៩ ted wi man ana French medical literature, could not satisfactorily familiarize himself with the advances in Ophthalmology, made during the past fifteen or twenty years, was well-founded, so long as we had only such. works as Lawrence, Mackenzie, Dixon, Jones, &c. The Hackley-Roosa translation of Stellwag has recently made us familiar with the doctrines and practice of the eminent oculist of Vienna; and now Wells gives us the result of his training and service in the specialty. Familiar, of course, with the literature of his subject, and having an extensive hospital and private practice, his connection with King's College and the Royal London Ophthalmic Hospital, adds to the weight of his opinions upon questions of pathology and treatment. The "Treatise" is clearly and concisely written, and deserves the careful consideration of students and general practitioners. In one respect at least, it is preferable to "Stellwag"-its type is uniform, and there are not to be found in it those many pages of fine print that in "Stellwag" make us wish the translators had either given us three volumes, or judiciously edited and condensed. MEMORANDA OF UNIVERSITY CLINIC AT CHARITY HOS- We are indebted to Professor Joseph Jones, M. D., for “Memoranda of University Clinic at Charity Hospital, New Orleans, Session 1868-9, by Professors Joseph Jones, Frank Hawthorn, T. G. Richardson, S. M. Bemiss, and Warren Stone; reprinted from the New Orleans Medical Journal, October, 1869." In a future No., we hope to have a review of this exceedingly interesting collection-at present, we will give two extracts from Dr. Richardson's contribution to it. The remarks on Spermatorrhea are worth more than half the volumes that have been written on the subject: "SPERMATORRHEA.-As usual, quite a large number of cases of this miserymaking complaint have applied for relief, but not one in the presence of the class. The shame which such patients almost universally exhibit is of no little value in a pathognomonic point of view. "There is scarcely a doubt-in my own mind at least-that the complaint has its seat in the moral nature, and is seldom productive of local organic changes, except these which arise from excessive secretion, such as atrophy of the testicle. The treatment should therefore be directed not to a fancied irritation in the pro static urethra, but to the correction of the morbid sentiments and imagination of the individual. "An occasional emission occurring in an otherwise healthy individual under the influence of a lacivious dream-to which even the most virtuous are more or less liable is strictly physiological, and any attempt to prevent it is as unwise as to endeavor to prevent the return of menstruation in females. Marriage is the only legitimate treatment, and is usually effective in both instances. "So also the emission produced by the filthy vice of masturbation, is in itself physiological-that is to say, it is the natural response to the genital excitement, although the latter has been produced in an unnatural way. But a secretion, which is purely physiological, may become morbidly abundant by frequent repitition of the exciting cause, and the over-taxed organs by which it is furnished may fall into a state of atrophy, which may be considered pathological. "But the precise line between what is physiological and what is pathological, is here, as in many other instances, difficult to define. An involuntary emission occurring once in ten days or two weeks might be strictly physiological in a strong, vigorous, highly animalized individual, but in one of an opposite temperament it would deserve to be considered as the result of a morbid state of the nervous sys tem. "Extreme cases, in which the seminal fluid escapes without any erection of the penis, whenever the patient goes to stool, and without any special sensation, pleasurable or otherwise, are frequently described in books, but seldom occur in practice. It is true that patients often make such statements themselves, and honestly believe them, but upon a strict surveillance, such as requiring the patient to go to stool in an adjacent room, and providing him with a suitable vessel to catch the seminal discharge, it will be found that such instances are rare. "Treatment—The seat of the difficulty in so-called spermatorrhoea being the brain, efforts at amelioration must be directed to the latter organ. One of the first things to be done is to persuade or assure the patient that his case is entirely curable; that he is not impotent as he imagines; and that involuntary emissions are not evidence of a loss of vitality, but, in many instances, result from a superabundance of animal life. "2d. The next, and a very long step towards relief, is a strict watch and control over the "thoughts and imaginations of the heart." This is not to be gained at once, but only after persistent efforts, and may be much aided by suitable mental occupation, avoidance of stimulants and other means of dissipation, regular habits, the society of ladies, etc., etc. "3d. The administration of such remedies as are known to exert a calmative influence upon the venereal desires. Of these only two have proved of any avail in my hands, namely the bromide of ammonium and the bromide of potassium. Either of these may be employed in doses of a drachm, dissolved in half an ounce of camphor water, on going to bed. "4th. Applications to the prostatic portion of the urethra