mass of hair removed. with iodoform and charpie and myrrh, and healed readily.

The wound was then dressed

DR. PORTER then reported the following case:

DIPHTHERITIC PERINEAL WOUND; CHRONIC CYSTI TIS; BILATERAL INCISION OF PROSTATE FOR REMOVAL OF STONE; ACUTE SUPPURATIVE PERITONITIS. AUTOPSY.

January 21st. L. D. V., aged thirty eight, farmer, about seven years ago first had pain on passing water. Had at that time a stricture which he claims was not of venereal origin. About a year later he underwent the operation of perineal section. Judging from the scar the incision was made through the scrotum down to the anus. There is now only a line of cicatrix. About three years ago noticed a desire to pass water very frequently; also noticed some pain both before and after passing urine. Passed small particles about the size of rice, which were hard; also passed blood at intervals. Since then his condition has been steadily growing worse. He now can retain his urine at best only ten or fifteen minutes. Has great pain at times, which he locates both in the back passage and in penis. January 23d. Examination by Dr. Wood. Color smoky; specific gravity 1008; sediment, much; reaction alkaline; albumen, large trace. Sediment: much pus; considerable blood; little triple phosphate; one epithelial cast seen; no large excess of bladder epithelium. January 24th. Dr. Porter passed No. 23 sound, and in the prostate the sound struck on a solid substance which gave the feeling of stone. Examination by rectum shows a dense, hard mass situated in the prostate. Seems to be immovable, and causes pain when pressed upon. The mass appears to be about as long as the finger.

January 26th. Etherized. Dr. Porter tried to introduce a lithotrite with intention of crushing stone, but was unable to get into bladder. Patient then brought down into position for perineal section. A staff was introduced into urethra. A cut was then made into periuæum about four inches long downwards and outwards. Staff was exposed, and left lateral incision made through prostate. Attempts were made to seize the stone with forceps, but without success. The prostatic incision was enlarged, and another made on the right side in a corresponding manner, in other words, bilateral incision of the prostate. After several attempts the stone was firmly clasped by the forceps, and withdrawn. A canula was then inserted, and wound packed with sponges. This afternoon canula withdrawn, and bladder washed out thoroughly with hot phenyle. Weight of stone 1320 grains. January 27th. Patient very comfortable. Bladder washed out with hot phenyle. January 28th. Wound doing well. January 29th. Patient has almost no appetite. Whiskey ss. every four hours. Pulse rather weak and 120. Complains of considerable pain over abdomen. January 30th. Complains of severe pain over abdomen, and especially over right side, extending up into chest. Has a sighing respiration, which at times is a moan. Amount of urine cannot be accurately estimated, but judging from the staining of sheets it would seem to be much diminished in last two days. Patient had poultices to side and over abdomen. Subcutaneous injections of morphia, grain one sixth, this morning, which gave some relief.

At eleven A. M. had an ounce of brandy, and a half ounce repeated every half hour after twelve.

About two P. M. was transferred to Ward D. Hot poultices and hot fomentations to side and over abdomen. At five brandy increased to 3vi. every hour. Throat dry and parched. Talks with difficulty. Lies in a sort of stupor. Moans, and can be aroused only with some difficulty. About nine P. M. had much trouble in taking stimulants. Brandy 3vi. Beef tea iii. given hourly by enema.

The rest of the night grew weaker, and died Thursday morning at five A. M., five days after operation. The autopsy was made thirty-four hours after death by Dr. Fitz, who showed the urinary organs in continuity. He stated that the peritoneal cavity held several ounces of thick creamy pus. The peritonæum presented a moderate vascular injection, and the intestines held but little gas. The lumbar lymphatic glands were enlarged to the size of almonds, soft, gray, and injected; the afferent pelvic lymphatics contained an opaque yellow lymph.

The bladder was firmly contracted, forming a dense, unyielding mass as large as the fist, in close apposition to the anterior wall of the pelvis, and nearly filling its cavity. The subperitoneal tissue over the fundus was abundantly fatty. On opening the bladder its cavity was found to be of the volume of a small peach. The walls varied in thickness from a half inch to more than an inch, and were incapable of distention, being largely composed of a dense fibrous tissue in which opaque yellow streaks were seen, suggestive of a fatty degenerated muscular wall. The mucous membrane was thickened and of a bluish slate color, with occasional small, shallow diverticula. A bilateral wound through the cervical portion of the bladder was continued into a perineo-urethral incision. The cut through the urinary tract was over two inches in length. lips of the perineal opening were glued together, and the general surface of the wound was coated with opaque yellow patches, firmly adherent, and representing a superficial necrosis of its tissues.

