Secondly. The present spirit of the Society is such as to insure its success. I say present spirit, not because it has changed during the past year, but because I speak from positive knowledge, and an intimate acquaintance with its members during this period. This results in part from the advantage in organization which I have specified; but still more, and mainly, from the character and habits of its members. No one comes here merely to hear himself speak; all come for scientific and practical improvement. And I may say that no reasonable expectations have been disappointed at a single meeting the past year, in respect to the character and quality of the papers here presented. There has been no failure at a single meeting; and some of the papers read have already been highly eulogized in foreign medical journals. During the past year also, about fifty members have been added to this Society; and it has for two or three years past been the largest medical organization in this country, except the American Medical Association.

Under the present influences, therefore, this Society must continue to prosper. But should it get under the control of a clique, or wander from its legitimate objects, from that moment its decadence begins. I trust that personalities may never find their way into discussions here. The provocation may sometimes be very great, but the gentleman and scholar must not yield to it. Science is not a personal matter-not a thing of to-day or to-morrow, or your property or mine-but belongs to all, and for all time to come. Let, therefore, the present spirit remain unchanged, and our exercises from month to month will continue to be worthy of men, the motto of each of whom should be that of this Society

"Miseris succurrere disco."

A vote of thanks to the retiring officers was passed after which the President declared the Anniversary Meeting adjourned, and introduced Dr. George T. Elliot as President-elect for the coming year.

STATED MEETING.

DR. GEORGE T. ELLIOT, PRESIDENT, in the Chair. THE PRESIDENT, on taking the Chair, spoke as follows

ADDRESS OF THE PRESIDENT-ELECT.

GENTLEMEN-In accordance with custom, a short address is expected from the President-elect of this Society, and it is extremely gratifying to me to express my thanks for the honor which has been conferred upon me. It has been spontaneous, unsought, unsolicited, nor had I any knowledge or surmise that such a step was contemplated until I received the official notification of my election.

Such kindness has inspired me with the warmest desire to prove myself worthy of the expectations of my friends, and with the determination that during my year of office, the Society shall not derogate from the high position to which it has been advanced by my predecessors, and by gentlemen well known to you, and within the sound of my voice. For the accomplishment of these aims I ask the cordial coöperation of all, and indulgence for faults which may spring from inexperience in the duties of a presiding officer.

As I understand these duties, they are chiefly-to deal fairly and justly with all; to respect individual rights and susceptibilities, while jealously guarding the time and rights of the Society; to persuade the seniors to lay before you the gathered treasure of their experience; to stimulate the young to condense within the limits of a short paper studies of the same subject published in

different languages by observers from different standpoints; to encourage debate, since from its heated atmosphere a flood of light is often thrown on obscure and vexed questions; to develop talent discouraged from lack of appreciation, or clouded by modest doubts; to bring together, in this hospitable and metropolitan city, physicians of education and earnest purpose from all nationalities, as well as those from all the States of our common country, who have cast their lot here with us; to weld together these constituents into a solid, homogeneous mass for the support and pride of our profession; to stimulate by our example our sister County Medical Societies throughout the landfor on the full development of this system of County and State Medical Societies, culminating in the National Medical Association, depends much of the power and influence for good which we can wield for our profession, and for the community in which we live.

Nor can the greatest attainable success in these endeavors conflict with that mutual interest and sympathy which we feel for the other medical societies of our city, working with us for a common purpose. We are linked together for good, and the advance of one must aid and stimulate the rest. It has become essential in this great city for men to test the attainments of their fellows, and study their characters, in these organized meetings. In the village and the town the evils of too great familiarity are often felt. In the great city the tendency is to estrangement. Men engaged in practice, who do not join medical societies, or labor in public positions, or write, or teach, may live without the acquaintance and the sympathy of their brethren. Such professional hermits hide their light under a bushel, though it may occasionally be as well, perhaps, that the amount and character of that light be kept from view.

Nor is the value of these societies limited to the amount of professional knowledge to be derived from their meetings. Prejudices are dissipated, misconceptions vanish, friendships are formed, kindly feelings. developed, the hard repelling exterior is often found to mask a strong intellect and generous sympathies, talent is borne to the surface, pretension and sciolism stand exposed.

With such feelings, then, we enter on the sixty-third year since the organization of this society. All but one of its founders have passed away; its archives teem with associations of the past; it is identified with the interests of our profession. God grant that, from the labors of the year, we may reap a harvest of pleasant and profitable memories for the future, that we may do something to encourage and stimulate our successors.

