SENILE PROSTATIC HYPERTROPHY. Dr. Orville Horwitz read a paper entitled "The Radical Cure of Senile Hypertrophy of the Prostate; based upon a study of 145 operations performed by the author." Dr. Horwitz stated that the question under discussion has, with the possible exception of appendicitis, attracted more attention in the surgical world than any other subject. It is well recognized that the danger to the patient with enlarged prostate begins as soon as it is necessary to resort to the daily use of the catheter and when this period arrives a surgeon should be consulted to supervise the case and decide what operative measures are desirable or necessary. It was emphasized that no one operation was suitable to all cases and that each patient is a law unto himself in the matter of choice of operation. The two operations which have stood the test of experience are prostatotomy by means of the galvano-cautery (the socalled Bottini operation) and prostatectomy. The speaker stated that the Bottini operation is extremely valuable, safe and always to be preferred to cutting operations in suitable cases. Out of 98 cases operated upon by the author, by the Bottini method, three died, two of uraemia, and one of sepsis; all three were very old men. Twelve cases were lost sight of after leaving the hospital but were much improved when last examined. This leaves 81 cases concerning which there was obtained definite knowledge as to results. The ages of the patients varied between 52 and 81 years. The speaker stated that his statistics proved conclusively that the earlier the patient submitted to operation, the better the results. Of the total 81 Bottini operations all the patients were either entirely cured or very much benefited; four required second operation, and a considerable proportion were treated for several months subsequently for accompanying chronic cystitis. Prostatectomy, the speaker stated, is regarded as a valuable operation but authorities differ as to when and how it is to be performed. As many as twenty different operations have been suggested. Here, too, the individual case decides methods, choice of operation, etc. The prostatectomies performed by the author were as follows: Three complete (suprapubic incision); 6 complete (combined suprapubic and perineal incisions); 7 partial prostatectomies (suprapubic incision); 34 complete perineal prostatectomies. Of the nine complete suprapubic operations, two died, one of suppression of urine, one of uraemia. In all the cases convalescence was slow; in five cases the ultimate results were all that could be desired. Of the thirty-four perineal prostatectomies, six died from uremia, sepsis or shock; six cases were lost sight of after leaving the hospital; sixteen were cured, four markedly benefited, one unimproved. Dr. Horwitz summarized the results of observations in his 145 operations as follows: 1. A routine method is not applicable to the treatment of prostatic hypertrophy; every case is a law unto itself and the treatment will depend on the various conditions presented in each individual case. The dangers attendant on the daily catheterism are greater than those of a radical operation performed at the onset of the symptoms caused by the obstruction. 3. The proper time to perform a radical operation is reached as soon as it becomes necessary for a patient to resort to daily catheterism. 4. The gratifying results obtained by a number of the operations in many cases demonstrates that the Bottini operation is one of great surgical value. It is applicable to a large percentage of cases; which if properly selected has proved to be the safest and best method of relieving an obstruction caused by prostatic hypertrophy. In those cases in which a stone in the bladder is associated with a prostatic enlargement, lithoplaxy may be performed in conjunction with a galvanocautery prostatotomy. 5. A complete prostatectomy is justifiable if performed early before the individual is broken down in health and secondary complications have supervened. In early operation the results are most satisfactory, recovery rapid, the mortality between 5 per cent. and 7 per cent. 6. A complete prostatectomy in feeble elderly patients with long-standing obstruction and secondary complication, the prognosis is grave and the mortality ranges between 15 per cent. and 18 per cent. If the bladder in these cases happens to be hopelessly disabled, the results obtained by the operation are negative. Cases of this description are only suitable for suprapubic drainage. 7. In 90 per cent. of all cases the gland can be readily removed by means of a median perineal incision. The perineal operation recommended by Bryson is considered the operation of choice. 8. Complete suprapubic prostatectomy is shown to be more dangerous than the perineal operation for obvious reasons. A suprapubic prostatectomy is safer if combined with perineal drainage. 9. Partial suprapubic prostatectomy is indicated in such cases as where a valve-like lobe exists which interferes with urination, or where there is a partial hypertrophy of one of the lobes. 10. A perineal prostatectomy is best suited for those cases where the enlargement of the lateral lobes has a tendency to progress towards the rectum, to obstruct the urethra, or project backwards into the bladder. 