No. 1447.

MAY 24, 1851.

LecturesON

SOME OF THE MORE IMPORTANTPOINTS IN SURGERY.

(Delivered before the Medical Society of London.)BY G. J. GUTHRIE, ESQ., F.R.S.

LATE PRESIDENT OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND;CONSULTING-SURGEON TO THE WESTMINSTER HOSPITAL, SURGEON TOTHE ROYAL WESTMINSTER OPHTHALMIC HOSPITAL, ETC.

(Continued from p. 479.)

The diameter of the urethra; the different portions of the urethra;Wilson’s or Guthrie’s muscle; anatomy of the prostate gland;uses of the prostate; the mucous membrane of the bladder,ureters, and urethra; researches of Quekett, Hancock, and Köl-liker respecting the involuntary muscles of the urethra; thefemale urethra.

THE diameter of the urethra is as uncertain as the length,varying in different individuals from three to five lines, oreven from a quarter to nearly half an inch. The orifice is the

smallest part, except in a few rare instances, when it is abouta quarter of an inch within it and in sight. The orifice isalso the least capable of extension, although every other partmay be stretched considerably. A permanent contraction,therefore, in any part of the canal, can rarely be effectuallycured by dilatation unless the orifice is enlarged, which canonly be done by its being divided-a fact now well known to allpersons of character and experience, but which from pruden-tial reasons is not always distinctly stated in books. In asound state of parts, the urethra continues of a size at leastas large as that of the orifice, and will from its elasticityadmit an instrument with ease which is larger; until itreaches the part where it begins to be surrounded by thebulb of the corpus spongiosum, and therefore called thebulbous portion of the urethra. This part of the urethra,although not very perceptibly larger in the natural statewhen examined after death, does admit of much more exten-sion than any other portion when a cast is taken of the wholeurethra by distending it with pressure by a fusible metal. Theaccompanying diagram shows this in a remarkable manner.

Fig. 1 is a cast made by Mr. Qnekett in situ, with some disten-tion. A is the anterior part of the urethra gradually dilatinginto the bulbous portion, which terminates and is againcontracted at B, in a more sudden and marked manner, beingthe part where the urethra is surrounded by the anteriorlayer of the deep perinaeal fascia, formerly called the trian-gular ligament of Camper. When a urethra is removed withthe parts around it from the body, and slit open on its upperpart, neither the bulging nor contraction are very observable.If the urethra be stretched whilst the points of attachmentof the fascia or triangular ligament are held steadily on eachside, the ridge the fascia forms under it may be distinctlyfelt and seen. I object to the term triangular ligament asapplicable to the part underneath the urethra, because it isfound with some difficulty on dissecting the parts; and leaveson the mind of the student an unfounded impression of itsnature, although the form, separations, and attachments of thefasciæ at this part constitute the most difficult part of know-ledge to acquire, give the most trouble, and are the mostimportant in the treatment of diseases of the urethra. It isat this spot at which the worst strictures exist, at whichfalse passages are usually made, and which the dilatable stateof the bulbous portion of the urethra in front of the resistingfascia greatly favours. The diagram shows this part well:at C it marks the entrance into the bladder, whilst it alsoshows that the distance from B to C, or the extent of themembraneous part of the urethra, and of the prostatic portion,is not near as much in the natural state of parts, when theyare held compactly together, as when they are removed andstretched out for measurement. Fig. 2 (also made by Mr.Quekett) shows a similar portion of the urethra simply filledwith the same metal, but without being distended. The de-velopment of the bulbous portion, or gulp7b as it was called by theancient anatomists, is not so marked as in Fig. 1, and the lengthof the membraneous and prostatic portions is greater. Thedifferences of length estimated by different surgeons for theseparts may perhaps be thus accounted for.The urethra obtains its full development at and after the I

age of puberty, previously to which it is more uniform in its dimensions, being nearly free from the inequalities whichhave been noticed. It assumes at this time a somewhat dif.ferent form as to its curvature, particularly at the posterior orprostatic part, which rises in the child much more perpen-dicularly into the pelvis than in the adult, and is comparatively

longer, the bladder being situated higher, and more elevatedtowards the abdomen, requiring, as has been long well known,a greater turn for the end of the staff in operating for lithotomyin the child, when a curved instrument is made use of.The membraneous part of the urethra is surrounded, not onlyby the sheath of involuntary muscular fibres just noticed, butby the voluntary muscle, first fully described in my lecturesin 1830, which is a sphincter, closing when in action the

