WztTz Com.pltmen.ts of tTce A.iz.t?ton. 
Catbeterism of the Ureters in the 
Male and in the Female 
WITH THE HELP OF GASPER'S 
URETER CYSTOSCOPE. 
WILLY MEYER, M. D. 
BY 
REPRINTED PROM THE 
■Neb) ITodt USebtcal Sournal 
for March 21, 1806. Reprinted tram the New York Medical Journal 
for March 21, 1896. 
CATHETERISM OF THE URETERS 
IN THE MALE AND IN THE FEMALE 
WITH THE HELP OF 
CASPER’S URETER OYSTOSCOPE* 
WILLY MEYER, M. D. 
Since Nitze’s new, simple, and handy cystoscope has 
been in use (since 1887), every cystoscopist has hoped for 
and expected a new instrument constructed according to 
the same pattern for catheterism of the ureters. 
In my treatise On Cystoscopy, in A System of Genito- 
urinary Diseases, Syphilology, and Dermatology, edited by 
Dr. Prince A. Morrow, vol. i, page 449,f I stated the use- 
lessness of Brenner’s and Boisseau du Rocher’s cystoscopes, 
until then the only ones designed for this purpose, both 
of which I had tried myself, and laid down my own ideas 
with reference to solving this task from a mechanical 
standpoint. I also explained why we could not attempt to 
make the instrument here. J 
* Read before the Section in General Surgery of the New York 
Academy of Medicine, November 11, 1895. 
f New York: D. Appleton & Co., 1893. 
% Ibid., p. 489. 
Copyright, 1896, by D. Appbeton and Company. CATHETERISM OF THE URETERS. 
That the cystoscope for catheterizing the ureters of 
both sexes had to he constructed according to the princi- 
ples originally laid down by Nitze, was always to my mind 
a matter of fact. No other instrument can bring more 
easily and more thoroughly into view the base of the blad- 
der, and with it the ureteral openings. To see and ap- 
proach the latter is, of course, the sine qua non in this kind 
of work. 
It is greatly to be regretted that Nitze’s inventive fac- 
ulty began to apply his cystoscope for the “treatment” of 
bladder diseases (operative cystoscopy) before he had en- 
tirely exhausted the diagnostic side of its usefulness. Thus 
it happened that others undertook the task which, by virtue 
of Nitze’s former ingenious inventions in this field, should 
have been accomplished by him.* 
On January 9, 1895, Dr. L. Casper, of Berlin, pre- 
sented his new ureter cystoscope to the Berlin Medical 
Society, demonstrating its practical use on two men. f In 
the discussion following his demonstration Nitze claimed 
priority for this instrument. He asserted that Casper had 
seen his (Nitze’s) cystoscope before starting to make one 
of his own design. Casper strongly and repeatedly ob- 
jected to this statement. To enter into this rather fervent 
controversy J would be futile. The profession no doubt 
owes thanks to Dr. Casper for his efforts in perfecting a 
cystoscope that permits of catheterizing the ureters with 
comparative ease, and in bringing it into the marlcet. That 
which Nitze stated had been used by himself for years and 
had been demonstrated by him before tbe International 
* According to Nitze—Zum Katheterismus der Harnleiter beim 
Manne, Centralblatt fur Chirurgie, 1895, No. 9—he really was the first 
who succeeded in constructing a ureter cystoscope. 
f Dtsch. med. Woch., 1895, No. 7. 
X See Centralblatt fur Chirurgie, 1895, Nos. 9, 11, 14, 19, and 26. CATHETERISM OF THE URETERS. 
3 
Medical Congress at Rome in 1893, 
the meeting of German Naturalists 
and Physicians at Vienna in 1894, 
and the Congress of the German 
Surgical Society at Berlin in 1894, 
is so far nowhere for sale. Thus 
it seems that we have a right to 
call this new important instrument 
“ Casper’s ureter cystoscope ” 
Its new features, in compari- 
son with the Nitze cystoscope No. 
