tion, contracted gonorrhoea when about 21 years of age, which left urethra stricture as a sequel. About 15 years afterwards the stricture was forcibly dilated by Dr. Bright. After this the urethral channel remained sufficiently open to admit the passage of urine without a great deal of trouble to patient until about 8 years ago, when, from some cause, the channel again contracted to such an extent as to bring about perineal abscess, which was opened by Dr. J. Flint. Through the fistulous opening left, patient passed his urine with not much trouble, until about 18 months ago. Since then up to the time of the operation he suffered almost constantly-mainly, as it was afterwards discovered, from presence of a stone in the bladder, which had not been suspected. About the first of October last, from some cause the writer did not ascertain, the fistula became obstructed to such a degree as to render the passage of urine very difficult, and ultimately to cause the formation of another abscess, which produced horrible suffering. After some days Dr. Cummins was called in and opened the abscess, before this, however, the perineal tissues involved in the abscess had become gangrenous, and soon afterwards sloughed away, leaving a large chasm in the perineal region, into which the bulb of the urethra could be seen projecting. On the 15th of October Dr. Cummins, accompained by Drs. Leachman, Ed. Richardson, and the writer, called to perform urethrotomy. Patient was chloroformed; very readily passing under influence of the anesthetic. Dr. Cummins then proceeded to adjust the parts for the operation, and while thus engaged had occasion to change the position of a catheter he had introduced into the bladder through the perineal opening on a previous visit, and in doing this became aware, by its click and resistence to the instrument, of the presence of a stone. He had come unprepared for lithotomy, and Drs. Leachman and Richardson volunteered to go out and look up a case of instruments, Dr. Cummins's being inaccessible at the time. In the meantime Dr. Cummins set about opening the urethra, with only one assistant to aid him in the operation and to keep the patient under chloroform. He first cut through about an inch of completely obliterated urethra, commencing at the meatus, and by this opening passed a sound a short distance through a portion of the channel which had remained pervious, when it was arrested by another deeper stricture, commencing at a point on about the level of the pubic arch. Using the sound now as a guide, he commenced cutting forward from the posterior limit of the stricture, (about the junction of the bulbous and membranous portions). About the time of completing the division of the stricture, Dr. Richardson came in, bringing a case of vesico-vaginal fistula instruments, from which, having failed to find a lithotomy case, he hoped Dr. Cummins would find some instrument that might be of avail in removing the stone. Having divided the posterior part of the membranous portion of the urethra and the neck of the bladder, as in lithotomy under ordinary circumstances, he now selected from the instruments at hand a pair of forceps used in manipulating the parts involved in the operation for vesico-vaginal fistula (doubtless a very good instrument for this purpose, but a very poor one indeed for extracting a stone), and seized the stone, which after several ineffectual efforts, because he could not maintain his hold on it, owing to the slipping of the forceps, he finally extracted it. The stone was nearly round, and rather over an inch in its longest diameter. Its composition was not determined.* Although the results of this operation have not been in every respect favorable, followed as it was by a recto-vesical fistula, which, under the very unfavorable circumstances of its performance, probably by no sort of care could have been avoided, and a large opening in the perineal region caused by the great amount of tissue sloughed away, and remediable only by a plastic operation, it appears, when all things are considered, a remarkable triumph of surgery.* The old man recovered very rapidly, and now enjoys a degree This paragraph is published strictly in accordance with the manuscript furnished.-ED. of health and physical comfort unknown to him for a long time. Another point deserving notice in his case, was the happy manner in which he endured the long administration of chloroform; during the severest part of the operation he lay motionless, breathing easily and regularly, almost as in quiet, natural sleep. ART. I.