urethra, and preventing the passage of urine from the bladder.The muscle may be sought for from within, which is perhapsthe best way, by carefully dissecting off and turning asidethe inner layer of the deep perinseal fascia with thp levatorani muscle, of which it was supposed by Mr. Wilson to form apart, but which is a totally distinct muscle, having no con-nexion with it. The pudic artery runs in front of it, butinternal to the external layer of fascia, the muscle and theartery both lying between its anterior and posterior layers,which posterior layer turns round the inner edge of the levatorani muscle, to invest the urethra and prostate. On the upperpart there is a median line of tendon attached to the pubesby fascia, one half of which runs backwards with the muscle,to be inserted into the upper surface of the prostate; theother half passes forwards on the urethra, through the trian.gular ligament, to be inserted in front of it, near the unionof the corpora cavernosa. On the under part there is asimilar tendinous line, which is attached posteriorly to thefascia underneath the apex of the prostate, and forwards tothe central tendinous point in the perinæum. The muscle onits upper surface is covered by fascia descending from thepubes. From the median tendinous line, in the upper part ofthe urethra, the fibres pass outwards on each side, con-

verging, as they proceed, so as to form a leg of muscular

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fibres. On the under surface the same thing takes place; anda leg on each side being thus formed from the superior andinferior fibres running from above and below the urethra,they unite and pass outwardly, that is, transversely across theperinmum, to be inserted into the ischium, near or about itsjunction with the descending ramus of the pubis on each side.

I have noticed this part of anatomy more than I shouldotherwise have done, because I have seen, in the latest publi-cations on this point, that some mistakes are yet made. It issupposed that the late Mr. Wilson, my old teacher of anatomyand friend, and I, have each described a muscle, and that thereare consequently two different muscles, which is an error.

Mr. Wilson described the same muscle but imperfectly, fromhaving always dissected the parts laterally-that is, by makinga side view of them; and he concluded that it was a detachedportion of the levator ani; but this is an error, one musclebeing anterior, the other posterior to the internal layer of thedeep fascia which is between them; but fasciæ in his day werenot so much attended to as at present. There are not twomuscles, but one muscle; and as it is as distinct in the femaleas in the male, it is evidently not for sexual purposes.Mr. Quekett, on making recently a careful examination of

this part, has found that some considerable portion of thismuscle is continued on to the anterior part of the prostate, andis intimately blended with its tissue; the transverse strise,characteristic of voluntary muscle, being very readily reco-gnised in this position. A muscle, termed levator proslatg. bySantorini, and also bv Ellis, has its origin at the posterior sur-face of the symphysis pubis, and is continued backwards, tobe inserted into the upper portion of the fascia of the prostate;this muscle, however, when present, is distinct from that abovedescribed.

It is not generally known, even if it be generally taught,that a tendinous part of the accelerator urinse muscle sur-rounds the urethra at the commencement of its bulbous por-tion ; and there is sometimes here a slight narrowing of thecanal, when compared with its anterior part, previously to theformation of the more dilatable portion or bulb; and at thispart a stricture is often found to take place. This conforma-tion would lead to the supposition that the accelerator urin2is also a sphincter; and Mr. Hancock believes that it is cer-tainly a depressor, opposed to the erectile forces of the generalstructure of the parts. The accelerator urinae and the com-pressor urethræ I have described have a singular resemblanceto each other, which can, however, be only seen when theyare carefully and fully dissected, which I apprehend is a per-formance not too frequently had recourse to, judging from thedescriptions I occasionally hear of these parts.The intimate structure of the prostate gland has been inves-

tigated by many anatomists even of modern times, such asMüller, Weber, Henle, Jones, and Adams; and again, morelately, by Mr. Quekett and Mr. Hancock, under the microscope.Mr. Hancock finds that the bands of the prostate noticed byDr. Jones as resembling involuntary muscular fibres, are inreality composed of such fibres, proceeding from and continuouswith those of the inner layer of the bladder, the nuclei beinglarger in proportion to the fibres in the young than in the old,from the prevalence of phosphatic deposit and fatty degene-ration ; and this defective state of muscular development may,Mr. Hancock thinks, in some degree, account for the incon-tinence of urine to which elderly persons are subjected. Mr.Quekett considers the secreting portion of this gland to con- ’sist of a series of minute follicles, aggregated together andcommunicating with an excretory duct; these are firmly en-closed by a dense fibrous capsule, derived from the vesicalfascia, which is divisible into two layers, between which theprostatic plexus of veins runs. When a vertical section ofthe prostate is made, especially if the gland have been in-jected, the follicles may be seen in outline, and an opaquebrownish fluid may be squeezed out of them; but if one ofthe ducts be injected, their shape is more clearly shown; theyare generally of a more or less oval figure, and in a healthygland may be said to measure, on an average, th of an inchin diameter. The interior of the follicles is lined with sphe-roidal or glandular epithelium, that of the ducts being amodification of the tesselated and columnar. In a well deve-

