few days later two ounces and a half of clear, yellowish fluid were withdrawn. Aspiration was repeated in five, and again in ten days, the same amount of clear fluid being withdrawn each time. At the latter operation it was noted that the ligated veins were very perceptibly smaller. There had been no inflammation of the epididymis or testicle. In short, in every respect, other than in the presence of hydrocele, the case had progressed in the usually favorable way.

After the last aspiration this patient went to the country, and I have been unable to see him since. I understand, however, that there has been no necessity for further tapping, and that the case has been steadily improving.

CASE II. was a vigorous, healthy man of twenty-four, who had never been the subject of any local disease other than a moderate sized varicocele, which had not, however, given him any trouble. Being debarred from entering civil service on account of his varicocele, he came to me for operation. In this case, also, absolutely no pain and but little swelling followed the application of the ligature. The patient was allowed to get up after the fourth day. For two weeks after operation there was, to the patient, no perceptible change in the size of the scrotum. At the end of that time, however, he thought something was wrong, and reported to me. The testicle felt a little larger than prior to operation, but was not painful or unduly sensitive. There was apparently some fluid in the tunica vaginalis. Hoping that absorption would take place, an evaporating lotion was applied, the part kept well suspended, and the patient given a saline cathartic each morning. The swelling, however, continuing to increase and beginning to give the patient some annoyance while at his work, it was aspirated, and two ounces of clear, faintly yellow fluid withdrawn. This was one month after operation. During the following six weeks aspiration was repeated nine times, the quantity evacuated at each sitting varying from a half ounce to an ounce and a half, and the fluid maintaining the same character These repeated aspirations were resorted to with the hope of hastening a cure. It is now three weeks since the last aspiration. The sac has refilled, but has not seemed to grow larger during the last two weeks.

That these hydroceles were not caused by the slight traumatism inflicted by the operation itself, would seem proven by the fact that effusion was not apparent for many days afterwards. That they were in some way the result of the operation and not accidental, seems equally evident from the fact that they occurred within three weeks. after the ligatures were applied, and without the history of such disease prior to operation or of any injury subsequent thereto. I can see no reason why hydrocele followed the operation in these cases except that

it originated in a passive congestion of the testicles and the visceral portion of the tunica vaginalis, due to the fact that the supply of blood was greater than the undilated and unligated veins could return to the circulation.

In conclusion I should like to present the following question to the Society for consideration. In such cases as these, provided recovery from the hydrocele did not take place after repeated aspiration, would it be justifiable to attempt to bring about radical cure by injection of carbolic acid? I suggest only the latter mode of treatment, because where injection is not contraindicated by the pathological conditions present, I believe it to be preferable to incision. Does the altered circulation following ligation of the varicocele contraindicate injection?

CASE III. Retention of Urine from Spasmodic Stricture of the Urethra apparently relieved by Cocaine Anæsthesia.

This patient was referred to me by Dr. H. A. Tucker, Jr. He was twenty-three years of age, and gave no history of venereal disease, but had formerly practised self-abuse. Four months previous to this attack he had suffered from retention of urine, and was relieved by the passage of a small catheter. This instrument, he stated, had, however, been passed with difficulty and had caused much pain and rather free bleeding. Retention had now lasted ten hours, and the patient was suffering greatly. The doctor had endeavored to pass a soft catheter, but without success. After an injection of cocaine an attempt was made to pass a full-sized instrument, but it was arrested at a depth of five inches. No catheter of any description could be passed beyond this point. The history of the case clearly showed the existence of a spasmodic stricture, but the impossibility of catheterizing the patient suggested the presence also of either an organic stricture or a false passage, or of both. I now determined to more thoroughly anæsthetize the urethra with cocaine, and pass a whalebone guide, over which I could perhaps conduct a tunneled catheter into the bladder. Injecting about half a dram of a four-per-cent. solution, I endeavored gently to force some of it through the stricture by external manipulation, and while so employed, in less than five minutes after this second application of cocaine, the patient voluntarily emptied his bladder.

A few days later I explored this patient's urethra, and found an organic stricture four inches from the meatus, with a calibre of No. 18 F., the normal calibre of his urethra being 33 F.

But, without detaining you with any further history of this case, the point to which I would draw your attention as one of some interest was the apparent effect of cocaine in relieving the spasmodic element, and thus enabling the patient to voluntarily empty his blad

der. I have often been struck with the freedom from urethral spasm while passing a catheter, or during exploration with the bougie à boule when cocaine has been thoroughly applied; but it has never before occurred to me that this agent might also be valuable in spasmodic stricture whether or not associated with an organic one. I have seen no mention made of its use for this purpose, and would suggest that it be given a fair trial before resorting to the ordinary methods of treatment; for, if further experience demonstrates its effectiveness in such cases as this, that is, where retention is due only or chiefly to the spasmodic element present, it will possess advantages enjoyed by no other agent.

Since writing the above I have learned from Dr. Tucker that he gave the patient one-fourth grain of morphia and 20 atropia before he came to my office. It might be argued that the result was due to the anodyne and not to the cocaine. Such, however, I do not believe to be the case, for the patient's sufferings constantly increased up to the time that he urinated, no anodyne effect whatever having been experienced; and I have never yet seen a case of retention relieved by opiates until the dose was sufficient to notably quiet the pain and spasm; then, and not till then, will the patient sometimes void his urine.