1, are : 
1. The shank of the cysto- 
scope (see figure) carries a straight 
groove, which can he transformed 
into a canal with the help of a 
movable lid (Li.) with a handle 
(IT). It is to receive the ureter 
catheter (U. C.). The outer end 
of this canal (0. E.) projects over 
a semicircular hard-rubber plate 
(PI.) which forms a convenient 
handle, and, being situated about 
an inch and a half away from the 
ocular end of the telescope (0.), 
can easily be reached by the opera- 
tor’s hands. The vesical end, about 
six millimetres in front of the prism 
(Pr.), is worked out in such a way 
that the ureter catheter, emerging 
into the bladder, when pushed from 
the outside, forms with the shank 
of the cystoscope an angle of forty- 
five degrees. By this means we 4 
CATHETER ISM OE THE URETERS. 
are enabled to enter the ureteral orifice with great ease, 
as the vesical end of the ureter and the fundus of the 
bladder form an angle of about the same size. But 
the angle of forty-five degrees between the catheter and 
shank is produced only if the lid be pushed in as tightly 
as possible. The canal is situated on the concave side 
of the cystoscope, the one which carries prism and lamp 
(La ). This is a very wise arrangement, and decidedly 
distinguishes Casper’s cystoscope from Brenner’s and 
Boissean du Rocher’s. Both the latter carry the straight 
tube on the convex side, and, having no piisra, force 
the cystoscopist to inspect the ureteral opening through 
a simple straight telescope. In order to do this the 
handle naturally has to be raised until it is almost ver- 
tical. For obvious reasons the result thus generally was 
very unsatisfactory. But in letting the catheter pass but 
right in front of the prism, its tip, somewhat magnified, 
always remains under the control of our eyes, and we han- 
dle the instrument just as we always use Nitze’s cystoscope 
for the inspection of the fundus of the bladder. 
2. The lamp is situated behind the prism in the longi- 
tudinal axis of the instrument—Lohnstein’s modification 
(see figure). The other cystoscopes carry the lamp in the 
tip of the beak. Lohnstein alleges* for his modification 
the following special advantages over Nitze’s original in- 
strument : 
(a) Foreign bodies in the bladder, larger stones, and 
tumors, that often have the tendency to fill out the con- 
cavity of the beak of Nitze’s cystoscope, and will then not 
be seen on account of not being illuminated, can be nicely 
observed. 
(5) Tumors situated at the side and above the internal 
urethral orifice will not escape the inspecting eye. These 
* Deutsche med. Wochenschrift, 1895, No. 4, p. 59. CATHETER ISM OE THE URETERS. 
5 
will generally not come into view by performing cystos- 
copy witli Nitze’s instrument No. 1. 
(c) Beaks of different shape and length can he made and 
screwed on the instrument. 
3. The beak of the instrument (B.) is made in one piece 
with that portion which carries the lamp. 
The arrangements as described under Nos. 2 and 3 
permit of shaping the beak according to necessity (hyper- 
trophy of the prostate, etc.). Patients will thus more 
rarely experience the slight burning sensation if the tip of 
the beak should touch the fundus. 
4. If the lid that covers the canal he pulled out, a 
straight metal mandrel (M.) can be inserted into the groove. 
By doing this the small catheter which had been pushed 
through the canal into the ureter is lifted out of the groove 
and thus liberated. Now the cystoscope can be withdrawn, 
while the catheter remains in situ. The latter is an Eng- 
lish web catheter of No. 4 French gauge. It is sixty cen- 
timetres (twenty-three inches and a half) long. A long 
thin wire mandrel obstructs its lumen up to about two 
inches from its tip.* The catheter is flexible, yet has 
sufficient stiffness to enter the vesical end of the ureters 
and to pass upward to the pelvis of the kidney if gently 
pushed from the outside. 
5. The ocular lens of the telescope is not in the same 
axis with the other lenses. It is moved to a place two 
centimetres below the canal described above under No. 1. 
This is done to enable the cystoscopist to handle the lid of 
the canal and the steel mandrel with convenience and ease, 
and to push forward the ureter catheter or its substitutes 
in a straight line. The picture is reflected to the ocular 
* In the newest pattern (December, 1895) the mandrel fills the 
lumen in its entire length, and the outer end of the catheter is funnel- 
shaped. 6 
OATHETERISM OF THE URETERS. 
lens with the help of a double prism. The view of the 
interior of the bladder is nevertheless just as brilliant and 
satisfactory as when it is seen through the other cystoscopes. 
The shape of the shank is oval, not round; its size, No. 
