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pital a week since, but has suffered from rheumatism in one ortwo joints.On referring to these cases, Mr. Maunder reminded the class

of a principle in surgery which he so constantly advocated-gentleness in the use of the catheter. On exploring the urethrafor the first time they should use a medium-sized catheter; and ifthere be an obstacle, note exactly its position as regards the threedivisions of the urethra by observing the angle made by thehandle of the instrument to the long axis of the body of thepatient. In the above cases the instrument could not be de-

pressed and brought parallel with the patient’s thighs withoutmulcting great pain, thus indicating obstruction ncar the neckof the bladder, and at once putting out of the question thepossible existence of "organic" stricture. The next step wasto explore the e rectum (a practice which he advised all studentsto take every opportunity of following, however distasteful itmight be), and the finger at once detected the cause, set asidethe suspicion of calculus, and the remedy was readily found.The use of the catheter was at once desisted from. Had itbeen persevered in with Case 1, and the bladder entered, itwould have been done probably at the expense of opening theprostatic abscess, and of forming a communication between itscavity and the urethra, and the cure would have been delayed.In all cases in which abscess is known to be the cause ofobstruction at any point of the urethra, it should be openedprior to the catheter being employed. It may render the useof the instrument needless, and prevent urinary fistula. Asto the cause of the prostatic abscess, he was inclined to regardCase 1 as an example of chronic pypsmia; and in Case 2 hethought cold was probably the exciting cause. Neither

patient had suffered from previous disease of the genito-urinaryorgans.With reference to the mode of evacuating a prostatic abscess,

Mr. Maunder recommended that the spot at which the puscould be most readily reached should be selected for puncture.If it "pointed" towards the perineum, puncture should bemade through that region ; if towards the rectum, the wall ofthat viscus should be incised. In the above cases the abscesswas readily opened by a bistouri cache introduced per anum.In either instance the finger detected a small artery in thewall of the abscess, and this, of course, was avoided. In acase in which the abscess points towards the urethra, the pre-sence of pus will probably be suspected only, until by dis-charging itself per urethram the nature of the malady is ex-plained. Such a case should not be mistaken for gonorrhoea.

KING’S COLLEGE HOSPITAL.A CASE OF LITHOTRITY FOLLOWED BY LITHOTOMY.

(Under the care of Sir WM. FERGUSSON.)ON Saturday last a young man, suffering from stone in the

bladder, was placed under chloroform upon the operating-table.Sir William Fergusson introduced the staff, but failed to strike Ithe stone. A common sound was then employed with moresuccess. The staff was again introduced, and lateral litho-

tomy performed. In its course two points were noticeable.1. When the bladder was opened, urine in unusually largequantities escaped by repeated gushes. 2. The stone was not

seized, as usually happens in Sir William’s hands, by the firstgrip of the forceps. At a second introduction of the instru-

ment,.however, a small calculus, flat and circular, was caughtand removed.

Sir William adverted to some interesting points connectedwith this case. A week previously he had introduced the litho-trite, but had experienced unusual difficultyineatcliingthe stone.He had succeeded, however, in doing so, had broken it, andhad then broken one or two of the fragments. The patienthad since complained of his symptoms about as much asbefore, and had, moreover, experienced a rigor. No debrishad come away, and in view of the difficulty there had been inemploying the lithotrite, it was judged expedient to removethe stone, without further delay, by lithotomy. A portion,represented perhaps by one-fifth, had been broken from thestone, and the fragments found lying in the bladder were re-moved during the operation by the scoop. What constitutedthe difficulty of employing the lithotrite in this case? Judgingfrom the unusual amount of urine which escaped (the man hadmicturated two hours previously) it seemed that the bladderwas abnormally large. The stone, too, was very light, so asalmost to float in the liquid, and to be displaced by the least

touch. Some years ago, Sir William said, it was thoughtnecessary for lithotrity that the bla<lder should contain a con-siderable amount of water, and if it did not do so naturally,some was introduced by injection ; but experience had shownthat this was neither necessary nor expedient, and the casebefore them illustrated this point very well. The difficulty ofseizing a stone in a large cavity was often well shown whenthe operation of lithotomy was being demonstrated upon thedead subject. In such cases the bladder was often very capa-cious, and its fibres so relaxed by death, that in the veryefforts of the surgeon the viscus was more and more enlargedby the forceps in its movements about the cavity. It mighteven be thrown into folds, and the stone lie hid behind one ofthem. Sir William pointed out that in a case like that of thispatient a light and small stone might easily have been ejectedwith the rush of urine, and thereby have occasioned, from itsabsence when looked for, great anxiety on the part of the sur.geon.

EMPLOYMENT OF LOCAL ANAESTHESIA.

On the same occasion a young woman, suffering from " house*maid’s knee" of long standing, was placed upon the table, andthe skin of the part was frozen by Richardson’s apparatus. SirWilliam made a vertical incision through it, and then pro,ceeded to dissect out the cyst. The patient evidently suffereda good deal during the operation; and, in answer to our ill.quiries afterwards, said that she had felt it very much.The process was also adopted in a case of fistula in ano,

where, from the fistulous track being more than usually super-ficial, it was hoped that the plan would be successful. Butthe patient, a young man, winced and groaned considerably,and asserted afterwards that he had suffered great pain.

ST. GEORGE’S HOSPITAL.

RUPIA-LIKE ULCERATION OF THE SKIN IN A CHILD ;POSSIBLE SYPHILITIC INFECTION BY VACCINATION.

(Under the care of Mr. POLLOCK.)WE have lately noticed two little girls in St. George’s Hos

pital whose appearance is strongly suggestive of syphilis,though, as not unfrequently happens, their history leaves thematter in some doubt.

S. C- is eight and a half years old, weakly-looking,with fair complexion. Her face is covered symmetricallywith patches varying in size from that of a pea to that ofa sixpence, raised but slightly above the surrounding skin,except in some places where there are scabs with more or lesstendency to a conical form. The neighbouring skin is of abright-red wine colour. Where scabs are wanting, the skinseems ulcerated, but in no case deeply so. There are a fewsmaller spots of similar character on the arms and neck, butthe rest of the body is free. The child has great angularcurvature of the spine. We learn from Mr. Pick, the surgicalregistrar, that according to the parents’ account the girl wasperfectly well until she was vaccinated. The wound then in-flicted, the mother says, "formed a hard ulcer which took along time in healing." Six weeks afterwards, sore-throat anda skin eruption showed themselves, which disappeared undertreatment. Her hair all came off. The parents are quitehealthy, and deny syphilitic infection. They have four otherchildren, who are also perfectly healthy. The present con-dition commenced three years ago. Eighteen months ago thechild was treated with mercury by a medical man, but withoutmuch benefit. When admitted into the hospital on Jan. 24ththe face and arms were thickly covered with large conicalscabs of rupial character. She has been treated by strongmercurial ointment spread upon a flannel belt, and worn con-stantly. Latterly, also, half-drachm doses of syrup of iodideof iron have been given three times a day. She has materiallyimproved in health, the scabs have very generally fallen off,and the eruption has assumed a less severe character.DEEP ULCERS LEADING TO NECROSED BONE IN BOTH TIBIAE OF

A GIRL, PROBABLY OF CONGENITAL SYPHILITIC ORIGIN.

(Under the care of Mr. POLLOCK.)In a bed opposite the last case lies a girl of cachectic aspect,

fourteen years old, who has been a patient in St. George’sHospital no less than eight times during the last four yearswith ulceration of the legs, which has always yielded speedilyto the influence of iodide of potassium. On the last occasion

(in August) the ulcers were phagedenic, and the bone became