are sometimes of very great service, but I am almost quite convinced that their effect is wholly moral. The simple introduction of a large sized bougie or catheter, a No. ten or twelve, will be often followed by marked improvement, especially if the surgeon is successful in impressing its great remedial value upon the mind of the patient. If this operation has been already performed without any good effect, the porte caustique or, what is still better, the catheter syringe, containing a weak solution of nitrate of silver, may be resorted to, the precaution being taken to obtain the confidence of the patient in the result. Either of these means may be repeated in course of a few days if the patient's faith has not been too much shaken. "5th. But after all, the grand remedy for this distressing complaint is matrimony; and in an experience of more than twenty years, I have yet to see a case that has not been entirely cured when the remedy was applied. The great diffi culty is to persuade the unfortunate sufferer of his ability to perform marital duties. He is like a youth upon a brink of a stream in which his fellows are swimming and disporting themselves, and calling to him to leap in and show himself a man. He hears the challege, he feels the reproach, and he sees the ease with which the necessary movements are performed; but, distrustful of himself, he shrinks back and hesitates to make the venture. As in this case, so in the other, has it often seemed to me that if some one could but come unawares behind the trembling doubter and push him in, he might flounder for awhile and make many ineffectual attempts, but with proper encouragement he would ere long, and suddenly as though by magic, obtain the requisite self-control, and all difficulty at once disappear." VESICAL OR URINARY STAMMERING IN A FEMALE, WITH RETENTION OF URINE; CURED BY OPERATION.-In an article entitled "Stammering in other Organs besides the Tongue," Mr. Paget, in a recent number of the British Medical Journal,* calls attention to a not unfrequent difficulty, whose essential nature consists in a want of harmony between the ejaculatory or extrusor muscle of the bladder and the sphincter muscle of the same. He describes it as occurring only in the male, and as manifesting itself ordinarily in an inability to empty the bladder, except under very peculiar circumstances, often of a moral character, in which alone the patient has found by experience that the sphincter of the organ will yield to the contraction of the muscular coat. This condition has been long familiar to surgeons, but no one has heretofore conferred upon it a definite name, hence its non-appearance in systematic treatises. But now that it is publicly and satisfactorily christened, it will doubtless attract more attention. Indeed, I have been only awaiting such an introduction to present the following account of a case, which it will be seen, does not belong to the Clinical Memoranda of the past season, and has been heretofore kept out of print simply for want of a name. "At one time I called the affection Urethrismus, in consequence of some points of likeness which it presented to that condition of the vagina denominated by Dr. Marion Sims, Vaginismus, but this did not satisfy me wholly. Again, I called it paresis of the bladder, but as the defective power in the muscular coat was not positive but only relative, this name was rejected. I submitted the question once to my distinguished friend and former preceptor, Prof. S. D. Gross, M, D., but he denied the individuality of the affection, and expressed the opinion that the case was one of hysterical retention. I also submitted it to the New Orleans Medical Association, but did not obtain the assistance that I required. Whether I have The article referred to is copied into the New Orleans Medical Journal for January, 1869. done right in claiming for it a place under Mr. Paget's denomination, I must leave others to judge. The principai object I have in view in bringing it forward is to illustrate the difficulties which are not unfrequently encountered in making a correct diagnosis. "History-The patient was an unmarried lady, aged eighteen, sent to me from an adjoining State by her family physician, with the following history: "I saw Miss G. for the first time in October, 1861. She was then laboring under fever, pain in the region of the left kidney extending down the corresponding thigh, great irritability of the bladder, and sympathetic disturbance of the digestive organs. I was told that two months previously she had received an injury of the back by the upsetting of a carriage, and had the symptoms just enumerated, but was soon relieved of all except the vesical irritability. The case was regarded as one of inflammation of the left kidney, with sympathetic disturbance of the bladder. The urine was very variable as to quantity and quality, but was generally loaded with mucus, very offensive and acid. With the decline of the fever there was no improvement in the condition of the bladder, which continued iritable without the power of emptying itself, the constant use of the catheter being required. This state of things continued until the following April, about five months, when, under the use of tonics, antispasmodics, cold bath, etc., her general health improved, and she was able to urinate without the use of the catheter. "From this time until November, 1865, a period of more than three