lated, certainly in three of them, and in two the prostatic catheter was employed under the belief of its existence.

The first was reported by John Hunter, in the Transactions of a Society for the Improvement of Medical and Surgical Knowledge, vol. i. p. 34. Here the retention caused death, and between four and five pints of urine were found in the bladder at the post-mortem examination. The viscus was pushed up into the abdomen by the pressure of the cyst below.

The second, by Mr. Curling, appears as an appendix to Mr. Lowdell's paper in the volume referred to above, page 356. Here the same appearances were observed, but in a less marked degree, relief having been given to the retention during life.

The third case occurred to the late Mr. Callaway, at Guy's Hospital, and is referred to in the Medical Times of Feb. 17, 1855. Hydatids were removed when the catheter was passed. After death a large hydatid tumor was found between the bladder and rectum, pressing on the neck of the former.

The fourth, a man aged forty, was admitted into Guy's Hospital with retention of urine: no catheter could be passed, and he died. At the post-mortem, a large tumor occupied the pelvis and hypogastric region, the anterior and upper part of which was formed by the bladder, pushed out of its proper place. The tumor consisted of a cyst containing three pints of hydatids. The preparation is No. 2104, 52. Another preparation is preserved there very similar to the preceding.

The fifth occurred in a man, aged fifty-nine, admitted to the Westminster Hospital with retention of urine, under the care of Mr. White. A catheter could not be made to reach the bladder, which was therefore punctured through the perineum, a pint of urine escaping. He died next day, and a large hydatid tumor was found just above the prostate,

pressing against the back of the bladder, so as to divide it into two portions, of which the upper still contained two pints of urine, the lower, which held one, having been evacuated by the puncture.

In the Museum of St. Bartholomew's there is a good example of a large hydatid cyst occupying a position between the bladder and rectum. In this case the prostate does not appear to have been affected. It is preparation No. 15,

series xxix.

It does not appear unlikely that Mr. Lowdell's case may have belonged to the same category, the prostate being more or less absorbed by pressure from an external cyst, so that the latter came at length to occupy the situation proper of that organ. The case is, however, given here in an abridged form.

CASE No. XXV.

HYDATID DISEASE OF PROSTATE.

J. I., aged 64, in Sussex County Hospital, in July, 1844, under the care of Mr. John Lawrence, jun. During three or four years had experienced difficulty in making water and frequent micturition; and of late, almost complete retention. The bladder was now emptied by catheter, after great difficulty, and three pints withdrawn. Much pus and mucus passed afterwards. He died in a few days.

P.M. Bladder very much thickened, and in the situation of the prostate was a tumor larger than a foetal head, which, when cut open, proved to be a hydatid cyst, closely packed, the true substance of the prostate being lost in it. Hydatid tumors were also found in the omentum.

Whether the hydatid cyst was formed in the prostate itself, or external to the organ, destroying it by pressure alone, is stated to have been a matter of doubt. Appearances led Mr. Lowdell, who reports the case, to the former view. The facts of hydatid disease of the prostate being unrecorded, together with the existence of other tumors in the omentum, inclined him to believe that he "should be scarcely warranted in maintaining that opinion without question."— Trans. Med. Chir. Soc., vol. xxix. p. 253. 1846. By George Lowdell, Esq.

CHAPTER XII.

THE BAR AT THE NECK OF THE BLADDER.

Close relation between this subject and Prostatic Enlargement.-Almost all Obstacles at the Neck of the Bladder are Prostatic.-A few cases which are exceptional.-Mr. Guthrie's recognition of them.-His Views defined.Views of Civiale, Mercier, Gross, Leroy.-A Bar may be due to repeated Contractions of the Bladder from any cause whatever, if long continued.— Shown to consist, in such cases, of Muscular Hypertrophy.-Examples.CONCLUSIONS On the whole subject.-Rarity of any Affection meriting the appellation of Bar in absence of Enlarged Prostate.-TREATMENT.-When due to Muscular Hypertrophy, as in Stone or Stricture, it will disappear on removal of the exciting cause. Mr. Guthrie's proposal to divide Obstructions at the Neck of the Bladder.-Mercier's Modes and Instruments.Results of Operations.-Consideration of these Proposals.