loped gland there are as many as fifteen or twenty ducts, allof which open into the urethra, in the neighbourhood of theverumontanum. The greater portion of the tissue niling npthe spaces between the follicles is composed of the areolarkind, containing a large amount of involuntary muscularfibres, to which, according to Dr. C. H. Jones, the hypertrophiedcondition of the gland is due, rather than to the phosphaticdeposit and fatty degeneration of Mr. Hancock.

In aged persons both the glandular structure and the in-termediate tissues are frequently much enlarged; the folliclesin persons of all ages, from childhood upwards, contain calculicomposed principally of phosphate mixed with a small amountof carbonate of lime. They are of a yellow colour and theirpresence so constant that they would seem to be a part of thenatural secretion of the gland. The deposition of the earthymaterial commences in the secreting cells of the gland, andthe calculi increase in size both by the aggregation of freshcells and by deposit in concentric laminæ. In the formercase they mould themselves to the form of the follicles, andin the latter they exhibit a concentric arrangement. Whendilute hydrochloric acid is added to them the earthy matterdisappears, and a cast of the original calculus remains inanimal matter.A few of the minute calculi are shown in fig. 3, under a

magnifying power of 1/250 diameters; these specimens vary insize from the 2oath to the 1/100th of an inch, they occur fromthis small size to large oval masses three inches in circum-ference; their most common diameter, however, is about thesize of a grain of mustard.

FIG. 3.

It is usually said, that the female has not a prostate, butmerely an erectile tissue surrounding the neck of the bladder.If the word prostate be used with reference to its derivation,as standing before the vesiculse seminales; certainly a womanhas not a prostate, because she has no vesicula- seminalcs; butshe has the rudiments of a muscular substance, sometimessurrounding the commencement of her urethra, which is oftenas large as the prostate in a boy before the age of puberty, andresembles very nearly in external appearance the same part inthe male. The ejaculatory ducts of the male, opening intothe urethra, are of course wanting, and there do not appearto be any proper ducts of the part itself, so that this substancemay be considered in the female to be entirely muscular, anddestitute of the follicular structure, which gives the additionalbulk to the male prostate. Cowper, who was well acquaintedwith this part in the female, calls it corpus globosum, and itperforms in her, in all probability, the first office attributed tothe prostate in man.The prostate gland in the male has at least three offices-

viz., 1, to stand before the orifice of the bladder, to give sup-port to it and the urethra which it surrounds, and a pointmore or less fixed, upon which it may act in expelling theurine; 2, to secrete a fluid peculiar to itself; and 3, to receivethe ducts conveying secretions from other parts: which twolatter uses cannot be attributed to it in the female, and the

! want of which may account for the difference of size in thispart, in the two sexes.The internal coat of the bladder, according to Mr. Quekett,

consists of mucous membrane having an investment of epithe-lium, and a sub-mucous areolar tissue; it lines the interior ofthe bladder, and is continuous with that of the ureters andurethra; in the undistended state of the bladder it is thrownup into folds. The mucous membrane is largely supplied withvessels which form a more or less hexagonal network, andare most numerous in that part near the cervix termed thetrigone, and around the openings of the ureters; in this lattersituation the network is very close; between the meshes ofsome of the vessels, especially near the cervix, minute mucousfollicles are situated. The epithelium of the bladder is of thesquamous or tesselated variety, or rather a modification of thatand the columnar; it is easily detached after death.The mucous membrane of the urethra is continuous with that

of the bladder, and throughout its course presents to thenaked eye certain points worthy of observation in each of itsdivisions. The office of the uvula is said to be that of closing

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the orifice of the bladder in its undistended state. In front ofthis the mucous membrane is slightly rugous, the rugæ, asshown by A, fig. 4, passing on each side of an elevated trian-

FiG. 4.

