conclusions regarding the nature of the disease. He is then questioned, and his answers form the basis of the instruction conveyed to his fellows. If his answers be correct and his conclusions just, the teacher amplifies and emphasizes them. If he has hastily rushed to a premature conclusion, a series of careful questions leads him gradually to see the inadequacy of the grounds upon which it has been based. If he has overlooked any important symptom, the interrogations are so framed as to direct his attention to the affected organ, and to induce him to note the symptom himself, rather than to announce it plainly to him. This method, in the hands of a master, is beyond question one of the most powerful means of intellectual stimulation at our command. It has the double advantage of conveying instruction in a very impressive form to one individual, and of enabling others to profit alike. by his knowledge and his ignorance. It is a method, however, that has its limitations and its dangers. In the first place, the student selected to bear the brunt of the teacher's cross-examination must possess a fair substratum of knowledge, otherwise his mistakes will be so egregious as to excite the ridicule of his companions and cover himself with confusion. Hence no very young and inexperienced student should as a rule be selected, unless the teacher has the happy knack of dealing gently and encouragingly with even the densest ignorance. Many are the cases in our hospitals of a young student who has been picked out at random from his companions, compelled to examine some obscure case of disease previously quite unknown to him, and then made to stand the full battery of interrogation and sarcasm from a man of long experience and ample information, who easily forgets that he was once as raw and ignorant as his helpless victim. A student, under such circumstances, may be excused if he feels a grievous sense of wrong, and reflects on the injustice of expecting from him a proficiency and experience which he has not yet had the opportunity of acquiring. On the other hand, he will often feel a lifelong gratitude

to the teacher who in such a case deals mercifully with his inexperience, shows him his ignorance without mocking at it, and thus at the same time points out to him his weaknesses and the means of remedying them. In the second place, the method does not adapt itself to all types of disease. In some cases, especially in those diseases of which we learn all or nearly all that we know by the eye, the method of demonstration is often to be preferred. The "Socratic method" is excellent for analyzing a case of cardiac disease or for investigating the nature of an obscure tumor, but is less signally useful in conveying instruction in such departments as diseases of the skin or surgical injuries. In such cases the student has to observe more than to reason, and it is rather in cases requiring more or less sustained reasoning that the "Socratic method" is valuable.

Socrates achieved more success as the assailant of error than as the propounder of new truths, and his method is nowhere more efficient than in showing a dogmatic and self-satisfied person the littleness of what he knows and the vastness of what is unknown to him. Criticism is always easier than creation, and demolition than construction; yet it is no slight gain to rid our minds of misconception, to clarify our ideas, to be sure that we know what we think we know, and to harbor the least possible amount of positive error. There is hardly any fault more pernicious in youth than the ready acceptance as ultimate truth of crude ideas and half-knowledge. It shuts the mind against new light, cramps mental development, and tends to the production of that most objectionable person, the "prig." The "Socratic method," in skillful hands, is likely to prevent the student from hugging the delusion that two or three years spent in the wards of a hospital can teach him all that is to be known upon health and disease, and to start him in practice with the determination to be always ready to observe, weigh, and consider, to guard against hasty conclusions, and to subject every judgment and conviction to such reconsideration as new facts, constantly evolved, seem to command.

CHOLERA AND WATER IN INDIA.-Renewed publicity has been given to a lecture delivered by Dr. Furnell, formerly sanitary commissioner, Madras, on the important influence which a polluted water service has upon the spread of epidemic cholera; and in view of the statements that emanate from India, and which so often imply that inscrutable mystery attaches to the causation of cholera in that country, it must be a satisfaction to find that there are skilled observers who see in excrementally tainted water as potent a source of cholera diffusion in India as can be found in Europe generally or in this country. Medical officers in India have more than once hinted that confusion existing in the minds of many as to the cause of such diseases as cholera and "fever" in that country is largely due to the fact that reports on these diseases have to be framed so as to suit those in authority; and Dr. Furnell, in referring to the fact that cholera is so often set down to what some are pleased to call "local influence," says that although this term is unintelligible, it is at present in India "by authority" the only "true faith, and woe to the sanitary commissioner or medical officer who publishes his belief in any other cause but 'local influences.'"-London Lancet.

