semble the cells in some scirrhous tumors that they have been mistaken for them. The observer must take the greatest care to avoid such an error, and thus suggest the existence of cancerous disease of the kidney in perfectly healthy people.

The epithelium of the bladder varies much in different parts of the organ. In the fundus, there is much columnar epithelium mixed with large oval cells; whereas, in that part termed the trigone, large and slightly flattened cells, with a very distinct nucleus and nucleolus, are most abundant. Columnar epithelium appears to line the mucous follicles, while the scaly is found on the surface of the mucous membrane between them. Many of the large oval cells of bladder epithelium lie upon the summit of columnar cells, and their under surface exhibits corresponding depressions. Various forms of bladder epithelium are represented in "100 Urinary Deposits," Pl. II, Figs. 25, 30, 32; and the manner in which the young cells of vesical epithelium multiply is represented under a power of 700 diameters (Fig. 30). The young cells are composed of a perfectly soft, granular material, and like other young cells possess no limitary membrane or cell wall whatever. The formation of pus from the bioplasm of epithelial cells may be well studied in inflammation of the bladder and urethra. The large cells of bladder epithelium grow very fast in cases of epithelial cancer affecting this organ, probably on account of the increased flow of blood to the mucous membrane established by the increased demand for nutriment excited by the rapid growth of the cancer.

The epithelial cells of the urethra are, for the most part, of the columnar form; but mixed with this there is also a good deal of scaly epithelium. Towards the orifice the epithelium is almost entirely of the scaly variety. The young bioplasts on the deep surface of the epithelium very readily grow and multiply unduly, and thus pus corpuscles result. Oftentimes this process goes on also in the small, glandular follicles of the mucous membrane. The epithelium of the glans is of the scaly variety, and mixed with it is a quantity of soft, white matter, seen under the microscope to consist of granules and numerous globules of earthy phosphate. This is the secretion from the modified sebaceous

mous extent.

glands in the mucous membrane of the corona, the so-called Smegma Preputii, which accumulates in some cases to an enorIn a specimen, which was removed by operation by my friend Mr. Bird, now of Melbourne, I found epithelial cells with many well-formed crystals of cholesterine.

The smegma preputii mixed with epithelial cells from the surface of the glans, fatty matter and earthy phosphates which have been deposited in it, sometimes forms hard, flaky masses, which have been mistaken for fragments of a phosphatic calculus. Not unfrequently the accumulation of this secretion excites inflammation of the prepuce and glans, causing severe pain and making the patient really ill. We are often consulted about a form of herpes which is prone to occur upon the mucous membrane in this situation. In some persons of a gouty tendency this affection is often very troublesome. It generally yields to the local application of Goulard water or even pure water, with a mild mercurial purge and citrate of soda or some other saline internally.

Vaginal Epithelium.—The large cells of scaly epithelium so commonly met with in the urine of females, and derived from the vagina, are represented in "100 Urinary Deposits," Pl. II, Figs. 24, 32. They, however, vary much in size and form, and are sometimes very irregular in shape, with uneven, ragged edges. It is very common to meet with cells of vaginal epithelium the bioplasm or germinal matter of which is much increased in size and is undergoing division and subdivision into pus corpuscles. The quantity of epithelium which is discharged from the surface of the mucous membrane of the vagina is sometimes very remarkable, and it is not surprising that its abundant formation. and detachment, from time to time, should cause symptoms which disturb the patient and are sometimes accompanied by pain and distress, or at least discomfort, which rivets the attention, and excites in the patient's mind fears of pathological horrors, about which, through the mistaken kindness, perhaps, of a learned female friend, she has been led to form some very vague and exaggerated notions. Injections of tepid water, tonics and mild purgatives often set everything to rights in a week or

two, and if you can persuade the patient that a vaginal examination is not immediately necessary, you may often ease her without resorting to that in many cases needless and objectionable method of investigation.

Casts of the Uterus and Vagina.—A considerable thickness of the epithelial layer of the vagina, and, according to some observers, also that of the uterus, is sometimes shed in the form of a membranous cast or mould. I have seen such epithelial casts or moulds from the rectum, œsophagus, and from the stomach. They may be compared with the layers of cuticle which are detached from different parts of the cutaneous surface after scarlatina. It is only the superficial portion of the epithelial layer which is detached in these cases.