THE PRESIDENT announced the admission to membership of Drs. J. Marion Sims, John G. Perry, Truman Nichols, John H. Griscom, Benj. F. Dawson, Adoniram B. Judson, and Henry Freeman Walker. He reported the death, on the 5th of October, of Dr. John William Shepard, a member of the Society since 1861; and on the 15th, of Dr. Robt. H. Maclay, a member since 1831.

The following standing Committees were announced: Committee on the Library: Drs. H. Mortimer Brush, Edw. H. Janes, and John Messenger.

Committee on Intelligence: Drs. James Kennedy, Robt. Newman, John Shrady, Wm. B. Lewis, D. B. St. John Roosa, Edw. G. Rawson, Foster Swift, Wm. T. Lusk, and B. S. Thompson.

Committee on Meteorology: Drs. J. P. Loines, Stephen Rogers, Wm. F. Thoms, A. J. Chadsey, and J. C. Barron.

Committee on Diseases; Drs, Henry D. Bulkley, Chas.

had rarely found structural lesion of the mucous membrane. It was simply thrown into folds by the deposit of inflammatory products ir. the submucous tissuethe real seat of the stricture. The deposit might extend further, often even obliterating the structure of the bulb. His own experience fully sustained the statement in the paper just read, that gradual, progressive dilatation was the proper treatment for most idiopathic strictures; and the above glance at the pathological anatomy showed that this did not stretch the mucous membrane-except when, as rarely, it was itself diseasedbut acted simply by stimulating absorption of the newlyformed tissue.

It had lately been his fortune to hear much on the subject of stricture from the lips of some of the men famous in its treatment; and he had come home more than ever impressed with its importance and with the vigor with which it was being worked up. He had found Holt men, Syme men, etc., each advocating an exclusive method. Mr. Syme hardly ever performed anything but external urethrotomy. Mr. Holt, if he could get his dilator inserted, would always stretch or tear the urethra. But his disciples say they do not commonly tear it, as shown by the rarity of urinary infiltration,—a fact going strongly to prove the position just taken, that the seat of stricture is commonly outside the mucous membrane.

Referring to some of the operations named, Dr. Wood said he had come into the profession as a pupil of Dr. David L. Wells, who had first in this city, and probably first in this country, performed perineal section without a guide. He had seen many of his operations, and they were always successful. This was owing largely to two causes. First, he selected his cases; he did not take old, broken-down patients, with the bladder the size of a filbert, the ureters as large as your arm, or the kidneys transformed into huge cysts (for lesions as grave do result from stricture). Secondly, he gave all his patients careful preparatory medical treatment. In this operation, as well as in Syme's "external incision," it was very important to cut in the median line, where the vessels terminate. Following this rule, hæmorrhage would rarely be troublesome. Where the bulb ntained much fibrinous deposit, its artery was often partially or completely occluded. After this, as after every operation, the periodical use of the sound must be insisted on. The patient should pass it at least once a week.

He would say a word upon stricture of the prostatic portion. Some denied its occurrence; but the records of Bellevue Hospital would show that, within two years, he had met with three cases, upon all of which he had successfully operated. These strictures were all three traumatic; he had never seen prostatic stricture from gonorrhoea, and it was very rare from any

cause.

Internal urethrotomy he had often performed, and would do it again, within three inches of the external orifice; and deeper than this if he could introduce Civiale's instrument beyond the stricture, so as to cut outwards. But to cut in the opposite direction a stricture too deeply seated to be under the control of the thumb and finger he deemed very hazardous.

The "medical surgery" of stricture was too little regarded. A patient would come into hospital passing his urine guttatim; he would put him on his back; apply a poultice to the hypogastrium; an ointment of belladonna or stramonium to the perinæum; insert an opiate suppository in the rectum; inject warm oil into the urethra. Presently the oil would flow into the bladder; and, with no surgical manipulation, the man would pass a stream, say as large as a knitting-needle.

Of late he had added a little carbolic acid to the sweet oil, having been led to do so by its happy effect on urethritis. Carbolic acid in combination with glycerine he had used in the treatment of clap, with the best results. The medical treatment, then, must not be forgotten. Many a poor fellow had had his bladder punctured, and within forty-eight hours afterwards sent a tolerably good stream through the natural channel.

