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Surgeon  General's  Office
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                 SOME

ABNORMAL  CONDITIONS
SKXI  AL   AM)   PKLVIC   ORCAXS,
IMPALU   VIPJL1TY
EDWARD  H. DIXON, M.D.
  Our Proc-n-ative Power is the best evidence of immortality ; sexual attraction
precedes parental love; it is a law of mtturo; ami man never knows bis holiot
emotion till bo feels the soft breath of his child on his rVn ek, and the beating
nt the little heart against his chest.                 •
  The man who is  not at mature age eoiiRcious of existing sexual imperfection
or waning power, is approaching pjryaieal and mental imbecility.
AUGUST  BRENTANO. 33 UNION SQUARE,
                      AND
    THE  AMERICAN NEWS COMPANY.

             PRICE, 25 CENTS.

    All orders out of the city must be addressed to
                               E. WARNER, Box 8121. 
SUPPLEMENT TO SOALPKL No.  10.
                          CH JMTMNTS.

   Diseases of the Rectum, Bladder, and Uterus ; their sympathetic symptoms
 in other parts of the body.
   Hemorrhoids, Fissure, Fistula; their insidious character and symptoms.
   Circumcision ;  its true meaning—was it a religious or a hygienic rite '!
   Varicocele ; what is  it, and wli.it  are its effects on health ?
   Neuralgia and Aiupmia ;  what aro they ?  People who are blood and neive-
 starved ; what is the cure?
   The Karly Decay of  American Women.   Is it proper to check the increase of
 family ?
   Treatment of Stricture b}r Internal  Incision ; a new and simple instrument
 for immediate cure.
   Loss of Virility in Young Married People ; an unsuspected cause.
   Do Idiocy and  Scrofula originate from the.  Marriage of  Blood  Relations, or
 nre they due to Incompatible Temperaments?
   I'>rty four  pages octavo, elegantly printed;  25 cents.   Inclose  to Box  No.
 8121.
   The whole work may be had of the  Kditor only, for $18, well hound, in  six
 large volumes of 500 pages each.  The last one contains the celebrated articles
 on Tobacco.  "We advise the formation  of village clubs to buy it as a library.
   "Every line from the pen of Dr.  Dixon is of value to the whole human  fami-
 ly."—Horace Greele^                                    ,  «
   " Dr. Dixon takes his stand with the conservative  men of the dav.   lie is
 universally known as a surgeon of great practical tact;  his journal is mdike
 any thing in the literature of the day:  in didactic power he has no equal, ami
 he  seems actuated  by  one  motive—the good of the  people."—N.  Y. JJaihj
 Times.
   '* Dr. Dixon is an earnest and thorough practitioner of science; he is a man
 of the great.--t capacity to teach ; every  word is weighty with meaning."—N. Y.
 Com. Aili ertuier.
   "Dr. Dixon has given us a most  instructive and useful number.   His extra-
 ordinary knowledge of the bibliography of these deeply interesting subjects foi
 such profound consequence to the whole  human  race)  is only equaled In  his
 great practical tact as a surgeon.  A pupil of the  great Xestor of surgery,  Mott
 and that most profound scholar and  eloquent man, the  late George "Macartney
 Bushe, he has added an experience  of  thirty years to his capacity  for treatiic
 this subject.  As a practical  surgeon, as a cautionary and  moral work  for tin
 thoughtless, it does equal honor to the  head and  heart of the author."—X  Y
 1.  • ■ ing  I'out.

   "The  author's acknowledged originality and thorough  devotion to  the  ia
 lonal principles of medicine, and his ingenuity under  trying surgical circuin
 stances, stamp it with more than ordinary interest. '—/Josion Medical and Sur-
<jical Journal. 
                      INTRODUCTORY.

   Tins tract has been prepared for the sole purpose of giving the views of the
author on certain morbid conditions of the sexual organs and their treatment,
as taught in his writings and practiced by him for the past thirty years.   How
fir his viewi  arc  supported by  the  stru< turc and  physiological  laws  which
govern these organs, must be judged by the reader and his per-onal experience.
So entirely do  they differ from the teaching of the books, that the inquirer can
expect no aid from those whose business it is to follow "the authorities."
    Those venerable gentlemen—"the fathers of our profession"—have been
for so many centuries casting  their nets into the stream of tradition, that they
have encumbered the medical shore with a  vast deal of rubbish.  'I he  person
who  proposes  to  take the author's advice for any of the abnormal conditions
treated of  in  these pages, will save himself much trouble by carefully noting
that  "medical treatment" rea-ives  very little consideration  in these  pages.
 Almost  every measure adopted by the author is predicated upon the necessity
of placing the  nervous  and arterial systems of the respective parts in a condi-
tion to carry out the intention of nature—in other words,  The Oiwasic  Law.
    In the embryo of every living creature, whether in  the womb or the egg,
 the nervous system is the first visible organization.   It precedes the formation,
 and governs the action  of the heart and lungs, the stomach  and its absorbents,
 the arteries and  veins,  the bowels, muscles, and bones, and the  reproductive
 or-ans; the perfection of the functions of the latter is nature s grand indication
 of health;  its  opposite, of disease.  Respiration, the circulation of  the blood,
 di cstion,  sanguification, motion, sleep,  and reproduction, arc all  absolutely
 controlled by  the nerves.  So numerous arc they in their ramifications that, if
 every particle of  the other tissues, veins, arteries, and muscular  substance, and
 even the bones themselves, could be removed, the nerves alone remaining, they
 would represent the perfect form of every organ and the entire body unchanged,
 like the skeleton leaves in the  phantom bouquet.   If such early development
 and pe. lection of mechanism do not indicate the necessity of preserving the
 integrity of action of the nerves on the reproductive organs, our conclusion that
 it is: unphilosophical to give  medicine to restore their tone is absurd,  and the
 di u—er mav  do his worst; be can do little harm.
     If there be an orwnir law which governs the formation of our bod.es, it must
 surely demand the integrity of each organ to enable it to perform  its functions.
 If a watch can not keep time when its structure  is deranged,  how much less
 can we expect so  complicated  a system as  the sexual to carry  out t:ie ,rea.
 plan when in an abnormal condition?   If, in the  greater part of the globe on
 which we dwell, the earth, the rocks, the entire  vegetable and  animal king-
 dom, if every organic atom can only take its place in the  grand cosmogony by
   he law of sexual attraction, then the poet was inspired when he said,
                   " v ilr fruit of love, the Orbs rose np to view,
                     \Y.d the vast mas* l\v generation «rew.
                    M .ttor and spirit toiled within one voke
                    \\ re they dkjoined. the law of <.ioJ were br-U\ 
2
  ITthrvrh'-'Uh:  IIow are they produce*! ?   Can they be cured without an ope
      ration?  Fistula. Fissure, and Concealed Ulcer of tlie Rectum.  Influence
      of these Diseases on the Sexual Powers and Functions of the. Bladder.

     Each portion of the human body, however small, contains its appropriate
  nerves, arteries, and veins.   The arteries and veins produce piles in the follow-
  ing manner: The bowels are formed throughout their whole length by an inner
  mucous lining, a middle and  muscular one, and  an outer one similar to the
  inner one, and continuous with the membrane that lines the cavity of the abdo-
  men.   The inner one produces mucus, which lubricates the inner surface of the
  intestine, and allows the surplus contents to pass easily downward.  The  mils-
 rular coat, by means of an alternation of contraction and relaxation, forces  these
 contents downward  on  their way out of the system.  The outer coat covers the
 .muscular one, and by its moisture and smoothness, enables the intestines to glide
 •easily  upon, and not irritate the numerous convolutions, nor the  membrane
 lining the cavity of  the belly.
    At the outlet, or anus,  as wo call it, the muscular coat becomes much
 thicker at the inch  surrounding the end of the bowel.   The object of this in-
 crease of thickness is, by its power of involuntary contraction, to keep the bowel
 well closed.   Now,  the reader  will  notice, that as this powerful muscle com-
 pletely surrounds the i:i:ctim, as the lower bowel is called, it must of necessity
 constrict all the veins that pass through and under its fibres to supply the mu-
 cous membrane, or the inner lining of the lowest part of the bowel.  These veins
 (as all  veins in  the body do) carry back the blood brought to the part by its
 arteries, after it has  contributed what the  mucous membrane  requires for its
 secretions and nourishment.  The  blood-vessels all  penetrate  the outer coat,
 and are chiefly distributed so as to surround the three upper inches of the rec-
 tum, while they run  lengthwise in  the two inches below, and pass  under the
 circular or closing muscle to  the verge of the anus, where the mucous membrane
 joins the skin.   Here piles always appear.
    "When there is no constipation of the bowels to distend them, and cause
 them to press upon the great veins within the belly into which the smaller ones
 of the rectum empty, all goes on smoothly;  the blood passes  upward from the
 anus, or opening of the  bowel, into these larger veins, and finds its way to the
 heart, notwithstanding the constriction of this circular muscle, or sphincter, as
 it is called.   But when  the  bowels are  distended and  obstinately costive, 'the
 veins can not, by their feeble power, overcome both the constricting muscle'and
 the obstruction above, and so they  swell into tumors, all round or on one side
 of the anus,  and very often give great pain by their distention pressin- upon
 and irritating the nerves that accompany the veins and  arteries.
    Now, remember, that the arteries which bring the blood to  the part bein-
 connected with and subject to every  beat of the heart, they easily convey  it to
die veins; but the veins bavlng to raise it upward, and the sphincter muscle 
/'"/K-tt'ons  of the  XireiA Of  the  A', ,-tum.              3
and loaded bowels both  pressing upon  them, they are too feeble to drive the
blood upward : it can not mount, and so the swellings increase; thus piles are
formed.  They arc often hollow, venous sacks, fed by art. ries.  Sometimes the
arteries predominate in them, and then they arc like a sponge in structure ; al-
ways, however, they are, as wc say, vascvlak in their origin, or composed of
blood'Vessels.  Very old piles arc often so low down as to be permanently out-
side the anus and covered with skin.
    Every person will soon  discover that  the blood finds its  way to the heart,
and ceases to distend the piles much quicker when he lies down, and when the
bowels arc empty.  Excesses of all kinds, wine and irritating food, and purga-
tive medicines increase the irritation, and  take away from the contractile power
of the veins ;  and so they can not as easily send the blood upward,  which  they
must do of themselves alone, because they arc not, like the arteries, subject to
the  continual contraction of the powerful muscular ventricle of the heart, but
return  the  blood to it, aided only by  the  much  feebler dilation  and  suction
of the thin walls of the right auricle, the receptacle for the veins.  Moreover,
the veins of .the  rectum have no valves to assist the blood to mount.
    The  nerves  that supply the internal  or mucous coat of the rectum play a
very important part in its action in health and disease.   "When no enlargement
of the veins, and no internal piles exist, they telegraph to the brain the necessity
of the stool;  but when these nerves, which thread with  a delicate  net-work the
entire mucous membrane, are covered up by the enlarged and congested veins
which the arteries constantly supply with  blood, they cease to notify the pre-
sence of the faces.  The sphincters, or closing muscles, arc  two in number ; a
circular one immediately  surrounds the last or lowest inch of the bowel; the
other is  elliptic,  and lies a few lines outside of the inner  one, Hat like a ribbon ;
it is supplementary only, and inferior in power to the circular one.   When  we
aro  in health, they arc always  tightly closed, as well asleep  as when  awake;
but when ill, or  exhausted  by discharges from internal or bleeding piles, or in-
ternal ulceration, or weakened  by protruding piles or prolonged  illness, they
relax, and permit the piles  or enlarged  veins to protrude, constituting external
piles.  They are Iho gate-keepers ; the nerves arc the sentinels and  messengers.
    The  rectum, in health,  is generally empty ; the fceccs accumulating in that
portion of the bowel called the coi.ov, live inches  higher.  No person is ha-
bitually constipated without more or less disease of the  rectum.
    Injections of water, and still more of  stimulating fluids, as salt  and turpen-
tine, for constipation, are pernicious.  They distend and destroy the healthful
contractile power of the bowel.  An examination of persons who have long used
 them, by tho speculum, always shows a congestive and relaxed condition of the
mucous membrane ; its adhesion to the muscular coat is weakened, and it slips
downward  and passes the sphincter muscle, constituting, in those  cases where
there are no distinct tumors or piles, the disease called Prolapsus of the tectum.
    Alter piles have existed for a long time, and  harassed the patient—some-
 times within and sometimes without, sometimes  painful nnl sometimes quite 
Fistula:  Tico  Kinds—Complete  an<I ///complete.
  endurable—the}- often become reduced to thick and partially solid tumors, ren-
  dering  the  person still uncomfortable by interfering with cleanliness, irritating
  and itching, and sometimes producing permanent thickening of the verge.   They
  also produce  Eistula, Eissure, Prolapsus, and other  ulcerations of the bowel,
  and by sympathy, great weakness of the bladder and its appendages.
     The  ligature is  the  best method of removing  voluminous piles ;  it  is
  absolutely safe,  and nearly always quite painless, when  carefully applied
  I' the morbid growth or  pile only, taking the greatest care to  exclude every
  fibre of the external  skin and the closing muscle below (he pile, that surrounds
  the  bowel;  we have often known this to be the cause of .severe  pain when the
  ligature was tied and cut, so  that it could not be removed.   A careful surgeon
  will  always  discover  it when passing the needle conveying the ligature ; for this
  reason no chloroform should  bo  given.  The operator requires warning.  Ten
  days are  usually sufficient  to  effect a  cure.   The  two other methods we
  adopt arc, the application of nitric acid to the piles only, and the instillation, by
  an exquisitely minute hollow tube and syringe, of a single drop of per-sulphate of
  iron.  Both  these methods will effectually cure, but  they require, if possible,
  more careful and experienced manipulation than the ligature : both methods re-
 quire more time.  Solid or external  piles only, had better be removed by the
 scissors, as there is,  like the  softer or internal ones, no danger from bleeding
    The question is often asked, Will not the "piles" reappear ?   The only  true
 answer is this:  Piles, at middle life, are the result of long-continued disease of the
 bowels,  congestion of the liver,  constipation, punratives, self-abuse and  pas-
 sional excess, and business exhaustion.   Most people acquire their permanent
 constitution of body when forty years of age.  The causes have then culmi-
 nated, and the man  is what he  is going to  remain, unless he soon die from
 bleeding and exhaustion.   He may reach old age with piles, but  he will be a
 burden to himself and others.  If thoroughly cured, he may nurse bis consti-
 tute ; but that can never be done when he has not a daily evacuation without
 Physic.or injections   Not one rase in a hundred would give  any trouble after
 cure  ,f people would only be temperate. Tobacco and liquor are fruitful causes
 of the formation of piles.   The former particularly has  a direct action in  ex-
 haustmg the  mucous membranes of the lungs, the urethra, and intestines.  Pur-
 gative medicines  for constipation are  always injurious and  exhausting to  the

