desired purpose can be accomplished. This can be readily understood where there are many partisans wedded to an only method.

What has been regarded as a most innocent means when opposing sentiments could be overcome by the argument that sexual life is at an end, viz.: castration has been before the profession for quite a number of years. Without entering into a discussion of the subject, I am personally satisfied that in the majority of instances it has failed of its purpose.

The Bottini method, in skillful hands and properly selected cases, has often been beneficial in its results, but it is by no means universal in its application nor devoid of risks.

Suprapubic puncture or incision with a view of applying a temporary or permanent drain, is accompanied with little risk, and though perhaps inconvenient, brings great relief and often prolongs life. A number of methods. and devices whereby the bladder can be emptied at will, without intervening leakage, have been fairly successful, but they all present the features of an apparent hardship, because unnatural.

The removal of the obstructing organ by either the high section or combined with a perineal cut, to my mind, is the correct method, whereby certainty is substituted for doubt.

One must certainly be endowed with preternaturally long fingers if he is willing to depend upon the perineal route alone, especially in fat subjects.

In some instances' where one, after sounding and cystoscopy, is reasonably sure that the bulk of the gland is extra vesical, the urethral floor may be lowered by approaching the obstruction through the perineum without opening the bladder, after the method of Dittel, or one of its several modifications. It goes without saying that this is not always feasible. It would be of considerable interest and, if time permitted, of much service to enter upon the technique of these various methods, but being confined to the exacting limits of your rule, I am obliged to desist, hoping, however, that the experiences of the members may be brought out in the discussion.

A number of complications that are prone to arise in the course of the so-called prostatic disease, could be profitably included in this paper, but I am obliged to refrain for the reasons above stated; but if I have succeeded in injecting a number of salient points into the discussion, or perhaps divulged some valuable hints in what may be regarded as a quasi disease, I shall be amply repaid for the time and labor bestowed upon this synopsis.

EYE HOSPITALS OF FRANCE, GERMANY AND ENGLAND.

GEO. W. MASON, M. D., Parsons, Kan.

The members of the American medical profession who visit France come home with a feeling that the French doctors are composed, as a whole, of clever gentlemen and most excellent disciples of Aesculapious. For there the members of the American medical profession are treated with the greatest consideration. The French people have a warm feeling for all things American; a trait which has been handed down in history from the time when Lafayette joined the American forces and helped us win our independence. England has never fully forgiven France for this, or America for the thrashing we were compelled to administer.

This friendly relation is still maintained and is shown as soon as you are introduced as an American. The hospitals of Paris are models of perfactly arranged buildings. While the exterior may have been built more than a thousand years, the interior has all the modern conveniences. The hospital that most interested me was the National Ophthalmic Clinic, a model in

stitution of its kind, and perhaps different from such institutions in the United States, in the manner in which it is conducted. The buildings and courts cover thirty-two acres of ground. Here the poor of Paris receive free treatment, and if unable to support themselves, are furnished a room with board. If, as is often the case, an inmate has a wife or family of minor children, the government provides quarters for them, so that the family are not separated. The wife or children are permitted to go out to daily work and earn the living, returning at night. The cooking is done by the family, and is an admirable arrangement to keep families together. On two afternoons a week a military band is paid by the government to play in the court for the inmates. Sentiment of this kind is in evidence on every hand in this city. In this clinic the celebrated Dr. Trouseau operates once every two weeks. He does nothing but cataract extractions, and seems to have a method all his He does the operation with but one instrument, a cataract knife, making his puncture in the usual place, and as the knife passes the pupil, depresses the point so as to lacerate the capsule, then elevating, comes out at the usual place. The balance of the operation is done so rapid that it is hard to follow the movement, but the cut is made entirely in the schleral margin. The back of the knife is then used to depress the upper part of the eye, at the same time pressure is made with the left hand on the inferior part of the eye, the lens comes up through the pupil and escapes through the incision without the slightest trouble. While this man does not have the praise he deserves from the medical profession in Germany and England, he is looked upon by his French colleagues as the most skillful operator in France. The government has erected a general hospital in Paris with a capacity of 800 beds, and named in his honor. Dr. Trouseau is alone in this method of operating, and is generally condemned by the more conservative operators. in Europe. The chief dangers are a greater tendency to prolapse of the iris. which is apt to be followed later by Glaucoma. I saw several of his patients that had been operated on some time before, and saw nothing but favorable results. There is nothing gained by rapid operation, the slower methods produce just as good results, except, perhaps, the coloboma, which remains after an iridectomy, which is a very small objection, as the upper eyelid covers the most of that.

Another complete eye hospital in Paris is the Hospital Lariboisiere, called after the countess of that name, who bequeathed the money to build the hospital. Dr. Morax is in charge. His cataract work is done with an iridectomy, a great deal of attention is paid to the proper sterilization of every thing used in operating, from the bandages to the instruments.

