seemed cheerful and lively, and desirous of conversing, but forgot so many words that it was impossible, frequently, to understand him. He would smile at his inability to call words, and seemed much perplexed. Pointing to Dr. Kerr, I asked him if he knew him. He replied yes. What is his name? He smiled confusedly, and said, "It's -oh-it's-oh—.” I named over several fictitious names, but he would reply no. I then said Kerr. He replied, "That is right." I was shown some of his writing, in which he attempted his own name as follows: "Thos. Thom. Stans." He remained in about the same condition until January 4th, at ten A. M., when he was seized with a convulsive fit, lasting about a minute and a half, and immediately expired. No post-mortem was made.

"PRIORITY IN THE USE OF WEIGHT EXTENSION."

BY GEO. C. BLACKMAN, M. D.,

Professor of Surgery in the Medical College of Ohio; Surgeon to the Samaritan Hospital; etc.

In the April number of the American Journal of the Medical Sciences, Dr. Edward Hartshorne, of Philadelphia, has published an elaborate and interesting paper under the above title, from which we extract the following:

"Some extended researches, in which I have been recently engaged for another purpose, have brought to my notice an interesting effect of second-hand quotation, and of erroneous compilation, in the European history of weight extension, which does not appear to have been noticed either in Edinburgh or London. The fact is, that the first European writer, out of the Continent at least, (italics ours) who definitely speaks of this mode of treating fractured thigh, and gives an unmistakable picture of the weight and its accessories, is John Bell, (Principles of Surgery, 4th edition, Edinburgh, 1801;) and he evidently does so without the slightest idea of suggesting anything new, although what he did present was, so far as the weight is concerned, the product of his own active and brilliant imagination."

Now, the Chirurgical Observations and Cases of William Bromfield, of St. George's Hospital, London, appeared in 1773. In the second volume of this valuable work, at page 111, we find the author extolling the advantages to be derived from the relaxation of the muscles in the reduction of fractures and their treatment. He then proceeds:

“Lately, indeed, I have heard that the practice is adopted by some surgeons of other hospitals in London; nevertheless, this is of as little weight almost as my

instructions were so long since, for even at this time, the advantages of this way are not sufficiently clear to some of the professors of surgery, as short splints and • stretched out limbs are, by them, thought the best method of practice; and even a large weight hung from the ankle joint, to keep the muscles of the thigh extended, when the femur is fractured, is not every where exploded."

We have placed in italics, sufficient, we think, to prove that Dr Hartshorne is himself in error in his comments on "the interesting effect of second-hand quotation, and of erroneous compilation, in the European history of weight extension," and it is evident that for many years' prior to the publication of Mr. Bromfield's work, the practice which this surgeon condemns, of hanging large weights from the ankle joint in the treatment of fractures of the thigh, had been adopted by the British surgeons.

OPERATION FOR IMPERMEABLE STRICTURE OF THE URETHRA.

BY G. M. BURKE, M. D., SULPHUR SPRINGS, IND.

(Communicated by Prof. Blackman, Cincinnati.)

MR. EDITOR: The operation performed by Dr. Burke is worthy of record, not only on account of its success, but for its variety. The patient was under my care for a few weeks, at the Samaritan Hospital, and I was unable to pass the smallest sized instrument to the bladder. In one instance, the patient being fully under the influence of chloroform, administered by my friend, Dr. Schenck, of Reading, I tried with bougies aud lancetted stilette, for more than an hour, but without success. I then proposed an operation by external incision, but the patient left for home on a temporary visit, and there became so much worse that he availed himself of the services of Dr. Burke, and with what success the report will show.

The only cases in which so extensive an operation has been performed, so far as we have been able to discover, are those in which it was done by Edward Molins in 1652, and by Solingen, also, in the latter part of the seventeenth century. Wiseman assisted in the first operation, and has given the details in the second volume of his Chirurgical Treatises, under the head of "The Ill Consequences of Gonorrhoea." At first, an incision was made in the perineum, but as with "probes and candles," the urethral passage could not be found, at the request of the patient, a few days afterwards, Molin "slit it the

whole length to the incision in perineo." The patient recovered, but a urinary fistula remained in the perineum.

For the notice of Solingen's case, we are indebted to Dr. Aristide Verneuil, who published in the Arch. Gen. de Med., Paris, September, 1857, an interesting paper entitled Note Historique et Critique Sur Urethrotomie Externe ou Section des Retrecissements de dehors en dedans, avant CXVIII Siecle. We translate his remarks on the case of Solingen: "Planque, in the article Carnosité, having quoted a successful case of cauterization, adds: 'Van der Wiel approves this method in preference to that adopted by Solingins (Solingen) in the case of a soldier. As the Urethra, according to his report, was full of carnosities, a sonde crénelée, which allowed the urine to pass was used; but all his medications were of no avail. For this reason, he introduced a grooved staff into the bladder, on which he incised the whole canal, even to the glans, and then destroyed with caustic all of the callosities. The lips of the extensive wound were then brought together and retained by means of the hare-lip suture. The operation succeeded so well, that the patient was able to pass his urine, at first through a small flexible catheter, but afterwards a plein canal." It is stated that Solingen had performed a similar operation with success, at the Livourne.

