general rule, a large sized silver catheter passes into the bladder with more facility than a small one. Remember what I told you in a previous lecture as regards lubricating the instrument that lard or ointment was far preferable to oil in every way. The catheter passes better in the recumbent position than any other, the surgeon standing on the left. The bougie, on the contrary, I generally pass, while the patient is standing. The rules for passing the instrument are to be found in every work on surgery, but you will gain more knowledge from seeing it passed and practicing it yourself on the dead body, a few times, than from reading its description a hundred times. However, rules to a certain extent, are useful in all operations, therefore, I divide the introduction of the catheter into two periods.

First period. Holding the penis in the left hand, between the ring finger and the little finger, with the thumb and forefinger, we uncover the glands and stretch open the meatus, and at the same time make very slight traction on the penis. The instrument, lubricated and warmed, is held in the right hand, between the thumb and first two fingers, the handle resting on the palm of the hand, is now introduced into the meatus, the direction of the handle looking to ward the left groin. With the greatest care and gentleness, the instrument is pushed on to the point when it glides under the arch of the pubis, a very slight traction being made upon the organ. This terminates the first period.

Second period. The direction of the instrument is to be now changed horizontal, corresponding to the median line of the abdomen, and at the same time the manner of holding the catheter, which is now to be held as a pen. The beak of the catheter having arrived at the sinus of the bulb, and just under the arch of the pubis, the handle is raised from the horizontal direction in which it has been held, to the vertical. In this way the point or beak is disengaged from the sinus of the bulb, and by now depressing the handle of the instrument to a level with the patient's thighs, and exercising the gentlest pressure, it glides into the bladder.

Such is a general description of the manner of introducing the catheter. I advise you to take every opportunity of carrying it into practice. I must beg of you above all things, to exercise the greatest patience and gentleness in performing this operation. You will

very often succeed in this way, where another before you has failed. It makes one's blood curdle to see the unnecessary pain and distress so often inflicted upon a poor sufferer by many otherwise expert practitioners, in their hasty and unskillful efforts to introduce the catheter. Remember that care and patience will affect all that can be desired. Avoid all pulling and dragging upon the penis, and all forcible punching of the catheter. If the catheter is left to itself, merely directed, it will glide into the bladder in the majority of cases, where the canal is in its normal condition.

The natural obstacles to the passage of instruments into the blad der, are the mucous follicles, the sinus of the bulb and the margins of the opening in the triangular ligament. Bearing in mind the situation and anatomy of these parts, you will not often be foiled in your efforts to reach the bladder.

Of the introduction of the bougie, I shall speak to you at some future time; only remarking in this connection, that where we fail to introduce the catheter, to relieve retention of urine, a small, delicate gum-elastic bougie may be passed and withdrawn. This is of ten all that is necessary, the urine following the withdrawal of the instrument. As I have before remarked, I firmly believe that by patience and dexterity, the bladder may be reached in every case either by means of the catheter or gum-elastic bougie. If puncture of the bladder should, by any chance, be absolutely requisite, I should advise the operation by the rectum, if possible.

I must say a few words to you upon a manner of introducing the catheter, called, le tour de maitre. This, as you well know, is a manner of passing the instrument with one hand, I do not wish to enter into a full description of the method, and shall merely show you the process. If there ever was a barbarous operation committed upon suffering humanity, this is one, and I can only say, that he who ever practises it, should likewise, in turn, be practiced upon.

In catheterism upon the female, always move the intrument from below upwards; never commence above and thus interfere with the clitoris.

You see here, gentlemen, every variety of catheter and bougie. I shall speak to you upon the proper shape of the catheter used in cases of retention from hypertrophy of the prostate, when I come to that part of our lectures. I make much use of the wax bougie, which

I consider preferable where simple delatation of the canal is necessary. I advise you to provide yourself with a few of these very small, delicate gum-elastic bougies, which you will often find very useful in cases of the retention from stricture. They find their way and insinuate themselves into the strictures, where other instruments would be found of no avail. They are also less likely to commit injury upon the neighboring parts. The French bougies of all kinds are infinitely superior to those manufectured in our country,

(For the N. H. Journal of Medicine.)

PAROTITIS IN CONTINUED FEVER.

BY WM. HENRY THAYER, M.D., KEENE, N. H.

