admits urine, more or less in quantity, to pass through it, and whenever urine passes outwards through a stricture, an instrument ought with care and perseverance to be got in.

Flexible versus Solid Instruments for Dilatation of Stricture.--Flexible instruments are very much preferable to solid ones for dilating a stricture. They pass more easily, and consequently with less pain, and will insinuate themselves where a solid instrument would fail. The latter property is especially seen in the French instruments, which are so flexible that you can wind them round the finger, and possess a tapering point slightly bulbed at the end. This instrument passes very readily, almost without your knowing it, and it requires no knowledge of anatomy to use it.

To pass a Bougie through a Narrow and Tortuous Stricture. Do not rely upon mere groping to find the orifice. You should always adopt some method-any method you please, provided that it shall seem to you exhaustive of the different modes of exploring the urethra. Take a small instrument and slide it down first the roof of the canal, because that is the firmest part, and by following it you are most likely to carry the point in. The floor, on the contrary, is the softest, loosest, and most spongy part, and will be most likely to yield to the instrument and give way. If your first effort does not succeed, take the right side; if that does not do, take the left; if that does not do, take the floor. There is no other method so calculated to help through a difficult stricture. If you are very careful, you may make the attempt in this way for twenty or thirty minutes without doing any damage.

Injection of Oil in Stricture.-When you have a very narrow stricture to deal with, it is sometimes of use to throw half an ounce or an ounce of olive oil into the urethra, holding the meatus well round the syringe. By this plan the passage is distended, and you may sometimes succeed in passing an instrument when you have been unable in any other way. The oil must be allowed to escape during the introduction of the catheter, and the plan must not be tried at all if there is a false passage.

Stricture of the Urethra with False Passage.-When you have a case of stricture with false passage to treat, remember that the false passage commences usually on the floor, and generally at the bulbous portion of the urethra. When the instrument is in the false passage you can tell at once that it is so by introducing the finger into the rectum when only the thin coats of the bowel will be felt between the finger and

the instrument. If the instrument is in the right passage you feel the whole thickness of the prostate, not always very considerable, between it and your finger, still quite enough to show that you are in the right path. If you find the catheter goes into a false passage withdraw it an inch or two, and in passing it again keep as close along the upper part of the urethra as you can, ascertaining by means of the finger that the instrument is not passing into the old route.

Contractile Stricture.-How are we to treat a stricture which after dilatation recontracts to its original size? In one of three ways. We may rupture, over-distend, or cut the unyielding and contractile fibres which constitute the stricture. Urethrotomy is perhaps the most generally employed, and internal oftener than external urethrotomy. But the rule is generally this, that the nearer the stricture to the cathe safer and more useful is it to cut; the deeper almost alwa ture the more desirable is it to over-distend. reatmevorming internal urethrotomy the bistourie-caché must be passed half an inch beyond the stricture, and, the knife being unsheathed to the desired extent, the stricture is divided by drawing the instrument forwards. After this a catheter must be tied in for forty-eight hours, and after that an instrument passed every third day, then every week, and so on. The plan of over-distension is to be preferred to that of rupture in those cases in which it is not thought advisable to divide the stricture, and for this purpose the instrument devised by the writer answers every end. It consists of two blades separable to any extent at one part by means of a screw in the handle. This part of the instrument is placed in the stricture. Strictures situated in the bulbous part of the urethra are more suitably treated by over-distension than by cutting.

Use of Caustics in Contractile Stricture.-Sir Henry Thompson, than whom there is no greater authority on subjects of this nature, condemns entirely the use of potash and other caustics in cases of contractile stricture. He believes them to be unnecessary, undesirable, and dangerous.

Mr. Le Gros Clark states that for many years he has been in the habit of employing potassa fusa in the treatment of old and impenetrable strictures, with the greatest advantage, and without in a single instance causing dangerous consequences. A suitable instrument, with care in using it, together with a little patience, are requisite; but these are elements of success in every operation.

Retention of Urine from Organic Stricture.--First try to pass the finest gum-elastic catheter, and if successful tie it in ;

if it cannot be passed try a No. 1 silver catheter. Efforts to pass instruments should not be persevered in too long, and great care must be exercised that no injury is done to the urethra. If unsuccessful, put the patient into a warm bed, apply hot fomentations to the parts, and give opium very freely so as to relieve the involuntary straining efforts which make the case worse, and afford no relief. By this means the dribbling of urine will probably become more free, and in two or three days it will be found that a catheter can be passed. If, however, these means fail, and a greatly distended bladder be felt above the pubes, we are necessitated to puncture the bladder. The plan of opening the urethra behind the stricture has been now nearly abandoned, as it is extremely difficult to hit that passage, and a cutting operaenerally becomes unnecessary if the urethra can M Delahaye, fallow for a few days. Mr. Cock, of Guy's Hospitendidad more experience than any one else in puncturing the bladder from the rectum. The finger of the left hand must be passed beyond the prostate until it reaches the bladder behind it, and the trochar glided along the finger to the point determined to puncture. This point is ascertained best by fluctuation being very distinct when transmitted from above the pubes by the other hand placed on the abdomen. A catheter can generally be passed a few days afterwards, and the stricture permanently cured.

