made from a vaginal depressor bent in the same curve. The advantage of these instruments is to steady and force down the gland while it is being removed. These instruments illustrate in prostatic surgery the old and popular adage "pull and, if you can't pull, push."

The technic of the operation of prostatectomy advocated by me at present is as follows: The patient should be prepared as usual, the perineum and suprapubic regions having been shaved; the rectum and bladder should be washed out clean before the operation. He should then be etherized and placed upon his back upon the operating table. A lithotomy guide is then passed through the urethra into the bladder and the patient placed in the lithotomy position. An external perineal

urethrotomy is then performed, opening the membranous urethra, after which the forefinger should be pushed through the perineal opening into the prostatic urethra with the object of examining it, and as much of the bladder as possible by palpation. This opening should then be dilated with the fingers, or instruments, to a sufficient degree to introduce the blades

SAXE-03.

Fig. 3.-Finger passed through opening in Fig. 2 and enucleating between capsula propria and external capsule.

of the scissors for cutting through the floor of the prostatic urethra. With the finger of the left hand in the rectum, pressing upon the gland, I introduce the point of the blades of a curved pair of scissors into the urethra until they have just passed the apex of the gland, when I make a transverse incision in its floor.

The tip of the forefinger of the right hand is then introduced through the urethral incision and gradually works its way between the gland and the external capsule separating it from this latter covering.

Fig. 4. Prostatic Depressor (Guiteras). For prying down the prostate during enucleation.

The depressor is then introduced; this, owing to its curve, can be held in the upper part of the perineal opening, entirely out of the way of the finger, and does not interfere with it at all (see Fig. 5). When the lateral lobe is freed, the forceps are placed upon it and it is delivered. At times the base of the gland can not be easily freed, in which case, if the forceps are put on and traction made, the finger can break up the adhesions and the lobe can be gently withdrawn. The prostate gland usually comes out in two pieces with a so-called middle lobe adherent to one of the lateral ones, but the middle lobe sometimes remains behind after the two lateral ones have been removed, in which case it can usually be loosened with the finger nails, or grasped and brought out by the forceps.

The gland having been removed, it is important to apply a pair of artery forceps to either side of the upper margin of the urethral incision and then sweep the finger around between the urethra and the capsule and introduce it through the urethra into the bladder to see that everything is free. The bladder

pass through the urethra if its floor is not under control, besides which there is danger of tearing the canal or introduc

Fig. 6.-Prostatic Forceps (Guiteras).

For removing lobe of gland after freeing it from external capsule.

ing it between the urethra and the external capsule. It occasionally happens after performing a very rapid perineal prosta

Fig. 7.-Showing traction-forceps on a lobe of the gland. Also the depressor passing through urethra into bladder. The left half of external capsule has been removed by vertical incision. The collar on the neck of bladder is the reflection of same . part of fascia which has been cut off at right angles to prostatic portion.

tectomy, that it requires more time to introduce the drainage tube than it had for the operation. A large gorget passed in