(punch Operation) for Small Prostatic Bars and Contracture of the Pros- Tatic Orifice*

In 1836, Mercier first vigorously called attention to the occasional occurrence of obstructions at the prostatic orifice in cases other than prostatic hypertrophy, and gave them the name of valvules du col de la vessie. He described quite accurately the elevation of the median portion of the prostate in the form of a bar, which he said in some cases was due to muscular hypertrophy, and in others to a glandular enlargement in this region. Mercier devised an instrument somewhat like a lithotrite by means of which he operated in a number of cases with fair success, but his operation was never adopted and soon fell into disuse. Later French writers, particularly those of the Guyon school, departing from Mercier's teachings, have attributed the condition to lack of bladder tonicity, and the term prostatisme sans prostate has been quite generally used to describe this condition, which they believed to be due to an atrophy or paralysis of the vesical musculature, rather than to the obstruction at the prostate. In America, Keyes, Fuller and Chetwood have recog'"zed the obstructive character of these cases which they "avë described as contracture at the neck of the bladder °i" stricture of the posterior urethra. For this condition duller devised a deep division of the median portion of 'he prostate and vesical sphincter, either through a ^ prapubic or a perineal incision, and Chetwood and jueyes have recommended highly the use of a modified "ottini operation done through the perineum to divide the obstruction at the orifice by means of an electro1 ;,l'lcry blade. By the surgical world, as a whole, however, this con¬ ation has been sadly neglected. In my own work, this condition has been attacked in Vl»i'ious ways: at first, through the urethra by means of