presents distinct lumbar and pelvic ureteral spindles. The lumbar ends at the iliac arteries (common or external). Its termination is at what I have termed the middle arterio-ureteral crossing or at the flexura iliaca ureteris. Calculi which pass the proximal ureteral isthmus can easily pass the middle ureteral isthmus, unless the calculus acquire accretions while tarrying in the lumbar spindle. Kinks, torsions or flexures seldom occur at the middle ureteral isthmus.

The lumbar spindle is a constant structure. The right spindle, according to my X-rays and paraffin casts, is shorter and larger than the left, especially in woman. The dilatations, spirals and constrictions of the ureter is a heritage from the irregular calibered ducts of the Wolffian body. The lumbar ureteral function, which consists of rythmical contractions and dilatations, hence dominated by the sympathetic nerve, will be discussed with the general function of the ureter.

The lumbar ureteral structure, which consists of (a) a tunica mucosa (no tunica sub-mucosa); (b) tunica muscularis; (c) tunica fibrosa; and (d) tunica serosa, will be considered with the general structure of the ureter.

In pathologic ureteral dilatations the dilatation occurs in the spindles and proximal ends of the calices, not in the isth

muses.

Hydrotherapy in Chronic Interstitial
Nephritis.

The following hints are given by O. Lerch (New Orleans Med. and Surg. fournal, "Practical Medicine Series "); A warm bath for the care of the skin twice or thrice a week, with alcoholic friction, but not with cold ablutions, followed by rest in bed for one or two hours. A hot air bath or sweat bath at 40 degrees C., followed by a dry pack with rest in bed, but not by cold affusions. This is especially useful in edema, but should not be given unless the heart is intact. Winternitz advises the sweat bath of the lower half of the body with an ice bag over the heart.

In the future no one but a graduate of a regular school of medicine will be allowed to take any of the postgraduate courses to be given by the University of Pennsylvania Medical School.

SURGERY OF PROSTATE, PANCREAS AND DIAPHRAGM.

BY B. MERRILL RICKETTS, PH.B., M.D., CINCINNATI.

(Continued.)

I. SURGERY OF THE PROSTATE. GENERAL MISCELLANEOUS BIBLIOGRAPHY (1727-1902).

Pribram, A. Ein Fall von angeborener penisfistel ektopie der prostata? Vrtjschr. f. d. prakt. heilk., Prag., 1867, xcvi, 44-48, 2 pl.

Dittel. Beitrage zur lehre der hypertrophie der prostata. Med. Jahrb., Wien, 1867, xiv, 142152, 2 pl.

Bron, F, Hypertrophie enorme de la prostate. Mem. et compt. rend. soc. d. sc. med. de Lyon (1866), 1867, vi, 206-216.

Bousseau. Hypertrophie de la prostate valvule prostatique tentatives de fausses routes. Bull. soc. anat., Paris, 1867, xlii, 578.

Schmitt, A. Ein fall von entzundung der vorsteherdruse. Aerztlint-bl., Munchen, 1867, xiv, 672.

Gross.

Enlarged Prostate. Med. Record, New York, 1867-8, ii, 82.

Hammond, T. H. Enlargement of the Prostate and Stricture of the Urethra. Humbolt M. Arch., St. Louis, 1868, ii, 196-204.

Sesary. Hypertrophie de la prostate. Mem. et compt. rend. sc. med. de Lyon (1867), 1868, vii, 145-147.

Molineir. Bull. soc. anat., Paris, 1868, xliii,

608.

Reinert, H. Ueber ganglienzelen der prostata. Ztschr. f. rat. med., Leipzig, 1869, 3 R., xxxiv, 194-205.

Lenhossek, J. Santorini's Vesical or Prostatic Venous Plexus. Orvosi hetil., Budapest, 1869, xiii, 97, 113, 145, 2 pl.

