lish an abnormal deviation in the size of any part of the urethra by exciting muscular contraction; the most important of which are the following: Catheterization, free use of alcoholic stimulants, irritation about the rectum, caused from the presence of ascarides, tapeworm, etc., hemorrhoids, fissure of the anus, fecal accumulations, surgical operations upon this part, disordered digestion, mental emotion, exposure to sudden changes in the atmosphere, etc.

The next general class is known as the permanent or organic variety. While this kind of stricture is altogether different from the spasmodic, there is often a complication of the two classes. The organic variety differs from the spasmodic by being of a constant caliber, and can only be gradually and slowly dilated, whereas the spasmodic variety is of no uniform caliber, and is subject to sudden variations.

Organic stricture may be caused from chronic urethritis, which results in the deposition of plastic material, and upon the organization of which contraction takes place which causes permanent narrowing of the urethral canal, or it may be caused from traumatism. Gross, Bumstead and Taylor seem to think that masturbation sometimes plays a conspicuous part in the formation of this lesion. The seat of the stricture may be in any part of the urethra, consequently the constriction is characterized by no definite location; but most frequently it is found in the sub-pubic curvature, as shown by Thompson. Out of three hundred and twenty specimens examined by him, he found 67 per cent in this location, and 33 per cent in the spongy portion of the urethra, which indicates that these two portions are most frequently the location of this trouble.

Whether the stricture be due to spasmodic contraction, traumatism, or deposition of plastic material, it seems as if there would not be more than one existing in the same subject at the same time; but this is not always the case. While there is not often more than one, there may be, however, three or four. Sims says from one to twenty; but I think he is extravagant in his views, because I think it is very seldom that we have as many as three or four, and very rare in

deed to find as many as six or eight. Thompson found, out of two hundred and sixty-seven specimens examined by himself, two hundred and twenty-six single strictures, the remainder being multiple.

The degree of contraction in the permanent or organic stricture is never sufficient to produce complete obliteration of the urethral canal, when it is not of a traumatic origin; but when the lesion is due to a traumatism, then this constriction is sometimes sufficient to cause complete obstruction of the urethra.

The pathological anatomy of urethral stricture can easily be accounted for, from the condition which the genito-urinary organs are necessarily placed. The part of the urethra behind the constriction is dilated sometimes to such an extent as to make a fluctuating tumor in the perineum, caused from the presence of urine, which is impeded in its course from the bladder; sometimes it may become contracted from chronic inflammation existing in these parts.

Abscess and fistula may take place from infiltration of urine into the cellular tissue, caused from straining at micturition.

The canal in front of the constriction is generally normal; sometimes it is in a state of chronic inflammation, which is brought about by the sympathetic irritation existing between this and the portion posterior to the lesion. The muscular walls of the bladder may become hypertrophied under the undue amount of work which the bladder is necessitated to do, in order to expel the urine through a contracted urethra. The ureter and pelvis of the kidneys may be dilated and the medullary substance may be atrophied.

Symptoms.-The earliest manifestations of this trouble are a gleety discharge, and loss of control, to some extent, over the action of the bladder, as characterized by dribbling and frequent and painful micturition, etc. The stream of urine is sometimes divided and is changed from its normal course to a spiral or corkscrew direction. A feeling of heaviness or uneasiness is experienced in the perineum and region of the bladder, and pain or a dull aching sensation in the back, loins, testicles, and sometimes acute pain in the urethra and glans penis, at

Piece of Knife Blade Taken From the Palatine Arch.

William, a laborer, some time since applied to me, to extract what he thought to be a tooth, emerging from the median line of the roof of his mouth, saying that, "it was cutting his tongue, and would like to have it taken out."

Upon ocular inspection, and digital examination, instead of what he supposed to be "a tooth," I found to be the end of some metalic substance, protruding down and through the palatine arch, into the mouth, about one-fourth of an inch.

I applied a pair of strong and closely fitting forceps to the substance, and with a very considerable tractile force, succeeded in removing the fragment of a dirk-knife blade, one and three-fourths inches long, and one-half an inch wide, to our great surprise.

