vain; and, as early relief was necessary, an operation was advised, but refused. On examination, it was found to have a hard, firm and painful structure about three inches from the orifice, for which I proceeded to use a catheter on the following principles:

1. As it is, the urethra is absolutely impervious to the passage of the catheter from a combination of causes, viz., the stricture growth engorged with mucus and blood, and rendered painful by futile catheterism; and certainly spasm. It.is not, however, absolutely impassable.

2. The tightest part of the stricture is that in front.

3. The unconditional use of a catheter would, in such a state of the parts, certainly intensify the difficulty by calling into play a new source of resistance, in the form of normal muscular antagonism, to its passage-a force that is ever on the alert to oppose the enforced passage of a foreign body through the urethra into the bladder.

4. The automatic force can be brought under complete control by an act of volition, and not only so, but be made to impart to the strictured canal the greatest amount of potency and passivity of which it is capable.

5. The means to this end consist in making the patient bring the sphincters or detrusors of the bladder and urethra. into a state of absolute rest by voluntarily, but gradually, calling into powerful action their antagonists, the expulsors or accelerators, and using the catheter whilst the force thus elicited is kept in a state of strain.

6. This mode of palsying the detrusors has another advantage which anesthesia does not possess, since it assists the surgeon by employing the urine as a dilator, and thus reduces the resistance of the stricture slit.

In the case before us, the method thus indicated was carried out as follows. The patient was made to stand, supported by assistants, upright against a firm support, with outstretched legs

-a position I always insist upon in catheterisation, if feasible -and being prepared with a well-warmed and oiled silver catheter (No. 4, at a venture, in this case), he was called upon to make an effort to pass his water and to gradually increase

it to the extent of his power, always under the impressed conviction that he will succeed. After straining thus for a few seconds, and being required to keep up the act until he had permission to relax it, the point of the instrument was gently insinuated into the urethra, and carried on to the stricture. By careful exploration, I was soon satisfied that its point and the slight force I was using were in a line with the axis of the canal, and that the entrance of the stricture had been reached. This I felt, for I had contrived to slide the instrument along the floor of the passage to the furthest point I could reach in any part of the canal, and by the sense of a slight grip of its point which was given me on making a simple move of the instrument onward, I was sure the passage had been gained. The patient still keeping up the strain, with a very little more force the catheter passed through with the usual, not always assuring, jerk. It could not, however, be made to enter the bladder, for its course was interrupted by another stricture at the membranous part of the urethra. This I did not attempt. to pass, being satisfied that if the instrument could be retained during the night, the remainder of the passage would be easily passed in the course of the morrow, for the catheter would now indirectly act as an expulsor, and therefore keep in check any renewal of action on the part of any counteracting power. The urine passed abundantly during the succeeding night, not through the catheter-for it contained some clotted blood, and, if it had not, I should have prevented it by the use of a closefitting stiletto-but around it; and on my visi. the next day, the instrument was passed through with the help of the tip of my forefinger. A severe rigor followed the first effort, which was subdued by a glass of hot brandy-and-water and one scruple of quinine in the course of the next twenty-four hours.

The subsequent treatment has been daily catheterisation, using a larger catheter each day, and allowing it to remain a few hours on each occasion. On the seventh day a No. 8 was easily passed. I need not refer to the watchful care which is always needed in the after-management of such cases.

I have ventured to ask permission to publish this case, trusting that the principle advocated, viz., that of falling back

upon physiological resources as a help in the treatment of severe cases of stricture-might meet with whatever attention it may be thought to deserve.

I may state that I insisted on this method of treating stricture in a paper published in June, 1861; and that, although it called forth but little attention at the time, and I believe less since, I have not failed to employ it in every case requiring it, with invariably the like results. I have also demonstrated it in the course of hospital and private practice, so that it is not entirely without its witnesses.-The Lancet.

Treatment of Colic.

Phares' method consists in inversion-that is, simply in turning the patient upside-down. Colic of several days duration has thus been relieved in a few minutes. The patient

may take the elbow-knee position, or may lie (face down) on the edge of the bed, with his head and shoulders hanging down. Complete inversion, however, is best. The mechanical aid, in giving vent to gases, is, perhaps, the most efficient element in the cure.―Jour. des Sci. Med.