Cheron et Moreau Wolf. Des services que puevent rendre les courants continus constants dans l'inflammation l'engorgement et l'hyperirophie de la prostate. Gaz. d. hop., Paris, 1869, xli, 594, 598, 1870, xliii, 1, 5, 14.

Hallin, O. F. Hypertrophia prostatæ. Hygeia, Stockholm, 1869, xxxi, 272.

Hahn, S. Ueber die verschiedenen leiden prostata. Berlin, 1869.

Paulicki. Partielle hypertrophie der prostata. Memorabilien Heilbr., 1869, xiv, 59.

De Bruyne, F. Hypertrophie de la prostate et de la vessie avec valvule triangulaire au col de la vessie incontinence d'urine et nephrite interstitielle. Ann. soc. d'anat path de Brux., 1869, xvii, 36 41.

Miquel. Memorie sur un moyen nouveau pour comprimer et dilater l'orifice vesical d l'uretre dans les cas de tumeur de la prostate. Rev. med. chir., Paris, 1849, v, 94 98. Also in his Tribut a la chir. prat., Tours, 1870-78, 82, 1 pl.

Mathieson, J. H. Prostatic Hemorrhage. Canada Med. Journal, Montreal, 1870.71, vii, 153. Lenhossek. J. A ferfi medencze visszeres torlata Pesten, 1870.

Kraus, B. Vorlaufige mittheilung ueber die function der prostata. Allg. med. Ztg., Wien, 1870, xv, 556

Furstenheim. Ueber einen fall von hypertro

Ferrin, G. A. Case of Enlarged Prostate. Tr. Wisconsin Med. Society, 1870, iv, 37-37.

Dubois, O. Hypertrophie des lobes latereaux et moyen de la prostate. Ann. soc- d'anat path. Brux. Bull, 1870, xix, 82 87.

Aubert. Presentation d'une hypertrophie prostatique enorme mem. et compt. rend. soc. d med. de Lyon (1869), 1870, ix, 2 pt, 187-189.

Reverdin. Tumeur periprostatique. Bull. soc. anat., Paris, 1871, xlvi, 20-22.

Patruban. Ueber das verhalten der harnrohre zur prostata. Allg. Wien. med. Ztg., 1871, xvi, 11-17.

Cases. Enlarged Prostate Causing Dilated Ureters and Pyelitis. Report Com. Pub. Charities, New York, 1871, xii, 52.

Mileik, A. O vospalenii jeliezi (prostatitis) v pat-anat. otnoshenii (Prostatitis from a pathologo-anatomical Point of View). St. Petersburg,

1872.

Walker, H. O. Lecture on Inflammation of the Prostate Gland. Detroit Review Medicine and Pharmacy, 1872, vii, 294 299.

Mowris, J. A. Enlarged Prostate, Vesical Catarrh and Consequent Renal Disease. Buffalo Med. and Surg. Journal, 1872-3, xii, 121-124.

Ashhurst, J. Jr. Chronic Hypertrophy with Adenoid Tumors of the Prostate Gland; Granular Kidneys. Philadelphia Med. Times, 1871-2, ii, 293.

Koch. Senile hypertrophie der prostata uremia mit totlichen ausgang. Ztschr. f. Wundaerzte u. geburtsh. Wimmenden, 1872-3, xxv, 265 271.

Mettenheimer, C. Ueber die v Schliess'schen einreibungen bei hypertrophie der prostata. Memorabilien Heilbr., 1872, xvii, 487-490. Quain, R. Clinical Observations on Some Forms of Enlargement of the Prostate Gland. Med. Times and Gazette, London, 1872, i, 566, 622.

Squire, T. H. Vertebrated Prostatic Catheter (Improvements in the Instrument. American Journal Med. Sciences, Philadelphia, 1872, lxiv, 433.

Firstenheim.

Ueber chronische prostatitis. Berl. klin. Woch., 1873, x, 487, 502, 5'4.

