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Cover
 Page i

The Scientific Basis of Urology

 Page ii

This page intentionally left blank.

 Page iii

The Scientific Basis of Urology

Second Edition
Edited by

Anthony R Mundy MS FRCP FRCS

Professor of Urology
The Institute of Urology and Nephrology
London UK

John M Fitzpatrick MCh FRCSI FRC(Urol) FRCSGlas FRCS

Professor and Chairman
Department of Surgery
University College Dublin
Dublin 7 Ireland

David E Neal FMed Sci MS FRCS

Professor of Surgical Oncology
Department of Oncology
Addenbrooke’s Hospital
Cambridge UK

Nicholas J R George MD FRCS

Senior Lecturer/Consultant Urologist
Department of Urology
University Hospitals of South Manchester
Manchester UK

LONDON AND NEW YORK

 Page iv

© 1999, 2004 Taylor & Francis, an imprint of the Taylor & Francis Group
First published in the United Kingdom in 1999 by Isis Medical Media Ltd
This edition published in the Taylor & Francis e­Library, 2005.

To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.
Second edition published in the United Kingdom in 2004
by Taylor & Francis, an imprint of the Taylor & Francis Group,
11 New Fetter Lane, London EC4P 4EE
Tel.: +44 (0) 20 7583 9855
Fax.: +44 (0) 20 7842 2298
E­mail: [email protected]
Website: http://www.dunitz.co.uk
All rights reserved. No part of this publication may be reproduced, stored
in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without
the prior permission of the publisher or in accordance with the provisions
of the Copyright, Designs and Patents Act 1988 or under the terms of any
licence permitting limited copying issued by the Copyright Licensing
Agency, 90 Tottenham Court Road, London W1P 0LP.
Although every effort has been made to ensure that all owners of
copyright material have been acknowledged in this publication, we would
be glad to acknowledge in subsequent reprints or editions any omissions
brought to our attention.
Although every effort has been made to ensure that drug doses and other
information are presented accurately in this publication, the ultimate
responsibility rests with the prescribing physician. Neither the publishers
nor the authors can be held responsible for errors or for any
consequences arising from the use of information contained herein. For
detailed prescribing information or instructions on the use of any product
or procedure discussed herein, please consult the prescribing information
or instructional material issued by the manufacturer.
A CIP record for this book is available from the British Library.
Library of Congress Cataloging­in­Publication Data
Data available on application

ISBN 0­203­64050­0 Master e­book ISBN

ISBN 0­203­69365­5 (OEB Format)

ISBN 1 90186 513 4 (Print Edition)

Distributed in North and South America by

Taylor & Francis
2000 NW Corporate Blvd
Boca Raton, FL 33431, USA
Within Continental USA
Tel.: 800 272 7737; Fax.: 800 374 3401
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Tel.: 561 994 0555; Fax.: 561 361 6018
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Distributed in the rest of the world by
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Composition by J&L Composition, Filey, North Yorkshire
 Page v

Contents

List of contributors viii

Preface to the first edition xii
Preface to the second edition xiv

1 An introduction to cell biology 1

Anthony R Mundy
2 The cell and cell division 31
David E Neal
3 Inflammation 57
Neville Woolf
4 Immunology 67
AC Cunningham and John A Kirby
5 The nature of renal function 83
George B Haycock
6 Principles of radiological imaging of the urinary tract 117
Uday Patel
7 Upper urinary tract obstruction 129
NJ Hegarty, R William
G Watson and John M Fitzpatrick
8 Interactive obstructive uropathy: Observations and conclusions from studies on humans 147
Nicholas JR George
9 Urinary tract infection 165
Nicholas JR George
10 The scientific basis of urinary stone formation 205
William G Robertson
11 Shock 229
David A Brealey and Andrew R Webb
12 Acute renal failure 245
Guy H Neild
13 Chronic renal failure 257
Guy H Neild
14 Structure and function of the lower urinary tract 265
Anthony R Mundy
15 Detrusor smooth muscle physiology 291
Christopher H Fry
16 The pathophysiology of bladder dysfunction 315
Christopher H Fry
 Page vi

17 The scientific basis of urodynamics 327

Michael Craggs and Sarah Knight
18 Male sexual function 343
Suks Minhas, John P Pryor and David J Ralph
19 The prostate and benign prostatic hyperplasia 367
Mark Emberton and Anthony R Mundy
20 Biology of cancer and metastasis 387
David E Neal
21 Tumour suppressor genes and oncogenes 395
David E Neal
22 The molecular genetics and pathology of renal cell carcinoma 407
Marie O’Donnell, Marie E Mathers, Eamonn R Maher and Steven C Clifford
23 Transitional cell carcinoma of the bladder 431
TR Leyshon Griffiths and J Kilian Mellon
24 Prostate cancer 449
Freddie C Hamdy, Mark I Johnson and Craig N Robson
25 Testis cancer 469
Alex Freeman and Stephen J Harland
26 Radiotherapy: Scientific principles and practical application in urological malignancies 493
Mary McCormack, Richard SD Brown and Heather A Payne
27 Principles of chemotherapy 507
Judith Gaffan and John Bridgewater
28 Embryology 521
David FM Thomas
29 Urological and biochemical aspects of transplantation biology 539
David Talbot and Naeem Soomro
30 Tissue transfer in urology 549
SN Venn and Anthony R Mundy
31 Energy sources in urology 561
Jeremy Elkabir and Ken M Anson
32 Urological instrumentation 579
Hugh N Whitfield and SK Gupta
33 Perioperative care of the urological patient 589
David W Ryan
34 Screening in urology 607
Nicholas JR George
 Page vii

35 The design, construction and interpretation of clinical trials 625

Julie A Morris
36 Evidence­based medicine for urologists 635
Mark Emberton

Index 647
 Page viii

Contributors
Ken M Anson MBBS FRCS MS FRCS(Urol)
Consultant Urologist
Department of Urology
St George’s Hospital
London, UK

David A Brealey BSc MRCP

Clinical Lecturer
Bloomsbury Institute of Intensive Care Medicine
University College London
London, UK