gular body, termed the vcru-7nog2tanuni, or caput gallinuginis,which has in its centre an opening, termed sinus 2.)ocularis,leading into a cavity, described by Morgagni, Ackerman,Weber, Huschke, and others, as a rudimentary uterus, in thesides of which the two common ejaculatory ducts open. Oneither side of the verumontanum, which in many instancesextends into the membraneous portion of the urethra, are theducts of the prostate. Immediately in front of the membraneousportion, the mucous membrane becomes very rugous, the rugsetaking a longitudinal direction; these are continued on to aboutthe centre of the spongy portion, where they disappear, themembrane here being smooth and glistening. In this part theorifices of many lacunae are visible; one of these, situated atthe upper portion of the mucous membrane, and sometimeswithin three-quarters of an inch of its termination in theglans, is termed lacuna magna; the anterior extremity of thespongy portion is more or less soft and villous, and at the ex-ternal meatus is continuous with the true skin. When, how-ever, the vessels of the mucous membrane of the urethra areinjected, and its several parts are submitted to microscopicexamination in succession, the following points of interesthave been observed by Mr. Quekett.In the prostatic portion around the zerunzonlanum the

mucous membrane appears puckered up into folds, those ofthe cervix being continuous with those of the commencementof the membraneous portion; between these folds are situatedthe openings of the prostatic ducts; and around each duct, aswell as around the sinus pocularis, the membrane is arrangedin a series of minute concentric circles. The capillaries ofthese parts are very delicate, and in some places small papillaeoccur. The mucous lining of the membraneous portion israther smoother than that of the prostatic; but immediatelyon entering on the spongy portion it becomes rugous, the rugse,as shown of their natural size by B in Fig. 4, or magnified ninediameters by C, taking a longitudinal direction; they aremost strongly marked about an inch anterior to the bulb, wherethey are nine in number. When uninjected, they present abluish tinge, and a fibrous structure like that of tendon.About midway between the’bulb and the meatus the rugae dis-appear, but the membrane is still glistening and fibrous.Within three inches of the glans the mucous membrane issofter; and in some specimens papillm occur in rows widelyseparated, which become closer and closer as they approachthe glans, in which part they are most abundant. In eachpapilla there is a looped capillary, which in most cases isslightly twisted upon itself. The rugæ are largely suppliedwith bloodvessels, the depressions or furrows being muchmore vascular than the projecting portions. If the urethrabe divided transversely, in this part of its course, the project-ing portions of the rugeo are nearly in close contact. Withintwo inches of the bulb, as shown by A in Fig. 5, in a prepara-tion of Mr. Hancock’s, the section of the mucous membranewill very much resemble a large leech-bite, there being gene-rally about three folds; in this situation, as represented by B,numerous papillae sometimes occur. Still nearer the bulb theprojecting portions are as many as six, seven, or nine in

Fm. 5.

number, and the section at this part assumes a stellate form.as represented by C in Fig. 5. The basement membrane ofthe urethra is very thin, and in some parts can hardly be saidto exist. The epithelium is of the tesselated variety; in theanterior part of the spongy portion nearer the bladder it ismore or less spheroidal, being to all appearance situated upona fibrous tissue. Immediately below the mucous membraneare the involuntary muscular fibres of Alr. Hancock, which,when seen in their natural condition, are rather smaller in sizethan those of the intestinal canal, and present a minutelygranular appearance. When acted on by acetic acid, theirelongated oval nuclei are plainly seen.

Since the delivery of the lecture, Mr. Guthrie has ascer-tained that the involuntary muscular fibres of the urethraand prostate, described by Messrs. Quekett and Hancock, hadbeen previously noticed by Professor Kölliker, of Wurzburg.The labours of these gentlemen have been, however, totallydistinct and unknown to each other, and they are alike en-titled to the approbation of their fellow-anatomists. Hisaccount is as follows, in the Zeitschrift fur Wissen, ZoologiesBand 1. pp. 67-71:-" The urethra and the parts connected with it present varioust

developments of the organic or involuntary muscular fibres.The prostate gland, and that part of the urethra which lies

in it, are the most remarkable for their richness in muscularfibres, the glandular structure being present in a, relativelysmall proportion, forming hardly more than one-third or one-fourth of the so-called prostate-a view which differs from thatof all other anatomists, with the exception of Valentin, whodoes not, however, express himself satisfactorily upon the point.