Perhaps the most famous hospital in Paris is the Hotel-Dien, which cost the enormous sum of 45,000,000 francs. This hospital is admirably fitted up with 828 beds, and is devoted to general work. It also has a staff of physicians to look after special cases. Here one always receives courteous treatment by the officials. You are invited to go through the various wards and can also witness the clinical work.

This hospital is only one of twenty general and special hospitals in Paris, which have an aggregate of about 12,000 beds and treat nearly a half million people annually.

Americans going to Europe for a post-graduate course in medicine should spend some time in Paris, as the clinics are open to visitors. While the language is French, the medical terms are Latin, and the pronunciation differs very little from the same terms as used in the United States. The professors nearly all speak English, so there is no trouble in getting the knotty points

explained. Last year saw many American physicians in Paris, and nearly all of the clinics were attended by some Americans.

A jump from Paris to Germany is like going into a new world. Here we have an entire change in the mode of living, as well as in the language spoken. The German professor is a man of profound knowledge and dignity. Doctors there approximate very closely to the nobility in the estimate of the people-if they do not in title, they certainly do in their humane work. The medical man has a finished education; it does not mean a three or four year or less course of study. So the men who enter the German medical ranks must have ample means. The laity have great respect for him, for what he knows, and his standing in society. Here is no field for the advertising fraternity. You do not find the pretender advertising a diploma, after a long, continuous course of two weeks' study, and it is to be hoped that some time in the near future, such wholesome laws will be enacted in the broad land of America.

The hospital internes show by their politeness the respect they have for the Herr Professor, for as soon as he is announced, every thing else is dropped to salute and follow the professor, listening to his remarks as he examines patients and gives directions as to treatment. He is the man who does most of the major operations. One of the greatest of these men is Prof. Sattler, of Leipsig Augen Klinic, who has done much for the relief of myopes. Prof. Sattler informed me that he has operated on over 300 cases. His method is to extract the transparent lens in cases where the degree of myopia was twelve dioptres or more, that he frequently had vision of 6-12; formerly he had done the ordinary needling operation, followed by the curette, but this immediate extraction was found to be the best.

Sattler's operation for senile cataract is done with an iridectomy, but the after treatment is unusual, as all former rules are ignored. He does not use a bandage on either eye, merely a wire gauze protector over the eye operated on, to prevent accidental injury, and contends that the movement of the lids tends to make the toilet of the wound more perfect.

Some weeks in Berlin gave me an opportunity to become well acquainted with the German methods of hospital work and the routine of treating the outdoor patients, principally at the Koenig Universitats Klinik fur Augenkrankheiten, where the staff consists of Prof. Michel and ten resident house. surgeons. The number of out patients treated here daily amount to several hundred. The chief house surgeon examined and treated 220 cases in one day during my stay. In this clinic Prof. Michel does the major operations, the smaller operations being made by the assistants.

Unless the number of cases for operation amount to at least a half dozen, they are postponed until the next day, when a sufficient number of cases are sure to be on hand. Michel is an excellent surgeon, and does a very nice operation, but he is a little past the age for the best work. His cataract operations are made with an iridectomy, but in some cases the knife is introduced behind the iris in making the flap.

The wards in the hospitals have all the modern means of sterilization. and carts for conveying instruments and dressings. The hospital has an isolation ward, where contagious cases are kept. Such cases as gonorrhoeal ophthalmia and oph nanotorun are to be seen in this ward.

One thing noticed in the German university hospitals is the large number of doctors with scars on the face and head, perhaps the number will be as many as one in three. The young doctors seem to be proud of the marks, which are made in the settlement of disputes by sword contests. Duelling is

still common in Germany. Some of the scars look recent. larger the scar the greater the honor.

It is said the

The teachers in medical schools are paid by the empire, and are liable to be sent, in turn, to the various schools in Germany, and like our regular army officers, have a lifetime position so long as their services prove satisfactory.

After a stay of five weeks in London and seeing something of medical life, the conclusion is easily reached that Londoners have an idea that all original methods in medicine and surgery necessarily start from London. For instance, referring to the cataract operations as done by Trouseau in Paris, one of the chief surgeons of the Royal Ophthalmic Hospital said he did not consider that the equal of a story he had heard, as coming from America. He had been told that the Boston surgeon had become so expert that he operated on both eyes at once with a knife in each hand. Probably the idea of English superiority is derived from the fact that so many American doctors visit London for post-graduate studies. There is a great field here for clinical material, where it is said that 50 per cent of the population are objects of medical charity after reaching the age of sixty years.

