URETHRAL FEVER, 
BY 
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PROFESSOR OF CLINICAL AND OPERATIVE SURGERY AND DISEASES OF THE 
UENITO-URINARY ORGANS, COLLEGE OF PHYSICIANS AND 
SURGEONS. BALTIMORE. MD. 
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D. APPLETON & CO., Publishers, 549 551 Broadway, A. Y. URETHRAL FEWER. 
BY 
THOMAS R. BROWN, M. D., 
PROFESSOR OF CLINICAL AND OPERATIVE SURGERY AND DISEASES OF THE 
GENITO-URINARY ORGANS, COLLEGE OF PHYSICIANS AND 
SURGEONS, BALTIMORE, MD. 
{REPRINTED FROM THE NEW YORK MEDICAL JOURNAL, FEB., 1878.] 
NEW YORK: 
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18*78. URETHRAL FEVER.' 
The subject of this paper—<kUrethral Fever”—lias been 
selected chiefly because of its importance, which, to the man 
who is called upon to treat the diseases of the urethra often, 
as well as to the general practitioner, can scarcely be exag- 
gerated. Besides this, is the disagreement as to what the 
term implies. As a celebrated genito-urinary surgeon has 
stated, there is an obscurity and uncertainty which sur- 
rounds that condition known as urethral fever which has 
not yet been entirely cleared up.” Many able and recent 
efforts to relieve this obscurity have been made, but their 
chief office seems rather to evidence the fertility and ingenuity 
of the authors than to carry conviction, or to serve any very 
useful purpose. They are eminently disquisitive, but do not 
seem to be very practical. 
It is highly probable that my comments to-night may have 
to be placed in the same category of comparatively useless 
material. It is of the first importance that some sort of an 
understanding or agreement should be had as to what we pro- 
1 The subject of an address before the Medical and Surgical Society of 
Baltimore, Md., September 13, 1877. 4 
pose to discuss, and this we reach by a definition which should 
be kept well in hand. 
Urethral fever, like any other fever, presumes elevated 
temperature, or pyrexia, which may be or not ushered in by a 
rigor, and which may be or not ushered out by a sweat. The 
more or less frequent occurrence of both rigors and sweats all 
through the paroxysm cannot, however, affect the accuracy of 
this definition. The prefix “ urethral ” is used to indicate that 
these phenomena succeed to the treatment—by far the most 
frequently surgical—of the urethra. This treatment may be 
either of the mildest or gravest description, such as the most 
smoothly or skillfully performed catheterism, or as the most 
formidable procedure for the cure of strictures, or for the re- 
moval of calculi. It is, moreover, a part of the syllogism, that 
no condition of health or temperament appears to exempt 
from, or predispose to, an attack. Neither in the frail nor in 
the robust, neither in the nervous nor in the stoical, does there 
seem to be any rule of occurrence. 
It also is important to an intelligent view of the subject 
that the scope of the definition given should be limited. It is 
here that we can look for and find something to explain the 
obscurity. There should not be included under the head of 
“ urethral fever ” those morbid conditions which have no other 
claim for being so considered beyond that of coincidence. 
For example, it is obviously improper to class with this dis- 
ease cases of extravasation of urine resulting from false pas- 
sage, in which the symptoms are mostly those which are due 
to the toxic influence of decomposed urine circulating with 
the blood. I refer to that condition which we now describe 
as urinsemia in contrast with uraemia—a difference in terms 
which future observation may not permit. No matter what 
the cause, nor where this urinous leakage, the symptoms 
which it induces are the same. 
I am not unmindful of a fact already briefly touched upon 
before this society, namely, the comparative harmlessness of 
extravasations of limpid, healthy urine, as demonstrated by 
actual experiment. 
According to Van Buren, “ Menzel first used acid urine, 5 
injecting it under the skin of several dogs, in quantities vary- 
ing from a drachm to an ounce, without any bad effects.” In 
another instance he dissected up the skin of a dog to the ex- 
tent of four inches, and then introduced eight ounces ot 
healthy human urine. This he repeated in four cases. In 
three of these the entire urine disappeared by absorption in 
four days, without any local injury, and in the last, as I read 
the experiment, there was absorption with local suppuration 
of a healthy character. The same result followed the inser- 
tion of the urine into the ischio-rectal fossa. 