Leucorrhea. In this condition very many imperfect cells of vaginal epithelium are formed upon the surface of the mucous membrane, as well as pus corpuscles. Many pus corpuscles originate in the cells of vaginal epithelium, even after the epithelial cells have assumed their distinctive form, but many of the younger cells of vaginal epithelium, and those in the numerous follicles of the mucous membrane, themselves divide and subdivide, giving rise at length to multitudes of the spherical granular cells we know as "pus corpuscles," which multiply very rapidly if freely supplied with nutrient matter. The manner in which pus is formed from the bioplasm or germinal matter of vaginal epithelium will be at once understood by reference to Figs. 106, 107, Pl. VIII, "100 Urinary Deposits."

Although it is not my province to discuss the nature and treatment of leucorrhoea, it may be well to state that many cases seem to depend upon an impoverished state of blood, without any special disease or derangement of a purely local character. These cases get quite well if attention be paid to the general health. Of all remedies the tincture of perchloride of iron is one of the most useful, and when there is any irritability of the mucous membrane, tincture of henbane, opium, or hop, or the extract of Indian hemp, will be found useful. The advantage of the local application of Goulard water with sedatives, and the frequent injection of cold or tepid water, and the beneficial

effects of the cold or tepid hip bath, in this condition, are so well known to practitioners, that it is almost needless to refer to them.

CANCER.

A careful examination of a urinary deposit sometimes affords the first evidence of the existence of a morbid growth from the mucous membrane of the bladder, or from the prostate, or from the kidney itself, a terrible form of disease which it is to be feared will end fatally. The morbid change may have been going on for many months, or for even a year or longer, without any pain or even discomfort having been experienced by the patient, and the reddish-brown deposit in his water, sometimes in considerable quantity, sometimes hardly visible, may be the first thing that attracts his attention, and that suggests the desirability of consulting a physician.

In cases of cancer of the bladder, it is not uncommon to meet with well-defined cancer cells in the urine. Some years ago, Sir William Fergusson requested me to examine for him a small portion of jelly-like matter, which had been passed by a patient suffering from disease of the bladder. Of the exact nature of this matter there had been some difference of opinion. Upon treating a fragment of it with a little glycerine and water, and subjecting it to examination with a power of two hundred diameters, I had no difficulty in making out loops of capillary vessels covered with a thick layer of cancer cells. The specimen presented the usual appearances which distinguish a cancerous tumor rapidly growing into a hollow viscus, and was evidently one of the tongue-like or villous processes, broken off from the mass. There could, therefore, be no further doubt as to the exact nature of the case. The diagnosis was confirmed by subsequent examination of the parts after the patient's death. I have seen several cases of cancer of the bladder in which the disease was detected for the first time by the microscopical examination of the urine. In most of these there was an abundant deposit of a dark brown color, much resembling blood in appearance when it occurs in the acid urine. This brown deposit was found to consist principally of a vast

number of cancer

cells," varying greatly in form and size, most of them being very large. Many were of considerable length, and contained “cells" in two or three different places. These so-called "cells" consist, in fact, of a soft material corresponding to the wall of a normal epithelial cell, in which masses of bioplasm are embedded in considerable number. A very good specimen of cancer cells from the bladder is represented in "100 Urinary Deposits," Pl. VIII, Figs. 103 and 107. The cancer cells multiply in the same way as epithelium, but faster and much more irregularly, instead of succeeding one another in an orderly manner, layer after layer.

66

The presence of cancer cells in the urine, it need scarcely be said, is irrefragable evidence of cancer of the bladder. This disease must be fatal sooner or later, and we can never give much hope of a favorable termination.

From time to time, however, specimens of urine are sent for examination, containing numerous well-defined spindle-shaped cells, which, from their general resemblance to the cells of scirrhus, have been supposed to indicate the existence of this terrible malady in connection with the kidney or bladder. But it must be borne in mind that cells from the ureter, bladder or urethra, in health, may be mistaken for cells from a cancerous growth. Certain forms of cancer cells, then, which have been detached from a cancerous growth, may be mistaken for epithelium, or the last for cancer cells, and the greatest care should be taken by the practitioner not to come too hastily to a conclusion on this matter. Moreover, as cancer is incurable, and as the disease often runs a prolonged course, not unfrequently extending over three years or more before it destroys life, there is no excuse for any hasty expression of opinion. To err on either side is a most grave matter, and it is of the greatest consequence that time should be allowed to pass before a decided opinion is given on a question of such tremendous consequence to the patient. I have known epithelial cells from the bladder and also from the ureter mistaken for cancer cells, and I have had the unpleasant duty of proving that a collection of what was supposed to be epithelial cells was really a fragment detached