John A Bridgewater PhD MRCP

Honorary Consultant in Medical Oncology
Royal Free & University College
School of Medicine
University College London
London, UK

Richard SD Brown MRCP FRCF

Department of Oncology
Middlesex Hospital
London, UK

Steven C Clifford PhD

Lecturer in Molecular Oncology
Northern Institute for Cancer Research
University of Newcastle upon Tyne
Newcastle upon Tyne, UK

Michael Craggs FRCS

Professor and Director of Spiral Research
Institute of Urology
Royal National Orthopaedic Hospital Stanmore
Middlesex
London, UK

AC Cunningham
Sunderland Pharmacy School
University of Sunderland
Fleming Building
Sunderland, UK

Jeremy Elkabir MBBS FRCS FRCS(Urol) FEBU

Consultant Urological Surgeon
Northwick Park & St Mark’s Hospitals
Harrow
London, UK
 Page ix

Mark Emberton FRCS FRCS(Urol) MD

Institute of Urology
Middlesex Hospital
London, UK

John M Fitzpatrick MCh FRCSI FRC(Urol) FRCSGlas FRCS

Professor and Chairman
Department of Surgery
University College Dublin
Dublin 7, Ireland

Alex Freeman
Department of Histopathology
University College London
London, UK

Christopher H Fry FRCS

Institute of Urology & Nephrology
University College London
London, UK

Judith Gaffan
Royal Free & University College
School of Medicine
University College London
London, UK

Nicholas J R George MD FRCS

Senior Lecturer/Consultant Urologist
Department of Urology
University Hospital of South Manchester
Manchester, UK

TR Leyshon Griffiths
Senior Lecturer in Urological Surgery
Department of Urology
Leicester General Hospital
Leicester, UK

Suresh K Gupta
Department of Urology
Wrexham Maelor Hospital
Croesnewydd Road
Wrexham, UK

Freddie C Hamdy MD FRCSEd (Urol)

Professor and Head of Urology
Academic Urology Unit
University of Sheffield
Royal Hallamshire Hospital
Sheffield, UK
 Page x

Stephen J Harland MD MSc FRCP

Consultant
Institute of Urology
University College London
Middlesex Hospital
London, UK

George B Haycock MB BChir FRCP FRCPCH

Professor
Department of Paediatrics
Guy’s Hospital
London, UK

NJ Hegarty
Department of Surgery
Mater Misericordiae Hospital
Conway Institute of Biomolecular and Biomedical Research
University College Dublin
Dublin, Ireland

Mark I Johnson MD FRCS (Urol)

Department of Urology
University of Sheffield
Royal Hallamshire Hospital
Sheffield, UK

John A Kirby DPhil FRCS

Professor of Immunobiology and
Postgraduate Tutor Applied Immunobiology Group
Department of Surgery
University of Newcastle
Newcastle upon Tyne, UK

Sarah Knight MA PhD

Clinical Scientist
Institute of Urology
Royal National Orthopaedic Hospital Stanmore
Middlesex
London, UK

Eamonn R Maher
Section of Medical and Molecular Genetics
Department of Paediatrics and Child Health
University of Birmingham
Birmingham, UK

Marie E Mathers
Department of Cellular Pathology
Royal Victoria Infirmary
Newcastle upon Tyne, UK
 Page xi

Mary McCormack PhD FRCR

Department of Oncology
Middlesex Hospital
London, UK

J Kilian Mellon MD FRCS (Urol)

Professor of Urology
Department of Urology
Leicester Warwick Medical School
Leicester General Hospital
Leicester, UK

Suks Minhas
Institute of Urology
University College London
London, UK

Julie A Morris
Head of Medical Statistics
Education and Research Building
Wythenshawe Hospital
Southmoor Road
Manchester, UK

Anthony R Mundy MS FRCP FRCS

Professor of Urology
The Institute of Urology and Nephrology
London, UK

David E Neal FMed Sci MS FRCS

Professor of Surgical Oncology
Department of Oncology
Addenbrooke’s Hospital
Cambridge, UK

Guy H Neild FRCP

Professor
Institute of Urology and Nephrology
Middlesex Hospital
London, UK

Marie O’Donnell
Department of Histopathology
Sunderland Royal Hospital
Sunderland, UK

Uday Patel MBChB MRCP(UK) FRCR

Consultant and Hon. Senior Lecturer
Department of Radiology
St George’s Hospital and Medical School
London, UK
 Page xii

Heather A Payne MBBS MRCP FRCR

Department of Oncology
Middlesex Hospital
London, UK

John P Pryor MBBS MS FRCS

Consultant
The Lister Hospital
London, UK

David J Ralph BSc MS FRCS(Urol)

Middlesex Hospital
London, UK

William G Robertson FRCS

Institute of Urology and Nephrology
University College London
London, UK

Craig N Robson PhD

Department of Urology
University of Sheffield
Royal Hallamshire Hospital
Sheffield, UK

David W Ryan MBChB FRCA

Consultant Clinical Physiologist
Department of Perioperative and Critical Care
The Freeman Hospital
Newcastle upon Tyne, UK

Naeem A Soomro MBBS FRCS(Urol)

Consultant Urologist
Department of Urology
Freeman Hospital
Newcastle upon Tyne, UK

David Talbot MD FRCS PhD

Consultant and Senior Lecturer in Transplant and
Hepatobiliary Surgery
The Freeman Hospital
Newcastle upon Tyne, UK

David FM Thomas FRCP FRCS

Consultant Paediatric Urologist
Department of Paediatric Urology
Clinical Sciences Building
St James’ University Hospital
Leeds, UK

SN Venn
Institute of Urology and Nephrology
University College London
London, UK
 Page xiii

R William G Watson
Department of Surgery
Mater Misericordiae Hospital
Conway Institute of Biomolecular and Biomedical Research
University College Dublin
Dublin, Ireland

Andrew R Webb MD FRCP

Medical Director (Clinical Services)
UCL Hospitals NHS Trust
London, UK

Hugh N Whitfield MA FRCS MChir FEBU

Harold Hopkins Department of Urology
Royal Berkshire Hospital
Reading, UK

Neville Woolf
Professor
Medical School Administration
University College London
London, UK
 Page xiv

