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to be such a decided advance that I am sure no one who tries it will return to the old method. Buy Levitra Online Europe It consists in using water, not only tepid, as suggested by Keyes, but hot — as hot as the patient can bear it. I have been in the habit of beginning with a solution of borax (about fifteen grains to the pint) at a temperature of 100° F., and injecting a quan- tity slightly below that habitually contained by the particu- lar bladder under Buy Levitra Online Europe treatment, then by daily additions of an ounce or two, steadily increasing the amount until the whole pint or more could be retained for periods of time ranging from five minutes to two hours. As tolerance was estab- lished, I have increased the strength of the borax in the solution to 3 j, and the temperature to a point limited only by the feelings of the patient. About 112° to 120° F. is the ordinary limit ; improvement has been rapid in most cases submitted to this treatment, and increase of comfort obtained in all. Occasional small injections of astringents may be made by the surgeon, such as argent, nit., 3 j, aquje, f j, recommended by Gross; or by Thompson for daily use, acetate of lead, gr. j ; aquae, 3 iv. The use of opium, belladonna, and hemp by the rectum will aid in procuring rest at night Buy Levitra Online Europe Buy Levitra Online Europe where great irritability of the bladder exists ; but for soothing this, where the pa- tient can be visited by his surgeon, Harrison's catheter is one of the best agents at our command. The model exhibited was sent me through the courtesy of Mr. Harrison, and with it, as you see, the bladder can be emptied, and then, without withdrawing the instrument, a medicated suppository dropped into the organ and left to dissolve. The suppositories I show you Buy Levitra Online Europe contain each one Buy Levitra Online Europe exposure to cold or wet, slight excess in eating or drinking. unwonted exercise, etc., the action of which, on the sensi- tive prostate, is to produce congestion or even inflamma- tion, as manifested by muco-purulent discharge from the urethra. The occurrence of retention is usually announced by symptoms with which all are familiar, and the indica- tions for its treatment, viz. — relief Buy Levitra Online Europe of the over-distended bladder — only too plain. But the embarrassments which surround the operation are many. If the patient is one who has been under the care of an intelligent practitioner, and is accustomed to catheterization, but little difficulty is encountered ; but in many cases the sufferer is a stranger to the surgeon, who, called in an emergency, must deal with the case as he finds it. As a rule, soft instruments are to be first employed ; and of these my own preference, Buy Levitra Online Europe in case the urethra is undamaged by previous manipulation, is for the rubber in- strument known as Nekton's. This failing, I try the metallic instrument made from a spirally curved wire ribbon, 'known as Gross's ; not succeeding with these, an over-curved gum- elastic instrument, or the French olive-pointed, may succeed. The celebrated catheter of Squires has a deserved reputa- tion in these cases, and was invaluable before Buy Levitra Online Europe the introduc- tion of the flexible Buy Levitra Online Europe instruments now used. If false passages exist, or if the obstruction is due to an enlarged median portion, the elbowed catheter 'recommended by Mercier may often succeed, or a two-foot guide may be introduced if the canal is very narrow, and over it a small metallic or open-ended soft catheter be conducted into the bladder. Failing in all these attempts, the bladder may in rare cases be still reached by Buy Levitra Online Europe a silver prostatic catheter, an instrument which, in spite of its decreasing Buy Levitra Online Europe popularity, I do not feel like dropping from my armamentarium, as I have succeeded several times in thus emptying bladders upon which every- thing else had been tried in vain. Valuable assistance can be given to the points of several of these instruments by a finger introduced into the rectum, and serving to guide them over the obstruction. This is especially valuable in cases where danger of creating a false passage exists, the point of an unyielding instrument being easily swerved from its course, and if undue force is em- ployed entering the tissues about the neck and base of the bladder, or tunneling its way between the prostate and rectum. I have seen several cases in which death occurred within a few days after the wounding of the deep urethra from in- struments used by patients themselves. In one, a patient of Dr. Skene's, an old man of seventy-four pushed a bougie which Buy Levitra Online Europe he had mistaken for a catheter directly into an en- larged median lobe, which, having reached the size of a small fig, lay directly in the track of the urethra, and gave rise to such severe hiemorrhage that the patient yielded to the exhaustion and shock incident to his injury within four days. Another old man of sixty-two, seen with Dr. G. Os- trander, broke a defective catheter in his deep urethra, and, although the piece was passed immediately after, with a large quantity of bloody urine, death ensued in about thirty- six hours. Several patients have within the last six months been sent into my service at St. Mary's with fresh false pas- sages, or copious hemorrhages, the results of accidents dur- 34 ROCKWELL: PATE0L007 AND TREATMENT OF ENLARGED PROSTATE. [N. Y. Mkd. JouR.r ing eflforts to relieve retention due to prostatic obstruction. Fortunately Buy Levitra Online Europe for the surgeon, urinary extravasation is a rare complication of the accident under discussion. If the pa- tient survives the immediate haemorrhage and shock, much can be done to alleviate or even remove the conditions pres- ent. The great dangers are haemorrhage, shock, or pelvic cellulitis due to wound of the investing fascia, or peritonitis secondary to the other complications. A glance at the anatomy of the parts concerned will give the reason for the facts just mentioned. Urinary extravasations, as a rule, oc- cur in portions of Buy Levitra Online Europe the urethra anterior to the triangular liga- ment, and find their way into the cellular planes which are bounded by the deep perineal fascia, and the sheath of the penis, or " Buck's fascia." Hence we find all grades of in- flammatory action following wounds in this vicinity, from simple perineal abscess to gangrenous destruction of all the tissues contained in the inferior or penile chamber of Til- laux, the scrotum, penis, and cellular tissue of the pubes