Inflammation of the parotid gland is either simple, scrofulous or specific. Its specific form, (mumps,) is far the most frequent; arising independently of exposure or any of the usual causes of inflammation, occurring generally as an epidemic, supposed to be contagious, regular in its course and duration, terminating nearly always in resolution, but with a disposition to metastasis to other organs, and affecting chiefly children. The parotid is liable, like other glands, to scrofulous inflammation, which is of chronic character and often terminating in suppuration. It is also the seat of inflammation or congestion during mercurial ptyalism. A simple inflammation of the gland is of very rare occurence- -from general exposure or local irritation and is much more liable than the specific form to terminate in suppuration. Parotitis sometimes takes place as a compli cation or a sequel of typhoid fever. It is, however, very infrequent; few physicians to whom I have mentioned it have ever met with this complication; and it is not alluded to by Bartlett, who, in his description of fever. not only drew from his own large experience but made use of all the works on the subject then published in this country or in Europe. So rare is it, that it would be regarded as merely of accidental coincidence with fever, were it not that it is almost unknown in connection with any other acute disease, (excepting the eruptive fevers generally, of which-especially scarlati

na-it is sometimes the sequel.) It is one of those irregular manifestations which continued fever presents in so great variety, arising from an occasional cause, not epidemic nor endemic, neither of place or season; but which is one of the results of the blood-poisoning which we all know to be the chief condition of the disease.

In 821 cases of fever, reported by Louis, Jackson, Flint, and others, there were 20 complicated or followed by parotitis. Besides these I have heard of 9 cases in private practice. The examination of such records as have been published, or I have had access to, shows inflamation of the parotid to be a serious complication, or an indication of a grave form of fever; for of 21 cases whose result is known, 11 were fatal. Of these 21, there was no suppuration in 8 of the fatal cases, and none in three of those who recovered. That is to say, no pus was discharged, nor its presence diagnosticated; but as Louis found the parotid filled with small abscesses, in one case, which had not been suspected during life to have reached this stage, it is quite probable that in some of the eight fatal cases in which there was no suppuration discovered, pus nevertheless was formed.

The following facts indicate the irregularity with which the inflamation of the parotid appears. Dr. Flint's 150 hospital cases are contained in three reports. In the first 38 cases of fever, from August, 1848, to March, 1850, there were 5 cases of parotitis. In the 48 cases, seen between October, 1850, and April, 1851, there was no parotitis. In the 64 cases, seen between October, 1851, and April, 1852, there was one who had inflamation of the parotid. Dr. Flint says, "it may possibly be suspected that a contagious influence was transmitted from patient to patient; but there is no ground for the hypothesis. The specific form of parotiditis was not prevalent at the hospital during the period these cases transpired; nor, except in one instance, were the patients brought in contract with any other patients laboring under this complication. The fact can only be considered as exemplifying what Sydenham and others have remarked, that fever at different times and places, may be characterized by peculiar and various local tendencies, and science is no better prepared to explain their occurrenee now, than at any past period in medical history."" Eight of the cases I have referred to as having occurred in private practice, were seen by one physician, (Dr. Thayer, now of Burlington,) in the central part of Ver

mont, between 1843 and 1855. Twelve cases occurred in the Massachusetts General Hospital between 1823 and 1847, in about 600 cases of fever. Two were seen by Louis among the 58 fatal cases that he reports. One I have seen myself. These are all of which I have seen any mention. The irregularity of its occurence is very noticeable.

The inflammation generally begins in the second week of the fever, sometimes later, almost always before convalescence has begun,"increasing the severity of the disease, and in one instance, it appeared to be the determined cause of a fatal issue." [Flint.] Beginning, generally, in the gland, it extends in most cases to the surrounding areola tissue, producing extensive suppuration around the ear and below the jaw as far as the chin. Usually confined to one side, but sometimes attacking both parotids. Dr. Flint's cases were three of typhoid feve, one of typhus, and two of doubtful type. All the remainder that I have quoted were cases of typhoid fever. I shall conclude what I have to say upon this subject with an abridged report of the case which I saw myself. It presented, besides the parotitis, an unusual pustular eruption on the greater part of the body, appearing soon after the inflammation of the gland.

Case. On the 7th of October, 1855, I was called to a boy, four years of age. He was of healthy family, but had been somewhat out of health the previous year. In the spring, I had treated him for scofulous ophthalmia, of moderate severity; this did not wholly disappear until the appearance of boils on his legs in the summer— after which his eyes became entirely well. He was attacked on the 3d of October with typhoid fever. The disease presented in its course nearly all the usual symptoms: restlessness, hot skin, rapid pulse, drowsiness, loss of appetite, thirst, diarrhoea, meteoism, dryness of mouth, coated tongue, and delirium. His pulse did not rise beyond 124 beats in the minute. On the 11th day of the disease, the impulse of the heart was absent, and the first sound shortened. There were no rose spot nor sudamina discovered, although repeatedly sought for. He was fairly convalescent on the nineteenth day, and on the thirty-second had entirely recovered. His treatment consisted of daily sponging over the whole surface, free ventilation, quiet, cold applications to the head, Dover's powder when restlessness or delirium required it, and from the eleventh day, brandy and