24 French gauge. It passes a urethra of this dimension 
without difficulty. The electric current is conveyed to the 
instrument by slipping a doubly perforated semicircular 
hard-rubber plate over two projecting wires, which are 
fastened on the hard rubber handle of the instrument (-f- 
-and —). A screw (S.) makes and breaks the current. 
The cystoscope is manufactured by W. A. Ilirschmann, 
Berlin, N. Germany.* 
Until January 9th, the date of reading his article be- 
fore the Berlin Medical Society, Casper succeeded in 
catheterizing the ureters with this instrument thirty times 
in twenty-two patients. Of these, twenty-one were men. 
lie failed in accomplishing his purpose only once. The 
majority of the patients were afflicted with chronic gonor- 
rhoea, a small number had cystitis, one had hypertrophy of 
the prostate. Two of Casper’s assistants also found no dif- 
ficulty in using the new cystoscope. 
My personal experience is so far (November, 1895) 
based on only three patients, one male and two female. In 
these I have catheterized both ureters simultaneously—i. e., 
six times in all. I have been in possession of this instru- 
ment for a very short time, and have used it in my private 
practice according to strict indication only. In a fourth 
patient, a gentleman of Brooklyn, who had vesical catarrh 
and probably unilateral nephrolithiasis, in whom I tried to 
catheterize the ureters five days ago, I did not succeed in 
finding the ureteral openings. I had clearly seen them and 
had been able to demonstrate them to his brother, who is a 
* It is for sale in New York by Messrs. R. Kny & Co., 17 Park 
Place. Price, $45. CATHETERISM OF THE URETERS. 
physician, five days before this attempt, on inspecting his 
bladder with the ordinary cystoscope. The trigonum and 
fundus were at the last examination injected and the tiny 
apertures thus rendered too indistinct. It would be incor- 
rect to call this attempt a failure. We necessarily must 
find the mouth of the ureters before we can enter them 
with an instrument. The vesical catarrh of this patient 
is now being carefully treated, and I hope soon to be able to 
enter the ureters with the same ease as I did in my first 
male patient.* 
Since reading this paper I have had occasion to catheter- 
ize the ureters of one more lady and four more men, in all 
instances successfully. One of the patients had a marked 
hypertrophy of the prostate. To my surprise, I did not 
find the procedure difficult at all. On the contrary, it im- 
pressed me as being easier than in patients whose prostate 
had the normal size. Thus I have succeeded in catheterizing 
the ureters with the new instrument, in all so far, sixteen 
times—six times in female and ten times in male patients. 
I consider the procedure an easy one, and believe that it 
will always be successful where the bladder will hold from 
five to six ounces of fluid, and where the mouth of the 
ureters can be well seen and approached. 
In performing catheterism of the ureters with Casper’s 
instrument in patients who need this examination, I should 
advise, provided the three cardinal conditions for employ- 
ing cystoscopy are fulfilled,f to proceed as follows: 
1. Wash and cocainize the bladder according to well- 
knowm rules.J 
2. Fill the bladder with from five to seven ounces of 
* Meanwhile the patient has gone on a trip to Japan. Before his 
departure I had no opportunitv to perform the examination. 
f See author, in Morrow’s Handbook, vol. i, p. 455. 
| Ibid., p. 456. 8 
CATHETERIPM OF THE URETERS. 
clear fluid. It is necessary to inject a little more than the 
usual average amount for a cystoscopic examination—viz., 
five ounces—because there is some continuous leakage 
alongside the ureter catheter. Of course the latter can 
not fit in the canal as snugly as a mandrel does; it has to 
remain freely movable. Consequently there must be leak- 
age, as the intravesical pressure is greater than the atmos- 
pheric. The fluid in the bladder is therefore slowly ebbing* 
away. By placing the patient in Trendelenburg’s posture 
of about twenty five degrees during the examination, we 
can reduce this leakage a good deal; also by slipping over 
the external entrance to the canal a short rubber tube of 
very small calibre, just large enough to permit of moving 
the ureter catheter. Until the ureteral openings have been 
found this tube should be well pressed against the catheter. 
A simple sling of a thread will also suffice. On the other 
hand, it is not wise to fill the bladder with too much fluid.* 
Six ounces should be the average amount. A beginner 
may probably do well, in order to save time and to succeed, 
first to use the ordinary cystoscope for ascertaining the 
situation of the mouth of the ureters and then to introduce 
the ureter cystoscope. 
