was entertained with a woful account of the terrible things that had happened since my last visit, the second day before. Suppression of urine, rigors, delirium, and collapse, were all most graphically described; but, when taken in connection with the patient's satisfactory aspect, so soon after their alleged occurrence, suggested to me no idea of danger either in prospect or retrospect. On the contrary, I concluded that everything was going on favourably, and that the patient, being an irritable, exacting, self-indulgent sort of person, had merely suffered rather more than usual from the nervous disturbance which is apt to attend the flow of urine, after the catheter has been removed, in such cases. Accordingly all went on well, and, so far as is consistent with my own personal knowledge,1 the only obstacle that intervened in the way of his recovery was a small abscess, which formed in the lower part of the scrotum, and was evacuated by incision eight days after the operation. I wished to pass a bougie occasionally; but was allowed to do so only once, when an instrument larger than the catheter employed was introduced without the slightest difficulty. The urine resumed its natural course almost entirely in the course of a month, and by the end of the following month the patient was dismissed from medical restraint. In July he afforded me an opportunity of passing Nos. 8 and 9, which were introduced with the utmost ease, and without any subsequent rigor. He was then, and still appears to be, in perfect health; and, I believe, considers himself completely relieved from a complaint which, but for the operation I performed, would have proved incurable. No. 12, I understand, can now be introduced without any difficulty; and, if the patient is not deeply grateful for the benefit he has received, he certainly ought to be so. The points of this case which seem most deserving of attention are, in the first place, that a stricture of twenty years' duration, which had resisted prolonged treatment by different practitioners, and progressively increased in severity, with serious derangement of the general health, was completely remedied by external incision; and secondly, that twelve months having passed without any re-appearance of the peculiar characters denoting the irritable or contractile stricture, the relief thus obtained may be reasonably deemed perma 1 I have purposely abstained from taking any notice of an abscess, which was stated to have been discharged from the rectum, six weeks after the operation, since, whether "lumbar," according to one statement, or "intra-pelvien multilocular," according to another, it is in my opinion, when coupled with the patient's satisfactory recovery, no less inexplicable than another circumstance communicated to the Society,-viz., that the patient did not enjoy a wink of sleep for six weeks. nent. The feelings and fancies of the patient during the period of recovery may have been intensely interesting to himself, and may have drawn largely on the kind nursing of his ordinary medical attendant, but are of no consequence whatever in regard to the general question, when compared with the effects usually experienced from the operation, now that the field of observation has become so extensive. In conclusion, I beg to remark that the mode of treatment which I have proposed is intended for the relief, not of stricture in its ordinary form, which readily yields to dilatation, but of that which resists this and all other known means of remedy. In cases of this kind-than which there are few presented in the practice of surgery more distressing-any proposal for the means of escape, even though attended with some risk and uncertainty, might have been expected to meet with a favourable reception, credit being given for the good accomplished, and time afforded for the improvement of details requisite to promote its efficiency. The future history of the profession will determine how far the opposition to my proposal has been reasonable, honourable, or successful. Unless a stricture resists dilatation, or speedily contracts after being dilated, I do not resort to division. Thus a few days ago I dismissed, with complete relief, through the use of bougies, a retired officer of the H.E.I.C.'s service, who came to Edinburgh, expecting that I would perform the operation. He had suffered severely for many years, and been under the care of different surgeons, one of whom, the late Mr Callaway of London, after inducing violent irritation and constitutional disturbance by ineffectual attempts to dilate the stricture, advised him never to allow an instrument to be introduced into his urethra, which, he said, was no less resisting than a "deal board." Yet, in this case, aggravated by duration and derangement of the health, from frequent attacks of ague, I met with no interruption in dilating the canal, and relieving the patient from every uncomfortable feeling. In circumstances requiring the operation, I have maintained that it is always practicable, perfectly safe, and adequate to afford relief, not only complete, but permanent. As these positions have all been denied, I may say a few words in regard to each of them ;-and first as to the permeability of strictures. The opponents of my proposal say that strictures are not unfrequently impermeable, so as to resist the entrance of a director for the knife. To this I reply, that there is no such difficulty that may not be overcome; and when told that this term implies arrogant over-confidence on my part, I ask to be shown an impermeable stricture. Mr Miller, while acting as a surgeon of the Royal Infirmary, I believe met with some such cases, and if, instead of resorting to extreme measures, he had tested my power to deal with them as permeable, and found the issue unsuccessful, he might then indeed have come to the Society with some show of evidence, against my fundamental principle. But as it is, |