A Recent Series of 60 Cases of Total Enucleation of the Prostate for Radical Cure of Enlargement of That Organ

TOTAL ENUCLEATION OF THE PROSTATE.SmB;xo85The,heart beat could i,ot be distinctly felt on that account, ;and the pulse was extremely irregular and intermittent.The patient looked in fairly good health, although he was *'asthmatic," and had suffered a great deal from the frequent passage of catheter by day and night during the previous 'three months.I removed the prostate in October, 1904.Dr. Cyril Lewis gave the anaesthetic, Dr. Jones assisted, and Mr. Cresswell, (.B., was present.The prostate and its eapsule were the toughest I have had to deal with and were removed piecemeal-four adenomata and three tough frag- *ments of capsule.My left forefinger got tired out, and I had -to usemy right forefinger before the operation was completed.Rubber gloves were used on the hands when manipulating in the rectum.On the night of the operation I was afraid he was in for an attack of bronchitis, but an emetic removed all anxiety.From the eighteenth day after operation he passed urine entirely per uretbram, and went home on the twenty- sixth day, retaining and passing his urine quite normally.lln March, I905, he reported himself, and said the result was perfect-" I do not get up at night."]In conclusion, I would venture to remark about the use of antiseptics in these operations.Weak antiseptic solutions for washing out the bladder are only a source of local irrita- tion, plus the possibility of being absorbed and throwing unnecessary tax upon the eliminating organs.Sterilized salt solution is better for irrigation, because the beneficial effect is really due to the mechanical removal of surgical dirt.Antiseptics to be of any germicidal value must be strong, and for suprapubic operations upon the bladder I find that pure tincture of iodine poured into the bladder (2 to 4 dr.) through the suprapubic opening is an excellent preparation to correct peptic conditions either at the time of operation or at subse- quent dressings.It is better than any powder, because it 'runs into all the nooks and crevices, and comes into con- tact with the entire field of operation.[Since the above paper was written Messrs.Weiss and Son tave made for me a special elevator for lifting up the base of ,the bladder, and in two suprapubic operations I found it most -useful; in one case where my fingers were too short without it I was able to pick out 47 calculi from a post-prostatic pouch -before I removed a big prostate.The elevator is passed into the rectum, and is under control of the operator.I hope later on to relate cases in which such an instrument is of great -value in raising the pelvic floor through rectum or vagina, in dovariotomy, hysterectomy, and bladder operations.