Preface to the first edition

For even the most junior urological trainee learning the basic medical sciences is all but a distant memory. Since then the sciences have changed as knowledge has
advanced and whole new disciplines have developed. The focus of a urological trainee is, in any case, fundamentally different from a student just beginning his or her
medical education who must have a grounding in order to be equipped to comprehend the whole field of medicine and surgery in the ensuing few years of
undergraduate medical training. So, even discounting all that a trainee urologist has forgotten, there is a great deal of new knowledge to acquire and a specifically
urological perspective from which to view that knowledge.
Five years ago the Editors were asked to organise an annual course on ‘The Scientific Basis of Urology’. The aim was to address basic science in urology from just
this perspective and to take account of the recent changes in the scope and format of medical and surgical under­graduate and postgraduate examinations, as a result of
which the student and subsequently the trainee is no longer expected to have such a detailed knowledge of these subjects as used to be expected. This annual course is
sponsored by the British Association of Urological Surgeons and the British Journal of Urology and is regarded nowadays as mandatory for all urological trainees
during the first two years of training. It is evidence of how highly we regard the importance of a grounding in basic science for training in clinical urology.
This book arose from the course, although some of the authors have not taught on the course, some of the course teachers are not authors here, and the titles of the
chapters in this book do not match closely with the titles of the lectures on the course. This is because we have tried to make the scientific material more clinically
relevant with a wider audience in mind. In this way we hope to make this book interesting to all practising urologists, although we should stress that although many of
the chapters address specific disease conditions the authors cover only the scientific aspects. Details of diagnosis and treatment will have to be sought elsewhere.
Equally, this book does not aim to be comprehensive. We have tried to keep it to a size that a reader, with an average attention span, might expect to read in its entirety
rather than let the book expand to a size that would confine it to a dusty shelf. Indeed some of the more basic ‘basic sciences’ have been skated over to a degree that
the purist might find objectionable. We have aimed the text, however, at the specifically urological audience who, we think, wants to be able to understand these
particular topics without necessarily acquiring any great depth of knowledge.
 Another Random Document on
Scribd Without Any Related Topics
 “It was my opportunity,” declared Starbright regretfully. “If I had
not made that miscue!”
“That’s the way in this world,” philosophized Ready. “Just as we
have the balls rolling our way and everything looks bright and
radiant, we slip a cog and fall down with a slam. It’s sad and
disgusting, but true—alas!”
“Will somebody be good enough to smother him,” mumbled
Browning. “Makes me think of Dismal Jones.”
“Ha! ha!” laughed Jack, with his old flippant air. “Refuse me! Let’s
be merry. Why does a chicken cross the road? Don’t hit me! My
fingers are crossed.”
Frank had seen enough to know now that Starbright was a brilliant
billiard-player, and more than ever he was determined to do his level
best. Nevertheless, Merry was somewhat rusty, and thus it happened
that he missed his fifth shot.
“Now’s your chance, Dick!” exclaimed Dashleigh, who was acting
as marker. “You can get the lead right here.”
The shot was a very hard one.
“You can’t make that, Starbright,” asserted Browning. “I don’t
believe it can be made.”
“Oh, there is a way to make any shot on the table,” Frank
asserted.
But Dick was not so sure of succeeding in this case. He took great
pains, and succeeded. It was a handsome shot, and Merriwell gave a
cry of admiration and approval.
“That reminds me of my playing,” murmured Ready. “It is so
different, you know.”
Inza gave Dick a smile of admiring approval, which did not escape
Frank’s keen eyes. But the balls remained separated, and
Starbright’s success and the applause that had greeted the feat
seemed to rattle the big freshman, so that he missed the very next
shot.
“I must get them together and hold them,” thought Frank. “No
fancy playing in this. The fellow might run forty or fifty any minute,
and that would be my Waterloo.”
However, his effort to bring the balls together caused him to miss
the very first attempt, and left the ivories for Starbright, everything
being favorable.
Thinking of the prize for which they were contending had made
Dick nervous, despite the fact that he had always fancied his nerves
were like iron. The glances he had received from Inza had added to
his nervousness, so that he discovered his hand was shaking a trifle.
Immediately he braced up, not wishing any one to discover that
he was in that condition. He was deliberate in his movements,
though inwardly eager and in haste.
The first shot attempted was made by a rank scratch, although he
made no sign that he had not tried for it in that manner. Instead of
rattling him more, the shock of getting the point after he thought he
had missed it served to steady his nerves. He looked toward Inza as
he came round the table. Their eyes met, and he fancied she was
urging him to do his best.
“I will!” he resolved. “I am going to win! I’ll beat Frank Merriwell
at something!”
Dick’s brother was looking on with breathless interest, being more
excited than the big college man, if possible. He longed for Dick to
come off victor, yet fancied such a thing could not happen, with
Frank Merriwell for an opponent.
That look from Inza aided in giving Starbright courage. He swung
into the work with remarkable skill, making another beautiful run,
reeling off point after point.
Phil Starbright could scarcely keep still. He wanted to dance and