3. Push the ureter catheter down to the internal open- 
ing of the canal, the lid of the latter being well in place; 
introduce the instrument. 
4. As soon as the interior of the bladder has been sat- 
isfactorily inspected and the ureteral openings have come 
into view, approach one of them.f A trained cystoscopist 
* Lately I have succeeded in catheterizing both ureters of a man 
whose bladder then held 650 c. c. (equal to a pint and a quarter). In 
another man I accomplished the purpose with 300 c. c. (equal to ten 
ounces) in the bladder. In both cases it was not so easy as in my other 
cases, where from five to seven ounces had been injected. 
f It will be, I think, a good plan first to collect the urine discharged 
by the kidney presumably diseased. We are not always sure of being CATHETERISM OF THE URETERS. 
9 
knows how to do this. He slightly raises the handle of 
the instrument and carries it over to the opposite side of 
the patient, at the same time pushing it in a little or pull- 
ing it out until the orifice is in the focus. By bringing 
the prism as near to it as possible, we greatly magnify the 
tiny hole, and can observe in a beautifully clear manner 
how the catheter becomes engaged in the opening, and, if 
pushed from outside, passes on and on. 
I have found it practicable to pull out the lid a little, say 
a quarter of an inch, before pushing the catheter out of the 
canal into the bladder. Its rather delicate tip is thus bet- 
ter preserved, and not roughened by the borders of the nar- 
row hole. 
The lid must then at once be pushed back into place. As 
mentioned above, this is absolutely necessary in order to let 
the catheter emerge at an angle of forty-five degrees. If this 
rule is not adhered to the catheter will not enter the ureter, 
no matter how we may turn or push or pull the cystoscope. 
5. Catheterism of the ureter having been successful, 
the wire mandrel is withdrawn from the catheter.* Urine 
generally at once begins to flow, drop by drop, at inter- 
vals.f I should strongly advise always to withdraw the 
able to collect the urine of both kidneys in one sitting, especially in the 
male, if, for instance, the bladder is irritable. 
* The thumb and index finger of the left hand must fix the catheter 
for this purpose in front of the outer opening of the channel; other- 
wise the catheter might be pulled out of the ureter. 
f I have found it advisable not to save the very first drops. They 
often appear brown, or even red, on account of slight admixture with 
blood. In spite of very gentle handling, we shall not prevent injur- 
ing the delicate superficial layer of the epithelial cells of the ureter, 
and sometimes causing minute haemorrhage. This, however, rapidly 
ceases. In two of my cases the flow of urine was not interrupted, ac- 
cording to the ureteral jets as seen through the cystoscope, and corre- 
sponding with the contractions of the ureter. It was almost continuous. 10 
CATHETERISM OF THE URETERS. 
mandrel as soon as the catheter has entered the lower end 
of the ureter for about one to two inches : this to find 
out, as long as the cystoscope is in the bladder, whether 
the lumen of the catheter is not obstructed. As soon as 
the urine flows, one glance through the instrument will tell 
us whether the catheter is in its proper place. If we push 
the catheter farther up toward the pelvis of the kidney 
and lift it out of the canal, pull out the cystoscope and then 
withdraw the mandrel, our entire procedure may prove to be 
a failure. In one of my last cases—the gentleman with hy- 
pertrophy of the prostate—I made this mistake. I had 
gathered about eight cubic centimetres of urine from the 
right (presumably diseased) kidney. Having entered the left 
ureter, I wanted to save the patient the little annoyance of 
the further presence of the cystoscope. I pushed the 
catheter quickly up toward the kidney for about twenty- 
five centimetres, liberated it, and removed the cystoscope. 
Now I pulled out the mandrel. No urine escaped. I 
pulled and pushed the catheter, and aspirated with a power- 
ful syringe : no urine. I pulled the eye of the catheter down 
into the lower third of the ureter and waited : no urine. 
I then injected a few drops of a sterilized saline solution, in 
order to clean the tiny lumen of the catheter which might 
have become clogged. As I had expected, a vehement renal 
colic was the result. But not a drop of urine appeared. 
I had to remove the catheter entirely, and now learned to 
ray disgust that the tip of the catheter had bent a little at 
the eye, and that within the latter a small shred of coagu- 
lated blood had been caught. In spite of a perfectly suc- 
cessful catheterism of both ureters the whole procedure 
thus was, in part at least, a failure. I had the urine of the 
In one patient, whose one (healthy) kidney discharged a hundred and 
fifty drops in four minutes, I had ordered a larger amount of fluid in- 
ternally before the examination was performed. CATHETERISM OF THE URETERS. 