The

Both ureters, especially the left, were dilated, thickened, elongated, and tortuous. Each contained a considerable quantity of muco-purulent fluid. The right ureter was large as the fore-finger, the left of the size of the thumb. The renal pelves were moderately dilated, and were connected with sacculi the size of the finger tip. The mucous membrane of the pelves and ureters was thickened, rough, gray, somewhat translucent, and showed numerous varicose, injected bloodvessels.

The kidneys were diminished at least one third in size. The capsules adherent, portions of the surface of the kidney being torn away with the former. The surface was irregularly lobulated, with gray, filmy patches. On section the cortex was atrophied, the tubular regions and Malpighian bodies indistinct. The alterations described were summarized as indicative of a diphtheritic perineal wound, lumbar lymphadenitis, and acute suppurative peritonitis, chronic cystitis and paracystitis, chronic pyelonephritis, with dilatation and hypertrophy of the ureters.

DR. PORTER also reported a case of

REMOVAL OF A FRAGMENT OF CATHETER FROM THE

BLADDER.

January 15th. William L. N., farmer, aged sixtyfour. Patient has an enlarged prostate, in consequence

He has no pain, but says that since the accident his urine has dribbled away constantly.

Patient was etherized, and the bladder explored with a small lithotrite, but nothing was caught. A medium-sized lithotrite, with closely-fitting, finelyserrated blades, was then introduced, and after several attempts the instrument caught a small object that proved to be, when withdrawn, a little calculus the size of a pea. After a few more attempts the lithotrite seized the catheter. The blades were then locked, and an attempt was made to withdraw the instrument, after first moving it about to make sure that the wall of the bladder was not nipped. When the blades of the lithotrite reached the middle of the urethra they were held so firmly that it was almost impossible to move them. Externally there could be felt, just at the knee of the lithotrite, a large, irregular lump. In order to explore this and make sure that the wall of the urethra was not being pulled along in front of the catheter, the urethra was slit up on its under side for a distance of one inch. A director, being then introduced, felt, by the side of the lithotrite, the end of the broken catheter. Strong traction then brought out the lithotrite with the fragment of catheter caught, an inch and a quarter from its rounded end, in the bend of the instrument. The piece of catheter lay along the shank of the lithotrite, and just at its middle was a double fold which had been made by the hitching of the end of the catheter while passing through the prostatic part of the urethra; this was the explanation of the difficulty in withdrawing the instrument, and the large, irregular lump felt in the urethra. At the moment of withdrawing the catheter it broke at the point where it was grasped by the lithotrite. It proved to be a dry and brittle piece of No. 16 French (9 E.) catheter.

A No. 12 English gum elastic catheter was then fastened in the bladder, and the patient put to bed, with a bottle and tube arranged to catch the urine. One stitch was taken in the cut on the under side of the

penis, and a little iodoform applied. Patient slept comfortably all night, and had no further discomfort. The catheter was removed after forty-eight hours, and the patient discharged on the third day. His temperature rose to 100° F. on the morning of the second day and the evening of the third day, being 999 F. in the mean time. It was normal at the time of discharge.

Recent Literature.

A Manual of Practical Hygiene. By E. A. PARKES, M. D., F. R. S. Sixth Edition. With an Appendix. Volume I. Wm. Wood & Co. 1883. The publishers of the Library of Standard Medical Authors have done a good service in issuing this excellent manual in its present shape, thus popularizing a valuable work, and awakening a deeper interest in a branch of medicine too much neglected by the general practitioner.

Chapter I. treats of Water; the quantities necessary for its use by man; modes of collection, storage, and distribution; its quality and impurities; modes of puriexamination for hygienic purposes. II. Air; its im purities and the diseases produced by them. III. Ventilation. IV. The Examination of Air. V. Food. VI. Its Quality, Choice, and Cooking. VII. Beverages and Condiments. VIII. Soils; their conditions, constitutions, and modes of examination.

Volume II. contains a continuation of Book I. which treats of the following topics: Habitations; The Removal of Excreta; Warming of Houses; Exercise; Clothing; Climate; Meteorology; Individual Hygiene; Disposal of the Dead; The Prevention of Disease both Specific and Non-specific; Disinfection and Deodorization; The Value of Statistics.

Book II. treats of Military Hygiene, the conditions under which recruits are admitted to service, the conditions under which the soldier is placed, the effect of military service, foreign service, military and naval, from the British stand-point.