shout when Dick passed Frank and took the lead. Browning looked
on in amazed silence, while Ready gasped:
“What’s this? what’s this? I fear me much the result is to be a
surprise. Be still, my fluttering heart, be still!”
“I believe Mr. Starbright is going to beat Frank!” whispered Winnie
to Buck.
“None whatever!” returned the Westerner. “Don’t get that idea into
your head, girl. I’ve seen Frank Merriwell before, and he’s never
beaten till the game is ended. He has nerves, while the big fellow is
unsteady and liable to go into the air any minute. You hear me!”
Starbright ran eighteen points, which gave him a lead of twelve.
“Now, Merry, old man,” urged Buck, “get into gear and do your
pretty work. We know you’re a bit out of practise, but just show us
how you can play at any old game when you have to play.”
Not a word did Frank say, though he smiled faintly at Badger. He
began by making three difficult shots, the third one bunching the
balls. Then he played in splendid form till he had added nineteen to
the three, making a run of twenty-two, which turned the tables on
Starbright, leaving Merry ten in the lead.
Dick missed his first effort, and Frank was given the balls again.
He sought to get them together for a run, and the attempt caused
him to fail to count with his second shot.
“You want only eleven to tie, Dick!” palpitated Phil. “You can get
’em. I’ve known you to run thirty.”
Once more Starbright tried to steady his nerves and play with the
coolness that was a feature of Merriwell’s work. Somehow that
coolness made the big fellow feel sure that under ordinary
circumstances Frank would completely outrank him at billiards. But
the prize lured Starbright to do his best. That Christmas sleigh-ride
with Inza was something worth working for.
Click, click, click—the big freshman tapped off the points,
Dashleigh counting the buttons as he slid them along the wire. One,
two, three, four, five, six, seven—ha! at last the ivories rolled hard
and lay in an extremely difficult position.
Pausing to study the shot, Dick heard Badger whisper to Winnie
that he must surely miss.
“I won’t miss!” he mentally cried.
Then, with his utmost skill and nerve, he played a cushion-carom
shot and counted.
“Good!” exclaimed Frank, promptly leading the applause.
Dick wiped the perspiration from his face. Not even the strain and
thrill and excitement of a football-game could set his nerves on edge
like this.
Inza’s laugh caused him to thrill with pleasure.
“She’s glad I made it!” he told himself. “Now I know I’m going to
win!”
Having succeeded at that critical point, Dick soon brought the
balls together, astonishing himself by his skill in this respect. Never
before had he made so many hard shots with absolute confidence,
and the witnesses of his work were breathless with suspense.
“He is going to win!” breathed Winnie, clutching Buck’s arm.
“Don’t you believe it!” returned the Westerner stiffly. “Frank won’t
let him win.”
Ten points, fifteen, twenty, twenty-five—no, he failed on the
twenty-fifth.
“Eighty-eight points to Merry’s seventy-five,” announced
Dashleigh. “You’re just thirteen ahead, Dick.”
“Thirteen?” exclaimed the freshman, with a start of annoyance.
“The fatal number again!” exclaimed Inza, but she laughed.
“Here’s where you have to do it, if you’re going to do it at all,
Merry,” said Browning. “Twelve more points lets Starbright out, and
you’ll ride with me to-morrow, instead of with Inza.”
Frank needed twenty-five, and he started in to make them, but
the balls persisted in running hard, despite his greatest care. Time
after time he came near missing, but not till he had scored ninety-
four buttons in all did he fail to count.
“Hard luck!” growled Browning.
“Now, Dick!” cried Phil; “this is your chance, and you must do the
trick.”
Starbright did not dare to glance toward Inza again; but, fancying
she was watching him and wishing for his success, he began the
task of trying to run out.
The first shot was a close shave, the cue-ball barely brushing one
of the object balls. Indeed, Browning fancied Dick had missed, but
Frank promptly declared he had plainly seen the shot, and it was a
fair count. Dick thanked him and proceeded with the play. However,
he was extremely anxious and excited, and his anxiety increased as
he passed ninety, crept up to ninety-five and then found himself
drawing close onto the end of the string.
The silence was intense. Indeed, it was so great that it began to
oppress Dick, and he longed for the spectators to talk, laugh, or do
something. He was tingling from his head to his heels.
Ninety-six, ninety-seven, ninety-eight—only two points to make.
“I told you!” whispered Winnie to Buck, in disappointment. “He
has beaten Frank!”
“Not yet!” returned the unshaken Kansan. “If he beats Merry, he’ll
be the first galoot to do the trick in a long time. He won’t!”
Ninety-nine!
One point more to be made!
“Nobody can beat Frank Merriwell!” huskily whispered Buck to his
wife. “He’ll miss this shot, and Merry will win.”
 The silence was so great that Starbright heard Badger’s words just
as he was on the point of trying to score the final button. He was
struck with the conviction that he must miss—that it would be a
marvel for him to defeat Frank Merriwell.
He missed!
“Well,” said Merriwell quietly, as deep breaths were heard on every
side, “you made a handsome try for it, and that was a case of hard
luck. I’ve got to make six, and I may slip up on doing that.”
Starbright’s failure at the critical point left him shaking all over. His
last faint hope was that Merry might fail, but Frank played with care,
precision, and coolness, and slowly but surely scored the six points
he needed, winning the match.
“Miss Burrage,” cried Frank, “remember your promise.”
Her merry laugh rang out.
“I’ll not forget it,” she said; “but there was a time when I thought
I’d surely ride with Dick.”
That laugh cut Starbright, for it seemed full of satisfaction and
relief.
“I guess it’s all right!” he thought. “She wanted to ride with him all
the time, and she thought he’d beat me more than he did. She is
glad I lost!”
 CHAPTER XXXII