Retention of Urine in a young and healthy man without Stricture.-The history of such cases generally is that the retention came on in consequence of the patient sitting on a cold stone or damp grass when overheated by exertion, or of his indulging in some emotional excitement. He will also tell you that he has had gonorrhoea at some recent period. The cause is inflammatory swelling of the prostate; its condition resembling that of the tonsils in inflammatory sore throat. The old treatment was bleeding and the warm bath; this however is bad, and must not be relied on to procure relief. The best plan is to take a moderate sized gum catheter (one not larger than a No. 6, as a large one gives in these circumstances unnecessary pain) which has been kept for some time on a stylet which has been overbent. In this manner there is generally no difficulty in relieving the patient.

Extravasation of Urine.-What happens when extravasation of urine occurs from rupture of the urethra behind a stricture? From the anatomical disposition of the fascia, the urine passes into the scrotum, up into the groin above Pou

part's ligament, and towards the belly. The urine cannot pass backwards behind the scrotum neither can it get into the thighs. It does occasionally get as high as the chest. In such cases do not be afraid of the knife. On each side of the perineum make a good deep incision, which need not be limited to two or even three inches, because you are cutting into urine and not flesh. The incisions generally bleed rather freely. An incision should be made on each side of the penis, because if it is made in the middle line there is not sufficient communication for the incision on one side to relieve the other. When the bladder has been relieved in this way the urine continues to drain off by the incisions, and the stricture begins to improve so that in three or four days a catheter can be passed.

Simple Urinary Fistula.-Whatever part of the canal a simple urinary fistula is connected with it almost always heals if the stricture is dilated, and no other treatment is required. Sometimes the external openings are numerous and the intervening tissues much indurated. These cases generally improve a good deal by dilating the stricture well, but sometimes they are not cured by that. The external openings of the fistula should then be well enlarged so that the urine may not be detained in the parts any longer than necessary. It may be necessary to excite inflammation in the track of the fistula by a hot wire, or by touching it with nitrate of silver. If the case is not cured by these means the patient must be taught to pass a catheter for himself, and told to use it every time he makes water. The catheter must not be tied in, for the urine by capillary attraction always passes between the outside of the instrument and the wall of the urethra, and so reaches the fistulous opening.

Ozone.

THIS remarkable substance, discovered by Schoenbein in 1840, has lately been the subject of numerous researches. Galignani says: "Our readers know that when air or oxygen is traversed by frequent electric sparks, it acquires a certain smell similar to that which is sometimes observed after a storm, or even a strong flash of lightning. It exercises a powerful action upon organic substances, and it is this which has recently called it into notice again. It has been shown by Dr. Scharr, of Berne, that ozone, as well as substances impregnated with it, will kill animaculæ with certainty and rapidity; and, as recent researches seem to place it beyond a

doubt that most epidemics, and cholera among the number, are owing to microzoaria, great hopes are entertained of it being possible to use ozone in hospitals as a disinfectant; and, perhaps, to extend its use still further. As might have been foreseen, however, from its being a modification of oxygen, it exercises an irritating action on the respiratory organs -a drawback which must necessarily reduce its application to sanitary purposes within narrow limits."-Exchange.

Poison from a Stuffed Serpent.

A MOST extraordinary incident occurred not long since in the drawing-gallery of the Jardin des Plantes, by which death was well-nigh caused by the bite of a stuffed serpent. M. Delahaye, the gifted artist to whose genius France owes the splendid drawings lithographed in the scientific works published by the Sorbonne and the College de France, had completed the drawing of a crotalum, one of the most dangerous of the rattlesnake tribe, and was replacing the stuffed reptile in its glass case, when the jaws, kept open by means of a spring, suddenly snapped on the artist's fingers, which bled profusely. M. Delahaye instantly sucked the wound and rushed to the laboratory for aid. Two doctors, hastily summoned, pronounced the danger imminent. They steeped the finger in a solution of alkali, and then introduced the platina needle into the wound, previously made red hot by the application of electric piles. The patient was next dosed with the usual antidotes for poison. After an hour of this treatment he was sent home. The excitement over, the savans inquired among themselves whether M. Delahaye's wound could have proved mortal. To ascertain the fact they sent for a rabbit, and, closing the jaws of the stuffed crotalum on the wretched animal's thigh, inflicted precisely the same wound as M. Delahaye had received. In half an hour the savans had the satisfaction of seeing the rabbit die in all the tortures of tetanus.

A Genuine Hermaphrodite.

DR. AVERY gives, in the Med. & Surg. Reporter, the details of a case which he declares to be a genuine hermaphrodite. The subject was a native of Nova Scotia, unmarried, twentyfour years of age; five feet ten inches high. She possessed