    A Fistula is  an ulcerated  passage communicating  with  the  inside of  the
  ectum or  lower bowel, and the skin  near the anus by small opening rarclv
 larger than a  puis head   When there are two openings, it i     n  ,1  co rf

a'n  nch^"  Tb" °^ inC°mP,ete-  If * enter the b™el »™ half an  nch to


bo»-o, also  „ne„ issue from ,„ ^ ^£^J% J^TZ" f,"»
down, it generally discharge ., «i,:„ • i                   Crs the bovvel low
        6    ally ^charges a thin ichorous or  mucus-looking fluid, and not 
('<iitsis of Fi<tnli: Ciution t<>  Oj>■ r-itors.
healthy-looking pus.   The outer opening often heals up and opens at intervals
of a few days, in the centre of a small vesicle.   When it only opens inside < f
lie  bowel, it is  often called a blind internal fistula; the contents of the bowel
work through this opening into the loose tissue that surrounds the bowel, and
prodii'-e considerable destruction b'-lbre it opens in the external skin.  This is
often accompanied by troublesome  itching.   The sooner these are  opened, the
less cavity will  there be to heal.
    A n-TEf-sKs form outsider of the gut in the loose  tissue that surrounds the lower
part of the bowel, like boils in other pari < of the  body.  These should be open-
ed  early, because, like the blind or internal fistula, they often destroy  the tissue
extensively before  they open by ulceration.   These  are not properly fistula,
though they may become so if neglected.  The contents are usually very offen-
sive, though no fn-ces arc mingled with them.   This is caused by the long re-
tention and decomposition of the pus, and the contiguity of the frees;  the thin
mucous membrane lining the bowel only intervening, and tho sulphurcted hy-
drogen passing through it.
    These, however, arc only descriptions of the simpler forms of the  disease.
 The fistulous .'anal  may extend far up  into the cavity; may be accompanied
 with many external openings; may extend far beneath the external skin, and
 be accompanied with hardenings, with foreign bodies,  with disease of the neigh-
 boring parts, the bladder, urethra, vagina, etc., etc, and even with the  bones of
 tho pelvis.  Wc have witnessed every possible variety of this distressing affec-
 tion, and  can scarcely  conceive a  more irregular  ailment.   In No.  II. of tho
 Hoshm  H'dical and Sim/icil Journal for 1*1:2, there is a case described by us,
 in which the greatest variety of fistuko of which we ever read or beard exited
 in one individual.   They were all  laid open and  cured after a few weeks, the
 patient being now actively engaged in business in this city.   Wc slate this with
 no other  motive than  to show that  the worst cases of this distress,..;; disease
 may be  cured.
     The cause of fistula can not always be satisfactorily determined.   Sometimes
 a  h„ne or foreign body passes through the  intestines, and is stopped by the
 sphincter muscle ;  remaining long enough before it is expelled to cause ulcera-
 tion of the coats of the bowel, and so,  by the irritation caused by the  entrance
 of its contents into the loose surrounding tissue, a fistula is formed,    "tt e have
 found a fish-bone, a pin, and a musk-mclon seed in abscesses opened  by the
 lancet
     The  constitutions of  those who are predisposed to  consumption or apo-
  plexy should  be  always subjected  to very rigid  scrutiny before  an operation
  for either piles or fibula  is determined on.  The balance of the vital forces
  should be maturely considered.  The discharge  from  the piles or fistula may be
  preserving some important  organ from  congestion or inflammation, and cow
  Lent destruction.  On the  other hand, it is to be remembered that long-con-
  tmued exhaustion, produced by either of these diseases, may, and  often does,
  wear out life   Nothing but experience, a philosophical estimate of the facts in 
Fistula  and Fissure:  Tiro  Ojnrations.
  the whole case, and the absolute integrity of the surgeon, will avail the patient
  who desires to do the best he can for the preservation of  life.  Therel'ore,  he
  should always apply to a person who is perfectly familiar with such cases, and
  one whose honesty is known.
     There arc  two methods of operating on fistula.  The one is, by  passing a
  finger of one hand into the rectum, or gut, and then,  after having ascertained
  the direction of the fistula, passing a probe-pointed director into the outer ope-
  ning, following it with a delicate-pointed knife, and thus opening the fistula into
  the gut.  The wound is then to be kept apart for a few days  with lint, to pre
  vent its healing on the surface and not at the bottom, thus causing the disease
  to continue.
     The other  method is  by the ligature.  A silk  thread, or, what is  better, a
  silver wire, is  passed through the opening in the skin into the gut, and then by
  a blunt hook  brought out of the bowel; this is gradually tightened or twisted
  till it cuts through the skin  and all  tho portion of the bowel included in the
  ligature.   It is a far more tedious and infinitely more painful method.   Mr. Ar-
  nott's beautiful device of chilling the skin with ice and salt in a gauze bag renders
  the knife as painless as though the person operated on was under ether or chlo-
 roform ; and, what is better, there is no subsequent headache and no possible
 danger.   We have used the ligature a few times  to please the patient, but think
 we shall decline it hereafter.  Tho ice and salt have ncjver failed in a number of
 cases; indeed,  it leaves nothing to be desired in all operations on tho skin and
 immediately contiguous parts.  We find ether and chloroform rarely necessary ;
 iti  our private  hospital we  have used them but five times during the past year!
    Eisst ke of tiu: Hectl'm is a  term used by surgeons to express not exactly  a
 crack or cleft in the bowel, but  rather an ulcer of its mucous lining.   It is usu-
 ally low down, and visible by separating tho  parts.  It rarely or°nevcr occurs
 in children, but  usually in adults, and is common in  females,  who  arc often,
 from their  sedentary  habits, constipated; this condition  often produces it.  It
 is also often caused  by an ulcerated internal pile; sometimes by mechanical in-
jury from the awkward use of a  syringe, or the passage of a hard  substance  ;
 also by syphilitic ulcerations.  It produces the most violent burning, sometimes
 amounting to such  extreme agony on  passing the contents of the bowels that
 patients will often delay defecation till compelled  to yield to the  demands of na-
 ture.   It causes wasting of the flesh and extreme nervous sensibility; wc have
 known it to produce temporary insanity.
    It comes on gradually, often by a persistent itching, at first attracting little or
 no attention.  The pain is produced by a spasmodic affection of the sphincter mus
clc that surrounds the gut; the  itching  is produced by the contact of the fceces
   There are two methods,  also, of curing this disease : one by various sedative
and caustic ointments and subsequent  dilation with various sizes of smooth
conical instruments, formed of India rubber, and called bougies; the  other bv
partially dividing the ulcer only, with the knife, which allows it to heal like anv
ord.nary cut  The latter is instantaneous and the far preferable method 
Stricture of the  llc'um: X<m M-Uirxl of ('are.
   The old method consists in dividing the sphincter muscle completely.  This
must always be done on one side, and neither directly forward nor backward,
for reasons connected with the structure of the parts;  these are well known to
the practical surgeon, and are impossible to communicate intelligibly to the gene-
ral  reader,   llividing the  sphincter is an operation requiring gentleness and
I act.   We have seen the muscle divided clear through.   This is totally unne-
cessary, and causes great distress.  The inner fibres only  of the muscle should
he divided.
   The bougie, if persevered in, will always relieve and often cure.  It is ne-
cessary to have a properly  selected set, beginning with the very smallest; for
the ulcer  is so extremely irritable that the muscle contracts with instant spasm
even upon attempting the introduction of the finger.   This extreme irritability
is greatly allayed by tho  use of a few grains of belladonna and sugar of lead
smeared on the part before the use of the bougie.   The patient, if intelligent
may carry out the treatment by the bougie without the aid of  the surgeon.
    Stiucti kk of Tin: Ui:<ti m is, fortunately,  a rare  disease.   Wo have been so
unfortunate as to see many cases, ami to be obliged to treat  quite a numb r;
but  this has required thirty  live years of practice, chiefly in pelvic diseases.  We
should not care to say how often we have  dismissed the patient who has applied
to us for treating the complaint, where it proved, on examination, not to exist;
constipation and a careless or incompetent investigation having deceived  the ex-
aminer.   When it doos exist, it is of sufficiently difficult  treatment to test the
patient's  philosophy, and to call  forth all the patience and  mechanical skill of
tho  surgeon.  After twenty years' trial of the old method of  bougies, we have
abandoned them entirely, and now use an instrument of our own invention, of
a character so simple and efficient that the patient can apply it without the aid
of the surgeon  with a  success and  facility that  leaves nothing to be desired.
When the disease is not cancerous in character—which  unfortunately  it often
is—the patient can  control it for an ordinary lifetime, and secure natural eva-
cuations without the exhausting effect or purgative medicines.  Of course, the
efficiency of the  instrument wc  have devised, depends upon the non-cancerous
character of tho stricture,  and this  can only be determined by a very careful
examination.
   The Sympathetic Symptoms of these diseases in the Bladder and Uterus, and
their consequences in producing prostration of the powers of the sexual organs
and bladder, is all we can add  to this short exposition.   People  rarely reason
correctly  on the nature of their symptoms.   They seem to isolate each part, and
forget that the human  body is only in health when all its  parts act  harmoni-
ously ; we can not be continually reminded of the existence of any part unless
something is going wrong in that part   In high health, the body acts in such
perfect harmony in all its parts, that we do not realize that it  is made up of va-
rious or-ans.  To show tho reader the importance of knowing  the extent  of
local or near sympathv, we extract from that acute observer and excellent sur-
geon Mr  Guthrie, ol London.   He  says  in  his work  on the anatomy and d.s- 
Sympathy  bcticcen the Bladder, Wo/al>,  and Rectum.
 eases of the sexual organs,  p.  14G : "Tho  urethra  is often sympathetically
 affected by disease of the rectum of so obscure a nature,  that tho  patient is
 scarcely conscious of the complaint  The sympathy which exists with hemor-
 rhoids (piles) is generally sufficiently marked, and whenever symptoms in tho
 urethra can  not  be accounted for after  an examination of that part, the stale
 of the rectum should be carefully investigated.   I have seen two very remark-
 able cases of disease attributed to the  urethra resulting from a small lissuro
 in the fold of the mucous membrane of the intestine, which remained  for a very
 long time unrelieved by all the means adopted  for their cure, until at last the
 fissures were discovered, and complete relief obtained by division of the sphinc-
 ter muscle and of the extremity of the rectum corresponding to the fissure."
 We have very often observed this origin of urethral  irritability.   In  our own
 work on diseases of the sexual system it is particularly noticed ; that  work  was
 published twenty-five  years since, and  scarcely a week  has elapsed without a
 renewed conviction of its truth.  Wc have seen hundreds of cases in which par-
 tial or complete impotence resulted from tho nervous exhaustion produced by
 Piles, and which gradually ceased on their cure.  The urethra and bladder arc
 almost always affected, and wo often refuse  to treat the patient for.supposed
 affections of these important, organs, well knowing that all his troubles originate
 from piles.
    Benjamin I'.rodie remarks, page 310, in his Us.viys on Hemorrhoids: "In-
 ternal piles often give the patient a great deal of inconvenience, besides which
 they are liable to irritate the neighboring  parts, often producing  tho  frequent
 desire to urinate, and  at other times inducing spasm in  the muscles  that sur-
 round the membraneous part of the urethra, so as to cause complete  retention
 of urine."  Wc have often been obliged to recommend laudanum injections for
 this condition of things, and it has been necessary to repeat them for days and
 weeks, the patient obtaining no  permanent relief until  the piles were cured.
 These cases arc often a great annoyance to the surgeon, because the patient, not-
 withstanding the  possibility of piles existing  when they do not come down at
 stool, and he  can  neither see nor feel them, will  not believe in their existence,
 insisting on the disease of the urethra only being attended to, when there is
 really no actual disease there.
    In  diseases of the  neck of the womb, the  sympathy with the  bowel is
 marked.  We scarcely ever find such a case without some morbid condition of
 the rectum.  Either piles or fissure, to which  women are particularly subject
 from  constipation of the  bowels,  are  often  found associated.  The  bladder
 scarcely ever escapes in a chronic case of  piles, and we never think of treating
their diseased condition separately.  The surgeon who understands these sym°-
pathies will never be influenced by his patient's  wishes to ignore one or the
other.   U e never attach the least importance to the opinions of our  patients
and always tell them so at the first interview; it saves a  great amount  of
trouble. 
Abridged from a T./rtore on the Pathology and Tr< ifmer.t of Strirturs.  De
    licered to his prirate Surgical Class, by Edward II. iJixon, M.D., Editor
    of Tin: Scalpel, and Operating and Consulting Surgeon, 42 Fifth Avenue,

' • i:n; i i.i:mi:n :
  Since the discovery of Mr. Syme, of Edinburgh, that stricture of the urethra
is only permanently curable by incision, Hurgeons  have been obliged to scru-
tinize one of  their best established and most cherished dogmas; one that was
sanctioned by the greatest  authorities, and apparently proved to be true by
centuries  of  professional  scrutiny.  Indeed, it bad become an aphorism ; anc
tho surgical neophyte would have been condemned to another year of study, if
ho did not know it,  when asked by his "tormentor," whilst " undergoing  his
first great sweat in tho green-room."   It was this :  " All wounds, when healed.
necessarily contract the parts  they unite."  In popular phraseology,  "Sears
shrink."  Now, all practical surgeons well know that this applies only to ul  r
ated  wounds where  there  is  much loss of substance, and especially  to the
skin,  as in burns ; it is quite doubtful if the aphorism applies at all  to incision
below the skin; it surely docs not, to tho numerous operations nowperformel
for deformities  produced by  contracted muscles and tendons, as  wry neck,
clubbed foot, contracted joints, efc, where incisions arc freely made under the
Bkin.   Surgeons have, for centuries, therefore, applied a rule applicable to ulcer-
ations only, to simple incisions ; and  the consequence  has  been, the failure to
euro  two of tho most  distressing diseases to  which we arc subject, namely :
"Stricture of the urethra, and stricture of the uterus." The former is but too
well known in our'own sex, and the latter, only unsuspected to exist by reason
of absolute ignorance of the nature of her own structure  and functions, by
those  women afflicted with painful menstruation in early life, and  unfruitful-
ness when married.   She would be as frequently the subject of stricture of the
urethra as man, were it not rendered  almost impossible by the shortness of
the passage,  making it easily and  constantly dilatable by the urine.  The pas-
sage from the cavity of the  uterus, in  its unimpregnatc 1  state, only requiring
the percolation  of the  menstrual fluid—as it Yverc, drop  by drop—and being
very  subject  to ulceration and contraction, besides having its caliber, which will
hardlv admit a pin,  in its natural condition, continually contracted by conges-
tion of the substance of the neck of the womb, through which it passes—is very
liable to stricture; indeed, nine women  out  of ten, who labor  under difficult
or painful menstruation, and are unfruitful, have this  disease.   But it is truly
astonishing that physicians still  persist in treating both these diseases with
medicines.  They belong exclusively to the surgeon, and can only be cured by
local and instrumental treatment   In  both, there is an alteration of structure,
which when  the diseases have existed for some  time, has become  permanent 
 13                 Causes, Symptoms, and Situation.

 Stricture is a thickening of the natural  tissues lining the respective passages
 from the bladder and  the  womb, making them smaller  than natural.   This
 thickening is the result of inflammation ;  in the urethra, it is usually caused by
 Gonorrhea or Clap;  not always, however, for there arc other causes of inflara
 mation; long-continued self-abuse may cause it.  It is only necessary to apply
 irritation to the urethra,  and  to continue that  irritation long  enough, for
 inflammation and thickening to occur in the lining or mucous membrane, and
 to extend far enough beneath  it to produce "stricture."  It may originate
 from mechanical injury.  We have had very bad cases of stricture from kicks
 bctYvecn  the legs; also from  falling astride of a rail;  and  in one instance the
 tail of a wagon-board,  astride of which  a man alighted suddenly.  The use
 of that shockingly dangerous instrument for cauterizing the  openings of tho
 seminal  ducts,  (Lallemand's  Port Caustiquc.) has made a few  of the  worst
 strictures yvc have seen.  As these result from tho contraction of an irregular
 ulcer of indefinite extent, produced by the caustic, tho cicatrix  forms a stric-
 ture of no describablo shape; the passage being so distorted,  that its natural
 continuity can ncY'er be restored; the only resource of tho surgeon is, to cut
 through it in a curved line, and  form a new passage.   We have  also had  sev-
 eral severe strictures under  treatment from local inflammation, caused by the
 continued passage of bougies by the patients themselves, when pursuing the
 old method of dilating the stricture with bougies.
   The barbarous method of forcing  through a stricture with a conical bougie,
 and piercing it Yvith  a pointed one, will often greatly increase it;  indeed, it is
 impossible, at this moment, to recall an accident, or evil result of  practice, that
 has not afforded us one or many examples of stricture.
   Strictures vary in degree, from the twelfth of an inch to two inches in length  :
 we have had examples of more than three inches of the urethra obstructed by
 one or more strictures of almost  cartilaginous hardness.   They are rarely at the
 opening or mouth; most frequently they are situated at the fourth or fifth inch
 of the urethra, when that passage is seven inches  in length;  it is not usually
 longer: stricture rarely exists at the neck of the bladder.