THIS is an affection so closely related to enlarged prostate, by identity of anatomical situation and of the symptoms resulting, that it is impossible to treat of one without also considering the other. As already seen, in the examination of the anatomy of the first-named affection presented in chapter the second, a bar at the neck of the bladder is very frequently due solely to enlargement of some part of the prostate; but it is not less a fact that a somewhat similar obstruction is sometimes, though not very commonly, present, when that organ is not the subject of disease. It is to this latter condition that the term, as designating a distinct affection, has been applied.

Although numerous forms of obstruction at the neck of the bladder have been frequently described, at some length, by the well-known French writers of the present century on urinary diseases, under the names of "bourrelets," "barrières urétro-vésicales," "brides," brides," and " and "valvules," no specific distinction was recognized between the form of obstacle about to be described, and that which consists in

enlarged prostate, until the late Mr. Guthrie called attention to the subject in his Lectures at the Royal College of Surgeons in 1830. He examined it with care, and arrived at more precise views respecting it than any previous writer had done, pointing out the distinctive characters of the two affections, the prostatic and the non-prostatic; and the term which he employed to designate the latter is retained here, in the sense which he originally intended it to convey. The views which he entertained respecting the entirely-distinct character of the two affections, are summed up briefly by himself, and may be given here in his own words. He concludes:

"1. That an elastic structure exists at the neck of the bladder, and may be diseased without any necessary connection with the prostate gland.

"2. That the prostate may be diseased without any necessary connection with the elastic structure."

He quotes two cases, one in which," without any affection of the prostate, and particularly of the third lobe, the patient passed his water with great difficulty, in consequence of the barrier formed by this unyielding structure, and died ultimately of the disease after much suffering." Another, in which, as a consequence of unequally-enlarged lateral lobes of the prostate, the right being most so, the mucous membrane of the neck of the bladder had been drawn up 66 so as to form a bar across its under part. This bar," he adds, “is quite membranous, and does not include the elastic structure which is not diseased, neither is that part called the third lobe, nor is there any projection into the bladder, save the bar or valve formed by its mucous membrane at the very meatus." *

On the Anatomy and Diseases of the Urinary and Sexual Organs; being the first part of the Lectures delivered in the Theatre of the Royal College of Surgeons, in 1830. By J. G. Guthrie. London, 1836. pp. 23 and 25.

In these two cases, as the author observes, one was exactly the reverse of the other. Each is, indeed, typical of two perfectly-distinct classes of abnormal conditions affecting the neck of the bladder. In the latter example there is presented merely a natural result of certain forms of prostatic enlargement which are occasionally met with, and some examples of which exist in our museums, in which the growth upward of some portions of the organ has the effect of drawing up the mucous membrane from the parts below, and sometimes with it some subjacent fibrous and muscular structures, but in which there is little or no enlargement of the posterior median portion (middle lobe) of the prostate itself. In the former case, there is an unnatural elevation of certain structures which underlie the mucous membrane at the posterior or vesical limit of the urethra, but which is unaccompanied by, and totally unconnected with, any enlargement of the prostate itself.

It is particularly necessary to draw the distinction clearly between the affection, to which Mr. Guthrie thus applied the name of "Bar at the neck of the bladder," and that obstruction which is constituted solely by an enlarged median portion of the prostate itself. Views differing very much from those which Mr. Guthrie held have been frequently promulgated as his respecting it. Thus the bar has been described by more than one author as an eminence situated just behind an enlarged middle lobe of the prostate. Now this is clearly not what was intended by Mr. Guthrie; nor can such an eminence be said to have for its locality "the neck of the bladder " at all, inasmuch as it must necessarily lie considerably posterior to it. As we shall see hereafter, the eminence so indicated is formed by a hypertrophied condition of those muscular bands which intervene between the two orifices of the ureters, and which are generally known as 66 the muscles of the ureters."

R