BOWLING.

A merry Christmas it was there at Starbright’s. The sleighing-party

was enjoyed by all who took part, and never had Inza seemed
merrier and brighter than on that occasion. She laughed, and sang,
and joked; but Frank observed that she was not in the least
sentimental, and she took pains to turn the conversation into
another channel when it approached a dangerous point. She seemed
to enjoy talking of Dick, his home, and his beautiful mother.
Somehow these thoughts did not please Merry, but he betrayed
nothing of the sort, and he spoke words of highest enthusiasm
about Starbright.
The dinner-party that night was one never to be forgotten. The
table was decorated with flowers and evergreens, the lights were
softened and shaded, and Jack Ready declared the turkey was a
“feast for the woozy old gods.”
Ready came out with a new batch of jokes, some of them fresh
and some “wearing whiskers.” Merriwell made a happy speech, and
Browning ate till his ravenous hunger was completely satisfied.
Then there was singing and music and a good time generally.
There was no Christmas tree, but the surprise came in the form of a
table-load of presents found in a room to which all were finally
invited by Mrs. Starbright. Everybody had been remembered, and all
declared they received just what they wanted more than anything
else in the world, which probably was an exaggeration in many
instances.
On entering the room, Frank had observed a bit of mistletoe
suspended from the chandelier. At last, Inza innocently paused
directly beneath it, and, in a moment, Merry had her in his arms,
claiming the privilege of a kiss.
But Dick had been equally observant, and he was on hand at the
same instant. Quick as a flash, she held them both off, laughing
merrily.
The others shouted and told her she could not escape paying the
forfeit.
“But what am I to do?” she asked, blushing crimson. “Both these
rude chaps seized me at the same moment, and both claim they
were first.”
“Oh, but I’m slow!” exclaimed Ready. “Why didn’t I have my eyes
open and get into that? It was ever thus! I’m getting to be a retired
number.”
“I don’t see but you’ll have to surrender to both, Inza,” laughed
Winnie.
“Oh, I can’t do that,” she protested. “They must settle it between
them somehow. Till they do, let both keep their distance.”
Then she skipped away from them, leaving them standing there,
face to face. Dick looked straight into Frank’s eyes, smiling a bit, but
there was a challenge in his aspect and look. More than ever Merry
realized that this big, fair-haired youth was a rival at whom it were
folly to scoff.
“How shall we settle it?” asked Merriwell pleasantly. “I’ll let you
name the manner, Dick.”
“Another game of billiards,” suggested Ready. “That’s the trick! Ah!
it takes me to solve these little difficulties. I’m a handy chap to have
round.”
 “No,” said Starbright. “I have another way.”
“Name it,” urged Merry.
“We’ll bowl a string of candlepins. The one who makes the highest
score wins the privilege given by the mistletoe.”
“Done!”
Winnie clapped her hands and Inza laughed.
“To the bowling-alley!” cried Ready, with a flourish. “I’ll be pin-boy,
and every little candle shall be on its post to a fraction of an inch.
Forward the Light Brigade! Charge for the pins!”
So down to the alley in the basement of the house they went. The
lights were turned on by Phil, and soon everything was ready for this
second match between Frank and Dick.
The entire house was heated by steam, and the spectators could
look on in comfort. The alley was regulation length, well built, well
kept, and handsomely polished.
It fell to Frank to lead off. He examined the balls, finding them all
of a size and in fine condition.
“I am going to beat you at this, Merry,” asserted Dick. “I know you
are too much for me at billiards, but I’m better at this business.”
“That being the case,” smiled Merry, “I must take care to begin
strong and hold out. Here goes.”
He sent the first ball skimming down the alley, and it cracked into
the pins, striking them fairly in the center and splitting them, taking
out three, which left four standing on one side and three on the
other.
“Oh, Laura!” exclaimed Ready, from his position beside the pins.
“This doesn’t look much like a strong start. Seven soldiers will be
good work for that break.”
“Look out for that hole, Frank,” warned Browning. “Keep away
from it.”
 Merry obeyed the injunction to the letter, and he swept off the
group of four pins with his second ball, leaving three standing.
“That’s clever,” nodded Dick. “Let’s see if you can clean them up.”
With moderate speed, Frank sent down a curve for the little line of
pins, but he barely missed the head one, clipping off the last two.
“Nine for Merriwell in his first box,” announced Dashleigh, who had
been selected to keep the score.
Ready set the pins up with care, while Starbright prepared for his
first effort. He stood on the left side of the runway, took a slow start,
and sent a swift ball into the bunch of pins, striking them on the
quarter and tearing them up as if they had been hit by a cyclone.
Only the head pin was left standing.
“Refuse me!” gasped Ready. “It’s dangerous down here. Oh, but
that was a soaker! Methinks I smell a spare.”
He was right, for Dick drove the second ball straight and true at
the single pin, which went flying against the padded end of the alley
with a sodden thump.
“Spare in the first box for Starbright!” cried Dashleigh, in great
delight. “It’s your turn now, Dick! He did you at billiards, but this is
different.”
“This is only the beginning,” smiled Dick. “I’m not liable to keep
that work up right along.”
“I should hope not!” exclaimed Frank.
Frank came up for the second box, trying a wide curve, which
missed the head pin and swept down one side of the bunch. His
second ball was sent straight down the middle of the alley, but it
took a slight shoot just before hitting the pins and left two standing,
one on the center and one on the corner.
“Spares are scarce on this side,” he smiled, apparently not a bit
disturbed.
“Hard luck!” growled Browning.
 “No,” said Merry, “poor bowling.”
Instead of trying to get just one of the two pins left, he used a
curve to the right for a billiard-shot, hoping to make them both, but
the head pin was missed by a fraction of an inch, and neither fell.
“Eight pins,” cried Dashleigh. “Seventeen in all.”
“Starbright is bound to have a big start,” said Badger. “In this kind
of a game, every pin counts.”
“Don’t forget this first ball counts on your spare, Dick,” warned
Dashleigh.
Dick did not forget. He whistled the ball down the alley, struck the
pins prettily, and tore down six of them.
“That gives him sixteen in his first box,” said Bert. “And he has a
splendid chance for another spare.”
Dick took the chance, too, for he got into the pins finely, cleaning
the alley, which caused the spectators to utter cries of applause.
“This is hot!” muttered Frank. “You seem to be keeping it up, old
man.”
“He’s making me lots of work,” observed Ready, as he deftly stood
the fallen pins on the spot.
Frank changed his position on the alley, but again he split the
pins, leaving two standing, one on each corner.
“No spare there!” cried Dashleigh.
“No poor bowling in that,” growled Bruce. “It should have been a
strike.”
Frank clipped off the two remaining pins with two straight balls,
which gave him ten in his third box, making twenty-seven in all.
Starbright got into the bunch again, but secured only five on his
spare, which left the pins in a difficult position. He did well in raking
down nine with three balls; but his lead on Frank was great, the
second spare having given him thirty-one in the second box, and on
even rolls with Merry he had forty.
“Up against the real thing now,” chirped Ready. “This Starbright
has played the game before, my friends. You’re buncoed, Merriwell.”
On his next roll Frank was able to make but nine pins, obtaining a
total of thirty-six, while Starbright cleaned the alley, which gave him
a lead of fourteen pins.