A MAN WITHOUT A LARYNX.-The Paris correspondent of the Lancet writes: A short time ago I read a note in a scientific journal. entitled as above, which was reproduced in the Paris Figaro, and which was to the following effect. At No. 22 Rue de la Banque, Paris, may be seen a man (a wine merchant) who has been living without a larynx for the last two years. In April, 1885, he consulted Dr. Fauvel, the celebrated laryngologist, on account of severe dispnea, to which he had been subject for some time. Dr. Fauvel diagnosed an osteosis with edema and ulceration of the larynx, and proposed to perform tracheotomy on the

1886; but, as this did not afford much relief, Dr. Péan, on February 27th-that is, a fortnight afterward-performed ablation of the the larynx. This was done at the hospital, and on March 19th he was able to eat, and left the hospital cured and apparently in good health. As newspaper reports of medical cases are not always very correct, I resolved to call at the address given and verify the statement published. I saw the man in his shop (a public house), serving his customers as if nothing had happened to him. He is thirty-seven years of age, but looks about fifty. request he very willingly showed me his throat, where I perceived the cannula which was introduced by Drs. Péan and Fauvel, and whenever he had to answer my questions he closed the orifice of the cannula with his finger, and although his voice was not very audible, yet he spoke very distinctly. He has not changed his habits, but eats and drinks as much as he ever did. As far as I can learn, the man had no antecedents of syphilis or tuberculosis, but had been frequently treated for "colds on the the chest."

At my

ALANIN-MERCURY IN SYPHILIS.-Professor de Lucca, of Catania, has found that combination of mercury with amido-propionic acid, or alanin, as it is called, is preferable to all other mercurial preparations for hypodermic use in syphilitic cases. Alanin-mercury is thus prepared: One part of alanin is disolved in twenty parts of water by heating gradually until it boils. While the solution is boiling binoxide of mercury is added little by little until no more will dissolve. The whole is then filtered and evaporated. The alanin-mercury crystallizes out in minute needles of a dull white color. With this substance Professor de Lucca has treated forty cases of recent syphilis. A

very small dose is sufficient, the average daily quantity given hypodermically being five milligrams dissolved in a cubic centimeter of water. In very few cases were abscesses produced. Alanin-mercury seems to be peculiarly suitable for internal use in infantile syphilis. In these cases from two to five milligrams were given daily, and in no instance was there any sign that it could not be borne. Professor de Lucca states that the cures produced by alanin-mercury appeared to be of a permanent character.-London Lancet.

ASPHALT PAVEMENTS AND THE PUBLIC

HEALTH.-The vapor of tar has been supposed to be beneficial in a number of disorders, but Dr. Edmund J. Mills, of the Glasgow Technical College, has written a short note on the injurious effects of tar vapors so copiously discharged on our streets while asphalt road-mending is going on. It is said that the injurious effects of these fumes is perfectly well known at tar works, where the pitch is always cooled down in a closed chamber prior to casting in blocks. Casual inquiries have convinced him that the operations of road repair in Glasgow have been, during the last three weeks, the cause of a great deal of totally unnecessary illness, the leading symptoms of which are nausea and giddiness. He himself has been three times prostrated in this way, and has been thereby debarred from pursuing his ordinary professional work until these repairs cease. In view of the serious inconvenience from which many more must have suffered, it is to be hoped that the use of pitch in the fnture may be dispensed with, as the operation of road-mending can, if desired, be conducted without any offense whatever to the public health.-British Medical Journal.