The patient, after being closely interrogated with regard to how it became imbedded in that locality, said: "Four years previous, he had an altercation of a serious character with another man, who "dirked" him with a knife, the blade of which was broken off at the outer angle of the left eye.

A physician was immediately called to the case, who anæsthetized the patient,

and after numerous manipulations, reported to the patient and his friends, that he had removed the piece of knifeblade. He also received his fee.

Now, four years after the melee, the knife-blade was removed, much oxydized and giving every evidence that the physician had not removed it, as he had reported.

The extraordinary peculiarity in the case being, how this foreign substance should remain imbedded in the parts, and in its passage to where removed, so long, without producing serious evidences of its presence. The patient having been all the time unconscious of its presence, through pain or inconvenience, until I removed it, as above stated, and in presence of witnesses.

The case certainly proves at least that things found in the mouth, "cutting the tongue," may not necessarily be "stray teeth." T. WILLIAMS, M. D., Late Surg. U. S. A.

South Jacksonville, Fla.

Nostalgia,

Or home sickness, bespeaks in its varied influences and attachments to birth, place, surroundings, impressions deeper and far more lasting and intense than appears to the eyes of the superficial observer of the world's routine customs. The evidences of these inbred effects are especially noteworthy in persons of cultivated tastes and sympathetic affections. However worldly wise they may be in the affairs of material gain and loss, a physiological observer of keen perceptions can not fail to trace an under current of common instinct alliance that extends from mind to matter, and exerts in mental reciprocation phenomena of the most marked and varied character.

In persons nearly allied by relationship these effects are more prominently brought forth from the meeting of opposite sexes whose family histories become known to each other in the chapter series of accounted accidents, conveyed from impressions of attraction or aversion. In tracing back to source these apparently unaccountable impressions, it is developed that under different names and foreign associations the families have been remotely derived from the same stock. In like manner inanimate agencies have

been the means of reviving and exciting anew, trains of nostalgic impressions, either of aversion or attraction.

From time to time these evidences of occult alliance will gain such force of concentration as by conjunction to attract in some remarkable way attention, as in the supposed birth influence of the son of the seventh son, and like hereditary transmissions of a nostalgic origin.

The human family by the mental process of memory, being able to retain and compare the past with present, have been able to test for a longer period the recurrence of remarkable events, and according to their analytic powers of perception, trace them to their cause. Upon the acuteness of their perceptive analytic discernment depends the correctness of their diagnosis.

Through all the affairs of life, and in death nostalgic symptoms prevail to expiration of the last breath, and in some measure express in foreboding or exultant sympathy the ante and post-mortem extension of the conscious principle of vitality.

Through these premonitions of continued life, we almost innately found our assurance of germ resurrection, and in accordance with the perfection of our conceptions, clothe our creations of imagination with the beauties of poetry and and songs of praise and thanksgiving. If, however, we endeavor to ultimate any fixed fact upon our actual knowledge of the constituents of vitality, we invariably fall back upon the old routine formulated from and demonstrated by experience. The chief of these derives its animus from the frailties and uncertainties of human existence.

The bible theories of a state of renewed existence draw their strongest support from the elements of nostalgic impressions, and through their interpretation thought and memory derive their inspirations to confirm the mystic conjunctions of hopeful expectation.

As the entire human family when in freedom from physical defects enact similar roles in the functions of sustenance, thought and action must in the main correspond, and become more or less confederated by nostalgic sympathy. That the prepossessions of our anatomical and physiological community of organs and

functions should in associate companionship generate a mutual dependency, and sympathetic aid communication follows as a mental sequence of cause and effect.

As an example, we find that the cultivators of the least productive lands, are the most energetic and fertile in resources and as in Switzerland are the most peaceful self-dependent and friendly in nostalgic intercourse, the rugged soil entering into partnership with their labors in the struggle of life for an existence.