Years ago Simon (Van Buren), the distinguished German 
surgeon, held that extravasation of urine caused gangrene, by 
the rapid compression and distention of the tissues into which 
the effusion took place. 
For the purpose of testing this, Menzel performed two ex- 
periments, which strike one as wellnigh conclusive. In the 
first, the quantity injected measured one-half of a pint, and in 
the other wre are left to measure the quantity by the size of 
the tumor, which was that of a foetal head. In both, absorp- 
tion had taken place in three days, without any bad symp- 
toms. To meet the objection that all these tests were applied 
to parts possessing a circulation and structure somewhat dif- 
ferent from those parts into which the infiltrations naturally 
occur, he experimented upon the genitals. Here the results 
were the same, possibly with the exception of a difference in 
the rate of absorption. There was no toxaemia, nor any ne- 
crosis of tissues more than was caused by the formation of 
fistulae, through which the unabsorbed urine passed in some 
instances. Some of the above experiments have been repeat- 
ed, and the opinions of Menzel confirmed. 
Dr. Partridge, at the instance of Prof. Van Buren, at the 
Charity Hospital, New York, made a number of hypodermic 
injections of healthy urine upon white and negro patients, 
who were left under the impression that they were receiving 
morphia. The quantity used was from one-lialf to one 
drachm, and in not one case did abscess appear, or any kin 
dred lesion. 
Velpeau has had a similar experience. The same results 6 
have followed the use of urine which was rich in urates, as 
obtained from patients suffering with acute inflammatory 
rheumatism. Urine alkalinized with soda or potash lias 
proved innocuous; but, when its alkalinity depends upon the 
presence of ammonia, an altogether different result ensues. 
When it is injected under the skin, no matter where, almost 
invariably there follow abscesses ; in some cases gangrene; in 
others, symptoms of blood-poisoning are present. 
The outcome of such experiments is, that given healthy 
urine and healthy tissue—tissue not contused nor inflamed, 
therefore in a condition which will favor more or less rapid 
absorption—extravasations of urine are of no more serious 
import than are those of the blandest fluid. Hence it is that 
certain propositions are offered and almost generally accepted : 
“ 1. That normal urine does not possess septic qualities, and 
does not produce gangrene by its chemical properties; 2. That 
distention by infiltrated urine does not produce gangrene; 3. 
That gangrene, when it does occur, is caused by contusion of 
the tissues into which the effusion takes place by the acci- 
dental inoculation of septic matter,” or the ammoniaeal de- 
composition. This latter condition, as in part just stated, is fa- 
vored by any interruption to absorption, or to the prompt and 
complete emptying of the bladder—in short, what favors ac- 
cumulation favors decomposition. In the face of the evidence 
it is needless to extend the range of this question, and almost 
as superfluous it would appear to reinsist upon the holding of 
those morbid processes and symptoms which result from the 
absorption of urine, as apart from and extraneous to genuine 
urethral fever: the one quite definite in character, specific in 
origin, and causing such effects as can invariably be described 
as toxic; the other less definite, seemingly not dependent 
upon the distribution of any poison, and presenting all the 
vagaries of an un-understood nerve-disorder: the one infre- 
quent, the other common, and to that extent at least the inter- 
dependence disestablished. I feel, therefore, that Gerard in 
his monogram, “ llesorption urineuse et uremie dans les mala- 
dies des voies urinaires,” is engaged in the discussion of a 
totally distinct subject from “ urethral fever,” and of one he- 7 
longing to a class of diseases altogether unlike those published 
in the Edinburgh Medical Journal, under the caption of 
u Certain Rapidlv-Fatal Cases of Urethral Fever after Cathe- 
terism,” in which the symptoms have strong resemblance to 
traumatic, surgical, or irritative fever of a violent form. Un- 
der these circumstances, I say—urethral and urinary fever 
discussed and described as synonymous terms, diseases dis- 
tinct considered as diseases with a common pathology—is 
there any wonder that “ the uncertainty which surrounds that 
condition known as urethral fever has not yet been entirely 
cleared up? ” With a view of stripping the nomenclature of 
all but its real belongings, of putting the disease where it 
should be properly placed—among the reflex disorders en- 
tirely—and of supporting this classification by strong proof, 
has this subject been chosen. 