                               BYMPTOMS.
   Mu-i are so unaccustomed to  observe  correctly  their own  feeling*, ana to
 trace out the causes that interrupt that  harmony  of action which constitutes
 health, that it is quite difficult to convince them of the existence of any  other
 symptoms  of stricture, than  such  palpable  ones as a great diminution of
 the stream, or occasional absolute obstruction to the  passage of the urine.  Now
one  would suppose  that it could hardly  be possible to overlook a diminished
stream, amounting to one half what it should be in health ;  but wc have only to
reflect, that  if an ordinary lead pipe, of  a similar calibre,  delivering a stream
of its own size, should receive a blow, causing a dent that should diminish it by
one half that  calibre,  it would still deliver a stream in appearance quite as large
as before ; but that stream would not be round and continuous, nor could it be 
                 Tr>'.m'mcnt f>r  Complete Obstru<-tion.              11

projected as far from  the orifice of  the  pipe as it would have been  before^ the
dent was made; it would be spiral, or more or less like a cork-screw, scattering
at the orifice, and it would fall nearer the opening of the pipe.   The patient rareiy
observes this, nor the increased frequency of the desire to pass his urine ; both
these symptoms arc so gradual  in their approach, that they are rarely noticed
till so marked as  to compel  attention.   I never yet heard a man say he could
determine  when  lie first believed the  stream  of urine was  essentially dimin-
ished.   When asked if he has noticed any diminution,  the patient will invaria-
bly say No -often even when a number  four bougie will pass with difficulty.
Still less will ho believe that  nervous  symptoms,  palpitations, chills, head-
ache, lassitude, and  increasing unwillingness and want of mental f<»rce in all
the business of life,  depend upon this morbid irritability of the urethra.  That
conduit is intended by nature for the rapid passage of tho urine, which is often
very irritating, because of the redundant acid and alkaline secretions from the
blood; tho  urethra being the greatest waste-gate of the body.  The urine is
poisonous;  if taken  into the blood extensively, or entirely, as in cases where
none is secreted by the kidneys, the patient dies, as surgeons say, of Uricmia ;
be becomes stupid  and dies --blood-poisoned by the  urrti.   Now when tho
passage is greatly narrowed by stricture from any  cause whatever, of course
tho force of  tho bladder can not act as much on the portion  of urine  be-
yond the stricture, as  it can  on that nearest tho bladder ; therefore  the  nearer
portion of tho urethra is distended, often to double and triple the  size of the
more distant portion.   This  distended part becomes  irritable from the  presence
of the acrid urine, and its lining membrane no longer remains smooth, nor don
it secrete the healthful mucus provided by nature to lubricate it, and cause it
to tolerate  the urine ;  this sore bag or sack, irritates the whole nervous system,
and causes  general constitutional  symptoms, as  above enumerated, chills, etc
In process of time, the stricture increases, by the  thickening of its walls, caused
by the constant inflammation, till the urine is only permitted to pass in a very
small  stream, or drop by drop.    Cold feet,  general chill, or a debauch with
wine  or women, throw the blood  from the  surface  into the membrane lining
tho stricture, and it swells till the urethra is quite closed, and there is absolute
d.-tention of urine.
  It is not advisable, nor indeed, possible, within the limits of a short  lecture,
|o enumerate the variety of  remedies administered by physicians, to cause the
jrino to flow.  Thev  are mostly inoperative  and unreliable.   Warmth in bed,
 ncreased by bricks  and bottles of hot water, is the only reliable  method of
re6pening the passage ; if there be spasmodic efforts  to pass the urine, and the
smallest catheter  can not pass, by  skillful and gentle efforts, no time should be
lost  Ether should be immediately inhaled—from a funnel-shaped napkin, the
ether being applied bv means  o(  a sponge the size of an  egg, placed in the
funnel poi.it of the napkin,  the patients nose being inclosed by its open mouth,
raisin- it every few seconds to admit the  air.  This  is  perfectly  scientific and
Bare  and should never be  omitted.   It  is  quite unnecessary to wait for the 
 12              Treatment f<r Complete Obstruction.

dcHnr or surgeon ; any person  of common intelligence should at once proceed
tc do <t without hesitation, and Yvhat is more, as soon as the patient is insen-
sible, he should, without the least fear, attempt very slowly and gently to pass
a small number four catheter of gum clastic.   He can do no possible harm, and
may save  the poor victim the  greatest anguish, and  tho danger of a bursted
bladder.   I can not conceive how it is, that people who call themselves men, do
not instruct their patients, especially in the country, where it is often  difficult
to get  medical  aid,  in this simple and necessary act.   No  man  worthy tho
name would fail to do it, nor  should  instruction in tho use of ether any longer
be withheld in our public schools. It is the most effectual remedy for spasmodic
diseases known to man.  When  our profession clc\-ato  their  code  of ethics to
the height, and  adapt  it to the breadth of  the requirements of humanity, then
they will have less cause to complain of the ignorance and ingratitude  of their
patients.
  If these efforts fail in enabling tho patient  to  pass his urine, no further time
must be lost.   The surgeon (not the physician) must bo called.    We  will en-
deavor to illustrate why v\-c say  this, by a few type-cases.  It is customary, in
all tho authors on Stricture we have ever read, not only to publish a great num-
ber of cases, but to give all tho  receipts, and the regimen  adopted in each case,
and to dismiss  the patient generally as "cured" by tho same.  We have no
recollection of having  "cured" a single case, in thirty-five  years' experience
by the method of dilating with  bougies; whenever the patient has not left ui
•n disgust because we demanded  payment of a bill, or because his disease re-
turned after a little relief by dilating the stricture, keeping his  feet warm,
and  ceasing his intemperance and other debauchery, he has either abandoned
us because he was promised a cure by medicine, or he has abandoned himself
in despair at the result of all treatment.   It  is only since we have adopted tho
treatment of incision by the Urethrotome, that we have derived any  satisfactory
results ; we now know that we alter the action of the nerves and minute blood-
vessels, that  made the stricture, by keeping alive the irritation and inflamma-
tion, thus thickening the membrane lining  the urethra, and closing it up.
  When you shall have read the authors on  stricture for  the  past  fifty years,
you will learn that it is not extravagant to  say that their treatment  for its radi-
cal cure is entirely worthless and absurd.   Mr. Syme, of Edinburgh, within tho
past fifteen years has changed all our ideas, and created the therapeutics of
stricture.   The canny old Scot has left us noYvhere.  Palmam qui meruit is
our motto.
  I will now present you, from a great number, three cases that will illustrate
each variety of  stricture.
                         EXAMPLES  OF STRICTURE.
  Case Fiiist. — Complete  obstruction, of  two days'  duration,  from  irritable
stricture.  Entering my office some time after the evening hour, I found  sev-
ffal persons in waiting; recognizing an interesting case in which I  had divided 
                 Treatment for  Complete Obstruction.              13

a stricture the previous week, I was making some  inquiries regard: n:; its prog-
ress, when a groan reached my ears, from a young man who had <■ »:ne attend-
ed by his phy.sieian.   I immediately noticed he had that peculiar expression of
countenance that indicates  what accoucheurs call  a "bearing-down,'' or labor
pain, such as that which accompanies  the commencement of the last or expul
hi\e stage of parturition.  Tho bladder occupies the  same region, and is gov
erned by nerves from the same part of tho spinal  marrow that the womb is;
and the effort to expel tho urine retimed for  two days, will  produce precisely,
so far as the face and abdominal muscles arc concerned, the action  of parturi-
tion ;  without relief, this would goon until the bladder burst, when death wo ii i
soon  follow  from tho effusion of  urine, causing inflammation in the abdomen.
 This young  man  was about  thirty years of age.   He had had gonorrhea or
clap for a long while, several years before; yet he was married since, and had
one child.    lie presented me a note from a friend, to this effect: "This man
has a bad stricture.   Wc (two gentlemen, his friends) have been  at him, off
and on, for tY\o days; we can not pass the smallest bougie  or  catheter.   Try
what you can do with your  new instrument"  Although this case was sent to
me so frankly,  most, surgeons will agree with me, that I had no cause to be
thankful for having thus thrust upon me tho awful responsibility of  a man  who
had been unsuccessfully  treated  for two days, and actually  had pains on him
 preparatory to the bursting of his bladder!   I am obliged to state the case in
this way, to show how far gentlemen  will  deem themselves justifiable in  pro-
ceeding, where three have been in consultation,  and where it is only human
 nature  to  suppose that one,  at  least,  considers  himself competent  perhaps
skillful.   The reader Yvill perceive, that in the event of failure in relieving  the
man by passing the  catheter, I should  have been obliged to operate  on him at
 once in my o\\ n house, or send him  to my hospital.  I say  candidly, that  I
 believe this latter was  tho  intention, and 1 think  it but fair to say to gentle-
 men who meditate such  acts of kindness, I shall  not be thankful for their fru-
 ition.   Tho medical  gentleman who came with the  patient, Yvas a hospital pupil
 of Mr. Syme, of Edinburgh.  On inquiring whether  he had  had any medical
 treatment 1 was told that all that had been practicable  had been done, except
 bleeding and the warm bath.  This would have been the treatment, according to
 all precedent and authority, when 1 commenced practice, thirty-five  years  ago,
 and it would have relieved him, after it had  half killed and prostrated  him for
 weeks, only to bo renewed on tho next occurrence  of cold feet, or slight de-
 bauch'  My second  question,  " Have  you had ether or chloroform?" was an-
 swered in the negative.   Seeing that tho whole evil depended upon spasmodic
 action of the  closing muscle  of the bladder-a circular muscular  tissue,  that
 closes the outlet or neck of tho bladder like a ribbon-and that this spasm was
 excited by the stricture, rendered more irritable by the  unsuccessful use of the
 instruments in so many hands-" drawing blood freely," as I was told-I made
 no further effort till 1 had placed the  patient under  the  full  act.on of chloro-
 form  1 prefer ether, but its slowness would not suit the urgency of the case; 
14
Division by the  Urethrotome.
  I feared the bursting of the bladder.   As soon as he was unconscious, I took
  a number six catheter, and passed it without the  least difficulty, tho urino issu-
  ing with such force as to pass over my shoulder, as I was kneeling on tho floor
  by the side of the couch on which he lay.  His relief was immediate and com-
  plete.   1  passed  a number ten catheter of gum elastic, and secured it with  a
  bandage,  the  doctor suggesting it, and I being unwilling to risk tho chance of
  his passing  urine  during  the night, as ho lived in Brooklyn.   Having com-
  menced this  case, I was obliged,  in  justice, to finish it, as  it created two ene-
  mies, out of the three gentlemen  concerned in it—how justly,  you may judge.
  The oldest of the three now laughs, and cites it as a case of their own  stupid-
  ity ; but he has retired, and being a man of the world, can afford it.
    The patient could not endure tho presence of the catheter longer than next
  morning, which was what wc both anticipated.   Tho reader can judge of my
  surprise, when I again found  him  the next evening, this  timo unattended,
  in my office,  unablo to pass a drop  of urine, tho same efforts having  been
  made by two  of the gentlemen, unsuccessfully, with no chloroform, to draw off
  the urine.  The same  treatment as before, was again successful.  I sent him
  home with the catheter in his possession, and positive directions to stay in bed
  with all the clothing  that he could pile on, warm  bricks to his feet, and a tea-
 spoonful of sweet spirits of nitre in a half-tumbler of  flax-seed  tea every two
 hours; if  that would  not answer, a dessertspoonful of laudanum in a wine-
 glass 0f starch, warm, to bo thrown  up the bowel;  in an  hour the catheter
 number four to be gently  tried under the cover, so as to avoid  chill.   If  that
 did not answer, chloroform to be  used, and  number six tried,  as I had done,
 telling him frankly that he never would be cured,  but constantly liable to  just
 such attacks from  cold feet, and general chills, to which he was constantly liable
 from his calling—stoking up and supplying an engine—till the morbid  action
 was for ever interrupted by dividing the stricture with the Urethrotome.  I de-
 sired him to give my opinion frankly to the gentlemen, and not bo unduly influ-
 enced by fear.  He went home and required no further use of the catheter, or
 any treatment except the warmth in bed and the spirits of nitre, the stream
 however, being smaller than before.  The two gentlemen opposed the operation'
 assuring him that  dilating  the stricture would cure it, and the operation  was
 unnecessary and unwarrantable.   He  had  now lost all confidence  in his ad-
 visers ;  and at his request, a fortnight after his last visit, I divided the stricture
 in  presence of Dr.  Henry,  of this  city.    The  other gentlemen were  not
 invited,  because they did not approve of the operation.   The patient was ether-
ized, although  it is  not necessary; there is no pain  in the internal incision  and
any case i.i which the smallest bougie can barely enter the stricture for a single
ime. can be divided, generally at the  first attempt   He, however, desired the
ether, and  it was  given in anticipation of spasms, as  ho had suffered so
much.   Immediately we placed a number twelve catheter in the bladder  the
 full size of  the urethra.   Not a bad symptom followed.  He was not confined
 an  hour ,n bed, and in a week he resumed  his employment,  being directed to 
                  Stricture from  a  Fall on a  Hoard.               15