The economistic life of the Swiss, demonstrate more clearly than any other people, the community demands of the associations for the preservation of health and peaceful good will while their prevailing industry and former habits of temperate living, made them exemplars upon which to base the physical requirements of a system of adaptation of nostalgic premonitions as a basis guide in the reconversion of our animal bodies, after death, into the future sentient personalities of a re-born and reconverted cannibal elementary products, of previous human and vegetable constituents of animality, reduced to ultimates derived from the recompositions of preceding composite generations, will afford prognostic material to determine the favoring habitat of human elements qualified with the predispositions required for the reproduction of a perfect race.

As like is derived from, and assimilates like, in the organic and inorganic world, of composition and decomposition, this can only afford the true metempsycostic process of " "heavenly" regeneration.

ELTON R. SMILIE, M. D.

San Francisco, Cal.

Small-Pox et Syphilis.

Will some of the readers of the BRIEF please tell what effect small-pox will have on a syphilitic patient (in any stage of syphilis) other than it would have on a subject not infected with the disease. Will it increase the action of the syphilitic poison or will it diminish it. Will it, under favorable circumstances and good care (treatment), leave the patient with his syphilis unaffected.

G. W. FRAKER, M. D. Excelsior Springs, Mo.

Rhubarb for Hemorrhage in Typhoid

Fever.

I wish to relate the following case in practice, and add a few remarks.

On November 4th, 1858, I was called to see E. L., sick with typhoid fever. He had been sick for a number of days, treated by an aunt, in whose family he was sick, who, by-the-by, esteemed herself, as others did, a competent nurse, and quite a doctor.

I gathered from some source that Lee's Antibilious Pills had entered into the treatment, and but for imprudence on the part of the patient, in getting up, and going eighty or a hundred rods, up quite a hill to a school building, resting for an hour or two, returned to his room, and bed, never to leave it, until carried forth by the undertaker. It was supposed to be a relapse induced by fatigue.

I attended him about seven days, with nothing marked in his case, and about the eighth day, I was called in haste, the messenger saying: "That fellow has got the dysentery." "Dysentery!" I replied, "he has hemorrhage from the bowels." I hastened to his room, about one-eighth of a mile distant, and commenced a course of treatment with astringents. I gave them faithfully, choosing different ones, together with opiates. But nothing seemed to cure the case. I then called my partner, Dr. J. R. Hartshorn, and we together prescribed,

and also staid with him much of the

time, one, or both of us, by night and by day. But, by the most persevering use of all approved remedies, he still continued to pour out his life's blood, until we were amazed at the amount lost. The longest we could hold his bowels was about four hours, and then would come an extra amount. Sometimes I think more than a quart at once. This went on for seven or eight days, until it seemed that he could not have a drop of blood in his body.

Dr. Hartshorn says: Well, we can do nothing but push the astringents, that is all. I replied, in substance, doctor, we have now pushed the astringents for more than a week and have gained nothing, and lost much, and to follow the course longer, promises nothing better. I said to him, my mind is to turn square about, and give him some full doses of

rhubarb until we thoroughly clear out his bowels. The doctor consented, and dealt out the powders with his own hand, containing as nearly twenty grains each as he could make them. We ordered them once every two or three hours, I do not remember which at this writing.

In a reasonable time the medicine took effect, and kindly moved the bowels, after which, not a particle of blood passed. At this time, he was so completely exsanguinated, that he was as pale as a mortal could be. We then tried to hold him up with nourishment, beef tea, gruel (milk in fevers was unheard of), eggs, with tonics, quinine, carb. ammonia, camphor, etc., with brandy; but the vital fluid was spent, and we had to surrender our patient, however unwillingly.

Soon after this, an old gentleman, a patient of mine, after only а day or two of sickness, developed a severe hemorrhage from the bowels. Being a family in which Dr. H. had formerly attended, he was called in. He prescribed astringents. I took him aside, asked him if he remembered the case of E. L., and the treatment we gave him. I said to him, I should give him rhei. He looked wise, and said, let us examine the evacuation again; he looked at it, and said, we will give him rhubarb. Its action was prompt, and no more hemorrhage. This was not a case of fever.