The American appendix to this volume is especially valuable as containing not only new material, but also matters peculiar to this side of the Atlantic. Due credit is given to Massachusetts for early and valuable work in the direction of Public Hygiene. The chapter on Water by Prof. E. Waller is quite full and complete. Professor Britten contributes a chapter on the Character and Distribution of American Soils. Dr. J. G. Richardson a valuable paper on the Climatology and Meteorology of the United States. Dr. D. F. Lincolu treats of Ventilation and Warming. E. S. Philbrick contributes a clear and concise paper on Removal of House - Waste, illustrated. The paper on Food Adulteration, by Prof. E. G. Love, is especially valuable for its abstract of the legislation of such States as have enacted adulteration laws up to the present year. The New York law is quoted in full.

Brief chapters follow on Disinfection, Vital Statistics, and Sanitary Inspection.

A Manual of Pathology. By JOSEPH COATS, M. D. Philadelphia: Henry C. Lea's Son & Co. 1883. This manual was written with the idea of furnishing a work on pathology in English to replace that of Wilks and Moxon, which has become antiquated. It is well up to the times and presents the subject in a very readable manner. This is increased for the general practitioner by numerous allusions to the clinical bearing of the changes noticed. The importance which microorganisms play in disease is recognized, and a due place is given to their consideration and illustration.

The work has not a great deal that is original beyond the illustrations, most of which were made especially for this work. The arrangement of the material is a very good one, and can be recommended to the student and practitioner as a good exponent of the modern condition of pathology, both general and special, in a volume of reasonable size.

An aged Welsh Druid was recently tried for burning the body of his child, but was discharged on the ground that there was no law prohibiting it.

At the Cleveland meeting of the American Medical Association a committee was appointed to consider the regulation of emigration by Congress. This committee recently drew up a bill, which was presented to the national House of Representatives last month by General Slocum, and referred to the Committee on Commerce as an amendment to the Emigration Act of last year. The bill will be found in full on another page. Its passage and enforcement would reform many of the abuses which at present unquestionably exist, and tend to place the marine medical servicean extremely necessary department upon large passenger steamships upon a positively and relatively useful and suitable footing, which at present is notoriously not the case.

The weak part of this bill is plainly the insufficient space prescribed for hospital accommodations. It may be that no more could be wrung from the cupidity of the owners of vessels, especially when it is at the same time demanded that the ship's surgeon, whose maximum pay has hitherto been only £9 or £10 per month and his position on a par with that of the chief steward or carpenter, should not only be provided with necessary assistants, but remunerated and treated as is the first officer or chief engineer,

It is said that competition between competing lines and dullness in trade and emigration have brought about a "cutting of rates" on ocean steamers similar to that with which we are familiar on our railroads. If

so the present will prove both a difficult and desirable moment to introduce the proposed reforms.

We all recall the perfunctory and even fraudulent methods of complying with the laws for the vaccination of immigrants on some vessels of some steamship lines coming to this country, but when one becomes acquainted with the obstacles and want of facilities or support under which the surgeons of these vessels labored, a large part of the indignation, then only too justly aroused, should be transferred in many instances from the surgeon to his employer, the Steamship Com

pany.

The great body of our citizens, whether those who travel or those who stay at home, have too direct and personal an interest in this reform of the medical service on ships to permit of its being dropped out of sight.

THE MEDICAL MAGNATES OF EDINBURGH.

DURING the earlier part of this century it was not uncommon for our medical graduates to finish their academic labors at the University of Edinburgh, which has just celebrated its tercentenary jubilee by conferring an honorary degree on Drs. Fordyce Barker and John S. Billings, beside a host of European celebrities. It is proper, therefore, to recall a few of the names that have made the University of Edinburgh illustrious in the annals of medicine and the kindred branches of learning. The University of Edinburgh, now one of the very largest in the world, and having more students than any other university except Paris, Berlin, and, perhaps, Vienna, was opened in 1583 as a town college created by and subject to the municipal council of the Scotch capital. The medical department of the University began in 1726, although a professor of botany had served since 1676, and Sir Robert Sibbard was not only appointed Professor of Physic in 1685, but received in the same year two unsalaried assistants. In 1706 Sibbard advertised in the Edinburgh Courant that he would teach natural history and the medical art in privatis collegiis, provided applicants could bring satisfactory te-timonials as to their knowledge of Latin, Greek, mathematics, and philosophy. The Independent College of Surgeons, which had received a patent in 1695, caused a Public Dissector of Anatomy" to be appointed in 1705.