Merry had been trying different kinds of balls and different
positions on the alley, seeking to discover just where he could do his
best work. Now he opened with a cross-ball, which struck the bunch
on the quarter and swept them down clatteringly. A shout went up,
for it was seen that but one pin remained standing, and that one
was tottering and swaying.
“Go down, you scoundrel!” roared Browning.
But it refused to obey the command, settling into position.
“Robbery!” declared Starbright. “You should have had it, Frank. All
the same”—with a quick glance at Inza—“I’m very glad you didn’t
get it.”
Merry made no complaint, but sent the next ball true as a bullet
from a gun, clipping down the pin and making a spare.
“Here’s where you gain,” said Browning.
But Starbright seemed on his mettle, and he proceeded to
duplicate Merry’s performance, making a particularly difficult spare.
“He refuses to let me overtake him!” exclaimed Frank.
“Gentlemen,” cried Ready, “have you no pity for a poor working
boy? Please leave a few standing once in a while!”
Frank had decided that the cross-ball was the one to use, and now
he made ready to get all he could on his spare. There was a hush as
he picked up the first ball and sent it spinning anglewise down the
alley.
 Crash—clatter!
“Seven pins!” shouted Ready.
“Good work!” muttered Browning.
But the remaining pins were left in such a way that it seemed
impossible to get them all with a single ball. Frank studied them a
moment and did his best, but his best left one standing. This one he
removed with the third ball.
“Fifty-three on your half,” said Dashleigh. “Sixty-three in your sixth
box.”
Starbright struck the head pin too full, which cut out four, leaving
standing two wings of three pins each.
“Four pins with his spare ball,” said Bert. “Sixty-four on his half.
That’s all right.”
“But Frank gained three pins there,” murmured Inza.
“Frank will win,” asserted Badger, speaking so low that Dick could
not hear. “I tell you he can’t be beaten! That’s whatever!”
“But he has a hard task before him,” whispered Winnie. “Mr.
Starbright is a wonderful bowler.”
Dick took pains and smashed down one of the standing wings with
his second ball. His third, however, left a pin standing, and Frank
had gained another.
In the sixth box Starbright had seventy-three, with Merriwell just
ten pins behind him.
By this time Frank had the range of the alley, and now he sent a
strike-ball tearing into the pins, mowing them all down in a
twinkling.
“I knew it!” said Browning, with intense satisfaction.
“Oh, mercy!” whooped Ready. “Did you ever in your life! Wasn’t
that a bird!”
 “Here is where he gets right into it,” said Buck to Winnie. “I knew
he would.”
But Starbright was not shaken in the least, and he came near
duplicating Merry’s feat, for, with his first ball, he smashed down
every pin but one.
“Now, that was genuine hard luck!” exclaimed Frank sincerely.
“That ball was just as good as mine, but the pins did not happen to
fall just right.”
Dick looked grim and determined, and he went for the single pin,
getting it easily, which gave him a spare.
“You may get as many with your spare as he does with his strike,”
said Dashleigh, encouragingly.
“But I’d rather have the strike,” confessed Dick.
Frank cut only two pins out of the bunch with his first ball, and it
began to look bad for him; but he placed the second ball perfectly,
sweeping off all the remaining pins but one, which gave him a score
of nineteen in his seventh box, the total being eighty-two. He
knocked down the last pin with his third ball, which added ten more
for his eighth box.
Strangely enough, Starbright did precisely the same thing with all
three balls, getting only two on his spare, which left Merriwell but
three points behind in the seventh and eighth boxes.
“This is too close for comfort, Dick,” palpitated Dashleigh. “You
have let him come right up on you. You must hold your lead in the
last two boxes.”
Frank was in fine fettle. He had a “good eye,” and his hand was
steady, while his aim was perfect. Again he put a ball into the heart
of the bunch, striking the head pin on the quarter, and again he
cleaned the alley.
“Wow!” whooped Ready, dancing about. “Wouldn’t I cut a cake of
ice in this game! My! My! I don’t know a thing about bowling!”
 “It’s the first time in all your life that you ever told the truth,” flung
back Browning.
“Frank will win!” murmured Inza, and somehow Winnie fancied
that she seemed disappointed.
Starbright did not smile now. His strong, handsome face looked
grim and resolute. He sent a straight, true ball shooting down the
alley, and, like a flash, every pin was swept off clean. Then what a
shout went up! Both had made a strike in the ninth!
Dashleigh leaped to his feet and danced with joy, while Phil
wished to hug his big brother.
“He’ll keep his lead now!” declared Bert to Phil. “Don’t you fear
about that!”
Merry was not smiling. He knew that overconfidence might prove
a great mistake, and yet he was determined to win if possible.
However, his first ball slipped from his fingers and barely knocked
down a single pin on the corner.
Dashleigh wanted to whoop again, while Browning felt like
thumping somebody. Only Buck Badger remained perfectly unshaken
in his belief that Merriwell could not fail to win.
Frank was deliberate in his movements, and he placed the next
ball to a fraction of an inch. The result was the complete collapse of
the pins and a spare for him in his last box!
Dashleigh’s heart went into his boots, while Phil Starbright simply
sat down on a bench, gasping.
“Twenty in the ninth; one hundred and twelve total,” said Bert
huskily. “I’m afraid that does the trick!”
The pins were up, and Starbright prepared for the last effort. His
first ball brought everybody to his or her toes, for it went straight
and true into the proper place, and down crashed nine pins.
“Hooray!” yelled Phil, leaping up. “He’s going to do the same
thing! He’ll get a spare, too!”
 But now Starbright found himself shaking a bit. In this respect he
lacked Merriwell’s nerve, for Frank was always the coolest and
steadiest when the critical moment came.
“I must do it!” thought Dick, but in his heart there was a faint fear
that he might fail. He sent the ball straight toward the pin, and
several cried:
“He’s got it!”
But the ball curved the least bit, brushed the pin, caused it to
move off the spot at least half an inch, but left it standing.
Dashleigh collapsed and seemed disheartened until he made a
sudden discovery.
“Hold on!” he shouted. “Merriwell has but one ball left! He should
have rolled that one off before Dick. There is a bare chance left if
Dick gets that last pin.”
“I fail to see it,” grunted Browning.
“Why, it’s plain enough,” declared Bert. “Frank has one hundred
and twelve in his ninth box, hasn’t he?”
“Sure.”
“And he’s made ten with two balls.”
“Right.”
“That ten goes into the last box, together with what he gets on
the next ball.”
“Correct.”
“What if he gets only one? He’ll have one hundred and twenty-
three. Dick has that already. If Dick gets that pin, Merriwell must
have two to tie and three to win. It often happens that a man
doesn’t get but one or two on one ball. Get that pin, Dick!”
Dick got it, making his total score one hundred and twenty-four.
“That’s enough to win any bowling-match,” muttered Phil.
 “Any but this one,” said Badger. “You’ll see that Merriwell is a hard
man to beat. I found it out some months ago.”
Frank now took up his last ball and sent it at the pins which Ready
had placed on the spots. It struck them, sent them whirling and
crashing, and left but a single pin standing.
“That does it,” admitted Dashleigh, at last. “He makes one
hundred and thirty-one.”
This is the score kept by Bert:
Merriwell. Starbright.
9 9 1 16 16
8 17 2 15 31
10 27 3 9 40
9 36 4 10 50
17 53 5 14 64
10 63 6 9 73
19 82 7 12 85
10 92 8 10 95
20 112 9 19 114
19 131 10 10 124
—— ——
Total 131 Total 124
Frank had won the privilege he sought to claim beneath the
mistletoe.
 CHAPTER XXXIII