LEPROSY IN RUSSIA.-The latest advices to hand point to the fact that in Russia, chiefly in the Baltic provinces, leprosy is increasing. In Lithuania, for example, there are to be found from two hundred and fifty to three hundred lepers, and in the district of Dorpat, it is said, the proportion of lepers is about one to a hundred of the population. There are reasons, however, for believing that the

latter estimate is somewhat of an exaggeration. The inhabitants of these districts are naturally exhibiting some uneasiness in relation to the increase of this terrible disease in their midst, and have petitioned the Government to appoint a commission for the purpose of inquiring into the facts, with a view to the adoption of some means for arresting the propagation of the malady. It has just been decided to open a hospital at Riga, with forty beds, for lepers, and this is undoubtedly a step in the right direction, though perhaps a small beginning. In Norway, where leprosy is also an epidemic, ample hospital accommodation exists for the

treatment and isolation of the disease. Three leper hospitals are maintained by the State: one at Christiana, in the south; another at Bergen, in the west; and a third at Trondheim, in the north; into which the patients are admitted from all parts of the country. At any time during the course of the treatment, the patients are free to return to their homes, in accordance with the belief in Norway, established by law, that the disease is not contagious.-London Medical Press.

CINCINNATI CENTENNIAL.-The Cincinnati Press Club dedicated the Press Headquar ters at the Centennial Buildings, Cincinnati, June 9, 1888, at 2 o'clock, P. M. We are beholden to the Committee on Invitation for a ticket, and regret that we could not witness the ceremony and partake of the abundant good cheer.

SPECIAL NOTICES.

COCA has maintained its reputation as a pow erful nerve stimulant, being used with good results in nervous debility, opium and alcohol habit, etc. The highly variable character of the commercial drug makes it uncertain however. Robinson's Wine Coca (see this issue) we believe to be a uniformly active article, it being prepared from assayed leaves, the percentage of cocaine being always determined by careful assay.

I HAVE used SUCCUS ALTERANS (MCDADE) in my practice ever since it was introduced, and have always found it eminently satisfactory in the treatment of all syphilitic cases of skin diseases, and also of all blood disorders.

J. C. MOREDOCK, M. D., Marion, Ohio.

I HAVE used ELIXIR PURGANS for a number of years, and consider it the best liquid cathartic that I have ever used. A. H. BRUNDAGE, Xenia, Ohio.

VOL. VI. [NEW SERIES.]

No. 1.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

SOME POINTS IN THE MANAGEMENT OF URETHRAL STRICTURE.*

BY E. R. PALMER, M. D. Professor of Physiology and Pathological Histology, Medical Department University of Louisville.

Urethral stricture is one of the most frequent, and often in its ulterior effects one of the most serious of the chronic diseases that come within the purview of the surgeon. The outcome of morbid influences both specific and non-specific, it often demands more than ordinary skill for its accurate detection, and, unrelieved, acts both remotely and directly as the causative and maintaining agent of neurotic states and organic obliquities whose tendencies are to shorten and make miserable human life.

In limiting my subject to-day to the management of stricture, I but recognize the impossibility of concisely encompassing the whole field in the short space of time I am expected to occupy. Before entering upon the subject proper of the paper, a few preliminary statements are necessary. Otis, who represents a large modern school of doctrinarians, lays down a number of principles which may be formulated as follows:

Strictures of the urethra should be classified as strictures of small caliber and strictures of large caliber.

Strictures of large caliber can not, as a rule, be detected by the ordinary curved sound.

Read before the Mitchell District Society, of Indiana, at French Lick Springs, June 22, 1888.

The diameter of the male urethra varies widely normally in different individuals.

The French law, that a urethra that will receive a 28 F. sound is always a normal urethra, is a pernicious law.

A proportion in health usually exists between the circumference of the penis and the caliber of the urethra.

Many urethras, when normal, have a caliber of from 34 to 36 and even 40 m. Strictures of large caliber in such, or indeed in any urethra, need for their detection and measurement the olive-tipped sound (bougie à boule), or, better still, a properly scaled dilating urethrometer.

Strictures of large caliber are common agencies in maintaining a gleet, and in establishing and keeping up other and even more serious morbid states.