There are many hospitals in this city, the largest of which is the London Hospital, located in the populous and poor quarter, Whitechapel. This hospital has 900 beds and treats 500 outdoor patients daily and has 300 nurses. Westminister Hospital is one of the very ancient structures, where can be seen a great deal of general work.

St. Bartholemew's Hospital has about 500 students.

The Royal College of Surgeons is merely an examining board, where the students are sent for examinations for the degree, and takes no part in the teaching. Just along side this college is the great Hunter Museum, free to medical men. Here may be seen an almost endless collection of pathological specimens, as well as antomical dissections, of all parts of the human body, together with those of the animal creation. The museum has about eight large halls, two stories each, all full, with descriptive catalogues for each section.

The finest hospital in the city is St. Thomas's, situated on the banks of the Thames, just opposite the House of Parliament. The buildings are segregated, and consist of seven immense structures, all connected with a long colonade. The walls are built of marble, the floors mosaic and make a grand promenade for convalescents. Looking from one end of the colonade it appears a half mile in length. Here may be seen all kinds of operations, from the most trivial to laparotomies.

Guy's Hospital is almost exclusively patronized by the British medical students, and is a very exclusive institution. On inquiry, there was not a single American student enrolled, and during my afternoon in this place, from the curious and quisical glances cast in my direction, I concluded the hospital bore a most fitting name.

At the London Throat Hospital the work goes on with great dispatch and skill. About twenty or thirty pairs of tonsils are excised every Thursday, the day for this variety of operations. These operations are done in less than two hours. The plan, briefly told, is as follows: The anaesthetic used being nitrous oxide gas. The patient sits up in a chair, the anaesthetist stands up behind the patient. A nurse straps and holds the patient, the gas is given and the operator, sitting in front of the patient, rapidly uses a Mackenzie tonsilatome and curettes the adenoids all before the patient has time to recover from the gas. Before the patient fully recovers from the anaesthetic, he is led from the room and another patient brought in.

A month of my time was spent in the Royal Ophthalmic Hospital, which seems to be a favorite place for American doctors, for there can be seen several students from the United States daily. The work is instructive, because the students are required to work out refractive cases and make reports of results to their respective instructors, which are then corrected, if unsatisfactory. There is a fine clinic in the Ophthalmoscopic room going on all the time. Rare cases are in turn pointed out to the investigators. When through with this department the tinkling of the electric bell announces that operations are about to begin in the operating room on the top floor. The room itself does not contain a single piece of wooden furniture, the walls and floors being tiled.

The number of cataract operations done here amount to about three hundred a year. I was informed by Mr. Long that they had only one case of suppuration the preceding year, due, he thought, to a new assistant who was not familiar with the proper sterilization of instruments. The staff of surgeons consists of the most celebrated oculists in London. Such men as Messrs. Tay, Tweedy, Gunn, Lang, Silcock, Lawford, Morton, Collins and Spicer operate in turn. The hospital is open to qualified medical practitioners, and certificates are issued to students who have attended the practice of the hospital for not less than three months.

Anæthetics for general operations in most of the London hospitals are given for rapid effect, by first using nitrous oxide gas, followed by chloroform for a few minutes, finally to continue the anathetics, æther is used. The three anathetics act rapidly, the first requiring about twelve full inspirations to produce its effect. The chloroform holds the temporary anæsthesia and the æether follows the chloroform because of its greater stimulating property.

After seeing the same work done by the representative men of France, Germany and England, we conclude that the same operations have a distinct individuality. No two operators do the same operation alike. Some of which were an improvement on the methods as taught in New York, while others. seemed to look like the surgeon was taking needless chances for his patient.

*PREPUTIAL ADHESIONS IN THE FEMALE.

E. B. LA FEVRE, A. M,, M. D.

Late Professor of Pathology and Bacteriology in the Kansas Medical College, Abilene, Kansas.

Within the last few years the profession has learned to examine the prepuce of the male whenever any obscure nervous phenomena occur which are not readily accounted for by other obvious causes. Oftentimes in the male a phimotic state of the prepuce is discoverable, with, in the majority, a prepuce more or less adherent with the glans. This condition is now generally conceeded to be capable of giving rise to many and varied reflex disturbances; so that even the merest tyro looks for, and recognizes, the pathologic sequence. These preputial adhesions in the male are oftentimes sufficient to render the individual subject thereto, where he is already predisposed to neurotic and neurasthenic tendencies, to a most miserable train of symptoms. So intense are the phenomena in some cases that the subjects even become mentally irresponsible; and efforts at self-destruction are not unknown. The phenomena may be of all degrees in intensity, from the very mildest and trivial, to the extreme indicated above.

This state of affairs being so well recognized in the male, it seems to me to be, to say the least, nothing short of curious, that this same profession

*Read before the Golden Belt Medical Society, at Salina, Kansas, October 3, 1901.