In conclusion Dr. Wood described an operation which he had for some years been performing, and of which he had seen no mention in the practice of other surgeons. Cutting down, after Syme's plan-a staff being fixed at the distal end of the stricture and a slender bougie being also, if possible, passed into the bladderhe had found that, as he approached the urethra by slow and cautious dissection through the fibrinous deposit, the stricture would gradually yield, until, without entering the canal or wounding the mucous membrane, he could by degrees press the staff on towards the bladder. This mode of relieving the stricture answered to the operation for strangulated hernia without opening the sac. He had repeatedly performed it successfully; he had also repeatedly failed, and been obliged to cut into the urethra, as would always be the case in traumatic stricture, or in idiopathic where the mucous membrane was much diseased. But it was always worth trying, for where applicable it offered the great advantage of rendering urinary infiltration an impossibility. And to such infiltration and the pyæmia consequent upon it were to be ascribed most of the fatal results of perineal section.

DR. GOULEY, while endorsing Dr. Wood's remarks with reference to constitutional treatment, thought its effects were often overrated. Rest, diluents, opiates, tincture of chloride of iron, were all valuable in their place; but we must rely mainly upon the mechanical treatment proper. This might be summed up in three classes of procedure: 1. Gradual dilatation, for the milder cases. 2. The immediate treatment, for cases more severe. 3. External division, for impassable strictures. Under the "immediate treatment" he included stretching, rupturing, and internal incision. He said stretching, because in some cases there was, as Sir Henry Thompson correctly stated, little or no tearing, under the use of his dilator, though actual rupture occurred in the more aggravated cases. He had gained very good results with Sir Henry Thompson's instrument. Internal division he had performed with the urethrotomes of Civiale and Maisonneuve, and with one of his own devising. It was adapted to strictures in the pendent portion of the urethra anterior to the scrotal junction; and Sir Henry Thompson had acknowledged that his own plan of stretching a rupture was not so well suited to strictures here seated. In one case, however, Dr. Gouley had thoroughly stretched a stricture anterior to the scrotal junction, and recontraction had not followed. The doctor gave his experience of Syme's operation and of perinæal section without a guide, agreeing substantially with the previous speakers. Mr. Cock's operation of puncture of the urethra he had also recently performed, and proposed again to try on a patient then under treatment, suffering from a stricture of both gonorrhoeal and traumatic origin, and truly impassable. He read, from Guy's Hospital Reports for 1866, Mr. Cock's own description of the operation. He regarded it as preferable to puncture of the bladder; as adapted to some cases where perineal urethrotomy was almost impracticable; and as perfectly safe, if performed with care, deliberation, skill, coolness, and anatomical knowledge.

In conclusion he gave the statistics of forty-seven

cases of severe stricture which he had treated within the last three years; of these 47 cases, 44 recovered and 3 died. In 26 cases the immediate treatment was resorted to, and in 21 cases external division.

All of the 26 cases in which the immediate treatment was employed, were followed by satisfactory esults. Of the 26 cases, 13 were treated by stretching and rupturing Thompson's dilator was used in 6 of these cases. In the 13 remaining cases, internal division was performed with Civiale's, Maisonneuve's, or his own urethrotome. No catheter was tied in, in any of the above cases, and they progressed with scarcely any untoward symptoms.

Of the 21 cases of external division, 18 recovered and 3 died. In 11 of these cases a guide was used; in the other 10 cases the operation was performed without a guide, as none could be passed. There were no deaths among these last 10, the fatal cases being those where the operation seemed least complicated and difficult. In 2 cases a catheter was secured in position for forty-eight hours; urethral fever followed in both of them. In the 19 remaining cases no catheter was tied in, the urine being allowed to flow freely through the perinæal wound; in the majority of these firm union took place within three or four weeks, and in none of them did urethral fever supervene, not even in the fatal cases. The causes of death were, in the first case, erysipelas and pyæmia; in the second, advanced disease of the bladder, ureters, and kidneys; and in the third, thrombosis of the heart. Any other surgical operation might have proved fatal in this last case; the patient died within forty-eight hours after the operation.