-THE FUNCTION OF BICHLORIDE OF MERCURY IN THE TREATMENT OF DISEASES OF THE SKIN. BY JOHN KENT SPENDER, M. D., Lond., Surgeon to the Mineral Water Hospital, and to the Eastern Dispensary, Bath. There is a body of authenticated traditions which justifies the use of bichloride of mercury as a remedy for certain diseases of the skin. I do not mean merely as an antidote to the cutaneous manifestations of the syphilitic poison, but as a medicine for some non-syphilitic diseases, though of empiric value and of somewhat uncertain character. It is this view of the question which I wish particularly to discuss now. A sort of mysticism has long surrounded the therapoia of bichloride of mercury; and a few of its supposed mystic properties have been dignified by the trite name of alterative, which simply means that what was dark before, we wish to make darker still. It is a medicine which is often a beneficial harbor of refuge to the weary practitioner, who, having met with disappointments, finds a solace in prescribing what he knows little about, in the dim hope that an arrow-shot in a fog may hit the mark. Further, the reputed potency of this medicine invests it with an august charm. Swift and deadly as a poison, its therapeutics are slow and wary; and it may be hinted that it sometimes re ceives credit for curing a disease whose "natural history" is to disappear in time. Administered within certain limits, its physiological properties are safe and harmless; and in very small quantities it might be given, probably for a long time,ŝto a healthy adult without much result. Nor does it (within the same limits) readily produce the specific toxical effects of mercury, such as purging and salivation; it is rare indeed for a grown-up person, and still more rarely for a child, to suffer inconvenient or dangerous symptoms. Now, the use of bichloride of mercury naturally divides itself into an external and internal function. 1. Externally, bichloride of mercury has a reputation as a parasiticide in the form of either lotion or ointment. Long before the pathology of Prurigo was understood, and its dependence on animal parasites recognized, the "yellow wash" was recommended by Bateman as an effectual application. Mr. Erasmus Wilson has published a formula which is now probably well known, consisting of corrosive sublimate, spirit of wine and of rosemary, in a menstruum of bitter almond emulsion. I have found this lotion of great use whenever the irritation has obviously depended upon parasitic disease; but I cannot endorse its alleged utility in allaying the itching of urticaria or any of the pure "neuroses." Dr. Waring says that a solution of bichloride of mercury (gr. xx-3ss. ad aq. Oj.) is very beneficial in the, treatment of obstinate scabies; but iodide of potassium ointment may be pronounced safer and better, when sulphur washes and ointment have failed. Dr. Pereira quotest an ointment composed of from gr. to gr. ij. of corrosive sublimate to 31 of lard, as an effective remedy for the "contagious porrigo" which spreads among children in schools. Fricke (as mentioned by Dr. Waring) speaks highly of the value of corrosive sublimate when dissolved in a warm bath; and French physicians used to order mercurial pediluvia to excite salivation, * Manual of Practical Therapeutics, p. 303. composed of half a grain of corrosive sublimate dissolved in a pint of water, in which a patient immersed his feet for two hours. 2. The venerable name of Baron Van Swieten will always be associated with the introduction of bichloride of mercury to internal therapeutics. He anticipated the modern doctrine, that salivation is not necessary for the cure of venereal diseases; and so he made experiments with bichloride of mercury, hoping that he might discover a preparation "that could be diluted at will, and so tried in a very small dose." Locker and Dzondi became warm advocates of the use of this mineral; and Dr. Graves was not less enthusiastic in its praise. There cannot be any doubt of the general correctness of the dogma, that bichloride of mercury acts in a quiet, unobtrusive manner when administered with judgment, and that its use indirectly promotes the nutrition of several tissue-elements. We easily discern that better nutrition on the skin, because it is the tegumentary covering, and it is everywhere displayed to view. In this sense we understand that the medicine has a tonic." influence, as Dr. Billing called it, paradoxical as this terminology sounds at first. Nor is it very important to demonstrate whether a dynamic change is wrought in the nervous system; or whether a poisoned "plasma" is deprived of its noxious properties. Bichloride of mercury is much prescribed in the treatment. of syphilitic diseases of the skin, and I believe that the followlowing rule will be a competent guide to its use. The chronic, squamous Syphilides are the most amenable to..its curative agency; and in children, when we doubt how far there may be a syphilitic root to a squamous disease, it is a good practice to combine arsenic with bichloride of mercury, and to give three doses daily of these medicines. Cod-liver oil may be added if the constitutional necessities of the child seem to call for it. The unquestionable syphilides, which affect, the palm of the hand and the sole of the foot, are immensely benefited by bichloride of mercury. It would be too bold to say that the |