A Button-hook in the Bladder and its Spontaneous

tion.

Emission.

BY H. M. WHEELER, M. D.

and of German extracTen days previously, calibre of his urethra,

On the 21st of April, I was called in consultation to see Mr. B., a young man 21 years of age, He told the following story: while at stool, he thought to try the and with this object in view, passed into the meatus a patent button-hook, with an oval handle; the hook, as shown by subsequent measurements, was two and one-half inches in length and seven-sixteenths of an inch in its largest diameter. in the meatus the hook slipped from his grasp, and passed into the bladder. With the exception of a desire for frequent micturition, the patient had suffered no physical inconvenience until the day on which I saw him. On this day, however,

While

he was unable to pass his water, and the bladder had been emptied with a catheter by the attending physician.

I passed a number twelve sound into the bladder and readily encountered the foreign body. The case was explained to the father of the patient, and the operation of lithotomy was decided upon, and the day for the performance of the operation was appointed. However, on the day before (that appointed for the operation) the patient in attempting to micturate, very inconsiderately passed the hook.

I find a case reported in the London Lancet of August 11, 1877, which may be interesting in this connection. This patient was admitted to the Liverpool Royal Infirmary, and was under the care of Reginald Harrison. The report is as follows: "W. B., aged 38, a militiaman, was admitted on May 22, 1877. His statement was to the effect that on the previous night, when under the influence of liquor, a pencil case had been introduced up the urethra by a prostitute in whose company, together with others, he had been. He did not, however, appear to have discovered anything amiss till the following morning, when certain uncomfortable sensations. in the region of the bladder made him come to the conclusion that his pencil must be in his bladder. The surgeon of the regiment confirmed his idea by discovering a foreign body about the neck of the bladder, and sent him to the infirmary for treatment. On examination by Mr. Harrison, the foreign body appeared to be lying obliquely in the bladder, and partly within the prostatic portion of the urethra. An attempt was made to remove it by means of Civiale's extractor, but this failing, a lithotrite was passed. The pencil was thus carried on completely within the bladder, where it was first seized transversely by the lithotrite. In this position it was impossible to extract it; however, by gradually turning the lithotrite toward one side, whilst at the same time the pencil was within the blades of the instrument, an end was reached, when the pencil was removed, point foremost, without any further difficulty or damage to the urethra. The patient was placed in bed, and a linseed poultice applied over the bladder. During the afternoon and night he passed urine quite naturally,

slightly tinged with blood, but on the following day he appeared in no respect the worse for what had been done. He was, however, kept in the infirmary until the 24th inst., when he went out on leave, but did not return."

A full-size cut of the pencil-case accompanies the above description, and by measurement I find that the case was three and one-half inches long, and one-fourth of an inch in diameter; thus it was longer than, but not of so great thickness as the button-hook. I know of no other case where so large a body was spontaneously ejected from the male bladder. -Physician and Surgeon.

POISONING. In one dozen cases of poisoning from the bite of the rattlesnake, Iodine proved curative, given in one or two drop doses of the tincture every hour, according to the severity of the case. In one instance, where the patient was "swollen terribly, mottled spots appearing over the entire body, breathing with great difficulty, and apparently near death," four drops of Iodine were given every hour with entire recovery. -Dr. E. F. Brown, in Cincinnati Medical Advance.

EDITORIALS.

MEDICAL SOCIETIES.

THEIR OBJECT AND A PLEA FOR THEIR MORE THOROUGH ORGANIZATION, AS VIEWED FROM THE STANDPOINT OF ECLEC

TICISM.

We have received a copy of an address upon the above subject, delivered before the Central Medical Association of Pennsylvania by L. T. Beam, M. D., President. It is a stirring appeal in behalf of organized effort on the part of physicians for the twofold purpose of individual improvement, and to prevent or lessen social suffering. We should like to present the address in full to the readers of THE TIMES, but we have only room for a few extracts:

"What is wanting to effect a more thorough organization of the medical forces in this district? Of course a goodly number