years, she enjoyed tolerable good health, complaining, however, more or less, at different times, of pain in the left side and thigh, and uneasiness in the region of the bladder, and difficulty in urinating. About the time last mentioned she again lost the power to micturate, and as I failed to afford her any relief after a few weeks trial, I sent her to New Orleans. "During all my acquaintance with the patient, her menstruation has been regular and healthy. She has frequently suffered from intermittent fever, rheumatic pains, and croupy colds; and in view of her strong family tendency to rhenmatism, I have been inclined to believe that her urinary troubles arose from this The urethra has all along been tender, and the introduction of the catheter was frequently attended with great suffering.' source. "Miss G. came under my care in December, 1865. Her general health was much impaired by protracted suffering and frequent attacks of intermittent fever; and in consequence of weakness and pain in her left hip and thigh, she was unable to walk. She was of a sanguineo-nervous temperament, but had become accustomed to confinement, and manifested no great desire to leave her couch. The urethra was sensitive, and the introduction of the catheter attended with considerable pain. The urine generally presented a healthy appearance, but was sometimes mixed with mucus, and when allowed to accumulate in the bladder to the amount of more than eight or ten ounces, produced great distress. Judging from the stream of water as it flowed from the catheter, the expulsive power of the bladder seemed to be somewhat diminished, but, as may be well understood, this was a very difficult point to determine. As the secretion of urine was not very abundant, the use of the catheter three times a day sufficed to keep her comfortable; and it may be well to mention that she had never employed the instrument herself and persistently refused to learn how to introduce it. "The determining cause of the retention not being apparent, but suspecting it to be hysterical, I directed my efforts immediately to the improvement of her general condition, and by means of tonics and generous diet soon succeeded in building up her strength. In the meantime, I gently cauterized the urethra from time to time, and applied extract of belladonna to the vaginal surface of the canal, with the effect of diminishing the sensitiveness of the lining membrane, but without producing any impression upon the real trouble. I now made a thorough exploration of the interior of the bladder, but discovered nothing beyond an unnatural degree of sensitiveness of the anterior wall. Suspecting that there might possibly be a circumscribed chronic inflammation of the organ in this locality, I injected a solution of nitrate of silver, ten and twenty grains to the ounce of water, directing the syringe toward the anterior wall. This was repeated several times, gave rise to no great suffering, but accomplished no appreciable good. "Having now thoroughly satisfied myself that no organic disease existed, I recurred to my original impression, that the case was one of hysteria, and treated it accordingly, but except that now and then during the defecation there would be a sudden flow and an equally sudden stoppage of the urine, no improvement followed. At the end of five weeks she returned home, her general health almost entirely restored, but still obliged to have the catheter introduced three times a day. "After the lapse of three months, say, in April, 1866, she came to me again, her general health broken as before, and the local affection wholly unchanged. I put her upon bark and iron, ordered a liberal diet, and she again rapidly improved. I now watched her more closely than ever, interrogated her in regard to every influence, moral and physical, that could by possibility give rise to the state of things that existed, but utterly failed to obtain the slightest clue. I tried systematically to make a diagnosis by exclusion; summoned the several affections in the long catalogue of known causes of retention and brought them one by one to trial, but with no better success. I called in the aid of my distinguished colleague, Professor Stone, whose skill in diagnosis is not exceeded by that of any one I ever knew, but although he fully appreciated the existing condition, he could not discover any satisfactory cause. "As the case now stood, the whole difficulty seemed to consist in a want of proper balance between the sphincter and the muscular coat of the bladder. Whether there was an excessive development of power in the sphincter, or a diminution in that of the muscular tunic, I could not positively determine, but it was quite evident that the organ could empty itself quite thoroughly if the excessive contraction of the sphincter was overcome. To this end, therefore, I addressed my efforts, and began by dilating the urethra by means of graduated bougies. This was continued only a few days, when, in consequence of the apparent suffering of the patient and the resistance which she made, I was compelled to desist. But one other resource presented itself, which was to incise the urethra including the neck of the bladder. This I resolved upon at once, and the next day, the patient being under the influence of chloroform, I introduced a grooved director, and with a probepointed bistoury divided the whole thickness of the upper or anterior wall of the |