, If the pars prostatica urethrse be opened from the point bya longitudinal section through the prostate, and the mucousmembrane taken away, the yellow longitudinal fibres of thecrista galli appear to join the lower end of the trigone, andcontain only a few scattered muscular fibres.On both sides of the caput gallinaginis, and as far as the

anterior wall of the urethra, there appear further similaryellowish longitudinal fibres, which form a strong layertowards the neck of the bladder, whilst, on the other handstowards the pars membranacea they become more delicate.

This longitudinally fibrous layer of the pars prostatica isconnected internally to the sphincter vesicse by a weak andindistinct layer of fibres, with a few longitudinal bundles ofthe muscular CO:1.t of the bladder lying at the side of thetrigone. It has, however, for the most part, no connexion withthe muscles of the bladder, and consists half of cellular tissue,with many nucleus fibres, and half of organic muscular fibres,with their characteristic nuclei. Upon this layer follows,secondly, towards the outer side, a thickish layer of yellowcircular fibres of muscular and elastic structure.The proper glandular structure of the prostate occupies

especially the outer and lower part, yet sends a few lobes intothe circularly fibrous layer, its excretory ducts penetratingthe longitudinal and transverse fibres.

It consists of a reddish-grey, or reddish-yellow mass, whichmay be very easily torn into fibres in the transverse direction.It may be said more exactly to radiate from the lateral partsof the crista galli, or the openings of the prostatic ducts.

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Here are found, as Valentin has said, (1) a great mass ofreddish fibres, the bundles of which join plexuses, yet run forthe most part radially; and (2) the glandular mass and ductsof the prostate.The first of these are almost all muscular. Their elements

are very beautiful, being an abundance of organic muscularfibres, of moderate length and considerable breadth, similar tothose of the bladder......

It may be readily comprehended that, under these circum-stances, any muscular coating of the vesicles and ducts of thegland would be quite superfluous; they therefore possess onlya coating of cellular tissue.The whitish-yellow walls of the vesicula prostatica consist

essentially of cellular tissue, with many nucleus fibres, withwhich, in the neck of the vesicle, a few, and, at its base, a con-siderable number, of organic muscular fibres are mixed.The prostate further possesses a strong layer of organic

muscular fibres, which invests it externally on all sides.In the pars membranicea urethras the organic muscular

layer is less developed. There is, under the mucous mem-brane, whose cellular tissue is distinguished by its richness inelastic structure, (nucleus fibres,) a layer of longitudinalfibres, which are connected with those of the pars prostatica.They consist for the most part of cellular tissue, containingnucleus fibres, and a smaller number of wavy, contractile,organic muscular bands, (fibre-cells,) which are sometimespartly isolated, and are more easily formed in fresh prepara-tions than in those which have been acted upon by acetic acid,in which they are obscured by the many nucleus fibres of thecellular tissue.They are 0.07 - 0.1 line long, 0.002 - 0.003 line broad;

nuclei, 0.012 to 0.014 of a line.Upon these longitudinal fibres follow externally transverse

fibres in a considerable layer, which for the most part belongto the musculus urethralis. A part of them, however-viz., theinner layers-shows pretty strong bundles of organic muscle,with cellular tissue and nucleus fibres, and partly mixed withthe animal bundles of the urethralis muscle. Still less deve-loped in general are the organic muscles in the pars cavernosaof the urethra. Sometimes they are to be found just like thelongitudinal fibres of the membraneous part. In other cases,longitudinal fibres may indeed be recognised under the mucousmembrane, but no muscles at all among the cellular tissue andits nucleus fibres.At a certain depth, however, we always meet with longi-

tudinal fibres with a larger or smaller admixture of organicmuscles, which fibres cannot be regarded as trabeculae of thecorpus cavernosum, since there are no venous spaces betweenthem; but they form a continuous membrane, which limitsthe proper corpus cavernosum towards the urethra.

This layer might be regarded as belonging to the corpuscavernosum, and the existence of a muscular membranebelonging to the urethra at this part might be altogetherdenied; but it seems more natural to regard the whole corpuscavernosum as a very much developed muscular investment,provided with peculiar vessels. For these are found in thetrabeculæ of this spongy body as far as the glans, mixed withcellular tissue, containing nucleus fibres, vessels, and nerves,and a great quantity of organic muscles, which render the wholestructure eminently contractile. IIn Cowper’s glands I find neither in the gland vesicles nor in

the long excretory ducts, any traces of muscularity; on theother hand, there is a very delicate investment round thegland, formed of organic muscles and cellular tissue; and therealso exists a fibrous structure rich in organic muscles withinthe gland, which must afford very effectual aid in compressingand emptying it."-p. 70.Female Urethra.-" In the urethra there is, besides an inner

