s circumstances direct. The patient should
lead a quiet life, free from sexual excitement. Horse-exercise,
cycle-riding, rough games and alcohol should be avoided.

_Enlargement of the prostate_ exists in a considerable proportion of men
of about sixty years of age and onward. It consists of an uncontrolled
growth of the normal muscular and glandular tissue of the prostate,
interfering with, or absolutely stopping, the outflow of the urine.
Gently pushing the bladder upwards and backwards, it increases the
length of the urethra, so that in order to draw off retained urine the
catheter must be longer than ordinary, but inasmuch as there is no
actual narrowing of the passage it may be of full calibre. The beak
should be well turned up so that it may ride in front of, and surmount,
the median enlargement. Because of the thick, ring-like mass of new
tissue around the outlet of the bladder, there is difficulty in
micturition, and because the muscular bladder wall is now unable to
contract upon all its contents a certain amount of urine is retained. As
the enlarged prostate bulges up in the floor of the bladder, a pouch or
hollow forms behind it, from which the muscular wall is unable to
dislodge the stagnant urine. This keeps up constant irritation, and if
by chance the germs of decomposition find their way thither, cystitis
sets in and the patient's condition becomes serious, not only because of
the risk to which his tired and irritated kidneys are submitted, but
because of the possibility of a phosphatic stone being formed in the
bladder. The seriousness of enlargement of the prostate does not depend
upon the size of the growth so much as upon the inability of the patient
to empty his bladder completely.

The surgeon forms his estimate of the size of the prostate by rectal
examination. But sometimes a patient has retention of urine from
enlarged prostate, when by this method of manual examination the
amount of increase appears quite unimportant. The explanation is that
the enlargement is chiefly confined to a small piece of the gland
which protrudes like a tongue into the water-way. Robert McGill of
Leeds was the first surgeon to remove by a supra-pubic operation this
tongue-like process of new prostatic growth. Attempts had sometimes
been made to get rid of it by instrumentation through the urethra, but
they had not met with much success.

When the surgeon has made out the existence of an enlar