In the 21 cases of external division, the following seemed sufficient indications for the performance of the operation: 1. Narrow traumatic stricture in sub-pubic curve. 2. Impassable mixed stricture (traumatic and gonorrhoeal). 3. Impassable stricture, with retention. 4. Stricture with retention and extravasation. 5. Narrow stricture, with perineal abscess. 6. Stricture with a perinæal fistula, which would not heal after persistent dilatation of the urethra. 7. Stricture which was undilatable, irritable, prone to bleed on the most delicate exploration, and attended with dribbling from overflow. 8. Stricture which, though dilatable to a considerable extent, recontracted very soon after cessation of the use of dilating instruments, notwithstanding that they had been used for a long time ("resilient stricture").

DR. GURDON BUCK-I see nothing to differ from in the views brought forward by Dr. Van Buren. He has presented the subject in the most judicious and discriminating manner. Regarding perineal section without a guide in the very serious form of impassable stricture, I would mention an expedient which in my more recent experience has proved very useful. It is this:-Pass down to the stricture the largest-sized grooved staff, open at the extremity; then open the urethra anterior to the stricture, and the grooved staff remaining in situ, pass your finer instrument into the wound and along the groove, with the aim of striking the narrowed canal through the strictured portion. Approached thus from a different direction, a stricture which may be quite impassable by even the finest instrument introduced by the meatus, will sometimes be found unexpectedly passed. An instrument very useful for this purpose, which we have at St. Luke's and at the New York Hospital, is a staff of flexible silver, as small as can be made with a groove.

Another expedient, not yet noticed, which I have once tried successfully, and intend to try again upon proper occasion-is puncture of the bladder beyond the prostate, through the perineum. It would be applicable

to such cases as Dr. Gouley has spoken of, and my own judgment would prefer it to Mr. Cock's operation, which he descriled. My case was that of a corpulent gentleman, to whom I was called in haste late at night. He was suffering extremely from retention, and his condition would not admit of delay, even till daylight. He had perineal fistula; irreducible scrotal hernia, concealing the penis and its orifice; phymosis; and impassable stricture. After satisfying myself of the impassable condition of the stricture, and of the impossibility of immediate relief through the urethra, I made a transverse incision, as for the bilateral operation in lithotomy. I carried it on till I could distinctly recognize the prostate in the wound, and define its outlines: and then, carefully noting these, continued my dissection between the prostate and the rectum. This completed, I introduced my finger as far as possible in this corpulent man, and carrying upon it a sharp-pointed knife beyond the prostate and even beyond the reach of my finger, punctured the bladder in the trigone. I was satisfied that this was done, although no urine followed the knife, owing, I suppose, to the falling together of the sides of the cut. A female catheter was inserted, with an ordinary bladder attached to its outer extremity. This relieved the immediate symptoms, and I then took my time to cure the stricture.

Laying open the prepuce, and introducing a sound, I found one or two strictures in advance of the main one. After resorting to every expedient to get through this last, I at length, after five or six months, made perineal section, which proved a very formidable and protracted operation. A catheter was now passed through the whole length of the urethra; and the one which had been in the bladder was withdrawn. The wound healed up with no difficulty; and, finally, the integrity of the urethra was established, and the patient lived for about three years, restored to society, able to retain his urine two or three hours. This case suggests that, by whatever method the integrity of the urethra is restored, we must still look after it during the rest of the man's life. With this patient, the catheter had to be passed every four weeks, or its introduction became difficult. This was kept up until his death, which occurred from some cause having no connection with the urethral troubles.

This operation I consider applicable in cases of impassable stricture accompanied with retention, with great irritability of the bladder, and cystitis. Its great merit is that the bladder and the urethra are put entirely at rest-an immense advantage. We may then take our time to attend to the cystitis and resort to the proper means for curing the stricture.

DR. NEWMAN dwelt upon the great success which had attended the use of Holt's dilator, in the hands of Mr. McNamara, of Dublin, and his assistants (vide MEDICAL RECORD, vol. 3, pp. 90-92, Report of N. Y. Pathological Society). But this instrument could be used only for strictures which would admit a No. 3 sound. To dilate closer strictures to this extent we must have other means; and the desideratum had, he believed, been found in the bougies of laminaria digitata. Their great advantage consisted in their effecting the dilatation gradually and yet speedily. These bougies were numbered from 1 to 6. He had used them with success in several cases, even in strictures that had at first seemed impassable. No stricture was really impermeable if there was any dribbling of urine. He would relate a single case. The patient had suffered for several years from stricture. When first seen he was in great agony. A No. 11 sound introduced down to the seat of stricture, established the diagnosis of this as in the prostatic portion of the urethra. The speaker was