of occasional introduction, cure may be considered complete. He thus concludes his narrative:-"The patient feels satisfied that No. 12 would never have passed without the operation, and that the effect of the latter has been to render the urethra less sensative than formerly, and hence has enabled a cure to be perfected, which otherwise had been impracticable. At the same time, it remains to be seen whether periodical recurrence to mechanical treatment may not be necessary; and it may be doubted whether, at the risk evidently incurred, the operation should be hazarded, except in cases incapable of being otherwise treated." I cannot conclude even this hurried communication, without expressing my deep regret that the discussion of this question of practical surgery has been embittered and deformed by acrimonious and personal attack.—I am, my dear Sir, very truly yours, Dr Wm. Robertson. JAS. MILLER. The Editor of the "Monthly Journal" begs to assure Mr Miller, that the article by Mr Syme, which appears in this Number of the Journal, is substantially identical with that which was read at the March meeting of the Medico-Chirurgical Society; a short foot-note only being interpolated by the author at page 335; and at page 333, line 9 from foot, the words "not having given" being substituted for "having declined to give." There is nothing unusual in printing communications which have been made to medical societies, apart from the discussions to which they lead, or before these have been made public. Of this practice, even had it not been frequently followed in this Journal, Mr Miller's own contribution to the "Lancet" of the 22d March, would be a sufficient illustration. Further, as Mr Miller's own paper was not sent to Mr Syme-whom it greatly concerned, and who had not the advantage of hearing it read-before its publication in a journal in which, for good reasons, Mr Syme cannot reply, it seems unreasonable that Mr Miller should now complain that Mr Syme's case (which Mr Miller had heard read), was not sent to Mr M. till on the eve of publication. It is not surprising that some difference of opinion should exist among the Conductors of this Journal, as to the justice of inserting Mr M.'s reclamation in our present Number. Mr Syme, to whom the Editor has thought it right to show Mr Miller's letter of the 24th, thinks it unnecessary to make any rejoinder at present. He holds himself responsible for the accuracy of the statements which he has already put forth, and which it is his intention still further to substantiate in our May Ňum ber. March 26, 1851,-11 P.M. Part First. ORIGINAL COMMUNICATIONS. ARTICLE I. On the Treatment of Stricture by External Incision. By JAMES SYME, Esq., Professor of Clinical Surgery in the University of Edinburgh. HAVING SO recently had occasion to express my sentiments in regard to the treatment of strictures by external incision, I did not expect that it would soon be necessary for me to write again upon the subject, but now feel that this operation requires to be defended from the representations respecting it, which have been published in the "Lancet" by Mr Miller. Before proceeding to do this, however, I may shortly remind the reader of what has already passed between that gentleman and myself, relative to the matter in question. The billet of business for the meeting of the Medico-Chirurgical Society on the 19th of February last, announced a "Case of Perineal Section" by Mr Miller. Now, whether rightly or wrongly, this title has certainly, in all the late discussions, been understood to denote the operation which I proposed. It is also certain that, although there may have been allusion to other cases, the one by far most fully then detailed to the Society was one in which this operation had been performed; also, that the operation, in this case, was performed, not by Mr Miller, but by myself; and also, that the account of it-read without my sanction or knowledge-was written neither by him nor me, but by the patient, who did not belong to the medical profession. Having reason to believe, from what was told me by various members of the Society, that a very erroneous impression had been made by the reading of this communication, at which circumstances prevented me from being present, I applied to Mr Miller for access to the paper, and by him was referred to the patient, who allowed me to see it on condition that I understood it was committed to me "confidentially, and neither for publication nor public critique." Being thus precluded from noticing the statement which had been made to the Society, I saw no way of counteracting it, except by giving one that might convey my own knowledge and belief, for which I should be held responsible, and did so in the paper which was published last month through the medium of this journal. Mr Miller says it con NEW SERIES.-NO. XVII. MAY 1851. 