But the medical department of the University owes its existence in part to the good sense of John Monro, a surgeon of King William's army, in part to four physicians -Sinclair, Rutherford, Plummer, and Innes who, on their own petition, were appointed the Medical Faculty in 1726. The illustrious layman who helped nobly in this work was George Drummond, who founded the Royal Infirmary, opened in 1741. Meanwhile Alexander Monro had been appointed Professor of Anatomy in 1720, and may, perhaps, be called the father of the Edinburgh Medical School, because he made it famous by his Osteology, published in 1726, by his lectures, and by his son, who died in 1817 in the enjoyment of a European reputation

fact of his having paid the larger fee must be noted on his card or certificate of attendance before it can be accepted by the university authorities. The Colleges of Physicians and Surgeons in Edinburgh grant licenses to practice, and it is largely in preparation for these that students attend the extramural lectures, and in such a case there is no restriction as to fee. Nor is there any restriction in the case of a university student if he has taken out the same class in the university and paid the usual fee, or has taken out the class at any other university.

Each extramural lecturer pays for his own rooms, provides his own apparatus, and holds all the fees he gets from his class. He is practically responsible to no one, but the university can always withdraw recognition of his lectures if they see a fit reason. When they grant recognition all they require is that the person has some status or standing in the subject on which he proposes to lecture, but recognition is often granted to comparatively young and inexperienced men; so much the worse for themselves if they are incompetent. A student for a university degree may only take out any four such extramural courses; all the others he must take in the university. This limits the effect of the opposition.

Besides these lecturers on the same subjects as university professors there are a few others who give courses on subjects not specially taught within the university, and not compulsory for the degree, as a course on diseases of the ear, eye, etc. Recently, however, a university lecturer on diseases of the eye has been appointed, as also one on insanity. These are the only two lecturers, not professors, holding their appointment direct from the university. In no case is the number attending the class limited. There are no small cliniques. Each of the clinical professors at the infirmary has a following of from twenty up to even eighty and one hundred. Men are drilled in the elements of practical diagnosis in groups of ten or twenty by the clinical tutor acting as assistant to the clinical professors. ⚫

The extramural teacher can lecture when and where he pleases, only he commonly finds it most convenient and profitable to lecture at the same hour as the professor of the same subject.

This system of extramural teachers is of great antiquity in Edinburgh, and has been found to supply a healthy stimulus to the university professors, many of whom came from the rauks of the extramural lecturers, especially in the practical subjects of medicine, surgery, and midwifery. A majority of the present professors were extramural lecturers before being appointed professors. The professor has always the advantage of endowment, better equipped and more commodious laboratories, and the chance of examining the student for his degree, which last induces men to stick to the university teachers.

In Glasgow a similar system has only recently been established, and there is now a very large number of extramural teachers there.

MEDICAL NOTES.

Two more deaths from foot-ball are reported from England, both from injury to the spinal cord. In one case death was sudden; in the other the unfortunate young man lingered for four months in a hopeless state of paraplegia resulting from hæmorrhage into the cord.

Mr. Lawson Tait recently read a paper on Relations of Ovulation to Menstruation before the Midland Medical Society, as we learn from the Birmingham Medical Review. He gave a historical sketch of the literature of the subject since 1843, the date of the publication of Dr. Ritchie's papers, and observed that although Ritchie's discoveries had been amply and frequently confirmed, the text-books still reiterated the mistaken view that menstruation was the equivalent of the oestrus or rut, and that it was due to the ovarian excitement of the ripened follicle. He next gave a series of observations derived from his surgical practice, in which it was shown that in fortynine observations there was evidence of the concurrence of ovulation and menstruation in nine ouly, whereas in forty cases the evidence was either negatively (fifteen cases) or positively (twenty-five cases) against the ovulation theory of menstruation. It was therefore impossible to maintain a theory which was controverted by nearly eighty-two per cent. of evidence.

- The London Practitioner quotes a practice said to have been used for some time in the Milan Hospital for an aid to the diagnosis of fracture of the neck of the femur. The measure consists in exploring (whenever fracture of the neck of the femur is suspected) the short space between the trochanter and crest of the ilium. In place of considerable resistance, which is then produced in the sound limb through the tension of the tensor fascia latæ, there is found, when injury has occurred, a deep depression due evidently to the diminution of the tension of this muscle owing to the approximation of its points of attachment.

- A recent visitor to the venerable University of Pavia found among other relics of Scarpa, who is the special glory of that seat of learning, the head of the great anatomist with the soft parts entire preserved in a bottle. The fingers are also exhibited. Probably most such zealous devotees of science would be willing to occupy permanently a niche of a museum if they could thereby serve to illustrate any curious point of anatomy or of pathology. But it would seem more appropriate to most minds outside of relic-worshiping Italy, that if any remains of the old professor were to be made immortal, they should at least have combined a scientific with a personal value. His triangle would have been a more tasteful souvenir than his face.

A curious pathological fact is related by M. Guillaume Chapus in a memoir, Sur les Médicins et la Médecine en Asie Centrale, which we find noticed in a French journal. One town of Turkestan, Kokane by name, is composed in great part of individuals

is struck with the appearance of the inhabitants, who