When I say reflex, I am aware of the more or less vague 
notion which we are compelled to hold concerning this “ re- 
flex system,” if system it be. From the very nature of things 
vital it could scarcely be otherwise. It is one of those domains 
of physiology which, marked by obscurity, is very full of im- 
penetrable mysteries, defies every attempt to reveal the es- 
sence of its existence, and is about as indeterminate and as 
little understood as irritation itself, which calls it into action. 
We must know it by its outward expressions, and not by what 
it is; but it is to-day a thing in the animal economy, to the 
existence of which almost as common and universal consent 
is given as is given to the function of vision, of taste, and of 
smell, despite its hidden nature. So far is this reflex prin- 
ciple settled, that men do not hesitate to formulate a chain of 
reasoning upon it. So far is it accepted as one of our cardinal 
truths, that we find Stuart Mill, in his “ System of Logic,” 
including it among ‘‘the miscellaneous examples of the ex- 
planation of the laws of Nature;” and, finally, so far is it 
accepted that experience has taught us that, when it is seri- 
ousty interfered with, disease, and sometimes death, follows. 
Might I be permitted to adduce here some examples of its 
importance, and instances, no doubt familiar, where both func- 
tional and structural troubles follow its perturbation, as, in 
part, given by Brown-Sequard : 8 
The production of tears in one eye from irritation of the 
other, or of the mucous membrane of the nose. 
The increased secretions of the eye or nose which follow 
the exposure of other parts of the body to “ cold.” 
The occurrence of cataract in one eye after similar disease 
in the other, or after neuralgia of, or injury to, the frontal 
nerve. 
The phenomena of sudden stoppage of the heart’s action 
after receiving an injury or blow upon the abdomen, which is 
said to be preventable by neurotom}7. 
The curious duodenal ulcer which occasionally follows 
burns. 
Those instances of distorted vision, said to have amounted, 
in some cases, to a complete loss, which have been caused by 
neuralgia, and cured by the extraction of a carious tooth. 
The interesting example of paraplegia which Prof. Brown- 
Sequard himself cured by slitting a contracted prepuce, 
thereby remedying an offensive balanitis.1 The case recorded 
by Sir Benjamin Brodie, in which the division of a close 
urethral stricture relieved a pain over one heel, which had 
lasted long and given great annoyance. Those cases of ure- 
thral spasm caused by fright, anxiety, shame, modesty, alcohol- 
ic excess, and a host of other illustrations which I might give. 
These are presented not as something at present unknown or 
new, but simply as reminders. They all agree in demonstrat- 
ing: 1. That “ the action which one part of the nervous sys- 
tem exerts over another part, and which we call reflex, is with- 
out any intermediate action on the brain, and, consequently, 
without consciousness.” 2. That that condition of which we 
speak as irritation, either active or passive, is the force which 
produces this action. 
With such facts as these before us, our case is clearer. 
If this same irritation, with its reflex action, can cause such 
disorders as excessive laclirymation, pain, spasm, ulceration, 
cataract, paralysis, loss of vision, etc., surely it can ex- 
1 I do not overlook here Leyden’s claim of continuous neuritis. It 
seems to be simply a claim for the present. 9 
plain and cause the occurrence of attacks of urethral fever 
without invoking the aid of septic, urinous, or purulent resorp- 
tion. It is here that the disease is to be studied, and its 
pathology, in part, to be rewritten. (In passing, I deem it 
proper to say that I have not overlooked the evidence which 
the above examples are supposed to offer of a system of troph- 
ic nerves.) This being offered as the pathology, I am the 
better prepared to present a hasty description of the clinical 
history. For very obvious reasons, if my argument be sound, 
there has been as little agreement upon this as upon the pa- 
thology. The arrangement of the varieties has been inexact, 
and therefore much of what is current must be rejected. The 
origin of all the forms of the disease being common—reflex— 
the subdivision of these forms will be such as is suggested by 
the intensity of the attacks, and is justified by actual bedside 
experience. 
For the sake of convenience, I have divided these into 
three, it being expressly understood that this division can- 
not be always rigidly adhered to. The first and most com- 
mon variety is where a fever, with a temperature generally 
not exceeding 101° Fahr., preceded by a chill, which may 
be mild or pronounced, is succeeded by nausea or vomiting, 
by sweating, sometimes profuse, and anorexia, with malaise. 
