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What is the caliber of a normal urethra? To answer that question categorically is an impossibility. Many have tried to do it and have found themselves disputed. Otis has made, and tried to maintain, a schedule of urethral calibers in exact relationship to the size or circumference of the penis; but his claims have been found to be both inadequate and inaccurate.

The Urethra Has no Certain or Fixed Caliber. The caliber of every urethra varies, not only with different persons, but it varies in each person according to the location of the measurement taken. As well try to answer, in a word, the question: what is the width of the Mississippi River? Its width varies at different parts of its course; so does that of the normal urethra.

Lack of knowledge of this fact often leads a practitioner into the fallacious belief that a patient has stricture when, in reality, he has none. The bulb sound, introduced by the unfamiliar hand, butts up against one of the narrowings of a normal urethra, and forthwith the diagnosis of stricture is made to supply the long-felt want of that patient. He has been seeking confirmation of his suspicion that that was his trouble, and he is very ready to believe it. Nevertheless, he does not get well-either after prolonged soundings, or a cutting operation. He goes to some one versed in the subject, who finds the real source of the difficulty, and cures it; but, incidentally, also learns that the patient never has had stricture, and the original diagnostician's reputation suffers correspondingly.

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Showing variations in the caliber of the urethra.

may be distended to thirty-two; and a half inch deeper than that, it must be contracted to twenty-eight in order to progress backwards. Then, for a distance of two or three inches, through the cavernous portion, the caliber is fairly uniform, at about thirty; but when the bulbous portion is reached it is found to enlarge abruptly, and considerably reaching about thirty-five. This enlargement terminates as abruptly as it began, and the narrowest part of the urethra, excepting the meatus, is reached, i. e., the membranous portion, which is only twentyseven, and maintains that size for threefourths of an inch. From there it merges

into the prostatic portion, which is pyramidal, beginning with about thirty, and enlarging rapidly towards the vesical opening, where it is thirty-five.

The force of the assertion, that the urethra has no stated caliber, is now plain. There are seven variations for it in the above description, and the variations are not inconsiderable: from twenty-four at the meatus to thirty-five at two other sites. Therefore, the likelihood of an unfamiliar hand finding strictures where there are none, is not overdrawn. Any worker in this field sees the evidence of dozens of such mistakes almost every year.

Moral: Remember the physiological narrowings in a urethra, and do not call them strictures in examining this organ.

On the other hand, many a stricture that is present, and doing actual damage to a patient, is overlooked because of the improper method of examination in another respect, viz., the use of ordinary conical-pointed steel sounds instead of bulbed instruments.

Suppose a patient possessed a stricture whose caliber was twenty-five. A No. 25 steel sound would be, at its point, only about twenty millimeters in circumference. It would pass into the stricture readily. prize it open as it was introduced, and the examiner would be none the wiser concerning the contraction. But a No. 25 bulb sound, introduced into the same urethra, has no gradually enlarging wedge to precede it and prize open the way; it runs up against the contraction suddenly, and, on passing beyond, is as suddenly released, only to be grasped and released as definitely on its return to the outer world.

Moral: Never use an ordinary steel sound (either blunt or cone-shaped) in examining for stricture. It will fail to detect all, save very marked, contractions.

A third, and equally important, pitfall for the unwary examiner for stricture, is furnished by the cut-off muscle (compressor urethra), that is located around the urethra, between the anterior and posterior layers of the triangular ligament (site of the membranous portion, in the figure). This point is usually about six inches from the meatus.

A medium-sized bulb sound pushed into this part of the canal will almost invariably be stopped, or obstructed, by the grasp of this muscle, and the simulation of a contraction there is close enough to mislead many into an incorrect diagnosis of stricture. A stricture of that kind can easily be demonstrated on any person, healthy or diseased, submitting to examination.

How, then, are we to guide our crafts between the Scylla and Charybdis of this case to avoid finding a stricture where it is not, and to be able to find it when it is present?

In the first place, in making such an investigation, always use the bulb sounds. That will enable us to attain the second object. Next, we must always remember and recognize the natural, or physiological, contractions of the urethra. That will prevent our calling them strictures when we run the bulb sound up against them.

And if such a sound fails to go through the cut-off muscle, or is so tightly grasped by it that it arouses doubt as to whether it is stricture or not, we must pass a full-sized, blunt-ended steel sound; this is not obstructed by the muscle, but passes it readily. That indicates a muscle grasp, and no stricture. A stricture located in this neighborhood is usually so narrow as to admit only very small instruments. 627 Century Building.

Relief of Pain.

In Gaillard's Medical Journal, Dr. Theodore W. Peers, of Topeka, Kan., has an article on Papine for the relief of pain. He reports two cases in which he used it with very gratifying results. In the first case, epithelioma of the left side of the face, he kept the patient comfortable with absolutely no unpleasant after-effects. In the other case, which was probably tubercular peritonitis, he used Papine for six months, with great relief to the patient. -Cin. Lancet-Clinic.