longitudinally-muscular membrane, also an outer transverselayer of smooth muscles, which, combined with the animalbundles of the musculus urethralis of the female urethra, mustgive it a very considerable power of contraction. The inner

longitudinally-fibrous membrane contains only a few organicmuscles which can hardly be isolated, and very often are madeout with great difficulty among the abundant cellular fibres,nucleus fibres, and vessels.The organic muscles in the very thick, outer, transversely-

fibrous membrane, are more abundant; yet here, also, they arepartly mixed with much cellular tissue, partly mingled ex-ternally with little secondary bundles of the musculusurethralis, the latter forming the outermost layer without anyadmixture of organic fibres."-p. 71.

(To l e continued.)

Abstract of the Introductory LectureTO THE COURSE OF

MILITARY SURGERY.Delivered in the University of Edinburgh, May 1, 1851.

BY SIR GEORGE BALLINGALL.

THE professor, after stating that five-and.forty years havenow elapsed since he entered the army as an hospital mate,and that almost thirty years have come and gone since theduties of the chair first devolved upon him, expressed hisregret that an indifferent state of health had compelled himto transfer his lectures from the winter to the summer session;and this chiefly on account of the diminished attendance ofarmy and navy surgeons which must be expected during thesummer months. With reference to the valuable informationobtained from many of these gentlemen, which he has alwaysbeen prompt and proud to acknowledge, he proceeded asfollows:"The advantages accruing to me from a numerous attend-

ance of this description of pupils, have, in some measure, beenmade up, for the present, by the enjoyment of several acci-dental and much-valued sources of information during myrecent absence. Since I closed my last course of lectures, Ihave been collecting materials for the improvement of a paperon hospitals, originally written for the " Cyclopedia of Prac-tical Surgery," and which I have been urged to publish in aseparate form. With this view, I have had the pleasure ofvisiting many of the civil hospitals of England, particularlythose of Manchester and Liverpool, and the numerous hos-pitals in Dublin, civil and military. In that city I had thegratification of meeting a numerous medical staff, and passingsome days in the society of my coadjutor, Mr. Tufnell, whohas for some years delivered a course of lectures on MilitarySurgery in the Irish metropolis. Of this gentleman’s intro-ductory lecture you will see honourable mention made in arecent number of THE LANCET for the 6th of April. On theoccasion of its delivery at the City of Dublin Hospital, he washonoured with the attendance of the Duke of Cambridge, theCommander of the Garrison, and his staff, supported also bySir James Pitcairn, an old and experienced officer who servedin the Egyptian campaign, and by the host of medical officersattached to the large army in Ireland. Mr. Tufnell is placedin a position where his energy, intelligence, and talent, havealready commanded distinguished success, although the Govern-ment has not yet seen fit to extend to him the advantagewhich is enjoyed by the professor of military surgery in thisUniversity as a nominee of the Crown, nor to give him thestimulus of a moderate endowment, to which he is so thoroughlywell entitled.

" Reverting to my own advantages, although not resident atany great school of medicine, I passed several months of thebygone winter amidst a group of old friends, military andmedical, at Cheltenham, where I was in daily communicationwith old and experienced army surgeons. Amongst thesewas Dr. Allardyce, a gentleman with whose name I have beenfamiliar for forty years, who has served in the Peninsula, inIndia, and in Persia, and who dates amongst the first of hisfields the battle of Assay e, where the Duke of Wellington laidthe foundation of his fame. There also was Dr. Arthur, anexperienced and esteemed medical officer, who has served inSouth America, and in the West Indies, and who, as a regi-mental surgeon, followed the fortunes of the ConnaughtRangers in sunshine and in storm, through the earlier yearsof the Peninsular war. There, too, I met with Dr. Franklin,whose services extend to nearly forty years in the Peninsula,in America, and in the West Indies, and who has recentlyreturned from India, where he held the important and re-sponsible position of Inspector of Hospitals to the Queen’stroops. He has come home enriched with all the recent

experience of the wars in the Punjaub, a participator in thedear-bought victory of Chillianwallah and the final triumphof Goojerat. With these gentlemen, and many others, I havehad much interesting and valuable communication, of which Ishall be able to avail myself in the progress of the course.

" Versed as they are in the usages, wants, and vicissitudesof the service, it is always pleasant and profitable to enter with