The penile urethra is the seat of the great majority of strictures, and the commonest site is within two and a half inches of the meatus, or where the producing clap expended its greatest force.

The cure of gleet and its fellow evils calls for the cure of the stricture, and the cure of the stricture is best accomplished by internal dilating urethrotomy.

In his recent Lettsomian lecture upon stricture of the urethra, Mr. Reginald Harrison advances some original and exceedingly rational views regarding the etiology of stricture and urine fever. The urethra, he says, is normally a water-tight canal-a canal impervious to urine. One of the ef fects of inflammation or traumatism is a desquamation of the protective epithelium, or a fracture of the urethral continuity, in each case tending to permit an escape of urine into the structure of the penis. To guard against this, plastic lymph is poured out into

the submucous layer, closing the leak by its speedy organization. A peculiar feature of this neoplasm is its exceeding contractility, going beyond in this respect the contractility of the cicatricial tissue that ordinarily follows a burn. To this property is due the frequency and obstinacy of stricture.

"Urine fever," Mr. Harrison suggests as the proper name for that alarming and occasionally fatal febrile state that sometimes follows operative procedure about the urethra and bladder. The following are his deductions:

"(1) That the presence of urine in relation with a recent wound is necessary for the production of urine fever. (2) That the mere contact of urine with a wound is not sufficient for its production. (3) That the retention of fresh urine within the area of a recent wound is almost invariably followed by its development in a greater or lesser degree. (4) That where urine is placed under such circumstances as have been last mentioned, the liability to the development of urine fever is greatly diminished when it is sterilized by local or general means. (5) That the retention of fresh urine, blood, and the débris of damaged tissue in the confines of a recent wound for a certain time at a temperature of somewhere about 100° F. could hardly be possible with. out chemical changes taking place in the constituents referred to. (6) That there is a common origin for urine fever is rendered probable by the uniformity of the symptoms attending it, which, though dif fering in degree, are identical, whether following a surgical operation or an accidental wound."

Elsewhere he states: "From my observations in connection with the surgery of these parts, it seems probable that the develop ment of urine fever is really due to the absorption of some such poisonous compound as an alkaloid which is derived either from urine or tissue or wound decomposition, or from all combined."

With these prefatory references and quotations stated, I propose to give you, not a rehash of what is to be found in most stand

ard treatises upon the treatment of stricture, but to put in shape certain results of my own experience, and at times strengthen these by corroboratory statements from other sources.

Nowhere is Listerism, in its broadest and fullest sense, more imperatively demanded. than here. Surgical cleanliness, both external and internal, of the patient, and surgical cleanliness of every surgical appliance should be invariably observed, whether dilatation, divulsion, or urethrotomy be the procedure to be pursued. To accomplish this, two or more means are at our command. The usual antiseptic baths for instruments, and the antiseptic cleansing of the patient's surface, need nothing more than passing mention. The care of the urethra and bladder calls for more detail. For twenty-four hours before any of the above operations the urine should be sterilized by the administration of full doses of boric acid, say fifteen grains every three hours. Where the passage of a catheter per urethram is possible, the bladder should be distended immediately before the operation, by means of a fountain syringe and catheter, with eight or ten ounces of super-saturated solution of boric acid at a temperature of from 100° to 105° F.; and after the withdrawal of the catheter the patient should be required to expel the fluid as if urinating. This not only still further renders the parts aseptic, but prepares the urethra for the better absorption of the cocaine, of which a four-per-cent solution retained in the canal for fifteen minutes will be found, in a majority of cases, all-sufficient for anesthesia.

Immediately after either of the abovenamed operations the urethra and bladder should be washed again, either with the same solution or a 1-20,000 or 1-30,000 hot bichloride injection. So long as danger of sepsis exists the urine should be withdrawn each time with a clean catheter, its escape being followed by a boracic injection, which, the catheter being now withdrawn, the patient passes through the surgically injured canal. I feel justified in insisting upon all of these precautionary measures in either form of