Stockton-Hough, J. A New Theory Concerning the Proximate Cause of the Enlargement of the Prostate Body (Gland). Philadelphia Med. Times, 1873-4, iv, 305.

Duret, H. Hypertrophie considerable du lobe median de la prostate. Bull. soc. d anat., Paris, 1873, xiviii, 163.

Squire, T. H. Paper on the Advantages of the Vertebrated Catheter in Prostatic Retention. Med. Record, New York, 1873, viii, 4.

Brinton, H. Hypertrophy of Prostate Gland; Retention of Urine. Med. and Surg. Reporter, Philadelphia, 1873, xxviii, 191-194.

Cases. Prostatahypertrophie. Jahresb. u. d. chir., abth. d. spit. zu Basel, 1873, 39.

Wharton. Disease of the Prostate Gland. Dublin Journal Med. Sciences, 1873, iv, 371.

Levis, R. G. Hypertrophy of the Prostate and

its Complications. Philadelphia Med. Times, 1873-4, iv, 485.

Curtis, F. B. On the Use of Catheters in Hypertrophy of the Prostate. Boston Med, and

Surg. Journal, 1873, lxxxix, 525-529.

Logan. Ergot in Enlarged Prostate Gland. Atlanta Med. and Surg. Journal, 1874-5, xii, 460. Hedenius and Brunn. Upsala lakaref Forh., 1874-5, x, 389 397.

Biagi, Z. Di un calcolo vesicale complicato a cancro della prostate della vessica. Ann. univ. di med., Milano, 1874, ccxxix, 326 331.

Cowan, G. Descriptions of Two Modifications of the Nelaton Catheter. American Journal Med. Sciences, Philadelphia, 1874, lxvii, 359 36.

Touplian, E. De l'hypertrophie prostativue et de son traitement. Paris, 1874.

Hillebrand, B. Ueber hypertrophie prostata, Bonn, 1874.

Kirmisson. Hypertrophie de la prostate ayant rendu impossible le catheterisme ponctions de la vessie autopsie. Bull. soc. anat., Paris, 1874, xlix, 830.

Bailey, J. S. Senile Hypertrophy of the Prostate with Cases. Southern Med. Record, Atlanta, 1874, iv, 205-217.

Pauli, C. Ueber harnretention in folge von prostata hypertrophie und ihre symptomatische behandlung. Deutsche Klinik, Berlin, 1874, xxvi,

302.

Sanders, H. Case of Enlarged Prostate Followed by Cystitis. Cincinnati Lancet and Observer, 1874, xvii, 715.

Mallez. Traitement de la prostatite subaigue par les courants continus. Bull. soc. de med. prat., Paris, 1875, 12-14.

Socin, A. Krankheiten der prostata handb. d. allg. u. spec. chir. Stuttgart, 1875, iii, 22, abth. b. abschn.. vii, No. 41-115, 4 pl.

Jurle. Zur einspritzunglvon jodtinctur bei prostata-hypertrophie. Mitth. d. ver. aerzte in Nied Cest, Wien, 1875, i, 246-248.

Zambianchi, A. Contribution a l'etude de l'hypertrophie de la prostate, Paris, 1875.

Bontemps, C. Hypertropie generale de la prostate avec cystite du col retention d'urine hernie double tres-volumineuse et irreductible impossibillite de penetrer dans le reservoir urinaire cinq ponctions de la vessie catheterisme practicable au bout de dix jours. Gaz. hebd. de med., Paris, 1875, xii, 37.

Gant, F. J. Diseases of the Bladder, Prostate Gland and Urethra, Including a Practical View of Urinary Deposits and Calculi. Fourth edition, London, 1876.

Lee, H. Prostatic Discharges. St. George Hospital Reports, 1871, London, 1876, vi, 17-35. Zemillantis, D. On the Origin of Amyloid Bodies in Prostate Gland. St. Petersburg, 1876. (To be continued.)