keep dry feet, body warm, live temperately, and introduce the catheter once  »
week for a Uw months.   We  have not seen him for nearly a year, but  learn
from several patients he has sent us, that he is  in perfect health.
  This  case  illustrates a  vast number;  it is by far the most frequent one we
sec; in its beginning, it  did not even arrest the notice of the patient;  like a
vast; majority of cases, it commenced in an obstinate clap;  that was the irrita-
tion that produced tho inflammation,  which finally made the stricture,  in its
most frequent, place, an inch  and a half from  the  bladder.   The patient was
perfectly temperate, but  liable to chills and  cold  feet,  the greatest exciting
causes of congestion and swelling of the blood-vessels that form the lining mem-
brane of tho  urethra.   A chill after great exertion, producing a sweat, oc-
curred ;  spasm of the muscles followed ; mechanical irritation was added from
too long continued efforts to overcome the stricture by bougies ; no chloroform,
tho great rclaxer of spasms, Yvas used; and nothing but relief could follow,
even from that, had it been used ; there could  be  no cure, till the morbid  con-
dition Yvas interrupted by dividing the  stricture. Hoyv far it illustrates our ideas
of tho evil  results of medical treatment, or of medical consultations,  wc leave
others to determine.  The patient has given leave to publish his case.  He is
in the employ of Mr.  Secor, ship-builder, of South-Urooklyn.
   Cask Slcond.—Stricture from a bruise received by falling from a height on
the edge of the tail of a wagon-box :  A. W. S.  Shippen, Cameron County, Pa.,
n  young man of twenty-four, iron machinist.   During some agricultural  pur-
suit, this young man fell and  alighted astride of tho tail board of a wagon,
bruising tho urethra and inducing tho  usual  symptoms of stricture: gradual
diminution of the stream, first, spiral form, and finally scattering of the stream
of urine, often threatened with  complete suppression from  checked  perspira-
tion, during his laborious business.   lie was several  years  in this condition,
but contemplating marriage, and being a \ cry conscientious and intelligent
man, concluded to seek surgical advice.  My journal, Tin: Scalpel, having fallen
into his hands, ho was induced  to seek my aid ; a friend following him to the
train, and earnestly dissuading him  from his rash conclusion, assuring him he
would meet his  death from so awful a man, and that the New York surgeons in
general were nothing but executioners.  I found  the stricture Yvithin a couple
of inches of the bladder,  or just where a person would alight in falling astride
of a board ;  a number two steel  sound would pass with diilieulty.  This, how-
ever, is ample for the Urethrotome.   I could have divided it at once, but yield-
ed to his desire  to have  a  little more opportunity to study his executioner's
habits.   In about a week I used tho  Urethrotome successfully, giving so little
pain  that  he laughed at his apprehensions.   In another  week he returned
to  his home, with several  number  twelve bougies, which  he Yvas directed  to
use occasionally.   I gave him a stock, because I believe strictures arising from
kicks or bruises, must most likely have ulcerated at the time the injury was
inflicted, and that the urethra has been  only preserved through the cutractcd
cicatrix, in a very irregular form.  One incision, therefore, forms a new pass- 
],3              Stricture from  the .U>use  of  Caustic.
 age in one  or  two points of its  course, not  enlarging tho old one  simply.
 Therefore it will take longer to reestablish it of a full size, and allow the whole
 t> be covered by a newly-formed  mucous membrane.  Nature docs not Yield
 po fast in irregular ulcerations.   These, we have explained, contract, because
 they ulcerate.   Such cases are, however, rare—we  have had  several  from
 kicks —this one is a type of most cases of stricture from a bruise.
   Cask Third.—A young man who had indulged during several  years  in self-
 abuse, became so exhausted from seminal emissions, that he applied to a vrrv
 notorious operator of this city for treatment,  lie proposed cauterization with
 Lallcmand's instrument.  This was repeated no less than  twelve  times, at  in-
 tervals of a week.  I can only suppose, that tho instrument was  used  for  de-
 ception, and for nine or ten times was either very slightly, or not at all charged
 with caustic, as I can not conceive the possibility of its having been used week-
 ly;  if charged and used  in tho manner directed by Lallemand, \n his book—the
 urethra would have been ulcerated  and completely closed by tho  fifth time.   1
 have never myself used the instrument of Lallemand, though I have for  years
 followed his book as a guide in such cases.  We owe him all that wc really knoYv
 of  tho principle of  cauterization,  and  although I  have seen tho instrument
 invented by myself,  described in tho thirty sixth volume  of the  Boston. Med-
 ical and Surgical Journal, extolled  by I >r.  Cross, in his great work on Diseases
 of the Urinary Onions,  as "the only one proper to bo used," I am  obliged to
 say that J deem them both dangerous:  Lallcmand's, because; it is  quite impos-
 sihle to  use it without injuring  tho urethra; my own, because;  it frequently
 atehesand tears the mucous  membrane in the opening through which the caus-
 tic is applied,  when the charged caustic holder is drawn back, previous to with-
 drawing the instrument.   I would gladly withdraw it from the shops if I could,
 but  such things,  when given to tho instrument-makers, arc beyond control;
 they will make whatever will sell; surgeons of limited experience will  use what-
 ever they think  promises well;  and the  patient suffers.  I now  use a much
 simpler one, which I will presently describe.
  I have never seen  a worse  case of stricture  than this one.  All the trouble
 originated after  the  tenth application ; the twelfth completed the  stricture.
 The  patient passed blood and  matter for several weeks,  he urinated with  great
 pain, and the only reason, in my opinion, why he did not have an opening from
 ulceration in  the urethra, and a urinary fistula from  the violence of the inflam-
 mation, was simply because the injury inflicted was at the very neck of the
 bladder.   Had there been a space of two inches, as in many cases of strict-
 ure from clap, the pressure of the  urine would  have caused ulceration in the
 urethra, and the patient would probably have had a fistulous opening between
 r is legs, or, as surgeons say, in the perineum.
  I could in this  case introduce no  instrument whatever; the contraction was
so extensive and so dense, that I was obliged to use the Urethrotome, without
the director, which, in ordinary cases, enters the stricture and acts  as an avant
 courrur.   I  used the instrument  that is made with the full curve  of tho 
•
                Stricture from, the  Alm.v of  CausCv               17

urethra in its undiseased state, and projected the blade line by line.   The strict-
ure was a full inch in length.   I succeeded  in  cutting through it, after ten or
twelve projections of the blade; as soon as the blade met no more resistance
1 passed a number ten catheter into the bladder.   The patient remained a fort
night,  by which time I had taught him  to  pans the gum elastic  catheter with
ease.   lie has since married, and  is apparently contented.   He  has, however
no children, and from  the scat  of  the  injury, involving the seminal  ducts, I
think it probable he is impotent   I am  inclined to think the observations made
in  my work on  Diseases  of tho  Sexual System, were  richly merit« 1  by this
dangerous instrument.   How far  any instrument would be safe in the hands
of senile- of our practitioners, I leave my professional brethren to judge, when
 I  was  teilel by a ce-lcbratcel  Professeir he used  it every fourth day!  Caustic  is
 certainly a very powerful agent, and although the practical surgeon can not pos-
 sibly dispense with it in an infinite variety of sluggish and irritable ulcers, and
 in passive spermatorrhea, it  must  always  be used with great care; in tho lat-
 ter disease, never nearer  than a fortnight between the applications, and  te v.t
 applied over four times to any one ease-.   I noYV use- the simple catheter, with its
 point,  cutoff, and a pyriform-hcaded gutta-percha  bougie inclosed in  it.   The
 caustic  is attached to  one inch of the bougie, directly behind the  head, by
 means of melted wax painted  lightly over that  one inch ;  it must liist  be
 powdered very finely, and tho waxed inch of  the bougie rolled round in  a fold
 of paper .outlining'the caustic, and pressed on the wax by the thumb and fore-
 finger.  When properly charge-el, the caustic should show the bougi.-,  or rather
 the wax, distinctly through it:  it should  only  be barely whitened  with  the
 caustic. ' Immediately before it is passed  into tho urethra, the patient should
 pass his last drop of water from  tho bladder.  If ho does not do this with ab-
 solute thoroughness, the urine will enter the  catheter and completely neutral-
 ize, tho caustic, rendering that application perfectly useless; indeed,  it will  be
 quite useless, should any urine  issue  from the catheter, to draw it  back and
 expose the bougie to the seminal ducts, because there will be no caustic on it
 Wait, in such an event, for three days, and  direct the patient to u>e more care in
 passing his urine.
    It will sou., times happen, however,  that there is a state of partial  paralysis
 of the bladder,  which renders it impossible to pass all the urine ; it  will drib-
 ble for some time alter the  patient readjusts bis  clothing.   The  urethra  will
 also  become relaxed  and baggy for a couple of inches from  the neck of  the
 bladder, forming  a small bladder, as  it were, out of the  urethra.   Ilu* will
 often allow the  stylet to bo projected  from the catheter, and the  surgeon w.l
  foci no resistance'; the instrument will often  indeed pass directly  into the b  ad-
  der with no resistance  from the  sphincter  or closing muscle  as ,s isual in
  healthy people.   These are the worst kind of cases and will admit of a much
    -er useof the caustic.   Strychnine is useful in such cases  but th>s dem ,eds
  the careful  attendance of the surgeon ; it  would perhaps lead to mischief if we
  were to give any  directions tor its  use.  Wo  take occasion  to caution the  sur
  geo,  in fh. use of our truncated caustic catheter, as now sold in the shop,  If 
 13              Dinger of  L<C1< maud's Instrument.

 the stvlct be made of whalcbeme, that substance becomes very brittle, if kept
 in a cold place; it is likewise eaten by a peculiar insect  It would  be a sad
 accident wen- the end to be broken off in the urethra or bladeler.  Mr. Tiemann
 now makes them of gutta-percha, which is perfectly safe-, and far  more flexible
 and easily  introducml into the catheter.
   This instrument is now, I believe, more extensively used  than any othe-r
 caustic catheter.   It was dcviseil immediately after the one I have condemned,
 and is, with the gutta-percha stylet, perfectly sale  and absolutely certain to
 touch the dints and the last inch of the urethra, whie-h is  always involved in
 spermatorrhea.   With Lallcmand's  instrument, aside  from  its mechanical de-
 fects,  accuracy in the place of application of the- caustic is impossible.
   We have now cited, out of a great number, three type cases, illustrating tho
 comprehensive charae-ter, as a curative instrument,  of the- Urethrotome.   We
 should rather use- the plural number, for there are six diflcrcnt instruments.
 These  cases are purposely selected from  the most difficult  ones.   In cvi-ry
 minor  case of stricture-,  some one of the instruments is equally applicable.
 In  cases of enlarged  prostate gland, where  the passage of  the; catheter  is
 very diflicult there is no reason  why the instrument should not prove cepially
 effective.   Our experience has been confined to two eases only;  in both, tho ca-
 theter  number  ten was passed, and the  patients are  still  epiito cennfortablo
 whilst themselves  using it.   In neither ease can a cure be; anticipated, as both
 patients are advane-ed in life.   Neither has ever been strictured.
   In cases  of leing-e-ontinued  gleet,  Yvhero stricture is  beginning  to form, th
 instrument will bo found very effective as a  resolver of local congestion.   It
 operates precisely like the delicate elivisions, made by tho lane-e-l, of the lining
 membrane  of tho  eyelids.   Wc have  cured numerous eases of gleet, which
 had resisted the various applications in use by the bougie, after n few very
 slight incisions, searcely tinging the urine with blood, and requiring no confine-
 ment  nor any other treatment whatever; the  di.sediarge, and sensitiveness of
 the urethra, have ceased in a few weeks, and where a number four or six bou-
gie would barely pass, with considerable pain, wc have  sent the patient nway,
able to pass number ten and  twelve, with perfect ease  and  no pain whatever.
 In cases of great irritability of the neck of the bladder, doubtless produced by
 baekward continuation of morbid action from the stricture, great relief has fol-
 lowed.  No doubt  exists on my mind, if the  unfortunate "business habits"
 of our migratory people would allow them  to  take  time for  treatment, most
 of these cases could be cured.  They require, however, the presence of actual
stricture, before most of  them can  bring themselves  to so great  a sacrilice.
 When the urine is actually suppressed, then only does the patient perceive the
 necessity of positive surgical treatment.  Out of many hundred cases of gleet
 few have been told  that a gleet is the first symptom of  the formation of stricture.
 It is the almost invariable custom for all such cases to  be placed  under med-
 ical remedies, that  is,  remedies to be swallowed.  Not  five per  cent are even
 sounded to ascertain whether there is not actual stricture.   It is far easier to
write a receipt for  medicine, and when the list of book-remedies is  exhausted, 
                 Treatment if  Conorrlna Fm],lr'i>al.               19

or the- patient has lost confidence in his physician, he goes to another, only to
experience the same- role  of elisappointment.  He finally becomes disgusted
anel  abandons himself to eating and drinking to  keep up his waning powers
until actual stricture- anel partial loss of virility warns him to seek the surgeon.
I printed tho opinion  twenty years ago in my work on  Incases of the Sex-
ual System,  that tho medical treatment of gonorrhea  and gleet was entirely
pmpirie-al,  and couhl never  be otherwise.   A "remeely"  to  be swallowed,
with the view of producing  any eertain action on th«; urethra, is absurd;  it
may act favorably, but no reliance whatever can be  placed  upon it.  It goes
into the stomach,  not into the urethra.   The  stomach first acts  on  it, and its
 indigestible; portions pass out of the bowels;  but a very slight action from any
 remedy, however powerful, can be expected on an entirely disconnected  cavity
 anel its lining membrane.   Moreover, it deranges the digestion, and thechief rem-
 edy relicel on, the balsam Copaiba, itself often produces  a formidable eruption
 over the whole  bexly and face, whieh insures the exposure of the patient as the
 probable vie-tim of a far more formidable, inelecl, an awful eliscase.   The re arc no
 scientific methods of treating clap but two: Fir-tly, and on  the appearance
 of the first symptom, meaning, thereby, on the first hour of its appearance, by
 the local application of nitrate of  silver by means of a wax bougie very light
 ly charged ; this  should never be inserteel over an  in« h, for there tho  poison
 exists  only.'  Injections aro absurd, for they go entirely past the spot, and pro
 eh.ee  inflammation lower down, inviting the  continuous action of the  poisoi
 throughout the whole urethra.   This method should never occupy over three
 days Tif then unsuccessful, thepatienf should starve himself elown, drink neither
 spirit's, water, tea, nor coffee, on the principle of  not filling the  blood-vesseN,
 and as soon as all inflammation, as evinced by scalding on urinating, has ceased,
 he may use injections, cither mineral or vegetable, to contract the relaxed mem-
 brane "of tho urethra, and aiel  the return of healthful  action.   If  the patient
 will not elo this,  and keep his feet and skin constantly warm, by staying in the
 house if necessary, or in bed, he may rely on it that the disease will last from a
 month to a year, before it ceases naturally.  In tho latter case, and if he be
 scrofulous, or  a great  smoker of tobacco,  it may leave a  gleet, or white dis-
 c-barge, which  is the symptom of incipient stricture.  This, gentlemen, is the
  verdict of every  scientific and honest man who has  had experience enough to
  discover, and has manhood enough to speak, the  truth.
    You may avail Yourselves of the patient's ignorance and prejudice in selling
  him "a cine," but vou will gain  no lasting professional character by following
  the general e'xample of your medico-commercial  brethren.  Cive your patient
  honest advice, and caution him against  his  indiscretions; impress on  him the
  necessity of keeping down inflammation for a fortnight,  an.l don't allow him to
  cheat you out of your fee.   He will  learn to esteem you far more than tUu/.i
  Vou pandered  to his prejudices.
  *   Our next lecture will  be on  the sympathetic  symptoms of  the urethra, rec-
  tum,  and uterus, in other parts of the body.  We shall also consider the <u->-
  ject of difficult menstruation and sterility, showing the admirable adaptation 
 20             Academic  Courtesies ;  Ilusiness Ff.'ios.