11 
right kidney (probably the diseased one) only, and none 
from the left for comparison. The patient’s condition did 
not admit of my introducing the cystoscope again and 
catheterizing the left ureter for a second time. Had I car- 
ried out what I had always done before and have advised 
above—viz., withdrawn the mandrel as soon as the eye of the 
catheter was well within the ureter, and had I then found out 
that the urine did not flow—l might very easily have changed 
the catheter, leaving the cystoscope in situ. If urine drops 
out of the catheter it is best collected in a small test tube, 
marked right or left according to the side which is cath- 
eterized. The average amount is from eight to ten cubic 
centimetres in about ten minutes. But the quantity may 
be materially smaller within that time.* 
It is of importance to know how much urine is abso- 
lutely needed for a scientific analysis of the same. Accord- 
ing to Dr. Frederick E. Sondern, of this city, the gentleman 
who does all the examinations of urine for me in his labora- 
tory, six cubic centimetres is the smallest quantity which 
permits of a thorough chemical and microscopical exami- 
nation. Of course the centrifuge is here of the greatest 
value. 
During the collection of the urine the cystoscope with 
the catheter may be left in situ. Then one will, of course, 
turn off the light and support the handle outside. If this 
* In such an instance either the kidney secretes less urine at the 
time, or we have to presume that not all the urine passes through the 
catheter, but that some runs alongside the same. In such a case it is 
advisable to move the catheter a little. Thus, a fold of the ureteral 
mucous membrane, which happened to occlude entirely or partially the 
eye of the catheter, will be pushed aside, or the latter drawn away from 
it. If after a while no urine appears at the outer end of the catheter, 
aspiration with a powerful syringe will often be found very useful. As 
mentioned above, the newest Berlin ureter catheters are funnel-shaped 
at the end—a great improvement, as it makes aspiration very easy. 12 
CATHETERISM OF THE URETERS. 
is not wanted, the lid is withdrawn from the canal and the 
steel mandrel pushed into it, thus lifting the catheter out 
of its bed. In the female patient we .may now, after ex- 
tracting the mandrel, replace the lid and refill the bladder 
through the canal with the help of a syringe without re- 
moving the cystoscope, introduce another ureter catheter, 
and drain the opposite kidney; then remove the cystoscope 
and leave both catheters in place. In the male, especially 
in one who has a rather narrow urethra, this is not so easy. 
The cystoscope can not be turned well within the urethra 
if even a small catheter passes through it. Here we had 
better catheterize one side after the other—i. e., either in- 
troduce the cystoscope twice, or refill the bladder through 
the canal after a sufficient amount of urine has been col- 
lected from the one kidney, and then catheterize the op- 
posite side. This means leaving the cystoscope in the 
bladder for about twenty to twenty-five minutes. . I have 
repeatedly satisfied myself that a bladder which is not irri- 
table stands this very well. 
I fear I have given you a rather lengthy description of 
the procedure. I have done so because I thought others 
might profit from the experience I have had thus far in prac- 
tice. You may even have thought that the procedure was 
specially troublesome and time-robbing; hut this is by no 
means the case. I can assure you it does not take so long 
to catheterize a ureter, in a suitable male patient, as it has 
just taken me to read this description. I purposely say in 
the male, because in the female it is still easier. The work 
itself is most interesting. Not in years have I felt such a 
real satisfaction as when I succeeded on October 25th for 
the first time in draining each kidney of a man separately, 
without any previous cutting operation. We can, of 
course, not expect success in every instance. We must be 
able: CATHETERISM OF THE URETERS. 
13 
1. To perform cystoscopy (and cystoscopy itself has its 
limitations). 
2, To approach the mouth of the ureters. 
It is often difficult to find the ureters, on account of 
their small size. Not unfrequently they are drawn aside 
hy intravesical pathological changes, or they are covered 
by hypertrophied rugae. The operator will, however, with 
increased dexterity and experience, find them in most in- 
stances. I can conscientiously state that I recollect only a 
few instances in my cystoscopic work of the last eight 
years where I searched in vain for the ureteral openings 
and jets of urine. I simply inspect the fundus of the blad- 
der until I have found them. The internal urethral orifice, 
also the intra-ureteral bar, are important landmarks for this 
purpose. The intermittent protruding and receding of the 
region where the ureteral openings are situated is also a 
great help in finding them. 