IN important amputations always loosen the Esmarch bandage very gradually, after having tied the few vessels whose divided ends may be easily found. This prevents a too rapid distention of the vessels with blood, and any further bleeding is more easily controlled.—International Journal of Surgery.

A Weekly Journal of Medicine and Surgery.

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CINCINNATI, O.

SATURDAY, JANUARY 10, 1903.

THE KASAULI PASTEUR INSTITUTE. In one of the most charming of our medical exchanges, one, too, that comes to us from the fairy land of Rudyard Kipling, i.e., India, we extract the following editorial on "The Kasauli Pasteur Institute." The Indian Lancet, of Calcutta, has always been a source of admiration on account of the fairness of its editorial criticism and the discrimination it ever shows in the matter of its general literary material, be it original or selected. This journal, too, is one that is not a scoffer at microbian theories, but a very careful analyst of all that goes on in the field of modern medicine. But to the editorial in question. The Indian Lancet says:

"When the man in the street ventures to question the conclusions of so-called experts, his criticisms are generally, and perhaps in most cases rightly, pooh-poohed as worthless and of no account.

But there

are cases where common sense has confounded empiricism. We wonder how time will deal with the Kasauli Pasteur Institute-whether the institute will confound the scoffers or whether it will be confounded! To hazard a conjecture would be dangerous and perfectly useless. All the same we are entitled to form our opinion on the premises on which the in

dence and public funds. For the year ending August 8, the officer in charge reports having treated 543 patients (215 Englishmen and 328 natives), five of whom, all natives, died. The expenditure during this period is reported to have been Rs. 17,020. The question is whether these figures indicate a successful result and justify the existence of the institute. It must be remembered that every case of dog bite does not necessarily mean a case of hydrophobia, so that it is impossible to say how many of the 538 patients treated at Kasauli who did not develop the dread disease owe their escape to that treatment. On the other hand, we are confronted with the absolute certainty that five persons who underwent the treatment did not thereby avoid their doom. Therefore, if the institute lays claim to having saved 538 cases from a horrible death, for which service an expenditure of Rs. 17,020 was comparatively insignificant, unbelieving thousands can with equal assurance retort that the whole 543 persons would have escaped at no cost whatever but for the treatment at Kasauli, which must therefore be responsible for the five deaths; while the more moderate might consider that in the natural course of events five out of 543 persons were destined to develop hydrophobia, and the treatment at Kasauli exerted no influence one way or the other. There are too many doubtful factors to allow of any definite conclusion being arrived at. There is the doubt whether the animal was rabid, and even if that was with certainty removed, the further doubt remains whether its bite would cer

tainly communicate its disease. These two doubts are sufficient in themselves to vitiate any conclusions, but they are not all. There is the greatest doubt of all whether the treatment is efficacious-and certainly it is not invariably so considering the five fatal cases above referred to-or whether, as some even fear it does not cause, or at any rate assist the development of the disease it is supposed to prevent. In the midst of all this uncertainty, one fact stands out clear. That is, despite government backing, despite its influential official supporters, and despite special advertisement, the Kasauli Institute, or rather the Pasteur method of treatment, has not yet made out its case. The number of patients operated upon is not, and

never can or will be any criterion of its success, while the number of such patients who die is a dead certainty of its failure in such cases. The very utmost that can be urged at present by the most ardent supporter of the treatment is that it tends to relieve the mind of the patient of anxiety and suspense. But if we remember rightly, in the formidable list of actual cases which the anti-vivisectionists were able to muster up in disproof of the pretensions urged by the advocates of the Pasteur system, there was one in which an English nobleman and his gamekeeper were bitten by the same animal; the nobleman proceeded to Paris for treatment while the keeper adopted no such precaution, with the result that the nobleman developed hydrophobia and died, while his keeper showed not the least symptom of the disease. So that whatever consolation remains to us is of the very slenderest, and it is certainly not augmented by the further statement that death from hydrophobia was practically unknown in Germany prior to the establishment of Pasteur institutes."

