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passed a probe from the perineal wound into the pro? imal end of the urethra. The instrument became ar- rested in the middle portion of the pendulous urethra and from this point on the tissues were simply bored through by forcing the instrument toward the artificial meatus already established. A section of a small- sized bougie was fastened in the anterior urethra, youtube viagra prescription brought up to about the calibre of a No. 9 French instrument. Antiseptic irrigations were made and the perineal wound was packed with iodoform gauze. The case was transferred, according to the hospital rule, to the surgical service, where I saw the patient about a week later. He was then in excellent condi- tion. Urine was being passed by the urethra, as I was informed it had begun to pass upon the day following operation; the perineal wound was almost clos and, as I understood, instruments were being regularly passed to maintain the calibre of the anterior urethra. Going off duty on the 1st of May I did not again see the case, and it is only now, wishing, because of the rarity of the condition, to put it upon record that I find the child died on May 16th, nearly one month after the operation. The only history I can find shows that on May 6th the child began to show a tempera- fine of io3-io4 : ' F., respirations running from 40 to 1 Read before the genito-urinary section of the New York Academy of Medicine, May 12, 1896. 50 per minute, and he was thought to have pneumonia. On May 10th jaundice appeared, and Dr. Herter saw the child with Dr. Brewer. The urine was passed to- youtube viagra prescription ward the close in very small quantity and was of a very youtube viagra prescription dark brown color. Before death the temperature became subnormal. The autopsy record showed: Perineal wound en- tirely healed. Heart enlarged. Weight of left kid- ney, three ounces. Weight of right kidney, two ounces. The left kidney measured two and a half inches in length and was lobulated. The hilum was distended with urine, as was also the ureter. The right kidney was two inches in length, slightly lobulated, capsule adherent in sulci. The cortex of youtube viagra prescription the kidney was pale yellow and the normal 50mg viagra prices markings were absent from the pyramids. The ureter was distended with urine. The bladder walls were over one-eighth of an inch in thick- ness. The urethra was pervious from the bladder to about one-fourth of an inch behind the glans penis. This, gentlemen, is all I know about the case. Whether the passage of instruments was continued after the time of change of service, whether Dr. Brewer or his house surgeon knew anything of the previous history of the little patient, what was the cause of the high temperature, what treatment was given, etc., are all lacking. The history books of the institution do not show. The history I have given has been kindly furnished me by Dr. Gilliam, who was present at the operation. I have just returned from a meeting of the American Medical Association in Atlanta, where a paper was read by Dr. Small, of Pittsburg, upon "Retention of I youtube viagra prescription line in the Newly Horn," during the discussion of which I inquired whether any present were familiar with youtube viagra prescription this variety of occlusion without hypospadias or an opening somewhere for the escape of urine. While speakers said they had observed a gluing to- gether of the urethral walls, forming a temporary youtube viagra prescription occlusion easily overcome, and the more common oc- clusion just at the meatus requiring simply a slight incision, none reported having seen such a condition as I have described. 1 am somewhat familiar with text-book articles bearing upon the question of deformities of the male genitals, and without looking up the subject at the present time, I think I am safe in saying that youtube viagra prescription the condition of absence of urethra in a considerable por- tion of its normal extent, or such a firm adhesion be- tween the two halves of the canal as 50mg viagra prices to entirely youtube viagra prescription ob- literate it, is rare. Slight obstructions, clue perhaps to inspissated se- cretions, or to easily overcome stenoses, are not so rare, and a youtube viagra prescription probe or small-sized catheter readily overcomes them. Here, however, there was complete obliteration for a considerable distance, and I believe I pursued the proper course in performing perineal section. To have bored a way through from the meatus, not being able to determine at what point the patulous urethra would be encountered, and perhaps not knowing w-hen it was encountered, if indeed youtube viagra prescription the instrument entered it at all, instead passing up alongside, seemed to me unsurgical and unwise. Such a course has been pursued with successful re- sults, to be sure. Dr. Campbell related such an in- stance in 1891, 1 in which there seemed to be no urethra. After prolonged effort with various blunt instruments a passage was forced into the bladder, and at the age of three years the child seems to have suffered no harm from the operation. Dr. Adams has reported two instances of occlusion. In one case no instru- ment youtube viagra prescription could be passed and the child died forty-eight hours after birth. In the second case a probe passed into the urethra met an obstruction not far in, which 1 British Medical Journal. 4 British Medical Journal, February 2S, 1S91. 802 MEDICAL RECORD. [June 6, 1896 was overcome when considerable pressure 50mg viagra prices was exerted with a soft French catheter. The first of these cases may have been similar to mine, though there was ap-