1457 was dry and parched, his breath was strongly urinous in odour, the pupils were very contracted, and he had general subsultus tendinum. The action of the heart could not be felt, and his radial and ulnar arteries were calcified and could be moved from side to side under his wrinkled skin like an articulated stem of a " churchwarden " pipe. Roentgen photographs subsequently taken after recovery showed three long dark tracks in each forearm in the course of the calcified radial, ulnar, and

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... erosseous arteries. I decided not to tap suprapubically, but to make an incision into the bladder under stovaine spinal analgesia. As soon as the bladder was emptied of foetid urine I poured about an ounce of pure tincture of iodine into the bladder, before proceeding to enucleate the prostate according to a method which I have adopted for the last seven years, and which was described at the British Medical Association meeting at Sheffield in 1908 and at the Twenty-second Congress of the Association Francaise de Chirurgie in 1909. I drained perineally after injecting tincture of iodine through the meatus along the urethra into the prostatic bed. Thanks to the assiduous care of my house surgeon, Mr. Owen, in irrigating with hot saline solution for long periods through the suprapubic opening, and to good nursing, the patient made a satisfactory recovery. There are three points in my operation which require emphasising, as several of my friends who have performed it had not grasped their importance. 1. The first is that the patient is lying on his back as in the ordinary suprapubic operation during the whole of its performance, the perineal opening being made upon the point of the forceps passed transvesically from above, whilst the legs are simply spread apart in order to see and to cut upon the projecting end of the forceps under the skin. The enucleation is as a rule easily done by the forefinger in the bladder, but frequently I pass the other forefinger into the perineal opening to assist the enucleation from below as in the ordinary perineal prostatectomy. The two forefingers enucleating en rapport greatly facilitates the performance of those cases which are not easily enucleable. 2. The pouring of pure tincture of iodine into the bladder before the enucleation is started is of great importance, because as soon as fresh raw surface is made in the process of enucleation the tincture follows into every hole and corner. The injection of the tincture along the urethra also ensures a cleaner urethra and further floods the freshly made " prostatic bed." Operations can, as a rule, be completed by rubber-gloved hands. (N.B.--There is no danger in using the pure tincture of iodine. I first advocated its use in a paper read at Carmarthen on Dec. 8th, 1904.1) 3. The operation can be performed as quickly as the suprapubic operation alone. The time I spent in the hospital examining, preparing for operation, completing the operation, and seeing the patient off to the ward was 25 minutes.