 of the  Urethrotome to the cure of this  pathological condition.  In inimeeliate
 connection with  this subject, you will sec  illustrateel the anatomy of the ure-
 thra and the vesicula  seminales,  and the prostate gland anel  bladder;  also the
 graviel  uterus  for  each  month, and  tho anatomy of the  pelvis of both sexes.
 These exquisite works of art are  the produce of the Florentine Academicians.
 I imported them expressly to illustrate these subjects, because it is impossibl
 to show labor on the  dcael body.  They will bo invaluable when yvo come to
 speak of natural and diflicult parturition.
   It shall not be my fault if I do  not  give you some return for the sacrifice of
 time and money which has brought you from your homes, and your own medi
 cal and surgical pursuits, to  see what you can gather from my  humblo table.
 Had you taken the same  step before you obtained your diploma, you would not
 only have been reject eel on  your examination, whatever your  attainments, but
 have been forever ostracized from  your brethren.   The Se ai.i'i:l,  and the inde-
 pendent course of its Editor,  have been very far  from securing him the ameni-
 ties of his academic brethren, and tho social delights  of a yearly dinner, with
 the high compliment to his intelligence of listening to a president who could
 not Yvrite his own languago correctly.  Hut these are the  days of reform and
 rebellion.  Cod grant that wc may live to see the  day when the people  and  our
 profession will  learn that they  have higher duties to  perform than the forma-
 tion of political and medical cliques, and  the acquisition of money.  Wo have
 aided in killing that infamous association, tho Kappa Lambda Society,  and wo
 hope to live long enough to purify the  Academy of Medicine.
  Notf..—It is due to our self-respect to explain why these have not been drawn
 and described in the medical journals, like all our other instruments.   During
 thirty-five years' practice in this our native city, we  have  invented a  greater
 number of instruments now in general use, than any other member of  the pro-
 fession.   If this be elenied, wc refer  the matter to  the surgical instrument-
 makers and to the Boston Medical and Surgical  Journal.   Our  own journal,
 Tin: Scalpel, contains cuts of several.
  These instruments have been  freely given to the profession.  Tho community
express surprise that professional men do not patent their instruments.   This,
of course,  no man of right professional feeling would do.  We have never even
 thought of the possibility of such  a thing. It is  but  human nature, however.
where a man has devoted his whole time  for  thirty-five years to  a  profession'
that he should wish to derive some credit from his inventions,  whilst still pur-
buinur that profession practically.
  We will record two little incidents to show how far  such  a result  is likely to
 happen.  Dr. Samuel D. Gross, Professor of Surgery at Philadelphia, in his -real
 Corny, ndium of Diseases of the  Sexual  Organs, when treating on  involun-
tary seminal emission, has given an accurate cut and description of our  caustic
catheter, (the one we have condemned  and now ceased to use,; taken from our
rork  on Diseases of the Sexual System, and after pronouncing it the only
safe instrument for that purpose, omitted to name the inventor, though that
very book wag presented to him by our own hand.  The  same gentleman ex 
Business  Xoticr.*.
21
a mining our six branch speculum, de-scribed in The Scalpel, at Mr. Ticmann's
shop in this city, denied that we were the inventor!
  Our Uterine- Hiseetor and Polypus I.i_Mtor, have both  been shown and  de-
Bcribed for years to the surgical classes at tho University in this city, and  the
name of  the inventor never once mentioned,  though we had presented the in-
struments to  the distinguished Professor, (our  own  preceptor,  Dr. Valentine
Moll,) who has been President of the Medie-al Academy !
  Is it necessary for us to say more?  Mr. Syme has been obliged to  sue  one
of the most eminent surgeons of London for eneleavoring, by detraction of his
character, as  a safe surgeon, to prevent his jir.i'tising  the  very operation to
avoid the necessity for which we have invented these; instruments.   Mr. Syme's
operation,  themgh perfectly effectual, is really a severe one.  If we  have  suc-
ee-e-ile'el in adding a good contribution  to the surgical armament, it will  be none
the less valuable when we have receiveel that return which it is but reasonable
to anticipate-,  and which, it would seem, is all we are likely to get.
   An experience of nino years since tho  invention and use of the instrument,
then first describe-d in a short essay published in The Scalpel on the "Treat-
ment of Strie-ture by Internal Incision," has convince-el us that the views there-
in expressed are quite; correct, but that the- instrument will not  answer for  the
worst cases of strie-ture.   During a part of that period, whilst in the pursuit of
the- object yvc then had in  view, but which we are now convinced was quite un-
attainable, namely, a single instrument sufficiently comprehensive in its adapta-
 tion to divide and elilate- all cases of stricture, we have invented no  less than six
elille-rent instruments, all adapted to different complications of stricture.  Theso
we still designate by the general name of the ITrcthrobmio.  It is with the view
of answering inquirers from  abroad more coinpre-hciiMwly than yvc could  pos-
 sibly do by letter, that we have prepared this short digest of a lecture on stric-
 ture prepared for our private  e-lass.
   Wo Yvould  suggest that a personal  investigation is almost invariably neces-
 sary for a correct opinion; yvc therefore  conscientiously  advise personal appli-
cation.  If this be impossible, wo must  insist on  the inclosure of our fee,  (£5)
 -—if the writer desires an answer to his letter.  It would occupy our  entire
 time, if wo attempted to  ansYver  tho letters we receive from those whose de-
 se-riptions aro entirely  inadequate  to give any idea of  their cases.  Wc are
 usually ohlige-el to ask  for other symptoms, which they have overloe.ked, before
 we can give any assurance that treatment will be available; this requires time,
 and we arc obliged to charge  for it, as we do for a personal consultation.   If
 any operation be  advised, an  accurate business  arrangement  must be made
 before the period appointed for its performance;  as  we  are frequently obliged
 to decline the terms offered—and are often absent  from home.   A weeks notice
 by letter will  prevent disappointment; this had better be directed to our resi-
 lience, 42 Fifth Avenue.   It will insure an early reply. 
 {bridge1 from a Lecture on Irritable Urethra and its Consequence*.   Delivet
    ed to his private Surgical Class, by Edward H. Dixon,  M.D., Editor <f
    The  Scalpel,  and Operating and  Consulting Surgeon,  12 Fifth Avenue.
    (Ttnth  Lecture.)

   Gentlemen :  You have now had an opportunity to examino tho structure of
 the urethra and  its appendages, and to see  the application of my instruments
 on the dead and living boely.  Vou  have noted tho  dimensions, structure,  and
 distances of the passage, and the position in Yvhicli  strictures most frequently
 occur.  I shall, therefore, take it for granted, that you are capablo  of judging
 of the propriety of adopting the views of Mr. Symo, and comparing them with
 those of the various authors on stricture, and of following mo in what I have
 now to say on that most frequent  and distressing  of all aflee-lions, Irritable
 Urethra, and incontinence of urine, with partial loss of virile power.
   Vou will find  a vast number of such cases  in country towns and  isolated
 farm-houses,  where  the ordinary excitements of society and city life  aro  not
 operative in diverting the mind from its too  frequent resource,  tho endtivation
 of the sexual passion.  The extent to which sclf-abuso is  carried in  our exci-
 table nation is fearful to think of.  Nearly twenty years have elapsed since  tho
 publication of my work on Diseases of the Sexual System, and after the  im
 mensc experience you may easily imagine I  have had  in eamscquenco of  tho
 circulation  of more than one hundred thousand copies of that work, I can  as
 sure you that the views therein  expressed of its  influence on  tho  mind anel
 body are more than confirmed.  I wrote that book from a conviction of its ne-
 cessity after three years' attendance as Surgeon to two of our largest institutions
 fir young people, namely, the Deaf anel Dumb Asylum and the House of Refuge.
 I visited also our prisons and poor-houses, and conversed Yvith  tho principals
 of  many boarding-schools.   The result of my  experience Yvas  the  conviction
 expressed in that volume, that it was the master vie;e of our young people, and
 that  its terrible conseepicnces Yvere by no means understood or  appreciated by
 our best physicians.
  The sympathetic influence of hemorrhoids, fissures and ulcers of the rectum
anel varicocele, in producing irritability of the urethra, and want of contractile
 power in the closing muscle or sphincter of the bladder, has been the subject
of one lecture; you will, therefore, always give the existence of cither of  these
affections due consideration  in  the  treatment.  Depend upon it, if you  over-
took  their existence, or take the  patient's assurance of the  soundness of  his
 ectum, without a careful examination with the speculum, you will fi eeiucntly
 b-j mortified in your efforts to cure incontinence of urine ; you will find it often
utterly intractable whilst either of these diseases exist.   The respective  parts
all derive their nerves from the same portion  of the spinal system, and all theix 
         Irritable  Urethra:  What  is ilf  How produced/      23

diseases arc mutually associated and dependent.  Toba-ceo  has a very powerful
influence in proelucing irritable urethra and piles.  I have given my views or
this subject with  those of the great Burgeons, Mr. Lizars and Sir  Benjamin
Hrodie, in tho forty-fifth and forty-sixth  Nos. of  The Scalpel.
  Let  us now consider carefully the condition of a man with irritable urethra.
What  docs it mean ?  A certain portion, usually near the neck of the bladder,
in whie-h the t\\e> seminal vessels send their  two elucts to open their mouths,
has taken on a morbid sensitiveness; if wc could see its color in the living
boely,  yvc would finel it much redder than the natural state ; indeed, we know
it must bo so, because the great sensitiveness could not exist Yvithout a  high
degree- e>f cemgostion or fullncss of the blood-vessels that form and nourish the
membrane. Observe, that when the pemnd, or catheter, reaches the two la-t inches
of the urethra, just before it enters the bladder, the patient will always shrink.
Sometimes this irritability extends over  the whole urethra to  the end  of the
penis.  The testicles also share it: they are often  as movable  as a  bunch of
earth-worms in a  bag.
    This condition of the urethra may be  produced by sexual excesses as well as
self-abuse-, and that most disgusting and  unmanly practice—partial  or  in.om
plete  sexual  communication ; a  habit  of our  unfortunately  ignorant young
married people, to avoid or regulate offspring;  this practice-, however, which I
was about to call  beastly, (but the poor beasts are too natural for such an act,)
  s often  followed by loss of virility and by incontinence ; a passive condition, the
  everse of irritability: for this  condition cauterization is used.  I have spoken
at  length on the subject of cauterization, anel  you have the work of  Monsieur
Lallemand, its inventor and advocate.   After a very large  experience in its use
 1 have assured vou that I have found it greatly overrated  as  a curative agent
 besides  being a'very dangerous remedy  and very likely to  produce stricture in
 the hands of the  empirics who use it so largely.   It is only applicable to pas-
 sive spermatorrhoea.                                                     .
    I et us now consider tho rationale of a remedy wo  use with great effect in
 several analogous conditions of other parts of the boely :  In ulceration of the
 rectum and fissure, where irritability and exquisite pain exist on passing the
 stool  an instant cure is the result of a slight incision through the ulcer or fis-
 sure'  In inflammation of tho conjunctiva of  the eye, instant relief follows the
 unloading of the  vessels by drawing the lancet across them.   In congestion of
 the lining membrane of the nock of  the uterus, constituting painful menstrua-
 tion  tlnT-simo result follows;  this  is precisely analogous to the use of my
 urothratomc for that purpe.se in the urethra:  and now I want you ,n this im-
    d  tc relation to follow me in the reasoning  I  adopted  ,n  thus  applying «
    h  uch adniirable results, that I shall not readily discontinue  ,t for the sub-
  titution of medicines, which of course can only palliate for the time they are 
 24        Hot  da?s  it  produce  Incontinence of Urine f

 through with difficulty, why, of course, you knoYV that the man's urethra is ob-
 Btructed to that extent, or one half its diameter.  Now,  if this condition exist,
 and he bo  the subject of urethral irritation either from clap or self abuse, ho is
 partiallyand  for a time strictureel—that is to say,  he has a congestive and irritablo
 stricture :  surely so, for what else  can you  call it ?  Suppose, now, you do
 nothing for it P  What is to prevent its becoming a permanent strie-ture t  every
 stricture has a beginning.    Is it  not, therefore, evident to common-sense,
 that if you let  the blood out of the congested or engorged  blood-vessels, and
 destroy the irritability of the ncr\-cs by dividing them, you will restore tho nar-
 rowest urethra to its natural  caliber, and  stop tho irritation  of the nerves by
 dividing the tissues, as wc do for congestion of the womb, lining of the eyelid,
 and  the rectum ?   And  that is precisely the  result   The- patient has  imme-
 diate relief by  a couple of slight incisions  that scarcely tingo tho  urino Yvith
 blood;  a number  twelve  catheter will instantly pass Yvith little  or no  pain;
 he will pass his urine in a full stream; and after a few times using tho  eatheter,
 if he will follow other rational directions, ho will  bo cured of a very sael and
 humiliating condition, and in all probability  a  permanent stricture, and per-
 haps partial or  complete loss of his  virility be prevented.  The first example  1
 presented you in the Lecture on Stricture fully illustrates this.
  It is this irritable and partially inflamed condition of the urethra, gradually car-
 ried  backwar.ls to the closing muscle or sphincter of tho bladder, that exhausts
 the contractile power of that muscle.   The irritation of the urethra goads tho
 bladeler to  contract, and the muscle loses its healthful organic or tonic power;
 it is  wearied out; it is no longer subject to the will, but contracts and  expands
 spasmodically, and the urine issues  in  drops unexpectedly.  Any sudelcn agi-
 tition, such as  fear, anger, or sexual desire by lascivious dreams, or unexpect-
 ed proximity  to the other sex, will often extend this spasmodic action to the
muscles which envelope tho membranous portion of the urethra and control the
 semen ; the contractile power of the seminal ducts is  also impaired, and morti-
 fying and premature discharges of semen occur in intercourse or in  dreams.
When this condition has continued a longer  or shorter  time, according to tho
power of the  constitution of  the patient, it passes into that painful  and pitiful
condition of passive loss of semen, in which he is quite unconscious of any sex-
ual emotion ;  the passage of the stools will cause its loss, and unless stopped,
 and the constitution improved, the patient will pass into  a decline, or  into the
 condition of fatuity—useless to himself, and a  nuisance to all  about him.
  This  condition is  no longer irritation, for  that word implies  action.  The
whole mucous membrane becomes  blanched and comparatively bloodless, and
passive  spermatorrhoea is established;  these cases require cauterization.
  All those  who  apply to  you in this  condition  for  relief, will  demand
medicine.   I  have for twenty years  received on an average  over a thousand
letters a year, complaining bitterly of the villainy of empirics who had deluded
the writers with promises to cure them, and yet any  one  of them would  have
gladly swallowed more from  my hands.  The  truth is, these poor people be-
come desperate, crazed ; they see the difference between themselves  and other 
         Will M< 'Heine  cure  the  loss  of  ()njanic  Pmccr T      25

men, and having no knowledge of  the laws of their sexual and organic nature,
they have no reason to doubt any promise that may be made them.  One
miserable individual  has actually made thousands believe by his advertise
ments that there is a great philanthropic college in Philadelphia, to issue advice
ami make medicine for their  relief.   Here, wc have the dear old clergyman,
whose  " sands of life arc nearly run," and who has made a very large fortune,
and is now in lusty youth  cngageel in  stock and property equations in Wall
stn-e-t   He has been  pointed out to me several times in the street
   Neither Lupuline, Krgotine, Gclsemine,  Tincture of Iron, nor any other medi-
cines have any permanent effect.   There is only one tonic which will give any
increase of  power to the system, and that is Phosphoric Acid, combined with
Strychnine; that medicine will, by adding to the exhausted nerves one of  the
greatest elements of their composition,  produce the well-known effect of a fish
eliet, which is remarkable- for its restorative effect on the jaded libertine.
   The Strychnine, you knoYV, is the most direct excitant of the nerves known
to physicians.  Neither of  these medieine-s, however, will "cure" the disease.
They can only raise the physie-al condition.  When  a libertine  is nearly ex-
hausted, anel has partially lost his virility from sexual excess anel smejking,
ami complains of coldness of the sexual organs, and dizziness, ringing of  the
ears, susceptibility to cold,  and general exhaustion, it is the best  tonic you  an
give him, and will often induce him to believo ho  is getting well, and  may re-
sume his excesses.  When the sphincter muse lc of tho bladder is weakened,
and his urine dribbles from him, or he is  exhausted from  hemorrhoids, fistula,
or prolapsus of tho rce-tum, or if woman,  the womb, it will greatly benefit most
cases.  Of course you must use the greatest care in  its  apportionment;  nor
should it ever bo received from  any hand  but one  of perfect reliability.
   The-  Phosphoric Acid of  the shops is quite unreliable;  much of it is doubt-
 less pure water.   Vou know the sources  whence it is to be obtained, and must
 be quite sure of its quality.
     LOSS OF  VIRILITY  IN YOUNG MARRIED  PEOPLE-AN
                        UNSUSPECTED CAUSE.
  " It  is not to physical derangements only, that the extinction of passion ifl
due • nor vet to the evil practices of youth.  A man may be so fortunate as to
bo perfectly formed, and escape the pernicious influence of evil instruction at
school; he" mav marry happily ; his  blood may be pure, and his prospects
brieht' and yet" from ignorance of a great law of Nature, he may, in a few > ears,
 nd himrfprostrateu in all his manly energies,  ami his very soul beeome
 ead Yvithin him whilst he mav bo utterly oblivious of tho cause.  I know of
noLhi^more  o'sitivein  its depressing influence upon the nerve-power of our
w Tthan that'insidious one, of a partial perfe.rmar.ee of the sexual  act so com-
mon amongst the newly-marrieel. after the birth of one or two clnMrn^rhe
purpose of preventing further increase of family,  loba.vo, itsilf, n*> a  U~ 
 -6           Boss  of X rce- Power ; a Powerful Cause.

