Beyond
question considerable improvement has followed this operation in cases
of enlargement of the prostate, especially where the enlargement seemed
to be general, soft and vascular. A similar though perhaps a slower
effect is produced when the duct of the testis, the vas deferens, is
divided on each side of the body. If there is no great urgency about the
case this treatment may well be tried, the bladder being all the while
duly emptied by catheter and washed by irrigation. But if the case is
urgent, there being difficulty or bleeding with the passing of the
catheter, the bladder being excessively irritable and the urine foul, a
more radical measure is needed. The best operation is that upon the
lines laid down by Robert McGill, who opened the bladder through the
anterior abdominal wall and removed that part of the prostate gland
which was blocking the water-way. McGill's operation was improved upon
by Eugene Fuller of New York, who, in 1895, published a full account of
his procedure.[1] Having opened the bladder from the front (as in
supra-pubic lithotomy), he introduced his left index finger into the
rectum and thrust the prostate gland towards the right index finger,
which was then in the bladder. With the nail of that finger, or with the
end of a pair of scissors, he made a rent in the mucous membrane of the
bladder and the capsule of the gland, and then shelled out the mass of
new tissue which had caused the prostatic enlargement. This operation is
called "prostatectomy," which means the removal of the prostate gland.
The prostate gland, however, is not removed, but only a muscular and
glandular mass (adenoma), which, growing within the prostatic capsule,
encircles the urethra and squeezes the original gland tissue out of
existence. Following on the lines of McGill and Fuller, P.J. Freyer has
done excellent work in England towards placing this operation upon a
sound basis.

Subsequently to the operation the bladder enjoys complete and needful
rest, and the kidneys, which previously were in a condition of perpetual
disturbance, improve in working power. The wound in the bladder and in
the abdominal wall gradually closes; the function of the bladder
returns, and the patient is soon able to go back to his usual occupation
in greatly improved health and vigour. The operation is, necessarily, a
serious one, and the age of the patient, the condition of his bladder,
of his kidneys, and of his blood-vessels, require to