In many of these cases the expression of weariness during the 
attack is striking. As a rule, this form makes its appearance 
almost immediately after the operation, and will probably 
have left no trace by the next day, provided the patient's 
urethra be not handled. It may come on after the introduc- 
tion of the catheter, or after a severe urethral operation. The 
following cases in point I submit from my own practice: 
Mr. S., aged about fifty years, suffering from retention of 
urine, with dribbling—some pain with urination—consults me 
with an enlarged prostate. Inasmuch as most of the symp- 
toms and distress in these cases are referable to the bladder, 
caused by a certain amount of residual urine, anodyne injec- 
tions through the catheter were directed. After the most of 
the injections, not all, sometimes immediately, sometimes de- 
layed for several hours, a group of symptoms, corresponding 10 
closely to those described above, set in. The next morning 
the patient would feel well. Indeed, so trifling was the 
trouble that the patient became himself indifferent to it, and 
at no time was the treatment suspended on account of it. 
The instrumentations were bloodless, but always more or 
less painful. For some reason or another there were times 
when the catheter could be passed without an attack. In 
this respect the case is typical. It is, moreover, important 
to note that neither quinine nor any other antiperiodic seemed 
to exercise much, if any, control over the attacks. The 
same may as well be said now in respect to the use of qui- 
nine previous to other and graver urethral operations. In 
nearly every one of a very large number of strictures treated 
by internal urethrotomy, I have taken all the precautions usu- 
ally urged, including the giving of quinine and morphia in 
ten-grain and quarter-grain doses, respectively. The very 
frequent occurrence of urethral fevers after the operations, de- 
spite all of these precautions, has been to leave me decidedly 
in doubt as to whether this medicine affected the result or not. 
What it might have been without it I am not prepared to sav. 
I refer only to its influence as a prophylactic. 
As a second illustration of cases where this mild form of the 
disease succeeds to a severer operation than that of catheter- 
ism, 1 present the case of Mr. K. lie consulted me, Novem- 
ber, 1876, on account of a gleet which had continued through 
a number of years, notwithstanding the use of the customary 
remedies. Upon examination a stricture was found, between 
three and four inches from the meatus, which was too close 
to admit the urethrometer. After a dilatation, by means of 
the Thompson divulsor, sufficient to pass the urethrotome 
of Otis, and a slitting of the meatus, the stricture was freely 
divided, opening the urethra to the required calibre. Upon 
the withdrawal of the urethrotome, the blades of which had 
been previously closed, it was found to have engaged a slip 
from the urethra, which was detached completely—an accident 
possible under any circumstances, and avoidable by my pres- 
ent practice of never closing the instrument entirely when 
about to remove it. In this case there resulted nothing worse 
than what occurred in the preceding case. Almost immedi- 11 
ately lie had a sharp chill, followed by fever, sweat, loss of 
appetite for one or two meals succeeding the operation, and 
some languor, all of which had disappeared after a night’s 
rest. His sudden loss of appetite was strikingly in con- 
trast with his normal condition, which seemed to be one 
of wellnigb insatiable hunger. In neither of these cases 
was there suppression of the urine, which was voided with 
some smarting, but without any rigor. In the two patients 
the seats of disease, it may be remarked, were different. In 
the first, it was in the prostatic urethra, and all treatment was 
required to traverse the entire canal. In the second, the loca- 
tion of the disease was in the front or penile urethra. I men- 
tion these facts, because it is said that attacks of urethral fever 
occur in by far the larger number of cases in which the ure- 
thral curve has been treated. This I am prepared to verify, 
f am sure that there are some men with whom explorations of 
the spongy urethra are accompanied with no untoward symp- 
toms, but whose membranous and prostatic urethra are very 
intolerant. I also know of another instance which I regard 
as very exceptional, that of a distinguished man in our pro- 
fession, whose entire urethra is so very sensitive that on 
more than one occasion the most alarming symptoms have 
followed the bare introduction of a gum instrument. These, 
as I say, are unusual. 
In the second variety of this disease the difference lies not 
only in the increased severity of the symptoms, but in the ad- 
dition of icterus—certain mental disorders, which may amount 
to delirium—and in the delay in the arrival of the attack. In 
order that cases may be classed in this stage, I consider it 
necessary that the icterus and certain mental troubles be pres- 
ent. I can the best illustrate this variety, as before, by the 
narration of cases which have come under my own observa- 
tion. 
Mr. C., a resident of the Eastern Shore of Maryland, while 
in the city May 20, 18YY, was compelled to consult his physi- 
cian, Dr. Salzer, because of complete retention of the urine. 