All of this Indian Lancet editorial is so logical that we defy even the really brilliant men who support such institutes at Chicago and Johns Hopkins to furnish a reply that will fit the occasion. In cases of hydrophobia it is too often the case that

"The man it was received the bite

The dog it was that died."

It is the misfortune of modern medicine that while it has much in it of true science, it is too speculative and illogical. It has suggested much to the general public that, while purely imaginary, has nevertheless developed a species of delusion. Ten years ago no one even suspected nor was it suggested that ordinary colds in the head were contagious, but the public was educated up to microbian ideas. When one man sneezed with an ordinary coryza the whole family sneezed in sympathy of belief in contagion. Then they all took antiseptics into their noses to destroy the microbes, and the medicine stirred up such an irritation of the whole Schnei

SPECIAL EDUCATION OF THE MENTALLY DEFICIENT.

The Board of Education of the city of New York recently required the principals of the public schools of that city to make. a report as to the mentally defectives in their respective classes. Out of 500,000 children attending school there were reported 8,500 mentally sub-normal, a percentage of 1.7 from mental deficiency, and not able to obtain the proper advantages of class education, and who in consequence are likely to suffer more or less seriously from the over-strain that must naturally attend their co-education with ordinary bright pupils. The first thing that strikes us in this report is the exceeding small ratio of children as being not up to a given percentage or average of mental attainments. While not inclined to go back of the returns of the New York school principals, there is an indication of a necessity for an establishment of special schools for the training of this class of pupils. It will be well for other cities to enter into a series of investigations for a similar purpose. There should be a report made as to all children who are to be classified as weak-minded, epileptic, or not in possession of normal faculties. Such children, wherever found, should be given the advantages of special individual attention that cannot possibly be given them in the ordinary schools save at the expense of their more intelligent

fellow-pupils. To the writer this seems to be a matter of very great importance, and should receive the attention of all boards of education. The requirement of such an examination as the one indicated may be made by the principals of the various schools. This will bring the matter to the attention of law-makers as to the interests for the special care of such children.

INFLUENZA OR GRIPPE.

kind brings up! What reminiscences he can tell! Forty-seven years ago there were not more than five medical journals published in the United States, of which the LANCET-CLINIC was one, the latter having been founded in May, 1841. There was a newness of the country and of the entire State of Indiana and all that was west of that State. Gold had just been discovered in California, and nearly all between the Mississippi River and that State was down on the map as the great American desert. What conditions of

its effects, has crossed the Atlantic and duly appeared in this country, and in the Ohio Valley within the past ten days. This epidemic in America is not near so frequently fatal or severe as in former years, usually affecting the bronchial membranes, resulting in bronchitis, which is often troublesome. The cough is always of a most distressing character, and is apt to lead to intercurrent affections. Apparently the best that can be done for cases of this character is to treat them on general principles, there being up to this time no known specific for the disease.

manifestations and treatment could be told

of by Dr. Lindley! The science of pathology has changed within that time not less than four times; at least, the scientists in medicine have made such claims, and our footings are not altogether clear What in this respect at the present date. roads the doctor has traveled! Corduroy, brushwood and all sorts, including modern macadam. The winters and summers, the extremes of heat and cold, year after year, for forty-eight years. Just think of it! In the saddle, sulky and buggy, always dispensing his own remedies. The practitioners of Dr. Lindley's early days were invariably good observers. To be sure, much of their practice-indeed, most of it was empirical in character. There was little or no pathology of any kind taught in the medical schools of that pe

riod.

Medicine has made marvellous progress since the days in which Dr. Lindley began to practice. The Boston Medical and Surgical Journal and the American Fournal of the Medical Sciences, with the LANCET-CLINIC, were the medical periodicals of that period. Two or three others, notably the New Orleans Medical Fournal, the St. Louis Medical Journal and the Nashville Medical Journal, were started about that time. But the three first named were practically the only ones from which he had an opportunity to make