 depressing influence; nor do I think that  tho associate vie-c of drunkenness,
 combined, would turn the scale in their favor, against this awful cause of the
 early decay of manhood; it  certainly ranks ahead of self-abuse, because 'hat
 vice commences in the very meaning of existence, whilst nature  is ye t gaining
 power, anel before  tho anxieties of life  commence their  devastating inroads
 upon  the nervous system.  As I have only space in  this appendix, to notice
 this master  evil of our vicious system of society, I can not enter into an explana-
 tion of the  theory of its sad consequences ; "the fact I know from extensive
 observation, and the most painful  narratives  of my patients ;  together  with
 numerous letters of inquiry.
   " But why should it excite  surprise ? think for a moment  on tho conseepience-s
 of such a check continually given to  that act by  which man demonstrates tho
 possession of  Hod's greatest gilt, CRKATIVi:  l'OWKK!  What an insult  to
 Nature and  Nature's (Joel!   To summon up a cold, calculating consideration,
 to quench the  fire on  that altar where man  was commanded by (Joel to prove
 his immortality !  Yes, Creative Penver is tho best proof of tho" immortality of
 t'l • soul!  nor  do T conceive it possible to practice the debasing custom alluded
 b\  Yvithout  man's whole moral nature being crippled long before tho  bodily
 powers succumb.
    Those who consult the surgeon for the consequences of this vice, are usually
 or an order of mind very unlikely to investigate  tho validity of any assurance
 of its baneful  consequences ;  because a man who has much physical or moral
 orcc would  never long praetice it, without  making tho discovery for himself;
 lie Yyould rarely proceed so long with the practice, as to require medical or sur-
gical treatment to restore his lost power.  Unfortunately for tho  prevention of
this yio habit  there  aro very few medical  men  sufficiently well educated in
physiology, to  have given this  subject any consideration adequate to its import-
ance ; and the commercial spirit of our people- is hut ill adapted to self-observa-
tion.   A vast number of married men, by the time; they have made the im-
agined necessary amount of wealth that will entitle them to rear a family,  and
supply i with  all the contemptible  requisitions  of fashionablo  life, will  find
their bodily energies so crippled, that nothing but sickly and sere.fulous beings
will follow the  feeble effort of  expiring manhood ;  and fortunately for tho next
generation, dropsy in the head, or the summer diarrhma, carries many of them
off 111  infancy,  and prevents the further propagation of such a miserable race
    •  i ? VmJ1011111 °f thlS V1CC l™™** himself to the surgeon, it is cither I
      ,  , , .,.,         --- •■— i"-""-"" uiiuocu io mu suikooii, u is cuncr ior
«T  f f.c,Hl,t-v». aPP»renVvhcn at  st°o1' or tIsc for a constant nightly drain,
nithout  the exctement of, or with very little amorous emotion. °It is quite
riflK^l^f87?'0"8' in-this aPPen««* ! most of those appertaining
 L»,     r  h   7 b\found on. in1uilX ^,1 a  still greater amount of despair"
nrSou'-l °  T^Ttf' ^ ^  married victim hasgono through that ordeal
from ?hi ■    i"  e consc1u,cnces "f that vice that usually incapacitates bin
sesSrfth?mnTyi??!,lTe8,ln? th,at  dednion  °f character Yvhich,  had he pos!
se^ed them  would have rendered such a wretched and calculating mr.ehiiiou
  -Tr^ZZlT  hr °ffSprinr' unneces^7 and repulsive to bis feelings.
^uterizati^  sZPl-anCe^CalCUl-ted to benefit Such case8' are> electricity anel
te the sn ne  a-^  wl™68   * ^^ may dcriv° bcnefit from irrit:,,lt< *PP"»J
 im, M?sLl HalTsZ^ "f Pf8* and continually repeated ;  at  the same
oSSSeof alcoholI  ™,i fift    a ^""nistcnng strychnine, a grain dissolved in an
vdHenefit  bdm   A l„en ^T- tak^n *"iceor thrice daily, for several months,

ES?t^ 
Sexual Irritability • a frequent cause for it.
               CIRCUMCIBION-ITS TRUE  MEANING.
  Tub word Phymosis is tircck, and it signiln s a muzzle.  It is used by surgeons
to indicate an elongation and contraction of the integument that in the natural
and  healthful < ondition of the  adult docs not cover  the end  or  glans of tho
male organ, but allows the, free exposure of this  sensitive part to the air.
This  is the natural condition of all tall and muscular  males  who have  been
healthfully nurtured, and have not sulleied from confinement and bad nourish-
mint   The question is constantly asked:  Why is it elongated an 1 contracted
at birth, if it were  not d signed to remain so; and was  it not intended by the
Creator as the proper shi< Id for that organ ?  Anel is it not invariably so in
elosed in animals?  These questions are pertinent, and we shall endeavor to
ansYvcr them.  To  do so effectively, yvc must begin with history.  Pope says:
" What can wc reason but from what we knoYv?"
  The rite of circumcision, which is  prae-ticed by  the  Jews  in early  infancy
upon all their male  children, consists in  shortening this integumentary covering,
which they call  the foreskin,  anel surgeons, the prepuce -- more or less, ac-
cording to the redundance of its length in tho infant,  so as to expose the  gl.ins
to the air, and enable the mother  to cleans:; it by ablution.   Th ■ idea that this
rite  is merely a religious one, and prae-ticed without any reference to its hygienic
results, is quite absurd.  Like  most of the other laws of tho Jewish people
relating to tho body, it has a profound and philosophical significance.  That ii
originated in a very remote period, is proved by the sculptures  on  ancient mon-
uments, where tho mother  is represented  circumcising  her infant with a  sharp
flint-stone.   In our college-days, wo sought in vain for an explanation from
tho  learne.1 professor  of surgery, who was, for the most part, fully occupied
 in  relating bis wonderful operations.    When obliged to test our own faculties
 of investigation, we soon discovered  its signiticai.ee.  Twenty years' observa-
 tion led us to express in tho work from which wo quote,  "Diseases of the S<xual
 System," published ten years  ago, in the chapter on  Sioclflc D<^iscs,  the fol-

  <U''There are two conditions of tho prepuce, that occasion during syphilis anel
 gonorrhea, tho greatest annoyance, anel often  demand  the interference of the
 sum-on with his knife.  Wc allude to Phymosis, or contraction and swelling of
 theVepuce to such  a degree  that it  can not  be retracted  for purposes of
 cleanliness, or tho  application of  remedies ;  and to  Paraphimosis, or that con-
 dition  wherein, in its contracted  and swollen condition, it has been drawn back,
   i falls into the circular  groove  behind the glans, which,  thus constricted,
       wells and if not released by the pressure of the  surgeons lingers  or his
ami
soon
knife, frequently mortifies and dMi.gu.vs the person for lit
   In either of tho t.vo diseases, syphilis or gonorrhea, swelling of the g
in a  greater or less degree always occurs ; and if the prepuce be thus retraced,
 his  .swelling must bo greatly increased by the constriction, preventing the re
 urn Of the blood from the highly vascular glans into the system.   1 ne ancu-n
t
tur 
2?                 Circumcision : its true meaning.

nations of the  earth undoubtedly practiced tho  rite of circumcision  to  meet
such emergencies ; for we have, as yvc  have endeavored  to prove in the chnph-r
on Syphilis, not the  slightest faith in the  idea  that syphilis was  of modern
origin.
   When  drawn back, the prepuce will be seen uniteel with an cxepiisitely deli-
cate membrane that is  continued over the glans, and into tho meatus or opening
of the urethra,  or passage fe>r the  urine, and thence it is continucel  into the
bladder, and through the tubes leading from the kidneys to that organ.
   This is precisely analogous to tho skin  passing from the  face over tho lips
into the mouth, stomach, and lungs.  The inner anel outer skins of our bodies,
if yvc may so speak, merge into each other; and  we here take occasion to say,
that this furnishes good reason  for carefulness in  avoiding chills, and all ex-
posures to night-air, and damp feet, when tho  mucous membranes of either
the respiratory or urinary organs are diseased.  The reader will remember the
desire for urination on going from a warm room into tho cold air, or the increased
sneezing in catarrh.  Standing on the marble hearth will produce a sudden de-
sire to urinate.   These  instances  are what surgeons call tho sympathy of tho
skin with the internal or mucous membranes.  But wo must not amplify here:
such subjects, however vitally important to the philosophical surgeon, properly
belong to  the college.
   We  now wish  to direct the reader's  attention  to an entirely new train  of
thought, and to show that a far more extensive meaning was  attached to this
rite of circumcision, than  our religious  instructors, or  our surgical pndossors,
have acconled it; and that the person who has an e-longate-d prepuce, can never
possess a high degree of procreativc virility,  or moral force, in  any of the prac-
tical pursuits of life.   Sue-h men arc infirm  of purpose.   Our observation for
thirty years has forced  us to this conclusion, and convinced us of  tho sublime
wisdom of the great  Jewish law  in  making circumcision a religious rite, and
thus insuring its performance.  No doubt remains in our mind that the compar-
ative freedom from sexual diseases of tho Jewish people depends upon the in-
creased facilities for cleanliness ; and that their freedom from morbid irritability,
both locally, and, as a  consequence, in the pruriency of their imaginations,
depends upon this rite.  We  never  saw a Jewish  boy Yvho was an  Onanist.
  We are  so accustomed, as a commercial community, to repudiate all conclu-
sions which do not culminate in the  gratification of our senses, or in the acqui-
sition of money, that it  will,  we fear, bu impossible  for  the reaeler, unless ho
will consent to follow  us in an  arbitrary  process of scientific reasoning, to
come to a  correct conclusion on this subject.
  If the foot be designed for progression, the hand  for prehension, the tongue
t) taste, the  eye  to see, and the ear to hear, then the  glans  penis  has a use
equally distinctive, and  possesses either a healthful  or morbid degree of irrita-
bibty.
  Man's strongest passion impels him to a knowledge of the uses of this struc-
ture, and that it is in a high degree under the influence of a healthful physical 
Circumcifn'on y its true meaning.
20
an 1 moral education.  Now, that irritability, we allege, from extensive observa-
tion, to exist in a far grc iter degree, and to occur far earlier  in our artificial
conelit.on of life-, in those who have Phymosis, than was eh signed by the Cre-
atir.   There can be no doubt that pruriency of the imagination and  telf-abuse,
is  far more common with those who are thus ekformed  Not only is there
constant uncleanlincss ami irritation from the natural sceretions of the minute
glands surrounding this  structure, but excessive moisture weakening the part,
and producing this morbid irritability.  The blood docs not circulate with that
frecelom designed by nature ;  the glans is contracted and acuminated;  and its
nerves starved and irritable.  All partially developed and half-starved pee.pic
are irritible; large and tall men arc less so.  Indeed the natural growth and
expindoii of  the glans is so palpably  checked  in such people  by the pressure
of the contraeted prepuce, that  they  often seek the aid of the surgeon,  not
only from sexual irritability evident to themselves from morbid exeitcment and
emissions, but from mortified pride.  Nothing can be more pitiful than the infirm-
ity of purpose apparent in the general deportment, and want of attention to what
is said to them, and incapacity to reason on the subject, than is shown by these
people-.  The- jactitation of the limbs, and  general restlessness, or the mental and
physieal stupor, is painful  to behold.  Many a youth has his  prospects for l.k
and his  constitution elestroyed by this wrete lied condition of his nervous sys-
tem,  depending solely upon this vice of conformation.  It is so palpable in its
consequences upon the manner and  physique, that wc are very often confident
of its existence before any investigation has been made.
   When persons thus afllictcd have been addicted to self-abuse, to  which  act
 they  havo a  great  proclivity from their morbid irritability,  and  have  had
 recourse to liquor or tobacco  as  a stupefier of their troubles, wc begin to
 instruct with little hope  of inducing conviction.  Indeed, this article is  pre-
 pared to aid  such  an attempt, by reflection; to  try and  produce the conviction
 that it is only by  following  out scientifically a plan of cure, with  such  aids
 as hist,., v anel science afford us,  that they can hope for amendment  Medicine
 is only secondary in its action, if at all necessary ; and marriage, in bad cases, en
 tails lasting misery on two persons, in place of one.  If offspring follow, feeble-
 ness of constitution and early death  attest the supremacy of Natures  law.
   It is truly sael to think what results follow a want of physiological knowledge,
 and  more than doubtful  if any plan of education  which does not  include
 a representation of the healthful structure and functions of the sexual organs.
 can ever result in tho happiness  of the race.
   It onlv remains that we should answer one of the questions usually  pro-
 posed-  Was not the prepuce designed as a protector to this  organ, and ,s it
 not  always so in animals?  This is the answer : the Jewish rite docs not len-
 der the action of tho membrane as a protector in  infancy : it  is only complete
 in its effect, bv the growth of the organ at puberty.  As soon as the emotion of
 sexual passion begins, the natural  growth of the glans completes  the proper
 ret. a  tion of the prepuce,  and the irritability of the part is not rendered exec. 
30                        What is  }'an'cocele f
  rive in its ae-tion, and docs not goad the mind to  pruriency.  In  animals, of
  rouse, this mental condition docs not exist ; they only seek the gratification of
  the sexual passion at such time and une'.er such conditions as a healthful dic-
  tion prompts them to ; their condition is physiological entirely, and the  morbid
  irritability is not produced by that covered condition of the organ,  essential to
  its protection from mechanical injury in the fields and forests.
    It is very fortunate for  those who require the operation of shortening tho
  prepuce  in adult life, that a far less severe operation than that of circum  ision
  will produce exactly the same results.   The Jewish iteration is that of exe-'s-
  ing an oblique segment of the integument entirely  surrounding and inelosiug
  the glans.   This, in  infancy being  unexpected, is soon done; in tho adult it
  would be very severe.  The French surgeons have taught us,  that  an  incision
  made on  a line with  the  glans, from before backward, Yvill  cause the imme-
  diate retraction of the integument, and the approximation of the divided  edges
  directly across the glans ;  a slight  dressing will allow  perfect union in a  few
 days.   The only caution necessary in the operation  is,  the accurate adaptation
 of the length of the incision to the degree of oemtraction of the prepuce, b> in-
 sure the  sufficient  retraction of the  integument  This, however,  will alwavs
 folIoYV, if  the surgeon is accustomed to perform the operation.  In tYvo days
 the patient can resume his usual avocations.  Indeed, the operation requires no
 confinement, and when time will not admit, no second dressing by the surgeon.
 The intelligent patient is equal to all the subsequent management of the case.
 It is a common  occurrenee for our own patients, to  leave on the same day the
 operation  is performed.  We consider this treatment, with the proper regula-
 tion of the general  regimen, to comprise all that is necessary in most cases of
 debility and irritability of the urethra.  Cauterization and medical treatment of
 all kinds are comparatively useless.