Catheters, at first solid and then gum, first one size and then 
another, were introduced without reaching the bladder. When 
seen by me he was in great distress, which I could not relieve 12 
with the catheter. At 2 p. m., May 31st, aspiration 1 by the 
suprapubic puncture was performed, which gave immediate 
relief, and, as usual after such operations, there were no bad 
effects due to it. There was a history of an attack of gonor- 
rhoea some years previous, which, from his accounts, was soon 
cured. Since that time the stream lias steadily diminished in 
size. When seen by me at 7 p. m. on the same day, the blad- 
der had refilled. Under the influence of ether, a stricture in the 
membranous urethra was stretched with the Thompson instru- 
ment, a double catheter passed and afterward secured. From 
Thursday to Saturday his urine was passed through this arti- 
ficial channel without anything unusual happening. On the 
latter day internal urethrotomy, with Prof. Otis’s urethrotome, 
was performed, cutting the urethra so as to easily admit a No. 
32 F. About ten hours after the operation there was a severe 
chill, followed by a fever, with rapid and bounding pulse; 
temperature 104°; with quite constant vomiting. The next 
morning, while the febrile symptoms had somewhat abated, 
there were complete anorexia, icterus, and listlessness, with a 
tendency to drowsiness. The patient had passed a restless 
night. Notwithstanding that the patient was cinchonized 
from ten-grain doses of quinia, frequently repeated, the rigor 
returned in twenty-four hours with no recurrence. After the 
attack was completely under control, the patient went on to 
a rapid recovery, and in about one week after defervescence 
the passage of sounds begun. At no time was there any other 
change in the renal secretion than could be explained by the 
high temperature. 
During the continuance of the fever, and as noted for one 
week after, no instrument passed the urethra, a rule which 
cannot be observed too closely. The decline of the fever, 
together with the other untoward symptoms, was marked 
1 I have performed a similar aspiration of the bladder a sufficient 
number of times to convince me of its being a far safer and less pain- 
ful method of relieving retention than is the usual mode of catheteriza 
tion. The latter I regard, both in spasmodic and organic obstruction, 
as providing relief less prompt, and a risk of damaging the urethra, 
which ought to be avoided if possible. In the first there is no risk of uro 
thral fever, at least. 13 
in this, as in other similar cases, by the returning desire for 
food. 
It is not necessary to relate in extenso the second case of 
this class, which, upon the whole, resembled the one just 
cited—the only difference being in the severity of the opera- 
tion. In this case a very interesting fact was observed—that 
the rigors and vomiting did not cease until a catheter had 
been fastened in, which became necessary because of spasm of 
the urethra preventing the patient’s making water. With 
these, the high temperature and rapid pulse—104° and 120 
respectively—which appeared in six hours, soon began to de- 
cline, an incident which apparently conflicts with the precau- 
tion urged in the case of Mr. C. Another point of interest is 
that of a peculiar rigor or trembling which would pass over 
the patient while under the influence of ether whenever an in- 
strument was inserted. It may confine itself to certain muscles, 
like the pectoralis major, or may cover the whole body, carrying 
with it a suggestion of the patient’s chilliness, as indicated by 
his reaching for extra covering. I have seen this often, and at 
first regarded it as ominous for evil, but a subsequent experi- 
ence has dispelled any apprehensions that I might have had. 
Its only significance seems to be that it insures an earlier at- 
tack of urethral fever which may still be slight. 
The third and last variety of this disease includes all those 
cases in which the reflex action is much more marked, and in 
addition come the symptoms of suppression of the urine, with 
signs of uremic intoxication, together with a lower range of 
thermometry. The duration of the attack is, as a rule, short, 
terminating either with death or convalescence shortly after 
its inception. Death has been known to take place in the 
course of a few hours, and, on the other hand, recovery has 
been decided within a few days. 
Like the other two varieties, a seizure of the above nature 
may follow the mildest and severest measures alike. It may be- 
sides occur in a man after the use of a catheter or sound to 
which he has been accustomed for years—like the case recorded 
by Sir Henry Thompson, where “ a man with an old, tight 
stricture died on the third day after the passage of an instru- 
ment which had been used upon him very many times before.” 14 
Vomiting, severe chill, and suppression of urine came on early 
and were followed by death in a few hours. In this case the 
kidneys were examined, and their condition described as “ con- 
gested and soft.” Then those cases already referred to in the 
Edinburgh Journal, and the others narrated by Velpeau, are 
suggestive examples of this, the gravest form of the malady, 
arising from a comparatively insignificant cause. I do not 
include in this list those cases in which death results from 
chronic lesions of the kidneys, which have been fanned into 
action, as it were, by the depressing effects of ever so slight a 
surgical procedure. 
