May 2nd: The nitrate of silver solution, being well tolerated, has been gradually increased to from thirty grains to two ounces; this injection is repeated every other morning, and the boracic acid alone used on the other days. The deposit of pus in the urine is now greatly diminished ; the reaction of the urine is neutral. There has been no return of the hæmaturia.—17th: Slight hæmaturia.—22nd: The hsmatnria has continued and patient is becoming exhausted; a solution of the perchloride of iron

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... has been injected into the bladder.—25th : No return of the hsematuria since the injection of the perchloride of iron ; but the patient became more exhausted, and died to-day. Necropsy.-The bladder was very small and its walls greatly thickened; the mucous membrane had a dark-slate colour, with here and there, and particularly about the neck, a very bright vascular point. Both ureters were dilated to the thickness of the forefinger. The pelves of both kidneys were dilated, and in the left one there was a quantity of sabulous phosphate material. Both kidneys were firmer suouiuuti paut3pumfiu inaucriat. DO1l Klulleys were nrmer than natural; Do suppuration. We have collected from different sources twenty-eight cases of tumour of the bladder, of various kinds, occurring in the male, which were subjected to operation and removal ; of these sixteen recovered from the operation and remained well for considerable periods, and twelve died within three months. Of the recoveries three have suffered from recurrence of the growth at periods of four, four and a half, and six months after the operation. The cause of death in the fatal cases can in only three of them be certainly attributed to the operation-viz" from peritonitis in two cases, and in the third from free and continuous bleeding. In four of them death is attributed to exhaustion ; in two cases death took place from uræmia three months after the operation, and in one of these all spontaneous haemorrhage was checked. In the remaining case death occurred a few days after the operation, but the cause of it is not stated. The above statistics refer to operations of all kinds and tumours of all natures; but in estimating the value of operations in these cases, it is well to consider, apart from the others, the results of the operations performed fourteen times by Sir H. Thompson and by one of ourselves. All operations may be looked at from two points of view :—I. The risks attendant on the operation itself. 2. The success of the operation in removing, or relieving, line conamon ior wnicn it was undertaken. 1. In calculating the risks of the operation we shall analyse, first, those cases in which a tumour was found; and, secondly, the total number of cases in which perineal urethrotomy has been performed, whether a tumour was detected or not. Of the fourteen cases in which a new growth was removed the patients recovered in eight ; in two death took place so soon after the operation, that it may be reasonably attributed to it directly. In the remaining cases, death occurred in fourteen days from exhaustion in one, in two months from secondary growths in another, and in three months, in the remaining two, from uraemia. The total number of cases in which digital exploration of the male bladder has been performed is twenty-five, of which nine died, but seven of these recovered from the effects of the operation ; so that, out of a total of twentyfive cases, the mortality of the operation is only two (eight per cent.) operation in removing, or relieving, line condition ior wnic. it was undertaken. 1. In calculating the risks of the operation we shall ana lyse, first, those cases in which a tumour was found; and secondly, the total number of cases in which perineal ure throtomy has been performed, whether a tumour was detecte{ or not. Of the fourteen cases in which a new growth was re moved the patients recovered in eight ; in two death toot place so soon after the operation, that it may be reasonably attributed to it directly. In the remaining cases, death occurred in fourteen days from exhaustion in one, in twc months from secondary growths in another, and in three months, in the remaining two, from uraemia. The total number of cases in which digital exploration of the male bladder has been performed is twenty-five, of which nine died, but seven of these recovered from the effects of the operation ; so that, out of a total of twentyfive cases, the mortality of the operation is only two (eight per cent.) 2. With regard to the success of the operation in the eight patients who survived the removal of the tumours, we find that four have remained well up to the date of the latest reports; that three, after a period of apparent cure varying from four to six months, have had recurrence of the growth; and that one is returned as being only relieved by the operation. In the female the cases of bladder tamour submitted to operation number twenty-eight ; of these the recoveries number thirteen, the deaths seven, and those whose symptoms have been relieved five. From these figures it may be concluded that operations for re,l11oval of new growths from the bladder have been attended With results that will compare favourably with any other of the major operations in surgery; and when we consider the dangerous state to which many subjects of tumour in the bladder are reduced by haemorrhage and pain, and when we farther consider the number of pathological specimens of easily removable tumours which exist, in which marked and sometimes fatal haemorrhage has been the only symptom, there is ample justification for exploration in these obscure cases, and for the removal of any growth that may be detected. The justification for exploration of the bladderin cases which baffle diagnosis by the more common means is obvious if we bear in mind that digital exploration has been made during the last three years in twenty-nine cases, and that a tumour capable of removal has been found in eighteen of them. The same operation also offers certain advantages in the treatment of chronic cystitis, for we secure a constant draining away of the irritating urine, and we are enabled to introduce into the bladder an unusually large double current tube, through which strong and voluminous solutions may be injected. There is a most marked difference in the tolerance of the urethra and the bladder of strong solutions of the perchloride of iron or the nitrate of silver. The feeble absorptive power of the bladder has been frequently demonstrated by Sir H. Thompson at University College Hospital, but the great tolerance of this viscus of strong irritants has not been so much insisted upon. It is not the same with regard to the urethra ; if a drop of these solutions should find its way into the urethra most excruciating pain is pro. duced. By means of the perineal opening a good opportunity is afforded of making applications to the bladder without the fear of the solutions leaking into the bulbous and spongy portion of the urethra. Cases 7 and 10 illustrate the beneficial results of the injection of nitrate of silver in cases of obstinate chronic cystitis. As an ordinary antiseptic injection a saturated solution of boracic acid and solutions of the permanganate of potash have been found the most effectual ; whilst solutions of the perchloride of mercury, peroxide of hydrogen, and of the nitrate of silver have remedial properties of great and special value in obstinate and protracted cases of cystitis. Manchester.