    WHAT IS  VARICOCELE, AND WHAT ARE ITS  EFFECTS
                             ON VIRILITY P
   Tns word Varicocele, is derived from a Latin and a Creek word, signifying a
 vein and a tumor; a venous tumor.  It almost invariably exists on the left side
 of the scrotum  or  purse that contains the te-stie-le.s; very rarely on the ri"bt.
 It is not a tumor, hoYvcver, but a mass of tortuous convolutions of the vein re-
 turning the blood from the testicle to a  great vein insiele of the body, whi<-h
 takes back the blood that has been supplied to the testicle by the spermatic ar-
 tery to produee. the  semen.   It is said by authors, very appositely, to feel like a
 bunch  of  earth-worms under the skin.  It is situated orcr  the testicle,  which
 in bad cases  it partially envelops,  producing an  irregular hardness on its back
and lower part.  Varicoceles, are in size  from a  white walnut  to a  hen's egg;
but I have seen them  even larger.  In  such cases, the delay in the  return of
the blood  during all the hours in which the patient is out of bed, always causes
partial wasting  of the testicle and  the impairment of its  functions,  and often
its complete atrophy.   When recumbent, varicocele entirely disappears. 
What is  ~\rari<-ocil, ?
31
  Varicocele exists in one out of every five men, and in one in ten it seriously im-
pairs their virile; and mental integrity ; it is produced by self-abuse-, excessiveex-
en-ise, corn-taut standing, and constipation.  One, or all e,f these  combined,  will
do it.   The elongation of the scrotum follows, and in the exhausting summers of
our climate, the dragging on the spermatic nerves which pnicecd from the loins,
cause s great weariness and distress, and uncertain action in the body and mind.
Prolapsus  of  the womb is analogous to  this complaint in the male, and the
two proelucc more mental and physical distress than any other affections of the
body.   The defuiency of manly resolve and sexual power dependent upon this
distressing complaint is fearful, and its influence on offspring painful  to think
of.  When aske el whether he would advise an operation  fer  its removal, the
surge-em who  has a proper  idea of the disease, and his own el.nity, should
answer the questioner: "That must elepend entirely on the value you attach to
your physical integrity and moral force."  No man  can pursue the  ordinary
avocations of  active life, and perform his moral duties  with  any degree of en-
ergy, who has a largo varicocele, and lmwever small it may be in its commence-
ment, active exercise in a short time will  certainly, and any unusual exertion
may  in a moment,  increase it to a large size.  We have seen numerous s- vere
eases eif varie-oecle and rupture produced by marching in the present war; in-
dee-d a great number of young men who have become soldiers, will never re-
 gain their integrity without the aid of the  surgeon.
    A  man who is not ambitious to exi-el in life, may get along very well by the
 aid of a suspensory bandage;  but there  aro many  whose  minds are so de-
 pressed by the consciousness of any imperfection in  their organs, that life is
 rendered miserable and  they demand surgical aid.  Wo never hesitate to ope-
 rate  <-n such  cases, and in an experience of thirty years have found the suc-
 cess  of this operation, when adapted to the  peculiar condition of the patient,
 equal to any in surgery;  but tho method of doing it has produced a wide de-
 gree of difference amongst surgeons.  When a pupil,  we were taught to cut
 down upon the cord and cut out a  portion and tie the ends of tho divided vein :
 it was a certain method, and wc adopted it until wo unfortunately lost a patient
 from  erysipelas  consequent on a  debauch at the supper-table on the second
 day  after  the operation.  This, though the result of extreme  carelessness,  ,„-
 duced us to try several of the other operations.  We  have  now adopted sub-
 cutaneous pressure bv the silver wire, a measure of certain efficacy, and in ten
 years' experience in a great number of cases, absolutely free from danger.  The
 patient need not keep his bed, but can. not take out-door exercise ; it requires
 |,.,t  ten davs to effect a cure, anel obliterate entirely the old vein ;  a new one  en-
 larging from the embrvo  stock in which it always exists, taking the place of the
 one consolidated.   The operation  of shortening the  scrotum, a measure only
 necessary in cases of voluminous varicocele, is rarely necessary; although we re-
 commend it in all cases where extremely active life demands constant exertion. 
 PEOPLE WHO ARE  BLOOD AND  NERVE-STARVED — INFLUENCE
     OF EXHAUSTING DISCHARGES ON THE CONSTITUTION.
   Physician?, who arc often highly educated and whose motives are- good, have
 two scientific and classical words with which they unconsciously befog the intel-
 lects of their patients.   These words arc  "Amemia" and "Neuralgia."  The
 first means "bloodlcssncss; "  the second, "pain in a nerve."   Neither arc cor-
 rect ; for those whom tlu-y tell that they arc amende, have often as much bloenlas
 healthy people, but it is poor and watery, and unfit to nourish tho tissues of the
 body.   Such people arc often plump, but they have always pale lips, cold hands
 and feet a"d bluencss under the eyes.   The second term, " Neuralgia," is cor-
 rect enough, because neuralgia may exist;  but pain  in a  nerve is only  a
 symptom of anaemia, which is  the disease that causes it.   It ought to be called
 ne-uriemia, or nerve-starved ;  because tho nerves, like the blood-vessels, there is
 every reason  to suppose, circulate  a fluid, though  yvc  do not and probably
 never shall know its character.  It is probably electricity, as that fluid will set
 the heart in action in a reee-ntly exe-cutcd person, anel actually e-ontinuc  for a
 short time the process of digestion, when applied to the great nerves that control
 that process, as they pass from the brain down each side of tho neck.   To pro-
 scribe medicines for cither of  these conditions as diseases, with the view  of
 curing them, without first ascertaining  tho causes that  produced  the  blood-
 starved condition of the sufferer, is quite absurd; anel yet the best of our med-
 ical men are  constantly giving iron, quinine, strychnine, narcotics, and valerian-
 ate  of  ammonia, and  a great variety  of drugs, to "cure" anaemic  girls,
 neuralgic women, and feeble and exhausted men, with either  no suspicion e f
 their terribly unnatural condition  and education, or  at best after a f w ques-
 tions, most  carefully studicel to avoid giving offense, by condemning  some
 darling  sin or unnatural habit,  or some gross carelessness in clothing or food,
 continued through every day of his life by the thoughtless and ignorant patient.
 The man or woman is blood-starved by some exhausting habits  or disease, such
 as sexual dissipation ;  piles of years and years' existence, accompanied with e-eui-
 stant discharges of mucus or blood;  smoking  and chewing, producing partial
 paralysis of the nerves  which  control the  blood-producing membrane of the
 blood-vessels, the  "Ekdangium" of physiology; leucorrhea or whites, repeated
 miscarriage either from exhaustion or abortionism ; fistula, fissure, dyspepsia,
 or bad  digestion, cutting off the very source of the blood, the foexl; sitting all
 day in close rooms and dancing half the night, and eating filthy confectionery
 in place of blood-producing food.  All  these  powerful causes  of ansemia and
 neuralgia are  continually overlooked,  and the physician attacks  these great sina
against the laws of life with medicines !   He gives tonics, when more air, food,
and sleep are  the only means of restoring  the lost power of producing blood,
and continuing the full action of the  nerve power. 
hisclairges and  Pmlap.it* pri.tlm;  Xturolgi".         33
  We have just been consulted by a married man of thirty years of a;e, who
has been carefully ex imiiud by two medical men of this city, one a very learned
and justly celebrated professeir, and treateel by one of them for a long time for
threatening abscess of the spine-, and by both now pronounced to have neural-
gia of the spinal column, near its  lower part.  This, as he stated  to  us, cam.
upe.n him instantly at night so violently as to be almost  beyond endurance;
bo is now exceedingly thin ; has a deep blue tint  under each  eye, and is very
easily fatigued.   He has had very large protruding piles and profuse elischargca
of blood  daily for years; be smokes tobacco; his sexual  excesses have been
ve-ry  great for  years;  ho has  bad no  children.  What prospect  has this
man for a cure from quinine, which  the profcsse.r has directed to  be taken  in
full  doses, till its charae-teristic  symptom, ringing in  the ears, is produced?
Nothing,  wo  te.ld him, coulel cure him, but the  remov.d e.f his bleeding piles
ami the'discontinuanec of his tobacco ami  other excesses.   Nature mu-t havo
a full chance now,  or some other disease, probably of the  lungs or head, will
carrv him off
   In woman, the existence of piles produces a constant irritation of the nerves
which  govern the blood-vessels, anel  a flow  <>f blood toward the uterus and
,,s aria  (for all these organs within the  pelvis, or great basin of the bo ly,  derive
their nerves from tho lower part of the spinal column;) the  monthly periods
 change to discharges of blood;  the  great  mucous membrane  lining the vagina
 is exhausted and bloodless, secretions profusely mucus;  the  woman has  per-
 manent leuoonhca or whites, and almost always prolapsus of the womb; >h>
 becomes  amende or blood-starved,  and has  often neuralgia, generally  in the
 head and fa.v, often in the back  and thighs; she is  short-breathed, pale, and
 ,asilv exhausted on standing or going up stairs, has often a  dry cough, gener-
 ally "headache ; if she conceive, she has  no strength to retain the  fudus and
 is almost certain to  miscarry ; reduplicating her misery at each renewal of h,s
 trout misfortune ; and, finally, either is incapacitate d to bear  offspring at all, or
 so rceluccl in her powers of producing healthy blood, that her infant , sure to die
 of dropsy of the head in teething, or wasting consumption of ><s bowels called
 L,l.s or summer diarrhea ; for all these arc  diseases  produced  by amemia
  of the mother ; the infants are also blood-starved.
    In advanced cases  of these  respective  diseases -namely, pdc,  1 u  orrlna,
  ,nd its usual attendant, prolans of the womb, and in varicocele  and ,tscon,e-
   u,  e  elongation  of the scrotum-all these parts fall downwards by the re  x-
  a on of the Vf which contain and  support them; and as the nerves *. b
  ! ntlv them all, come from the lower part of  the spinal column, and are  f
        oh long enough to reach their respective destinations m the womb,
      ,^  ;Mnd testicles, in their natural potion, these nerves are=
  nly .retched; and their functions  hdng  ^ ^^ ^nfi.™
  blood-vessels winch nouns  those  P^  • uu «d^         ^^   ^ 
                            1ST OTI ("" E
   Edward If. Dixon-, M.D., Editor of Tiik Scalpel, will give his usual Course
 of Lectures on Diseases of  the IVlvic Viscera to those Surgeons and aihanc.-d
 Students who are already familiar with, but wish to acquire a practical know.
 ledge of the modern  improvements in the Therapeutics  and surgical treat men
 of these important organs.   The various instruments and  peculiar modes of
 operation invented by Dr. I)., and deseribcel in Tiik  Se-.vi.PKi. during  the  last
 sixte-en years, anel in his works  on  the  Diseases of Women, anel  tho Sexual
 System, will be sIioyvii and  illustrateel.  The method of  curing Strie-ture of tho
 rrcthra, Hernia, Hemorrhoids, and  Fistula will be  illustrated on tho dead
 boely, and the diseases of the Uterus by a series of wax preparations made- by
 the Florentine Acaelemicians.   Ne> expense will be spare-el  in making  the  lec-
 tures as comprehensive and  graphic as modern  science Yvill  admit.    \Vhe-ncvcr
 possible, the  operations  performed by Dr. D. in his  private practice and Hos-
pital may be witnessed by the students.   Lectures commence November first
  The  fee in all  cases is $100 in advance.  A  Cerlifie-ate of attendance and a
full set  of Diagrams,  illustrating all of Dr. D.'s methods, will be given.   Apply
at his residence,  No.  12 Fifth Avenue, between 1  and  3  daily, and 7 anel (J
eve-nings.
   Surgical Hospital,  under the care of Hdwaiu) II. Dixox,  M.I).,  Fdilor  of
 The  Scalpel, fe.r  the  espe-e-ial  treatment of diseases  of the IVlvic Vise-era.
 Most cases of  Hernia,  Hemorrhoids, Fistula,  Yaricoe eh-,  and  Stricture no
 admit of a radical cure in a few  weeks or days, in place of the palliative  trea'-
 ment of fe>rmer  years.
   by a newly invented  instrument of Dr. D.'s, Mr. Symes's method of dilating
 stricture (see  Scalpel So. 4(ij has been  redueed to such  simplie  ity that a full-
 sized Catheter may, in most cases, be used at the first  attempt.   This methne]
 is often applicable to Enlarged Pn.state.   Hemorrhoids and  Fistula are- often
 curable without the knife or ligature.   Oblique Hernia  er Rupture radically
 cured by injection,  so that  the truss may be laid aside.   Indeed, the surgery
 of the Pelvic Viscera may be said  to have  been entirely changed by the dis-
 coveries of the past hventy years.
   Over two thousand cases  have been discharged, cured, within that period by
 Dr. I).
  In all cases, after a personal examination, the case is either pronounced cura-
 ble or dismissed.  Consultations  from 8  to 9 k.x., 1 to 3 p.m., and 7 to 9 even-
 ings, at Dr.  D.'s residence, No. 42 Fifth Avenue.   At all other hours  he  is  at
 the Hospital.  For all visits requiring more than one day's absence  from the
 city,  a week's  notice  is nee.-essary.   Fees: Consultation at office, sr,  to  $10;
 letter of advice, so;  visits  within twenty miles, §-2.1;  fifty  miles, $.-,(); ono
hundred  miles, *Hmj, providing  it be accessible  within a day; over  "that dis-
 tance, and all operations, by special agreement 
Till]   SCALPLL:
ANT ENTIRELY
ORIGINAL  EXPOSITOR
L AW  S   ()  F   II F A L T H ,
AND ABUSES OP
MEDICINE  AND  DOMESTIC  LIEE.
WHO SHALL eiUARD TIIK SHEI'HKUDB T
EDITED IIY
KDWAUD   II.  DIXOX,  M.D
 N iii-iii U ever t>mv, by the silent operation of her own r»ree.-, en.leavorlng to cure diso.i«e. Her
j.-.llelnes are, air, warmth, light, food, water, exercise, :md sleep. Tl.elr use Is directed by in'tiu U,
,n,l that man Is moht worthy the nana- of Physician, who most reveres it. unerring laws.-A'.Wor.
VOLUMES XI. AND  XII.
                       \KW-Y011K:
MUST BRENTANO. S3  UNION  SQUARE ;  THE AMERICAN Nl'.WS
           COMPANY;  AND E. WARNER. Box 3121. 
 
INDEX   TO   VOLUMKS   11   AND   12.
                                    No.  40.
                                                                           P1QI
A. Wholesome Ride for the Japonica Philosophers on the Physiological  Buffalo;
     What, are the Temperament*? Importance of distinguishing the-rn before con-
     tracting Marriage ; The Life bine ; Is it possible to tell, by measuring his Head,
     hern- long a Man will live: ? I>o Intellectual Pursuits aeld to Longevity ?  .    .   1
Sixth I.'iter from John  Matthews:  England and  English Sports; Crops;  llor-e
     Talk;  Lords and Ladies; Tin- People; Churches;  Tombs; Infant Schools;
     Ke-w Hardens; Wat Tyler; Johnson, Lold-nnitH, and Carrick; Suiithfield aid
     its Horrible Discoveries ; Charred Hones of the Martyrs,     ....   9
Photographs from the Highways, relleeted by the Sealpel  Camera; The Prol'.-snr
     anel  his Med'u-ated Scgar; The New Consumption Curer;  The Black  DoctresiJ
     and her " lie-of Aartli Vonns,"   .........  24
A Visit to a Mad House:; Curious Narrative of a Vitriol-Thrower ; Psychology of
     that Propensity,  ...-.••••■••  33
The Dry Iloiie-s of the Probang Controversy  dissecte-d  and  articula1i-d, hut not
     whitewashed ; Who was accountable for Mr. Whitney's death ? Was the  course
     of Drs. Mott and Beah-s justiliable?........-  "•'
Physiological Incompatibility between the Sexes in relation to Progeny ;  Cases il-
     lustrating the subjee-t, ......••••■*'"'
Bonner and the New-York Ledger;  His Po.-iiion ;  Summing up of the Nature and
     Merits of his  Magazine,..........■''
Religious Dissipation; Moral Cemsequcnccs of Church  Fairs; Is Kaflling a Religious
    'Privilege?.........•    •     •     •  "j;
A Countryman's Religious Experience ; Description of a Young Devil, .     .     .64
                                    NO. 41.

