136 Commentary on plates 61 & 62.

Fig. 2, Plate 62.--The three lobes, a, d, c, of the prostate are enlarged and of equal size, moulded against each other in such a way that the prostatic canal and vesical orifice appear as mere clefts between them. The three lobes are encrusted on their vesical surfaces with a thick calcareous deposit. The surface of the third lobe, a, which has been half denuded of the calcareous crust, b, in order to show its real character, appeared at first to be a stone impacted in the neck of the bladder, and of such a nature it certainly would seem to the touch, on striking it with the point of a sound or other instrument.

Plate 62.--Figure 2. Plate 62.--Figure 3.

Fig. 3, Plate 62, represents the prostate with its three lobes enlarged, and the prostatic canal and vesi­cal orifice narrowed. The walls of the bladder are thickened, fasciculated, and sacculated; the two former appearances being caused by a hypertrophy of the vesical fibres, while the latter is in general owing to a protrusion of the mucous membrane between the fasciculi.

Fig. 4, Plate 62.--The prostate presents four lobes, a, b, c, d, each being of large size, and projecting far into the interior of the bladder, from around the vesi­cal orifice which they obstruct. The bladder is thick­ened, and the prostatic canal is elongated. The urethra and the lobes of the prostate have been perforated by instruments, passed for the retention of urine which existed. A stricturing band, e, is seen to cross the membranous part of the canal.

Plate 62.--Figure 4. Plate 62.--Figure 5.

Fig. 5, Plate 62.--The prostate, a a, is greatly en­larged, and projects high in the bladder, the walls of the latter, b b, being very much thickened. The ure­ters, c, are dilated, and perforations made by instru­ments are seen in the prostate. The prostatic canal being directed almost vertically, and the neck of the bladder being raised nearly as high as the upper border of the pubic symphysis, it must appear that if a stone rest in the bas fond of the bladder, a sound or staff cannot reach the stone, unless by perforating the pros­tate; and if, while the staff occupies this position, lithotomy be performed, the incisions will not be re­quired to be made of a greater depth than if the pros­tate were of its ordinary proportions. On the contrary, if the staff happen to have surmounted the prostate, the incision, in order to divide the whole vertical thickness of this body, will require to be made very deeply from the perinaeal surface, and this circumstance occasions what is termed a "deep perinaeum."

Fig. 6, Plate 62.--The lower half, c, b, f, of the pros­tate, having become the seat of abscess, appears hol­lowed out in the form of a sac. This sac is separated from the bladder by a horizontal septum, e e, the pro­per base of the bladder, g g. The prostatic urethra, between a e, has become vertical in respect to the membranous part of the canal, in consequence of the upward pressure of the abscess. The sac opens into the urethra, near the apex of the prostate, at the point c; and a catheter passed along the urethra has entered the orifice of the sac, the interior of which the instrument traverses, and the posterior wall of which it perforates. The bladder contains a large calculus, i. The bladder and sac do not communicate, but the urethra is a canal common to both. In a case of this sort it becomes evident that, although symptoms may strongly indicate either a retention of urine, or the presence of a stone in the bladder, any instrument taking the position and direction of d d, cannot relieve the one or detect the other; and such is the direction in which the instrument must of necessity pass, while the sac presents its orifice more in a line with the membranous part of the urethra than the neck of the bladder is. The sac will intervene between the rectum and the bladder; and on examination of the parts through the bowel, an instrument in the sac will readily be mistaken for being in the bladder, while neither a calculus in the bladder, nor this organ in a state of even extreme distention, can be detected by the touch any more than by the sound or catheter. If, while performing lithotomy in such a state of the parts, the staff occupy the situation of d d d, then the knife, following the staff, will open, not the bladder which contains the stone, but the sac, which, more­over, if it happen to be filled with urine regurgigated from the urethra, will render the deception more com­plete.