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IN the treatment of cases of prostatic hypertrophy one is frequently confronted with severe complicating conditions which require most careful study and treatment before an operation to cure the obstruction to urination can be carried out. The kidneys are so frequently injured by long standing back pressure that the phthalein test shows in more than 40 per cent. of the cases an impairment requiring drainage for a more or less protracted period and forced water by mouth to restore them to a sufficiently good condition for operation. The heart is also frequently involved as a result of the renal lesions, but both kidneys and heart usually improve rapidly on appropriate preparatory treatment so that perineal prostatectomy can be carried out without danger. The ordinary valvular lesions and moderately severe myocarditis are usually not sufficient to contra-indicate perineal prostatectomy, though care should be taken both in the preparatory care of the patient and in choice of anaesthetic-which should be ether in such cases. A quick operation and thorough packing of the wound to prevent loss of blood is sufficient to carry them through safely. It is often amazing to see how well they convalesce and in not a few instances the heart is benefited by the removal of a focus of infection in the prostate. Occasionally we meet with very severe cardiac conditions which do not clear up or improve sufficiently under careful hospital treatment to warrant the risk of a serious operation. Such cases usually go un-operated and unrelieved, and it is with the idea of furnishing a new means of curing such casies of urinary obstruction that I am presenting the following case: The patient arrived at the hospital in desperate coiidition. An enlarged prostate with I300 c.c. residual urine had led to great impairment of the kidneys, and severe degeneration of. the heart which was in such bad condition that the patient came near death several times during the nine months of treatment which he underwent. It was evident early that a serious operation was out of the question. Anasthesia 633

THE USE OF RADIUM AND THE PUNCH OPERATION IN DESPERATE CASES OF ENLARGED PROSTATE