continue it long enough, it might have an impression upon the slow inflammatory process, that was going on, in the prostate gland.

Nov. 11th, was called at two o'clock in the morning, and found him suffering severely. He had not been able to draw his. water since my last visit. His soft rubber catheter had given out and he was at sea, without a rudder. I drew his water for him, with a leaden catheter, that I had devised myself, bent to suit the curve of his urethra. I visited him again at 4 P. M., and drew his water, with the leaden catheter without the least difficulty Continued the treatment of yesterday.

[TO BE CONTINUED.]

Selected Article.

ARTICLE LXIII.

FITZGERALD ON A NEW OPERATION FOR THE RADICAL CURE OF HERNIA*.

Dr. N. T. Fitzgerald, F. R. C. S. I., speaks as follows: Impressed with the manifest failure of Wutzer's, and the limited success of Wood's plans, some years ago I schemed out an operation, of which the following is a modification, and which I have performed a large number of times.

The only instrument employed is a long stout needle, simi'lar to those used in perineal operations, but the hank is longer and the point less curved. Sometimes I suggest, though I do not use it myself, a long needle without a handle, with an eyed point at each end; the employment of which, at one stage of the operation, avoids what appears to be an awkward movement of the hands, and enables the operator to pass his stitches more easily than perhaps he otherwise would do.

The patient having had his bowels cleared by a purgative the evening before, and an enema in the morning, is placed on

*

The Cuts for this Article were kindly sent us by Bermingham &

Co., of New York.

his back, with his hips raised on a pillow. An anesthetic is administered, and as soon as complete muscular relaxation is effected, the hernia, external ring, and neighboring parts, should be carefully examined; notice being taken as to the size of the ring, and whether the rupture is oblique or direct. The hernia, if descended, should be reduced, and the index finger of the left hand, pulp uppermost, carrying the scrotal integument in front of it, pushed through the external ring into the inguinal canal. If the opening be large, two fingers must be introduced; but above all, care should be taken that the hernia, once reduced, be prevented from slipping down. It may be necessary to obtain the aid of a skilled assistant to effect this, by pressing on the abdominal wall over the internal ring. The needle is then inserted about two inches from the inner column of the external abdominal ring (a), and about half an inch above the pubes, pushed downwards and outwards, keeping the point of the neeFig. 13.

Figs. 13, 14, 15 and 16 show the four positions in which the needle is inserted in the course of the operation. Throughout, a represents the spot where the needle is first is inserted; b, the point where the first stitch comes out; c, point where the second suture is inserted, d spot where needle first enters for third stitch.

dle deep and quite close to the abdominal muscles, till it meets the internal pillar fully a quarter of an inch from its free edge; this it pierces, and also picking up the conjoined tendon, is carried over the forefinger, lying in the canal, and guarding the spermatic cords and vessels, till it reaches the external pillar; under this boundery of the ring it passes for a quarter of an inch, when it is thrust into Poupart's ligament, till, traveling under the skin and superficial fascia, it comes to the surface at the same distance from the external pillar as its point of entrance was from the inner column (6).

By this means a substantial hold is taken of both pillars, which, before they are pierced, are tilted forwards, by the point of the forefinger from underneath, so as to avoid wounding the structures beneath. When once the digit is in the canal, and the operation commenced, it should not be removed till the stitches are finally pulled together.

The next step is to thread the needle (at b) with a piece of pure gold wire from fifteen to eighteen inches in length, and

Fig. 14.

sufficiently stout to withstand a tolerable strain; the needle is then withdrawn, and the wire left in its track. The second

from the inner pillar of the external abdominal ring, and an inch higher up than the first stitch. This time it is made to pierce the integument, subcutaneous tissue, and conjoined tendon; then it is passed on over the forefinger and Poupart's ligament (or the external pillar) to emerge at (b), the point where it came to the surface, in passsing the first stitch; the

needle is then wired, with the end hanging out there, and withdrawn as before. In passing the third stitch, a little more difficulty is occasionally experienced, and to do it neatly requires a certain amount of dexterity and some manipulatory skill. The long needle, sharp at either end as described, would render the operation less troublesome. If the same needle be used by the surgeon all through, the right hand and arm must be swept round the lower part of the abdomen, and the point of the instrument introduced through the skin and external pillar at a spot (d) about an inch from (b) and allowing for the obliquity of the canal, opposite the puncture where the needle entered in commencing the second suture (c). Having perforated Poupart's ligament, it now passes over the forefinger across the ring, over the internal pillar, and through the skin at (a). If the long needle be used, its course is naturally reversed; enter