prostatic inch is the proper thing to do in cases where there is no stone in the bladder or cancer in the case, and that the use of sounds is not enough at the time of the operation where you are trimming up and smoothing them so that the sphincters shall not shut down on irritable tissues and nerves. In passing the sound use soap and not vaseline. The best lubricant is soap. It cuts the mucus and clings to the sound. Then, as to the subsequent use of sounds, we ought to reason from our knowledge. The same nerves supply the prostate that in the female supply the uterus and the same principles prevail. In endometritis one dilating and packing is not enough; it must be repeated. These irritable conditions may go on to atrophy or hypertrophy. You may have to pass sounds repeatedly, and sometimes you may have to put in an intra-uterine stem and let it remain there a considerable length of time. The mere passing of the sound to clear the urethra is not enough. You have not aroused the sleepy organ to reactiou. You can lay down no absolute rule. Your guide must be the reaction in the case. Sometimes the sound must be passed at bedtime and left in fifteen minutes. If there is no action from that practice I would next night leave the sound in a longer time and so on. It may be necessary to hold it in situ for two hours possibly. I operated on a doctor for paralysis. He had to wear a urinal all the time and could just barely stagger along with two canes. He had complete paralysis of the bladder, and had had it for ten years. I operated upon him orificially, but in a year's time there was no effect. In a year he came back and I repeated the dilatation, and still there was no action. A year later he came back again and I advised the sounds. I told him to use the sounds to the point of reaction until he came to a little fever. He took a sound to bed with him one night and dropped off to sleep and slept all night, and when he awoke the next morning he did not say anything about it even to his wife; he did not think what a shock it must be to his system, and he got up and rode several miles to see a patient, and he was taken with a chill and the man nearly died, but was rescued from the precarious condition, and then he had perfect control of the urine after that. I advise passing the sound hot or cold, and electricity, and then we do not have to perform cystotomy.

DR. MCDONALD: I just want to refer personally to the sugges tion of Dr. Thompson with reference to cimicifuga. I have used those things pretty carefully and I have used internal medication just as carefully as I could, and while I don't pretend to be an expert prescriber, I do not think there is another man to-day who pays more attention to prescribing than Professor James does, and he was my teacher. I cannot get any results in that kind of a case where the worst cases come up and you have foetid and ammoniacal urine.

You are not going to do very much with treatment in that

kind of a case; we get just as much good from cystotomy as from prostatotomy, and it is less dangerous. You must operate promptly when there is much spasm of the bladder.

I am rather complimented by Dr. Pratt's remarks; I am complimented even if he differs with me. He says it is not necessary to do a cystotomy where you have got prostatic hypertrophy. You have irritation of the mucous membrane. He tells me that the prostate is the analogue of the uterus in the female. Why does he not cure fibroids in the uterus on the same principle?

DR. PRATT: I was not talking about tumors, but hypertrophies. DR. MCDONALD: Another thing: If he tells you that he cures all of these cases he does it, and I believe it, but you and I cannot do it. But if we can find two patients with the same sized prostate and with the same conditions, and if he will operate on one patient with the American operation I will do the cystotomy on the other, and I will bet you I will have the best results from the cystotomy. A man cannot wait for the American operation, and it will not give prompt results, and if you do not give your patient immedi ate relief he will die very promptly. Now, I presume that Dr. Pratt gets most excellent results by introducing his sounds and waiting for reaction, but I should be afraid to do it, because where the sounds were introduced and left I believe that retention of the sound would be equal to inflammation; they are synonymous.

ADULT HYPOSPADIC HERMAPHRODISM.

BY J. WYLIE ANDERSON M.D., DENVER, COLORADO.

A CLINICAL case exhibited under the Section of Surgery at American Institute of Homœopathy:

Geo. S., æt. 24, born in Vienna, of German parentage, being the twelfth child. Family history good, and all of brothers and sisters were normal. Patient standing five feet six and a half inches, weighing one hundred and thirty pounds, dressed as a male, shoulders broad like those of a male, hands large and masculine as though accustomed to manual labor, feet smaller than usual for one of this size, hips not overly prominent. Voice not characteristic of either sex, being taken at times for male or female, having no beard, face is as smooth as that of a girl. Mammary glands large and as well formed as that of a female, nipples prominent. On viewing the breasts one would invariably decide that they belonged to a well developed woman.

Next we note the mons veneris; by reference to accompanying illustration, you will observe what resembles the glans penis, somewhat rudimentary, being about the ordinary size of that of a boy's six years of age, being about one and one-fourth inches in length and imperforate.

The prepuce just back of the glans passes down and is split on the under side, and ends on each side in well defined labia minora, at the posterior portion of which one inch and a quarter from under side of enlarged clitoris, or glans penis, is the opening of the meatus urinarius.

The labia majora are well developed, and within each of them is seen and felt, a large well developed testicle. Next we observe the orifice of the vagina, which is not more than an inch to an inch and a quarter in depth, ending in a blind pouch to which no uterus is felt.

On digital examination per rectum could detect neither uterus

nor ovaries, and not being permitted to pass a sound into the urethra, my examination was not complete, but I am convinced that if the uterus or ovaries exist, they are rudimentary.

A few interesting facts about this anomalous case. The penis, which I have described as being one inch and a quarter in length, is supplied with erectile tissue, and when excited becomes enlarged in size and increased to one and one-half inches in length, curving downwards and slightly to one side.

On being asked if menstruation occurred, the subject stated that bleeding from the nose occurred every four to six weeks, sometimes during one day, and again recurring one or more times for two days, at times quite profuse when patient would have a sense of fulness, in lower portion of abdomen. Coming as it did somewhat regular, could this not be considered as a vicarious menstruation?

Inquiry developed the fact that at times nocturnal emissions of a clear watery fluid associated with voluptuous dreams of the female

occurred.

The question to me arose, that inasmuch as patient assumed the dress of the male, might not that, through the law of association, account for dreams of the female sex.

On urinating, patient assumes the sitting posture, similar to the female.