The Popular Medical Race Course ; A diverting article on family afl'.urs, which the
    reader will probably understand better at the end than the beginning,   .    .  65
Seventh Letter from John Matthews : The Tower of Loudon ; East-India Company's
    Museum • Ragged Schools ; Boot-blacks; St. Paul's ; A  Show Simp lor Bishops
    anel Clerical Functionaries ; Royal Stables; Horses and  Carriages ; The Crystal  ^

TheHypocrisy'oVlivmnastics; Violent Exercise Hurtful to Youth     •     ■    •  90
The Kancv Pigeon Coop ; Philosophy of Pigeon Culture ; Loves and 1 anions of the
    Pigeons ;  Analogies to Human Bern"-1
   es of Parisian Experience, by an Anu...
 1'he Clergy and tho Religious Press ;  Keview of their Papers;  Trie Clergymen in
Notes of Parisian Experience, by an American Student     .     •     •     •   . • luu
The Clergy and tho Religious  P.ess;  Keview of their Papers;  Tne Clergymen in
    the Pulpit; Advantages and Disadvantages ol his Position,   .     .     .
The Lager Bier Question? Will that Delectable Beverage Intoxicate? Lditors .
    perience,     .     .     •         •.....
\n Awful Case of Malpractice at San irane^ce,  .    .    .    •
What Moral Considerations should prompt the huutau.u of i-amuy,
117 
38
INDEX  TO VOLS. 11  AM) 12.
                                     NO.  12.
                                                                             Pi 01
 The Constr.ietion of Sleeping Apartments in Country Houses ; What Influence have
     they had in Ke hieing the I. ife-Fowcr of our People?    ..... 1'".I
 K.-ghth Letter of John Matthews:  London and its Notable Places,     .     .     . 1,'iO
 The Natural Powers of the Benly  to Cure Disease  vs.  the  Impertinence  of Drug-
     giving,       .............lis
 What is a Drug-Shop? and what is a Druggist in New-York ? The College of Phar-
     mne-y, what is that ?...........159
 Suicide;  Is  there any Organic  Law Favoring its Cominission ?  A Remarkable In-
     stance,       .............]«0
 A  Crushed Heart ; Scene from a Medical Student's Note-book,    .     .     .     .  lf.7
 What is Quinine, and what is its lTse? Editor's Opinion,.....171
 The Women of New-York ; What, they are, and what they ought to he,.     .     .177
 Tears of Contrition; Mr. Robert Bonner anil the Philadelphia 'Presbyterian ; Efforts
     of that Distinguished Philanthropist  to  improve the Morals and stillen the
     Back-hones of American Youth ; Moral Scenes from the Ledger ;  The Scalpel
     annihilate-d,    .........          ,       180
Ludicrous  Speech of Old Chabert, the Fire King; A siele splitter,  .     .     [     !  187
The Surgical Goslings of Belleveie—Work ! Addressed  to the Editor   .     .     .  Hid
                                    NO.  43.

A Slight Diversion for the Pauper Philanthropists : The Organic Law ;  Pauperism
    in New-York ; What is to be done?........193
Ninth Letter from John Matthews:  Lincolnshire Fens ; Newcastle;  Descent and
    Journey through a  Coal-Mine ; Hazardous Experiments with  a Safety-Lamp
    Health of the Pit-Men and their Heirses,     ....
A P.ov's Thce.logie-al Expetie-nee; Ideas of He-11 and Heaven,  !    '.     '
Crucifixion of Children  bv the Pontine System of  Education ;  The  Analysis of th
    Temperament of Children indispensable to Puri-uts,
An Indian Celebration ; The Corn Dance and its ISloodv'Oeremonie-s
Five Severe Cases of Scarlet Fever treated  without Meilieine,       '
Finishing at a Fashionable Boarding-Sehool; My Wife anel Dau-diter
Quinine, a Personal  Experience ; Criticism of the Editor,     .  °
Illuminating Water-lias, what is it?    ....
Evil effects of the Oil in Corn Whisky ; Source of Horrid Crimes i'n our'Country
A Charming Letter lmm a Vermont Yankee Girl:  A Magnificent  New-York Par
    lor i Cra-sus and his Throne; Her ideas of the Editor"and the Scalpel
s-yplnhzation : (  .in Inoculation cure Syphilis ?
Dome-tie Felicity: Cost of Crinoline ;The Matrimonial Exchange ;' A Sweet Youne
    Man for Breakfast and Tea; Moral for Husbands who don't "Point " a Poem  " ,4
198
212

220
228
2:u
2:17
210
212
2bi
2.V)
253
NO. 44
Sailin? Orders  for our next Voyage, by the Home Admiral:  New Chart;  Medical
    Toadstools ; Literary Cuckoos ;  The Academy of Medicine ; Treatment for that
    A enerable Dry Nurse ;  The Nature of her Probable Ailment
Practical Observations on the Use and Abuse of Tobacco: Its two Deadly Elements'
    hL^°k  g °u  \1'-°m"'- moSt danSerous? Description of all  the Diseases pro-
    duced by each; \\ ill a C, gar communicate Syphilis ; Cancer produced by Smok
    mg; Disease ot  the Heart; Lo-s of Virility;  Dv.pep-ia ; Apoplexy   PaX
    sis; Mama ; Amaurosis; Deafness; Incontinence of Urine  Ap°pIexy '  rara^
257
SAO 
INDEX  TO  VOLS.  11  AND 12.                    39
Te-nth L<-it.-r from John Mitthcws:  Scotland and its No table Places,   .     .      271
Suicielc anel Civilization ; Various Classes <>{' Vetiras,  ...... 2*5
(Jadding in the; Bu-h, or a Trip to Saratoga ; Flash  Matrimony.....2'.»3
The Gn-at Pi i/.e-Fight  ami Pugilism ; its  Psychology and Physiology,  .          . ;":'1
Itational Gymnastics at Be-rlin; (iraefe; Ophthalmic Hospital,    .     .          . W
T!ie Cure of Consum[ition ; Injection of Nitrate of Silver into tin- Lungs again.    . :jli
NO. 4."..
821
330
342
Our Oil and Young Farmers and Villagers; What is  the M at -.  with them * Are
    they living Rationally? Pi oposition by the Editor,    .          .   _.
Sir Benjamin Brodio on Tob.ice-o ; Does it act on tie- Nerves? E litor's Opinion and
    Ex'peiience-Continue-1 from last number; Does it produce Piles   .       #. ■•-»
Kl,-veiith be to  r from John Matthews : Se-otland and Ireland; A Charming D--scnp-
    ti<in of tln-ir chief Cnrio>itie-s and Heautie-s,.......
 15,-ar'ne'Chil.ln-n Phvsiologicallv; Rules for Parents,  .    .     .     .    •    •
 Is tl.c Ame-rh-an ne-eessarilv a Sponger ? Process e.f Victimizing a Doctor,    .    . «••
 Uetcntion of the I'la.-.-nta after Abortion ; New Instrument lor, with I late-,   .    . .ioJ
What is Tic-Doulourcux, or Neuralgia; Why so common in Am.-rie.iii Women; It,    _
    cure,   ...••••••'■■'" .....
 Constipation;  Are Inje-.-t'mns hurtful te> the lteiwels?   .    .    .     •      .   "   °
 |.o,,„,'r.nation and  lh-probation; A  Child's Mc.n.1 Kxpcrience; A llypocnte .
     De-ath-iie.i,       .....•.,   • _.....:;,;,
The- Evils of overtaxing the Voi.-.-; How to sing without Danger,     .     .    .  •■
 Nai.ue anel Cure of Popliteal Aneu.C.n without an Operation ; t urcof a Student <-r
     .Medicine by the Eelitor,........
                                   NO.  4f>.

Diseases of Defe-etive N.itrition  in  the Young Girl ; Can Me licine cure Scrofula
' '  tCmsumption, or Diseases of the Joints? What  she.ulbe  done lor them?
    n, .; .,,.. „f Chil.lren • Exercise  V> Hat it can do; V* Imt does it do,    .    •  «»->

    Io.hin.r-  in't,-n nro.luctiveed Fistula, (intelligible to all,)    .    •    •


■*rb  s  i"-  't^s^;s»-q&^.j
AC";:,:,' ',me„« mvon.cd ..y .Ho K.li...r, »i.l.., IW T tho l„-.™m«.t .-d >,.« ^

    lativVs. orarethevduetolncmpatibleTeiupeuumnts.     .                ^
Evils of Diploma Shops ; AdC.ce to Country  1 copl,-..     -    •    •      4..(1
Abuse Of the great Organic Law of our Lace . Iu t a m> ot  the V> »
- A Lecture on the l^hologvan    reatnum^^^^^hv.rie.y of suie-
    Instant Cuiv by h\^,  '-  ^^J Stricturo ; T.^UnunU of ^mple.e
    tine :  <■ ausc>, Swuptoms, an i                        }  s,  .ture from the
    Obstruction; Stricture horn kicks an 1 « *»» »«lft  ''    \  p      of Laile-
     Abuse of Caustic;  A New ^^^^£^^^rWT^^ to
    milnd's 1-tn.uient; hvaum-nt  ^onorrh^.^  ,. ^^ .^ ^ rf ^

     ^Si^ ^ -^ ^- * «* <di,or-   -"«- ^ 
40
INDEX TO VOLS.  11  AND  12.
                                      NO.  17.

  S.xtc-n -\oars of Elitorial and Thirty-four of Professional Life: Editor's  Origin ,
      Is  the  Scalpel the Production e>f a Vertebrate Animal?  Delights of Early
      Practice in New-York—its ^Esthetics and  Economies ; The Teneler Metrics oY
      the Brethren;  The  Kappa  Lambda Society;  Patrick and his Wife the Tor-
      mentors in the Medical Purgatory,........4 3
  Our Sewers  and  Tenant-Houses—what  Relation do they bear to  the  Cholera?
      Can the Present Syste-m of Draining this City effect "the Object ?  Answer:  It
      cannot;  Early Errors in Grading ; Brooklyn;  Kahway ; How  to Reme-ely the
      Evil and to Sub-Drain the City..........138
 The Cholera—what is it? Yellow Fever—what is that ? The Laws of their Disse-tni-
      nation;  The  Cattle Disease;  Small-Pox; Vaccine Disease; M.-as|,..s ;  Se-arh-t
      K'ver;  Diphtheria; (danders;  Dysentery; Typhus Fever;  Syphilis;  Their
      Nature anil Mode of Communication,.....'       .    , 440
 /Esthetics and Economies of a Brown Stone Front:  The Kitchen  anel the " Be-
     spectable Young Woman ;" Tributary to the Cousins nt  Mackcrelvillc ;  Her
     Dressing ami  Dining-Koom ; A Convenient  Stem-Room ; Keys in Duplicate' to
     that and the Li.|.iorClose-t;  The Furnace; Gooel for Croup and  Pneumonia
     I |>-Mairs; The Mo.lcrn Parlor: Its ('lassie Adornment; Mrs. Shoddy and her
     . aloem;   "Freicjeed" Ceilings;  The  Consequences to the Family  and  its Fu-
     ture,            .......              J            48-
 The Poor Man :  Where  shall he l.iv.- ?  Who' shall' Build  his House ?  How shall he
     Buy his  l-o,».l? And who shall smother  those Jne-kalls, the  Groce-r and  Coal
     Dealers ? How- shall he g«t to his Daily Work ? E.litoCs Plan,    .           4-55
 A Beantilul Device for  Purifving  Bed-Kootns,   .                              ' 45g
     Worms in Pork and Mutton ;  Railroad Ruffians—their Modest  Propositions •
     A 1  r,.senpt,e,n tor  them ;  " (Wing » Disease-Can it be done ?  Napoleon the
     Gtvat; M. 1 ai.l, ami the Editor's idea  of  it; Irish  Servant (.'iris and their
     Dishonesty; The Remedy; Jeff Davis ami his  Trial;  Has the Country Back-
     bone enough to bring him to Trial and Punishment ?   .    .    .           # 462

lo»^,n1Al"l,;V,^,?diTC <'r>ntainin"J  Is it Proper that  any Considerations should be al-
loned to  Check the Increase of Family ? Treatment of Stricture by Internal Incision-
New Instrument f.,r that Purpose ; Rationale of its Ap,,li,;ation aeeoreling to  Mr. Syme •
IV UtOr S \ lews ■ l,n-<j nf  \ 1 ti 11 r «• __»•% I',..........1.. .1 11      1 »•      .  . °         J    1
 Lhtors Wws; L,„S0f W.l.ty-an  !:..,..spected Cause;  Circumcision-was it a kV
 igious or Hygtenic Rite?  Its Origin  and great Aiiii-pity; Editor's Views   What  s
  ancoee,-    Should  itheOpeni.eelon?  limb,  m!,,,^?  Lcucm- 1 "a-  Prolapsus

end"'on^C.on'  thClr 1,lfl"enCe ittProd1"^ ^ -algia, Starvation of theZod!

  Also a L-cture-on Irritable Urethra  and Incontinence of Urine : What  is Irritation ?
 Vlat'me^eine .^i**" V T^" I?conti»««='-' ' Will Medicine Cure loss of Vdri by
»> nat medicines are those winch promise auv relief?

31^rVogoVPaSe9eeXtIa\ Ind?rSC  fifty cents for "y number to E.  Warner,  Box 
*
                            a. TitJCA/risrc
                                    ON


DISEASES  OF  THE   SEXUAL   SYSTEM.

               BY  EDWARD  H. DIXON,  M.D.,

                          EDITOR O* TIIK " SCALPEL."

                    Truth lUiltlon; 3W> pp.; price, $lJiO.

  This edition contains  four new chapters: one on the Treatment of Stricture by in-
ternal incision; one on Circumcision a cure for venereal weakness; one on the various
operations for Varicocele;  and one on Loss of Virility in young married people—an
unsuspected cause.  Every married man desirous of preserving his health, should reael
thig extraordinary chapter; it is written with great plainness, but in the usual moral
and elevated style of the author.

  Horace Greeley remarks: " This is a work for which there was the most  urgent
need/- Thousands are  annually  hurried  to premature  graves by rices which  they
scarcely know to be  such, and would havu been preserved for lives of usefulness and
honor, by the seasonable perusal of a work Uke this; there is not a page that does not
bear upon its face an impressive warning; shall not the warning be heard ?"
  "It is written  in a clear, nervous style, and is calculated, as we think, to do much
good."—N.  V. Journal of Medicitu.
  " Dr. Dixon has pieced  the profession under great obligation  by this excellent and
practical digest."—London Lancet.
  " His books are written with great delicacy and care, yet  with an apparent desire to
communicate truth with the utmost force and earnestness."—A'. Y. Evening PosL
  " There are startling things in this book, which the non-professional  reader will re-
paid  with  surprise.   We  have our  doubts about presenting to all  sorts of readers
the s,> expositions of the vices and frailties of those who labor under  a weak  moral
sentiment; vet  the author's  acknowledged originality  anel  thorough devotion to tie
rational principles of medicine, and his ingenuity under trying surgical  circunwtAncv,
stamp it with more than ordinary interest."—Boston Medical and Suryieal JimnaL

                              ROBERT M. DE WITT, Publisher,
                                                     So. 13 Frankfort Strert.

   C#" A copy  of the above will be sent hy%ail,*re-e of postage, oo receipt of $1.50.
              BACKBONE.


                   BY EDWARD H. DIXON,  M.D.,

                          EDITOR OF THE " SCALPEL."

BEING A COMPANION VOLUME TO 8CKNF.S IN T.IE PRACTICK OF A NFAVY0RK IU-,.;:,S
                           Over 400 pages, 19mo.

              Address the Publisher,          ROBERT M.  DE WITT.
                                                    \„. IS Fr*m*fur* HtreM.

  IS" A copy of the book will be sent by mail, postage paid, on the receipt of $' W 
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