The above extract is quoted by Planque from the Biblioth. de Med., tom viii, page 61, ed. in 8, and he remarks that it is evident that external urethrobomy was performed during the latter part of the seventeenth century in several countries of Europe.

Dr. Verneuil refers to an operation reported by Van Hoorne, and which was performed to relieve a patient affected with hypospadias, the abnormal orifice of the urethra being just in front of the scrotum. The penis was laid open from this point to the end of the glans, a leaden canula introduced, and the whole wound closed with suture. The operation was successful.

One word in conclusion. Although the operation just quoted, like that reported by Dr. Burke, terminated so fortunately, it is probable that the majority of practitioners would, in similar cases of stricture, feel disposed to try, first, the effect of opening the membranous portion of the urethra, relieving the retention of urine, and diverting the channel for a time, in order to give the indurated portion of the urethra an opportunity of becoming softened and more dilatable. Mr. Cock, of Guy's Hospital, Mr. Simon, of St. Thomas', and Mr. Wormald, of St. Bartholomew's, London, and others, have furnished us with much evi

dence of the softening influence thus produced over strictures, when once relieved of the irritation passing over them, or to use the language of Mr. Wormald, by giving "the diseased urethra a holiday," (Medical Times and Gazette, December, 1856.) We confess, that had Dr. Burke's patient returned to the city, as contemplated, that was the course we intended to pursue, and failing in this, quoting from Wiseman, "to slit it the whole length to the incision in perineo." Certain, it is, however, that in the hands of no surgeon could a more brilliant result have been obtained than has been achieved by Dr. Burke.

CINCINNATI, APRIL 14, 1869.

Youre truly,

GEO. C. BLACKMAN.

"Wm. S. Mc, age thirty-six, traveling agent for wholesale boot and shoe house, Toledo, Ohio, was thrown from a wild horse, at age of nineteen years, falling on his back; horse striking him on the privates; he was carried home in a fainting condition; parts swelled enormously, and were very painful; was confined to house for five weeks; during the time suffered severe pain in urinating; two years after was riding a colt, and was thrown on to the horn of the saddle, causing a severe and sickening pain; parts swelled up again and it was difficult and painful to pass his urine; was confined to the house for three weeks, under treatment; size of stream passing from penis was diminished greatly; it became smaller after first accident than it was in good health before the accident; shortly after my recovery from second accident, was compelled to use a bougie to keep urethra dilated, and have continued to make use of an instrument of that kind for fifteen years, up to present time, and lately have suffered severe pain in introducing one into urethra; on December 16th, 1868, I rode horse-back twenty-nine miles; suffered an unusual amount of pain during the trip, and continued suffering pain in urethra and parts adjoining, until December 22d, 1858; tried ten times to dilate the urethra as usual, but failed in every attempt; being fourteen hours without passing my urine, bladder was distended and very painful, and in that condition called on a surgeon in Anderson, Indiana; he called in two other doctors to assist him; I was then put under the influence of chloroform three times, and they as often failed in introducing the smallest instrument into the bladder; but in their efforts, they did not fail in making a passage from urethra into the scrotum, to which place my urine escaped, causing me to suffer

extreme pain; it became enlarged by the urine, and was then punctured, and urine escaped with considerable blood; on morning of 23d December, was sent to Cincinnati, requiring twelve hours to make the trip by railroad; urine escaping by scrotum, by being squeezed out by my hands."

I was called to the case, January 11th, 1869, half-past eleven, P. M., two days after his return from Cincinnati; I found him suffering extreme pain from retention of urine, caused by stricture of urethra; he was, in fact, mad with pain; bladder enormously distended; tongue coated; bowels constipated; fever; unimpaired appetite; I was informed that chloroform had no effect upon the parts to facilitate the introduction of a catheter into the bladder; I applied extract belladona to penis and perineum, and placed him in tub of hot water, patient and all covered by a quilt, excepting his head; kept him in that condition until profuse perspiration ensued; patient suffering extreme pain all the while; administered four grains of powdered opium; before taking him from the bath, I introduced a small catheter down. to stricture, and made gentle pressure upon it for about five minutes, and had him taken from bath; and on withdrawing the catheter, it was followed by urine in a small stream about the size of a small knitting needle; with great straining by the patient, his bladder was partly emptied. He offered up a fervent prayer for his safe delivery from death, got into bed and went to sleep from effect of anodynes.

January 12th, 8 A. M.-Resting easy; ordered extract belladonna to parts; saline cathartic and opium to quiet him; stated his condition; the only manner of relief; the danger attending the operation and the result, and to consult his friends concerning it and his condition.

January 13th, 8 P. M.-Called and found him in same condition as before; same means resorted to for his relief as on former occasion. January 14th, 9 P. M.-Called again, and found him in same condion as on two previous occasions; same means were instituted for his relief; he made up his mind to be operated on, and consent of his relatives and friends.

January 16th, 9 A. M.-patient very restless during the night, and awoke unrefreshed; he was in any condition but favorable for the smallest operation in surgery on him; pulse weak and frequent; tongue heavily coated and inclined to dryness; great thirst; no appetite; nervous system very much impaired; scrotum enormously swollen, indu