DEFEAT AND SUCCESS.

Indoor sports were not the only kind enjoyed at Starbright’s.

There was skating on the lake, and Phil took them out for a spin
over the ice on his ice-boat. The day after Christmas, however, an
accident happened that made the girls afraid of the ice.
It is a well-known fact that, even in the coldest weather, any large
body of water that is frozen over has weak or open spots in the ice;
“breathing-holes” they are sometimes called.
In this respect Seneca Lake was like other lakes, and so it chanced
that, skating together, with hands clasped, Inza and Winnie struck
one of those places. Before they could turn about, the ice broke
beneath their feet and they found themselves struggling in the
chilling water.
Several of the fellows were skating near-by, and they were startled
and horrified by the shriek that came from the girls as they broke
through. In a moment, every youth was dashing toward the spot.
Starbright was nearest. His heart sprang into his throat, for he
realized the terrible peril of the girls, knowing they were liable to
clasp each other about their necks and go down immediately.
Frank was only a short distance behind Dick, but Starbright
reached the spot first. As he came up, he saw Inza’s head disappear
beneath the surface, and straight into the water he plunged,
clutching at her in the wild hope that he might be successful.
 Fortunately, Dick was able to grasp Inza before she sank beyond
his reach, and he dragged her back to the surface. Then the others
came up.
Badger was there almost as soon as Frank, and they pulled Winnie
out on to the solid ice. Immediately Merry turned his attention to
Inza.
“Take her!” Starbright chattered. “Get her out quick, Merriwell! I
thought she was gone!”
“Guess she would have been if you hadn’t plunged in after her as
you did,” said Frank.
The ice was solid close to the dangerous spot, so there was little
trouble in drawing Inza out, after which Starbright was helped from
the water.
Then the girls, wrapped in the coats which the boys stripped off
and threw about them, were hurried away to the house, where they
were doctored and given warm drinks and placed in bed.
Some hours later, when the boys were all together again, Winnie
and Inza appeared and thanked their rescuers. Frank observed that
Inza first went straight to Dick, giving him her hand.
“I thought I was gone,” she said. “I was stunned when I went into
the water, and I couldn’t seem to do a thing to help myself, though I
knew I was sinking. Then I felt a strong hand grasp me, and you
pulled me back to the surface. I know I owe my life to you!”
Dick’s face was crimson, and his heart thrilled as she gave his
fingers a warm pressure, looking straight into his blue eyes.
“We all did what we could,” he stammered. “Frank was on hand to
pull you out.”
“But Starbright was the only one who really saved you,” said
Merry, with perfect generosity. “There can be no doubt of that.”
After a little time, he slipped away unobserved and retired to his
room, in the solitude of which he sat a long time, pondering over the
things that had happened since his arrival at the home of the
Starbrights. Once more in his heart throbbed the pain of loneliness
that had seized him in his room the night he received the brief
message from Elsie.
“I will delay no longer,” he finally murmured. “I’ll seek Inza, and
come to an understanding with her.”
Then he went down-stairs, having first looked into the billiard-
room, where Ready and Dashleigh were indulging in a game. In the
library Browning was stretched on a Morris chair, reading a book.
Through the house Frank searched, but he found nothing of Inza till,
at last, he heard the crash of falling pins in the basement.
“They are bowling,” he said, and descended the stairs.
Dick and Inza were there. He had been instructing her in bowling,
and neither of them heard Frank, who paused on the stairs.
“It was just too bad he beat you!” Inza was saying. “I don’t
believe he could do it again.”
“I don’t know about that,” laughed the big fellow. “But I don’t
think I ever wanted to win anything more in all my life than I did
that string of candlepins.”
“Did you?” she murmured, idly marking on the score-board.
“I did!” he declared, getting close to her and watching her write.
“And I’ve felt ever since that I was robbed of something.”
“Perhaps,” she murmured—“perhaps somebody else wished you to
win.”
“You?” he breathed, all atremble—“did you wish that—Inza?”
“Perhaps so.”
“I didn’t know—I thought you might want Frank to beat me. What
are you writing—my name?”
“Yes—and mine.”
 Having written her own name beneath Dick’s, she began to strike
out such letters as she could find in both names. He watched her
with interest.
“Let’s see,” he said, “how it is done? You take the letters that are
left, and how do you say it?”
“Love, hate, marriage; love, hate, marriage,” she explained.
“There are seven letters left in my name,” he declared. “It’s love
for me, and never anything in this world came truer!”
His voice betrayed his emotion.
“There are four letters left in my name,” said Inza, her face turned
from him.
“Love again!” exclaimed Dick softly. “Love for both of us! Inza—is
it—can it be—true?”
“Didn’t I say I was sorry Frank defeated you at candlepins?” she
murmured.
“By Heaven!” he hoarsely exclaimed; “he has not defeated me
after all. And I’ll not be robbed of the privilege the mistletoe gave
me!”
Then he caught her in his strong arms and kissed her.