Skin Diseases.

Dr. A. T. Conley, Cannon Falls, Minn., says that Iodia is especially fine for many skin diseases.

[Written for the MEDICAL BRIEF.] The True Principle of Reform.


St. Louis.

The crowning excellence of Jesus, as a reformer, is found in the fact that he sought to rule men by appealing to their hearts, awakening their affections, and leaving them to the guidance of their own better nature. He was not a philosopher, saying this is wise, and that is unwise, and aiming to make men righteous by teaching them prudential maxims; he was not a law-giver, saying thou shalt do this, and thou shalt not do that, and aiming to regulate the lives of men by legal enactments; but he was a great moral genius, who, fully comprehending the broad truth that, "out of the heart are the issues of life," sought to purify the streams of human conduct by cleansing its fountain. He relied on neither philosophy nor legislation to govern men. Instead of aiming to turn them from evil, and lead them to good, by the power of wise precepts and righteous commandments, he aimed to form within them a right spirit-a loving disposition-which would control their lives, and lead them to discern and do the things that are true, and beautiful, and good. He urged men to be righteous; but he did not attempt to determine for them what acts are righteous. On the contrary, he taught them to "judge out of themselves" what is right. He urged men to imitate his example, but he did not urge them to submit to his authority. He founded a kingdom, not on the wisdom and authority of its king, but on the loving spirit of its subjects.

This crowning glory of Jesus was perceived and stated by Napoleon, when, conversing one day, at St. Helena, about


great men of antiquity, and showing how the man of Galilee far surpassed them all, he said: "Alexander, Cæsar, Charlemagne, and myself, founded empires; but upon what did the creations of our genius depend? Upon force. Jesus alone founded his empire on love, and to this day millions would die for him." Jesus saw that hereditary worships, and race differences, too deeply rooted to be overcome by philosophical


teaching and authoritative law-giving, fade like phantoms when the heart is touched. He saw that, in the fervid heat of divine love, all selfish designs are destroyed, all prejudices are melted down, all envies and jealousies are consumed, and all the barriers that separate men, and make them hostile and unjust to one another, are burned away. Hence, through the power of love, he sought to subdue anarchic and lawless passions, to overthrow ancestral traditions, to conquer human alienations, and to bind men together in a brotherhood of justice and mercy, peace and good will.

In thus founding his empire on love, he did not leave it without law, but he did leave it without a code of laws. He established it on the principle in human nature which underlies and makes laws. The laws, or legal enactments, by which men are governed originate in, and are expressions of, the humane and loving sentiment of the men themselves. Through all ages, the legal code, whether civil or religious, has reflected the spirit of the time. When men were cruel and vindictive, their laws-even those which they claimed to have by inspiration of God-were cruel and vindictive; and, as the moral consciousness of the race has been developed, and men have become more loving, their laws have become more just and merciful. We no longer have religious laws like those of the Pentateuch, which required the Jews to destroy, without mercy, men of other religions, and made it the duty of the husband to kill the wife of his bosom if she sought to induce him to turn from the God of Israel to the service of other gods. We no longer have civil laws like those of the Romans, which visited the penalty of death on the slave who killed a ploughing ox, but permitted a master to kill his slave with impunity. Our statutes are no longer framed on the principle that "might makes right,' and "they should take who have the power, and they should hold who can." Our laws are more just and merciful, not because they have come to us in any supernatural way, but because we have risen to a higher moral plane, and have more of that love which perceives the ties of human brotherhood, recognizes the right of fellowmen, and inclines the

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judgment to justice and mercy. Always the spirit of love in men, according to its development, frames the laws by which they are governed; and Jesus, instead of aiming to govern men by external law, wisely left them to be governed by the power that makes external law.

He thus established a progressive religion, and became the contemporary of all ages. Had he sought to govern by external laws, he would have been compelled, by the necessities of the case, to frame a code suited to the conditions of his own time; and such a code, authoritatively defining the faith and practice of men, would, as far as his influence extended, have fixed the limit of human growth in knowledge and legislation. Men could never have risen to any conception of duty, or any rule of conduct, more humane and loving than that given by him for his own age, without rejecting his authority. In that case, his followers must have either renounced his leadership, or ceased to progress. But founding his government on the spirit of divine love-the law-making power in men themselves-he placed it on a basis that can never be outgrown. He left men free to grow in love and in the divine wisdom that is born of love, and to adopt such laws for the regulation of their conduct as their larger love and wisdom might suggest. Hence, he has never been, and can never be surpassed. The new spirit coming into the world with new generations of men, and walking in the larger light of later ages, may find, as it has already found, new and better methods of life; men may come to see, even as Jesus himself failed to see, how the law-making power must touch social problems, and effect changes in human institutions and relationships; men may come to see, as Jesus failed to see, how the law of love, written in the human soul, must uplift woman, and break the fetters of the slave, and strike the scepter from the hand of the king; men may come to clearer and broader conceptions than Jesus himself had of the application of this governing principle to the life of the world; but they can never go beyond the principle itself. When they have risen to the highest possible conception of truth and duty; when they have framed