I have used the rhubarb treatment for

hemorrhage for over thirty years, and have never had it fail to give prompt relief.

My friend and former pupil, who has had a large ride for over thirty years, bears testimony to its unfailing promptness in curing the hemorrhage of typhoid fever; it never fails him, so he affirms.

I like the BRIEF because it fills a place in medical journalism which no other journal does. I look for its monthly visits, as I would to the visit of an old friend. I am glad of its prosperity, and think I do not have any too much time to peruse it, although a monthly. H. P. SAUNDERS, M. D. Alfred Centre, N. Y.

THANKS.-Subscriptions are coming in

handsomely.

About Calomel Again. Clint L. Luce, M. D., in the February BRIEF, in an article entitled "Some Thoughts on Calomel," advances a few ideas that are directly opposed to what has been my experience during the four short years that I have been in practice.

The subject of calomel, one would think, would have been worn threadbare by this time, and the discussion stopped, with all the points settled; but, like Banquo's ghost "it won't down." And why? Simply because it is a valuable remedial agent that we can't very well dispense with. I am not what Dr. Luce calls a "Calomelite" by any means; yet I do give calomel when it is indicated, and get decidedly better results from it than with any other drug.

I am in the habit of using a combination of euonymin, cascara sag., podophyllin and aloin, and get good results from the formula; but now and then a case comes along which this will not reach, and I am compelled to fall back upon my tried and true friend, calomel. I am subject to occasional "bilious attacks," of the real old fashioned kind, and when suffering from these attacks, nothing clears up my stomach and head and drives away the "blues," so common in this disease, as calomel.

The doctor says he wishes the profession would boycott this enemy of good masticators." No need, my dear doctor, of salivating your patients because you give them calomel. I have given it to a great many patients, and there has never yet a case of ptyalism occurred in my practice. However, I never give more than one grain as a maximum dose, preferring to give it in small doses often repeated rather than in a single large dose. My method is to combine it with sugar of milk, in the proportion of one part of calomel to five of the milk sugar, and thoroughly triturating it. Six grains of the mixture represents one grain of calomel, and so on. To an adult I often give six grains of the mixture every two hours until the desired result is obtained. Given in this way, and mixed as Opie used to mix his colors-with brains-I think there is comparatively little danger of salivation. Not the least reason in the world for "loosening all his teeth every time he has an ailment."

The doctor thinks we ought not to be so eager to follow in the footsteps of our preceptors. I am not so sure about that. We ought not to follow blindly, but intelligently, being able to think and observe for ourselves. Some of my most marked success has come from following the teachings of my old preceptor; and when I get into a tight place I find I am pretty sure to come out all right if I do as he taught me to do. Those old preceptors did not study and think and observe so many years for nothing. I do not believe in us young medics, just out of college, setting ourselves up as monuments of wisdom and steering our barks too independently (I speak in a general sense, and not with reference to Dr. Luce).

There are many of the good old time remedies that our preceptors used that have stood the test of time and to-day proudly maintain their position against legions of new claimants for professional favor and calomel stands near the head of the list.

Judging from the tone of the article, I don't believe the doctor has ever used calomel, or else has not learned how to use it right-certainly he does not appreciate it. I rather think he speaks more from prejudice than actual experience.

Then again, one reason he brings forward why it ought not to be used is that it is made up largely of "mercury, a most dangerous poison." Would he boycott strychnia, atropia, opium, digitalis, and many others for the same reason?

I think the whole thing may be boiled down to this: There is a time and place for calomel, and a right and wrong way of administering it. It does not want to be given in any haphazard sort of way, but only when clearly indicated. Correctly given, it is a powerful agent for good, incorrectly a powerful agent for harm. B. J. WETHERBY, M. D.

Arlington, Kan.

Who Wants It?

I have Surgeon General's Report, Circular No. 2, on "Excisions of the Head of the Femur for Gunshot Wounds." I will send it to any one on receipt of twenty-five cents to pay postage.

C. H. MERRICK, M. D.

Dwamish, Wash. Ter.