THE END.

No. 67 of the Merriwell Series, entitled “Frank Merriwell’s Search,” by

Burt L. Standish, has a thrilling tale of the sea and many exciting
adventures in which Frank acts like the hero he is and proves once more
that he is without fear where duty is concerned.
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27—Buffalo Bill’s Long Trail By Col. Prentiss Ingraham
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100—Buffalo Bill’s Mystery Man By Col. Prentiss Ingraham
101—Buffalo Bill’s Bold Play By Col. Prentiss Ingraham
102—Buffalo Bill: Peacemaker By Col. Prentiss Ingraham
103—Buffalo Bill’s Big Surprise By Col. Prentiss Ingraham
104—Buffalo Bill’s Barricade By Col. Prentiss Ingraham
105—Buffalo Bill’s Test By Col. Prentiss Ingraham
106—Buffalo Bill’s Powwow By Col. Prentiss Ingraham
107—Buffalo Bill’s Stern Justice By Col. Prentiss Ingraham
108—Buffalo Bill’s Mysterious Friend By Col. Prentiss Ingraham
109—Buffalo Bill and the Boomers By Col. Prentiss Ingraham
110—Buffalo Bill’s Panther Fight By Col. Prentiss Ingraham
111—Buffalo Bill and the Overland Mail By Col. Prentiss Ingraham
112—Buffalo Bill on the Deadwood Trail By Col. Prentiss Ingraham
113—Buffalo Bill in Apache Land By Col. Prentiss Ingraham
114—Buffalo Bill’s Blindfold Duel By Col. Prentiss Ingraham
115—Buffalo Bill and the Lone Camper By Col. Prentiss Ingraham
116—Buffalo Bill’s Merry War By Col. Prentiss Ingraham
117—Buffalo Bill’s Star Play By Col. Prentiss Ingraham
118—Buffalo Bill’s War Cry By Col. Prentiss Ingraham
119—Buffalo Bill on Black Panther’s Trail By Col. Prentiss Ingraham
120—Buffalo Bill’s Slim Chance By Col. Prentiss Ingraham
121—Buffalo Bill Besieged By Col. Prentiss Ingraham
122—Buffalo Bill’s Bandit Round-up By Col. Prentiss Ingraham
123—Buffalo Bill’s Surprise Party By Col. Prentiss Ingraham
124—Buffalo Bill’s Lightning Raid By Col. Prentiss Ingraham
125—Buffalo Bill in Mexico By Col. Prentiss Ingraham
126—Buffalo Bill’s Traitor Foe By Col. Prentiss Ingraham
127—Buffalo Bill’s Tireless Chase By Col. Prentiss Ingraham
128—Buffalo Bill’s Boy Bugler By Col. Prentiss Ingraham
129—Buffalo Bill’s Sure Guess By Col. Prentiss Ingraham
130—Buffalo Bill’s Record Jump By Col. Prentiss Ingraham
131—Buffalo Bill in the Land of Dread By Col. Prentiss Ingraham
132—Buffalo Bill’s Tangled Clue By Col. Prentiss Ingraham
133—Buffalo Bill’s Wolf Skin By Col. Prentiss Ingraham
134—Buffalo Bill’s Twice Four Puzzle By Col. Prentiss Ingraham
135—Buffalo Bill and the Devil Bird By Col. Prentiss Ingraham
136—Buffalo Bill and the Indian’s Mascot By Col. Prentiss Ingraham
137—Buffalo Bill Entrapped By Col. Prentiss Ingraham
138—Buffalo Bill’s Totem Trail By Col. Prentiss Ingraham
139—Buffalo Bill at Fort Challis By Col. Prentiss Ingraham
140—Buffalo Bill’s Determination By Col. Prentiss Ingraham
141—Buffalo Bill’s Battle Axe By Col. Prentiss Ingraham
142—Buffalo Bill’s Game with Fate By Col. Prentiss Ingraham
143—Buffalo Bill’s Comanche Raid By Col. Prentiss Ingraham
144—Buffalo Bill’s Aerial Island By Col. Prentiss Ingraham
145—Buffalo Bill’s Lucky Shot By Col. Prentiss Ingraham
146—Buffalo Bill’s Sioux Friends By Col. Prentiss Ingraham
147—Buffalo Bill’s Supreme Test By Col. Prentiss Ingraham
148—Buffalo Bill’s Boldest Strike By Col. Prentiss Ingraham
149—Buffalo Bill and the Red Hand By Col. Prentiss Ingraham
150—Buffalo Bill’s Dance with Death By Col. Prentiss Ingraham
151—Buffalo Bill’s Running Fight By Col. Prentiss Ingraham

In order that there may be no confusion, we desire to say that the

books listed below will be issued during the respective months in
New York City and vicinity. They may not reach the readers at a
distance promptly, on account of delays in transportation.

To Be Published in January, 1923.

152—Buffalo Bill in Harness By Col. Prentiss Ingraham
153—Buffalo Bill Corralled By Col. Prentiss Ingraham

To Be Published in February, 1923.

154—Buffalo Bill’s Waif of the West By Col. Prentiss Ingraham
155—Buffalo Bill’s Wizard Pard By Col. Prentiss Ingraham

To Be Published in March, 1923.

156—Buffalo Bill and Hawkeye By Col. Prentiss Ingraham
157—Buffalo Bill and Grizzly Dan By Col. Prentiss Ingraham

To Be Published in April, 1923.

158—Buffalo Bill’s Ghost Play By Col. Prentiss Ingraham
159—Buffalo Bill’s Lost Prisoner By Col. Prentiss Ingraham

To Be Published in May, 1923.

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