11. A prostatectomy is always attended with more danger than the Bottini operation and the convalescence is more prolonged. In suitable cases the latter operation is therefore the one of choice. Dr. Edward Martin discussed the preceding paper as follows: He agreed with Dr. Horwitz that, if operation has been advised and consented to, the circumstances of the individual case decided which of the several operations is to be performed. He believed that the Bottini operation has proved of great value and is preferable to cutting operations in suit. able cases. He did not, however, advise operation in all cases of enlarged prostate. He recognized the inconveniences and dangers attendant upon the daily use of the catheter, but be lieved in the value of palliative measures in the majority of cases. He recommended care in the selection of catheters and one that enters the bladder with the least force and least pain to the patient. If a soft rubber catheter cannot be introduced, a woven elbowed one is to be chosen. If obstruction or spasm necessitates habitual resort to a metal catheter, surgical intervention is required. When patients use the instru ment upon themselves, the hands should be washed thoroughly, dipped in bichloride solution, the meatus washed with the same solution, and be provided with an irrigating bag containing one pint of hot argyrol solution, 1 to 1,000. In fection of the bladder is commonly present and should be treated by means of bladder irrigations. For this purpose a fountain syringe, supplied with a catheter, should be suspended two feet above the level of the bladder. The anterior urethra is first thoroughly flushed, after which the catheter is pushed into the bladder and the urine withdrawn. The flushing of the bladder is continued until the return flow no longer contains pus or mucus. The tempearture of the argyrol solution employed should be of the temperature of the body or a little above it. When practicable this antiseptic flushing should be done each time the catheter is passed. If this treatment is inefficacious continuous catheterization becomes necessary. For this purpose a large soft rubber catheter, or a self-retaining one, is selected and the antiseptic solution introduced; if the catheter is properly introduced, the entire amount of the solution will return. Twice a day the urethra and bladder are thoroughly flushed with the antiseptic solution, the catheter being withdrawn far enough to allow the injected fluid to escape from the meatus, and then being pushed back into its former position. The success of this treatment depends upon securing free and continuous drainage and this is incident to the permeability of the catheter and its retention in the proper position. When skillfully applied it is one of the safest and most successful means of treating cystitis, which so frequently complicates obstruction from prostatic enlargement. Beconds, Beqollections and Beminiscencęs. OUR NEXT REUNION. The next annual reunion U. C. V. will be held in the city of Nashville, Tenn., and the dates definitely decided upon, June 14, 15 and 16, will witness a larger gathering of the "Boys who wore the gray" than has been assembled since those trying days when they strove, struggled and starved for that which they believed to be right. While the Capital City of the Volunteer State is not so large as some that have entertained this heroic host, yet the hearts and hospitality of her citizens are as large as any. The reunion held here before has been most favorably remembered by all who were present, and the "pace was set" that others have endeavored to maintain. Well, this year the same efforts, energies just as sincere, and efforts not one whit diminished will again be the order of the day with every citizen within her gates. Its central location, the early summer days, her progressive and determined spirit in behalf of the future, and her recollection of those sad days of the past, the friendly home-like manner of her treatment of all visitors, will combine to give all who may come a welcome, yes, a welcome that will long be remembered. More than ordinary delay this year in determining where the reunion should be held, and a change of date from that first selected by the committee having this matter in charge, will have no effect in the manner and character of the entertainment. A general committee of thirty, composed of ten members of the Chamber of Commerce, ten from the Retail Merchants' Association and ten from Frank Cheatham Bivouac will have entire control of the city from Tuesday, June 14, until the last day of the occasion, which will be made the grandest in all the eventful history of this city. The general committee will hold weekly meetings until the week of the reunion, and the sub-committees will meet as often as may be required. The following well-known citizens constitute the general committee: Chas. F. Frizzell, Chairman; I. C. Garrabrant, Vice Chairman; Joseph Frank, Treasurer; L. R. Eastman, Secretary; Dr. J. R. Buist, H. W. Buttorff, W. C. Collier, Lee Cantrell, W. J. Cummins, Capt. M. S. Cockrill, S. A. Cunningham, C. H. Eastman, E. C. Faircloth, Edgar M. Foster, W. D. Gale, Thomas C. Hindman, Humphrey Hardison, Eugene O. Harris, Leland Hume, C. R. Handley, George Holle, Capt. George F. Hager, Capt. I. J. Howlett, Col. John P. Hickman, Capt. John W. Morton, Charles Mitchell, Jr., Dr. W. J. McMurray, Lawrence G. O'Bryan, Jesse M. Overton, Capt. M. B. Pilcher, Col. George C. Porter, W. P. Rutland, James B. Richardson, P. A. Shelton, Maj. John W. Thomas, Oliver J. Timothy, M. B. Toney, Maj. T. P. Weakley, J. Mat Williams. Various sub-committees composed of the members of the general committee, largely reinforced by other citizens of Nashville have been appointed, and the details of the work is |