652 PROCEEDINGS OF SECTION G. 
Even external urethrotomy for old or impermeable stricture is not 
a fair simile to use. The truer homologue, indeed (so far as 
etiology and method, though not purpose, are concerned), is our 
operation for incising the urethra in cases of impacted calculus or 
foreign body. The latter operation is well known to be a simple 
and safe proceeding—free, not only from the dangers more imme- 
diately attending perinzal section and external urethrotomy for 
stricture, but also from those risks which have to be run during 
the healing process after those operations, both as regards sep- 
ticemia and urinary fistula. Perineal section is said to be of 
ancient date—practised even in the tenth century, A.D.—but was 
for a long period a dreaded operation. Even now the conditions 
which give rise to the need for its performance preclude our 
deriving the full advantages of aseptic dressings after it. In the 
native, however, upon shorn THOKA LOSI 1s about to be undertaken, 
all the important dangers are absent. There is no hospital air ; 
there is no extravasation of urine or other septic abomination in 
possession of the field before the operation. The incision is made 
through sound and uninflamed tissues. The patient has no 
stricture to hinder healing or to complicate the after-treatment by 
needing the retention of a catheter, and he is neither a drunkard 
nor even a moderate user of alcohol. He is also a stranger to 
syphilis, and his tissues possess a happy quality of healing readily 
even after the most severe wounds. The disease against which 
the THoKA LOsI is intended to militate has its seat at a distance 
from the site of the operation, and is often in itself a more painful 
than serious ailment. 
For these reasons it has appeared to me that in the cases in 
which THoka Lost has been followed by the death of the patient, 
this consummation has been brought about, not by the THoxKa Lost, 
but by the original disease, which it was intended, but failed, to 
relieve. An examination into the circumstances of individual 
cases has borne out this belief. The cases which have ended 
fatally have been chiefly those of old men attacked by pneumonia 
in the wake of influenza, which in Fiji is better described by its 
i arrhal fever—and they have died with- 
out hemorrhage or sloughing at the seat of operation, or 
septiceemia. The successful cases, on the other hand, have 
commonly been those of less acute diseases, chiefly making their 
presence felt by pain lower down in the back than the bases of 
the lungs—pain of a rheumatic nature, commonly enough met 
with among a people who live in a rainy climate, dwell in damp 
houses, dress without discrimination, and sleep in damp _ bed- 
places, separated only from the earth by a scanty layer of 
mouldering grass or cocoanut leaves. - Such, then, is the Fijian 
operation of THoKA Lost—incision of the urethra. Let me not be 
considered its advocate, nor even its avenger. I merely wish to 
put forward an impartial criticism of a subject which has been 