CASE IV. Stricture of the Urethra presenting some interesting features.

C. S, aged forty-five, had suffered from stricture for eighteen years. During that time he had occasionlly consulted a physician, but had in the main taken care of his own case by the frequent introduction of a small bougie. When admitted to the Long Island College Hospital he was passing a very small stream of urine at short intervals, a portion of the urine at the same time finding its way through a perineal fistula, which had existed for over three months. His urethra for the first four inches was practically one long stricture admitting 16 F. Here and there distinct bands could be demonstrated, but no uncontracted urethra lying between them. In the deep urethra was a tight stricture admitting only a whalebone guide.

The strictured portion of the pendulous urethra was divided through its entire length by dilating urethrotomy. The deep stricture was freely divided by an external perineal urethrotomy. The prostatic urethra was found to be three inches in length, due largely to median hypertrophy. The bladder was drained for the first three days, when the catheter was withdrawn. The highest temperature after the operation was 1010, and it fell to normal within twenty-four hours. Urine ceased to flow through the perineal opening on the ninth day, and by the eleventh day the wound was completely closed.

Two weeks after operation the patient began to complain of pain along the urethra, most marked just beneath the glans. This was associated with frequent urination and marked vesical tenesmus. The urine did not indicate any inflammation of the bladder. Examination per rectum gave no clue as to the cause of his symptoms, which so closely resembled those of a patient suffering from a so-called "fit of stone," that I again explored his bladder with a searcher, although it had been carefully examined at the time of operation. Nothing was found. The pain at times was so severe as to necessitate the use of an opiate. The bowels had been thoroughly evacuated daily, so far as could be ascertained from the patient and his attendants, since the third day after operation. About ten days after the beginning of these symptoms the diagnosis was suddenly cleared up, and the patient as suddenly and permanently relieved, by the expulsion from the rectum of a number of large and very hard scybalous masses. These must have lain high up in the rectum beyond the reach of the finger, for they had not been detected, although repeated digital examinations had been made.

The points of interest in this case are, first: The amount of hypertrophy of the prostate in a man of only forty-five, appreciable hypertrophy being rare under the age of fifty. This condition had probably been hastened by the long existence of an improperly-treated series of strictures. It will be interesting to note if this enlargement materially subsides now that the urethra has been restored to something near its original calibre. Second: The group of symptoms produced by the presence of scybala, so closely resembled those indicative of vesical calculus that it was to me an entirely new experience. Probably every member of this Society has met with cases of vesical irritability from fæcal retention, where the cause could be readily ascertained and removed, but the symptoms in this case were quite typical of calculus and were persistent, although the bowels were apparently evacuated daily, and the cause was obscure until relief was obtained.

CASE V.-Rectal Polypus.

This patient, whom I saw with Dr. E. F. Pearce, was a male, seventy years of age. He had suffered from internal hæmorrhoids for over twenty years; and for ten years or more at every evacuation of the bowels a tumor would protrude with the hæmorrhoidal mass. These were reduced with increasing difficulty, until his sufferings became so intense that he consented to operative interference.

Upon examination, after he had voluntarily expelled the entire mass from the rectum, I found this tumor which I show you. Its length was about two inches and its greatest circumference four and a quarter inches. The veins of the entire pile-bearing

There

region were dilated, forming a large mass around the anus. It was to this mass and well within the external sphincter, when the whole was reduced, that the polypus was attached. Its pedicle was short and about three-fourths of inch in diameter. were no distinct hæmorrhoids. Within the rectum was a large and irritable ulcer, which had been caused by the presence of the polypus. The patient also had an enlarged prostate, a dilated bladder, and chronic cystitis. So far as the hæmorrhoidal mass was concerned, only Whitehead's operation could have promised relief, and the patient's general condition contraindicated such extensive interference as this would entail. It was, therefore, deemed best to remove the polypus alone, and forcibly stretch the sphincter ani. It is now about two weeks since the operation, and the patient's condition is steadily improving.

I present this case as being comparatively rare, both as to the character and size of the polypus. It is of the so called fibrous variety, and, according to Allingham, is not often met with even by surgeons of large experience. He has only seen a few such in severa thousand cases of rectal disease, and they have been smaller than an English walnut.

Dr. Joshua M. Van Cott, Jr., who kindly examined this growth for me, reports it to be a fibro-myoma, rather than of the purely fibrous variety.

DISCUSSION.

Dr. FOWLER.-I cannot recall any similar instances of hydrocele following varicocele. It would seem as if the explanation of Dr. Rand, that it was due to the occurrence of some circulatory disturbances, and retarded exit of venous blood from the region, would account for it more satisfactorily than any other. Certainly, in the absence of any better explanation, I should be inclined to adopt this one. I have operated by both Lister's method and Keyes' method a number of times. It has not been my fortune to have such a sequel as this, and I do not know just what the literature of the subject is.

Dr. RAND-I find no mention made of any such complication or sequel.

Dr. FOWLER.-I have never known it to occur, and I know of no cases reported of such peculiar conditions following varicocele. If the pathology of hydrocele were understood, it might throw some light upon these cases.

Dr. PILCHER.-The only case that has come under my observation which might resemble these of Dr. Rand's is one in which I operated for the radical cure of hernia, the case being one of the congenital variety, in which that portion of the sac that was cut off and left behind