THE JOURiSIAL OF PHARMACOLOGY. 271 



At this spot in the urinary passage the catheter encountered an obstacle 

 from the very beginning which always had to be passed by repeated 

 advances and withdrawals of the instrument, and which seeme i to be 

 'essentially a false passage. Additional evidence of the correctness of 

 this view was afforded by the fact that there were always a few oMer 

 blood clots in that place, which came out entangled in the eye of the 

 catheter. Such was the condition of the patient's urinary passages at 

 the time when he was received at our clinic. 



From the first day until the time of his death (May 11 to June 20, 

 1900), the patient, besides other treatment, was given 0.5 gram (7^ 

 grains) of urotropin in tablet form three times daily. He took alto- 

 gether nearly 60 grams (2 ounces) of urotropin ; and though the amount 

 of nourishment which could be administered was but very small, he 

 never objected to the tablets. By-effects which could be attributed 

 to the drug were never seen ; but of course it would have been difficult 

 to demonstrate them in view of the severe general disease and the 

 apathy of the patient. Even in so short a time as eight days after 

 beginning the treatment no more pus was voided by the urethra, and 

 catheterization could be effected more easily. After one week's fur- 

 ther treatment the urine began to pass involuntarily from the bladder 

 without that organ being full; there was greater resistance to the 

 catheter again, and after the evacuation of the urine pus fiowed from 

 the bladder. The amount of the pus increased during the next few 

 days; and on introducing the catheter through the prostatic region 

 the instrument seemed to pass through softened tissue. It was evi- 

 dent that a new abscess formation was in progress ; and since the pus 

 only flowed from the catheter with the last few drops of the urine, 

 its source was not the bladder itself. It would not, of course, have 

 been surprising had this been the case; the bladder had oportunity 

 enough to become infected. The constant defecaction in bed, and con- 

 sequent soiling of the genitals ; the extensive decubitus ; the inflamma- 

 tory edema of the one thigh and the adjoining skin of the abdomen; 

 the edema of the prepuce; the constant transference of pus by means 

 of the catheter from the prostatic region to the bladder ; all these were 

 complications from which the anterior segment of the urethra could 

 probably not have been permanently protected, in spite of carefully 

 cleansed glans, sterile catheters, and sterilized oil. And pus organ- 

 isms present there would reach the bladder without difficulty by means 

 of the catheter, and perhaps accentuate the action of the prostatic pus. 

 Nevertheless the excretion of the pus in the urine diminished again ; and 

 before the patient died it was certain that whilst the autopsy might reveal 

 an affection of the bladder of moderate grade, it would not show a 

 severe inflammation. 



