TOTAL EXTIRPATION OF THE PROSTATE FOR RADICAL CURE OF ENLARGEMENT OF THAT ORGAN
Several attempts were made in the ensuing year to keep her well at home but they invariably failed. It was about this time pointed out to me by the child's father that some days before the stools commenced to lose colour an earlier symptom manifested itself-namely, coldness and dryness of the extremities. The child was carefully watched and on return to town this appeared to be the first symptom, being rapidly followed by loss of appetite. I therefore ordered that she should sleep between
... ts with a hot-water bottle and that her arms and legs should be well covered up during the day, with the pleasing result that the threatened attack passed off and the child is able for the first time since her illness to live in London. The practical importance of observing this early symptom is obvious from the point of view of treatment. Whether it throws any light on the pathology of this obscure disease it is difficult to say. However, it does suggest that changes in atmospheric conditions may act as exciting causes of acholia in children predisposed to temporary loss of hepatic function. What these atmospheric changes are and how they act are problems that await solution. It is with the object of calling attention to the fact that treatment of this early symptom may ward off the full development of acholia that I venture to bring the case before the readers of THE LANCET. A MAN, aged 71 years, was admitted into the North Devon Infirmary on Oct. 23rd, 1903, suffering from "retention of urine and false passage." For four years he had passed a catheter for himself many times daily, but of late he had done this with more and more difficulty and frequently with some haemorrhage. On Oct. 23rd he was unable to micturate and sent for a medical man who passed a silver instrument, drawing off urine which was very blood-stained. The patient was then sent to the above institution. He had been losing flesh for some time and was in great pain. His bladder was much distended and a No. 9 silver catheter was passed and a large quantity of blood-stained urine was drawn off. No soft instrument would pass. On Oct. 24th I performed suprapubic cystotomy and left a long rubber tube (No. 12) in the bladder which was drained into a vessel containing phenol. The patient was much relieved and the urine became free from blood after a few days, but would not pass through a rubber catheter introduced into the bladder, although the bladder could be washed out through it. On Nov. 7th I decided to perform prostatectomy. I therefore opened up the suprapubic wound, snipped the mucous membrane with scissors over the most prominent part near the urethra, and enucleated the middle and right lobes of the prostate, assisted by pressure upwards in the rectum. I removed this portion with volsellum forceps after some trouble owing to its size and then enucleated the left lobe which was smaller, leaving the prostatic urethra intact. What was removed weighed altogether four and a half ounces ; the bleeding was copious. I irrigated freely with hot saline solution and then replaced the rubber drainage tube as before. The patient was under A.C.E. mixture for about one hour, the enucleation taking about 20 minutes. On Nov. llth he passed about two ounces of blood-stained urine naturally. On the 13th he twice passed a little urine and then for several days did not pass any. The drainage was continued and a No. 8 soft catheter was passed easily but no urine came through it. On the 17th a herpetic eruption appeared on the right side of the scrotum, the penis, the perineum, and the right gluteal region. The urine was still bloodstained and foul; the bladder was washed out daily. On the 23rd the drainage was stopped as the man passed urine quite naturally and has continued to do so up to the present date (Dec. lst). The urine is acid in reaction and normal in character. It is passed with freedom and ease, the patient being up and about and practically quite well. Barnstaple.