REPORT ON THE SCHLEICH SOLUTION.
Authors: ROBERT MARSENA STONE
Journal: JAMA (1899)

roscope to an effective instrument, as easily manage¬ able in the hands of the general practitioner as in those of the specialist, will, I hope, stimulate others better equipped than I, to further the interests of science in this unfortunately neglected channel.To summarize my thoughts on the subject: 1.No chronic disease of the urethra can be diagnosed or in¬ telligently treated without the urethroscope. 2. The technic of urethroscopy is not difficult. 3. A urethro¬ scope must be easily manageable, of a prime cost, and of a price of maintenance within the means of the aver¬ age general practitioner.All these requirements I think are attained in the little instrument I have the honor of demonstrating.discussion.Db. L. B. Tuckeeman, Cleveland, Ohio-I do not desire to open up a discussion on a question on which I am not com¬ petent to speak.I am a tyro in urethroscopy, working with an instrument of my own devising and with a head mirror.I wish to compliment Dr. Valentine on the exceeding beauty of the light and the results; but I wish to show an instrument by which urethroscopy can be extended into cystoscopy.I have for the purpose of vesical examination made a slight modification in the shape of the obturator.You know, when you introduce the ordinary instrument to the end of the patulous urethra, if the obturator, the point being at the mathematic center of the circumference' of the instrument, in the hands of the ordinary A-Otis urethroscope.B-Conical ovoid obturator.C-Otis urethroscope lengthened.D-Obturator modified to facilitate entrance into membranous urethra and passage over the prostate.practitioner, catches under the opening in the triangular liga¬ ment, it makes some considerable pain to the patient to get it in.I have modified the shape of the obturator, making the point at the side, instead of in the middle, and, by that means, with a little care, the point enters with ease through the trian¬ gular ligament into the membranous urethra over the prostate and into the bladder, and with Dr. Valentine's light, you can see the fundus of the bladder, just as easily as you can the urethra, and by altering the direction of the instrument you can explore the whole of the inner surface ol the bladder as you can the female bladder with the Kelly cystoscope.If you have the skill to bring it into view you can see the opening of the ureter in the male as plainly as you can in the female, and as you withdraw the instrument you can get a complete and satis¬ factory view of the whole posterior urethra.Dr. Campbell, Chicago-I would like to ask Dr. Valentine how he decreases his amperage sufficiently to regulate the heat, as you do with your light, and whether you can increase your amperage without increasing your heat, and how long is the life of a battery?Dr. Ferd.C. Valentine-It is satisfactory to me to note that Dr. Tuekerman is working along the same general lines that have prompted me to devise a cystoscope for the use of general practitioners as well as specialists.In principle, however, Dr. Tuckerman's instrument, which he had the amiability to pres¬ ent, is a modification of the one devised by my honored friend, Howard A. Kelly, who, by extending his tube hitherto used for the female, has made a male cystoscope of it.To my mind the curved form of Dr. Tuckerman's obturator is a great ad¬ vance in the right direction.These instruments, however, all use reflected light.The cystoscope which I devised uses a di¬ rect light within its beak.In this it does not dilfer essentially from the Leiter, Nitze, Caspar, Albarrän or other eystoscopes.But by the special manner in which the fenestrum is cut, it gives a larger view of the bladder.Furthermore, 100 experi¬ ments have shown me that the bladder can be dilated with air,