the best possible code of laws; when they have wrought every possible improvement in human conditions, divine love, unexhausted, inexhaustible, and capable of ever widening application, will still rise before them, calling them to higher and better things. Hence, Jesus has ever been, and must ever be, foremost in the vanguard of mankind's progressive army. The watchwords and rallying cries of all true reformers have ever been, and must ever be, partial expressions of the divine spirit of love by which he sought to govern.

And in calling men to indwelling love rather than wise precept or outward law as the governing power, Jesus called them to a higher order of morality. The morality which results from nothing higher than prudential considerations, or legal requirements, is entitled to little respect. The highest morality— the only true virtue-is that which results from no prudential or legal restraint, from no cold and calculating sense of duty, but from an indwelling love of what is right. Some one has well illustrated the difference between these two kinds of morality by the case of two men, one faithful to his country in obedience to law, and the other faithful in obedience to the promptings of patriotic ardor. These two men are offered a large bribe to betray their country. Neither will accept. But the mind of the one will picture the advantages and pleasures that might accrue to him from the possession of the gold, and his fingers will itch with desire to handle it. The other will have no such feelings. The one has his evil desire under control; the other has no such desire. The one is virtuous to the extent that he is incapable of committing the crime; the other is virtuous to the extent that he is incapable of being tempted to commit it.

And in seeking to govern men by the spirit of love within themselves, Jesus calls them to the virtue of the higher and only genuine kind. He demands that they shall be virtuous, not only in form, but in essence-not only in outward life, but in character. He demands that moral state in which unlawful desires are not only restrained and controlled, but altogether cast out from

the heart. It was this higher order of morality which he inculcated, when he said to his followers: "Except your righteousness exceed the righteousness of the scribes and pharisees"-the outward righteousness which consists in obedience to commandments-"ye shall ín no wise enter into the kingdom of heaven." Mere obedience to law, though it be as unfailing and undeviating as the stars in their appointed courses, is not the righteousness of God which gives the peace of God. That is obedience born of love.

And when man has love enthroned in his heart as the ruling principle of his life, he will need no written law-no divinely given and authoritative commandments-saying thou shalt do this, and thou shalt not do that, to restrain him from wrong, and hold him in the paths of right. He needs the constraining power of law to make him loyal to truth and duty, no more than a loving husband needs law to make him faithful to the wife of his bosom-no more than the loving father needs law to make him provide for the children, whose presence makes his home glad. His soul will echo the words of him who said: "The law no more binds or restrains me, now that I love my neighbor, than the dike built to keep in the sea at high tide restrains that sea, when it has sunk to low water mark." The indwelling principle of love will say thus far and no farther to all the swelling waves of selfishness and passion, and hold him in the right far more strongly than any dikes of outward commandment. Take away the commandment to be honest, and, impelled by the promptings of his own heart, he will still live honestly. Take away the outward commandment to deny self and serve others, and the promptings of his own heart will make him faithful unto death in the service of his fellowmen. Love, possessing his heart, quickening his spiritual being with a divine enthusiasm, will open his mind to the reception of all knowledge, and bind him to what he sees to be true and good with a loyalty, which all the temptations, persecutions, and terrors of the world can not shake.

3928 West Belle Place.

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I offered to send, by mail, on receipt of one dollar, six hundred of these pills, to any physician wishing to try them, or one hundred for twenty cents. Thousands took advantage of this offer, and have continued to use them constantly in their practice since. I still receive orders from many who have used them for six years, and they write me, they will not do without them, after having tried every kind of a laxative pill on the market. I think, above all other journals, the back numbers of the MEDICAL BRIEF must be kept, and read again and again, for I am constantly receiving letters from physicians whose attention is being called to my article of 1891, asking if I still send these pills, and I am forced to ask the favor of the BRIEF that I may answer all these letters at once, by stating, that offer still remains good to all who wish to be benefited thereby. I have received many thanks from the profession for furnishing so good a pill.

I am often asked: What is the action of the xanthoxylin? It is an alkaloid of the prickly ash, and is a powerful stimulant to the intestinal glands, and is also valuable in chronic rheumatism, in which this pill has proved beneficial.

Within the last few years I have had my attention called by patients to the benefit received from this pill in migraine. If taken in the stage of disordered sensation, the stage of sick headache and disturbance of vision will seldom occur. This, I think, is due to the action of hydrastis, xanthoxylin,

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