3 F tains "groundless personal charges" against him, and expresses his regret, that the discussion of this question of practical surgery has "been embittered and deformed by acrimonious and personal attack." The reader may, and I trust will, judge for himself how far Mr Miller has been warranted in making such an accusation. He says, indeed, that my charges "are modified" from the original form in which they were produced at the Society, but with what truth will appear from the fact, that my paper, after being read, was put directly into the hands of the secretary, and by him committed to the printer without any alteration. The proof then came to the proprietors of the journal, and they can testify that no change took place, except in the addition of a foot-note, with the substitution of "not having given," instead of "having declined to give." To this extent, and no farther, was the statement modified. In the "Lancet" of 23d March, Mr Miller contends-first, that a large proportion of strictures admit of remedy by simple dilatation; secondly, that all strictures are not permeable; and, thirdly, that the operation which I have proposed, though warranted under circumstances of extreme urgency, is not free from the risk of producing the most dangerous effects. The unavoidable inference from the first of these positions, maintained not by any ill-informed writer at a distance, but by a surgeon of the same hospital in which I practise, and a colleague of the same school in which I teach, must be, that I undervalue the process of dilatation, and resort to the operation in cases that would yield to the bougie. Now, every member of the profession in Edinburgh must know, that I have always been a strenuous and consistent advocate of simple dilatation, and that from first to last up to the present time, I have constantly employed this as the proper means of relief, unless it appeared from experience that some special peculiarity of the case rendered division of the stricture necessary. In originally bringing the operation before the notice of the profession (1844), I thus expressed myself "In conclusion, I beg it may be understood, that nothing can be further from my intention than to propose division of strictures by a cutting instrument as in general preferable to the treatment by bougies. It is strictly to those cases which are found to resist a careful trial of the latter method, that the operation should be limited." It thus appears, that in so far as the principles taught by me are concerned, there was no occasion for Mr Miller's vindication of the bougie. But it may be supposed that there was, perhaps, some laxity in my practice which required restraint; and I will, therefore, afford the reader grounds to form a judgment as to this, by placing before him all the cases which I have subjected to operation in the Royal Infirmary during the present session. They amount to seven in number, and may be thus shortly sketched : 1 1 Edinburgh Monthly Journal, 1844. P. 823. 1. George Thom, æt. 45, from Upper Canada, came home on purpose to obtain relief from a stricture deemed impermeable, with great thickening and induration of perineum. Stricture dilated by bougies, but speedily contracted-with aggravation of all the symptoms. 2. James M Millan, æt. 27, farmer, from Ireland, sent by one of the surgeons of the Belfast Hospital, as labouring under stricture irremediable under the ordinary means of treatment, all of which, and especially dilatation in every form, had been carefully tried. 3. Thomas Stevenson, æt. 46, mason from Thornhill, extremely tight stricture. Bougies of very small size tried in vain for two months. 4. John Dixon, æt. 35, labourer, from Lincoln. Sent as suffering from stricture incurable under the ordinary means of treatment, which had been assiduously employed in the county hospital at Lincoln. 5. Robert Lyell, æt. 45, railway porter, from Berwick-on-Tweed, sent as labouring under impermeable stricture,-phymosis,-fistula in perineo, and scrotal tumour. 6. Daniel Macdonald, æt. 55, bootmaker, from Glasgow. Stricture repeatedly dilated by bougies, at different times, without relief. Division performed at his own desire, from the good effects witnessed by him in the hospital. Sent as 7. Stewart Niven, æt. 47, seaman, from Campbelton. labouring under incurable stricture-for which he had been under a great variety of treatment, and six times in the Glasgow Infirmary. In my private practice, the cases subjected to operation have been, if possible, still more hopeless under any other sort of treatment, and on the whole, therefore, I feel entitled to say, that if Mr Miller's statements have led any one to suppose that I do not employ dilatation by bougies as the ordinary rule of practice in treating strictures, they have conveyed an impression equally groundless and unjustifiable. The second position which Mr Miller has endeavoured to establish, is, that all strictures are not permeable, and here he has resorted to an argument which I approach with feelings of no very pleasant kind. He says (the italics are Mr Miller's) :-"But, without seeking for distant authorities and manifold examples, I would content myself with the following, derived from a source which, under the circumstances, must be held as quite unexceptionable-namely, from a paper on the Treatment of Stricture, communicated by Mr Syme to the Monthly Journal of Medical Science, in 1844. In Case 3 (p. 822), a tight stricture followed the kick of a horse on the perineum; and it is stated, 'I found a stricture of the urethra opposite the scrotum, so tight that it would not admit the smallest probe, and surrounded by a mass of thickening and indurated texture, &c. After trying various instruments, without success, I passed an exceedingly slender catgut bougie,' &c. This is almost an impermeable stricture; the next is completely so. In Case 2, stricture fol |