Dr. Gross, Jr., states his point correctly, that “ the mor- 
tality after operations on the urethra is generally due to 
chronic Bright’s disease or pyelitis.” For this reason, pru- 
dent surgery suggests the precaution, which I have of late in- 
variably observed, of examining the urine and the heart in 
every case before operating. 
I am aware that there is said to be a variety of kidney-dis- 
ease—the “ contracted granular,” as it is called by some—in 
which sometimes neither casts nor albumen can be found. 
This I believe to be an error, and that persistent effort will, 
as a rule, be rewarded in microscopic examinations by the de- 
tection of the former. Fortunately, however, we are not 
compelled to rely upon these for our diagnosis, and are per- 
mitted to look for other reminders of this serious disease in 
such cases. It is a safe practice to suspect renal lesions in 
every case of old stricture. Of course, I do not mean to be 
understood as saying that renal disease of a serious character 
exists in every case of urethral stricture. I simply urge the 
suspicion as a means of enforcing caution, and of the surgeon’s 
providing himself with ample protection. While not prepared 
to assert the amount of danger of operating upon the urethra 
when both albumen and tube-casts are to be found, nor the 
relative merit or security of various procedures, such as li- 
thotomy or lithotrity, or the cutting, stretching,.or rupturing 
of strictures, under similar circumstances, I am prepared, 
from analogy, to assert that there is danger. Then come oc- 
casions, however, when some kind of manipulation is neces- 
sary, and when, no matter how grave the kidney-disease, there 15 
is a call for instant relief. For example, a patient presents 
liimself for treatment, as happened to me only a few days 
ago, with Bright’s disease, and, at the same time, a very close 
stricture in the penile urethra, which causes at times reten- 
tion. The diagnosis of Bright’s disease rested upon the detec- 
tion of albumen and suspicious casts in the urine. In a case 
like this I at first divulsed with the Thompson urethrotome, 
and afterward divided with that of Otis. In both cases no 
chill or fever occurred. I am not disposed, though, to suggest 
such a course in all cases, but would think the process of 
gradual dilatation is, perhaps, the safer. Upon this subject 
a great deal more light is needed before a decision can be 
reached. We must see many cases, and have tried all the 
methods, lest we make unfair distinctions and draw unsound 
conclusions. 
As to the prognosis in this disease, it is very favorable. 
A disease Which I once regarded with much dread I now 
consider as comparatively simple. I feel that I am war- 
ranted in here stating that I have seen nearly one hundred 
cases, and it is upon these I found my opinion. When death 
occurs after Bright’s disease, septicaemia, or pyaemia, when an 
operation upon the urethra has been recently performed, the 
complaint must be lodged where it properly belongs. As, 
after every or any other surgical operation, death may be 
caused by either of these conditions, so may it after the opera- 
tions upon the genito-urinary tract. 
Concerning the treatment I can be brief. The indications 
are to keep down the temperature with large doses of quinine 
and morphia, plenty of ice, and free sponging with simple or 
acidulated water. In addition to these, free purgation wdien 
indicated, and sustained vicarious action of the skin and bow- 
els, are very serviceable. Whenever disposed, let the patient 
eat, but not otherwise. 
Such is a brief resume of some of my views upon the sub- 
ject of the part reflex irritation plays in urethral fever, and I 
hope at some future time to inquire into the possible relation- 
ship which may be found to exist between this irritation (irri- 
tative fever) and the pyaemia so called. It will be curious to 
see how long the old orthodoxies of metastasis and transported 16 
cells will be able to stand—bow far the theories of blood- 
poisoning, uraemia, septicaemia, pyaemia, and the like, may 
have to give place to something less vague. Will they be 
compelled to surrender to the more modern doctrine of nerve- 
energy or nerve-irritation ? At present, a priori arguments 
may be against it, but it must be weighed in the balance of 
experiment. It is here that we can use as d propos the old 
saying, “ There is nothing true that is not possibly false, and 
there is nothing: too absurd to be true.” MEDICAL WORKS 
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