It may he of interest to add that the manipulations 
within the ureteral canal itself are void of special pain, a 
fact which is well known to those who do ureteral work 
according to Kelly’s method. One can push the flexible 
catheter up to the renal pelvis. The patient has no more 
annoying sensations than a catheter produces that is intro- 
duced into the bladder. Casper found that if a non-irri- 
tant fluid was injected into the lower portion of the ureter, 
colicky pains set in ; if, however, it was injected into the 
upper part with gentle pressure, one could safely irrigate the 
pelvis of the kidney. The patient then has hardly any pain. 
Casper professes to have cured two patients with ascending 
suppurative (gonorrhoeal) pyelitis by repeatedly irrigating 
the pelvis of the kidney with a nitrate-of-silver solution. 
In comparing this newest method of catheterizing the 
ureters with former useful ones, only Kelly’s comes into 
consideration. I need not tell the members of this section CATHETERISM OF THE URETERS. 
of the great scientific and practical value of the same. Yet 
it can be applied in the female only. lam absolutely con- 
vinced that, with the help of straight metal tubes as neces- 
sarily used by Kelly, we shall never succeed in satisfactorily 
catheterizing the ureters of a number of male patients. In 
exceptional cases it may be feasible; but the method 
must be far inferior to the one just described. As stated 
above, the straight tube has also made Brenner’s and Bois- 
seau du Rocher’s cystoscope a practical failure. 
For ureteral work in the female I prefer Kelly’s method. 
I do not like to say that it is easier, for there can not be 
anything simpler for a trained cystoscopist than to work 
successfully with Casper’s instrument. I believe even that 
in cases where we fail with Kelly’s method we may often 
succeed with Casper’s. But Kelly’s procedure gives more 
satisfaction to the surgeon, because it can actually be car- 
ried out aseptically. His instruments can all be sterilized. 
Kone of the cystoscopes can be boiled except the French 
one, and this, unluckily, is the least useful. We have, to 
satisfy ourselves, to disinfect the instrument according to 
(mfo’septic rules, by carefully washing and irrigating and 
rubbing it after use with a five-per-cent, carbolic solution, 
and afterward with sterilized water, and immersing it in a 
five-per-cent, carbolic solution for an hour before trying it 
for the next patient. The small ureteral catheter, though, 
can be boiled a number of times without injuring it. 
It is to be hoped that the cement which holds the prism 
in place in the cystoscopes built according to Nitze’s prin- 
ciples, the only part which does not stand boiling, will in 
the future be prepared in such a way that it will answer this 
demand. This would naturally greatly increase the value 
of the instrument in a surgical sense, according to modern 
views. In considering this point we ought not to forget, 
however, that attempts at manufacturing flexible catheters CATIIETERISM OF THE URETERS. 
15 
that will stand sterilization by boiling are of very recent 
date and have been only partially successful. And flexible 
catheters have been used by doctors up to date without pre- 
vious boiling, and, by a careful man, almost always without 
detriment to the patient. I can conscientiously state that I 
remember a very few cases only where prolonged cystos- 
copy produced an irritable bladder. Where it has hap- 
pened, the bladder had always been the seat of an inflamma- 
tion before. For the last four years I Jiave always carefully 
washed the posterior urethra and the bladder once more im- 
mediately after cystoscopy, and let the patient take ten 
grains of quinine on reaching home. Since strictly adher- 
ing to this precaution I have not observed a single case of 
instrumental cystitis. 
The construction of Casper’s instrument has in this way 
at last really completed the diagnostic capability of the 
cystoscope from a mechanical standpoint. Catheterism 
of the ureters will now, in the male also, be an extremely 
important and never-to-be-ornitted factor in cystoscopy for 
renal disease. 
Thus, Mr. Chairman and gentlemen, we can to-day safe- 
ly state it as a fact that the problem of conveniently cathe- 
terizing the ureters in the male, as well as in the female, 
without a previous cutting operation—in other words, the 
problem of the “ bloodless, separate collection and analy- 
zation of the secretion of each kidney in both sexes ”—is 
now actually solved. The New York Medical Journal. 
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