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pool, who has recently described it in a little pamphlet, " On the Prevention of Prostatic Obstruction," and it is briefly this : Having under his care a gentleman who, several years before, had been informed that he was affected with the early stages of prostatic enlargement, and who, in conse- quence of his dread of the disease, had daily passed a full- sized gum bougie upon himself, and, having occasion to make an autopsy upon this patient after his death from some other cause, he having meanwhile presented no signs of prostatic obstruction, he found, to use his own words, that, "though the middle portion of his prostate was considera- Donde Venden Levitra Generico En Mexico bly enlarged, the level and patency of the prostatic urethra were in no way altered, the growth or enlargement being, as it were, deeply bisected by the canal which the daily use of the instrument had impressed upon it." Struck by the benetioial results of the treatment, as seen in this, case, Har- rison began experimenting, and has formulated a treatment which he has now successfully used for several years, which is certainly an improvement upon the earlier attempts of Mercier and Thompson, by dilatation or divulsion, and elas- tic compression. Immediately on the detection of urinary obstruction the patient is put upon the daily use of an olivary bougie, the size of which is determined by the surgeon, until the pa- tient is wholly competent to manage this part of his treat- ment Donde Venden Levitra Generico En Mexico for himself. If, for any reason, the daily introduction of this instrument is undesirable or impossible, the patient is compelled to attend to it at least three times a week, upon retiring at night. The peculiar shape of the instru- ment exercises pressure upon the narrowed canal as it is passed through into the bladder, and again as it is slowly withdrawn — a point which Harrison deems essential, as it corresponds with the direction of the dilatation caused by the stream of urine. Some stress is laid upon the position of the patient while passing the bougie, which should be a recumbent one, with the buttocks slightly raised, the in- strument being passed slowly down the urethra until fairly in the bladder, and then gently withdrawn. This procedure should be at first repeated every fort}'- eight hours, then every twenty-four hours, and, where en- largement is already somewhat advanced, twice daily, no limit being put to the time over which treatment should extend, simply that it should be persevered in long after all signs of obstruction have ceased. Where any intolerance to the treatment exists, careful inquiry into the presence of abnormal quantities of uric acid in the urine is suggested — a hint which holds good over the entire field of urethral therapeutics. Where residual urine habitually remains in the bas-fond of the bladder, a catheter shaped like the bougie is used, and all the benefits of self-catheterization are added to those just mentioned. I have at present under my observation an old sea captain whom I have directed in the care of his own case for the past six years. During the last four he has been steadily following the foregoing plan, and for the past year has only used his catheter once or twice for a few days, because he fancied his troubles were about to return. When he began treatment he had already had one or two retentions, and was suffering from a chronic cystitis. The first use of the instrument was followed by an aggravation of his cystitis and a swelled testicle, but tolerance was at length established, and he is now free from all obstructive trouble. In regard to the management of the complications which exist during the early or moderately advanced stages of enlarged prostate, time will only allow the mention of two — residual urine and cystitis — and in both cases the question of self-catheterization is the first to be settled, if ultimate success is to be achieved. A careful study of the peculiarities of each case can alone determine what form of instrument will best suit a given case, though practically the choice is limited to one or two Donde Venden Levitra Generico En Mexico of the varieties about to be mentioned. The surgeon must be prepared to give much time and trouble to the examination and instruction of his patient until dexterity and self-confidence have been acquired in the use of the instrument chosen, Donde Venden Levitra Generico En Mexico and then a small stock should be selected by the surgeon himself, and kept by the patient for daily Donde Venden Levitra Generico En Mexico use. He should be instructed in the dangers at- tending the use of imperfect or brittle rubber and gum Donde Venden Levitra Generico En Mexico in- struments, and shiuld pay particular attention to the edges of the eye, lest an irregularity in its surface set up irritation and inflammation of urethra or testicle. All these points being attended to (and they amply repay one for the Donde Venden Levitra Generico En Mexico labor expended), the patient, who may have simply residual urine, is to be treated in accordance with the amount habitually retained, as ascertained by passing a catheter immediately after the patient has passed his water in the ordinary man ner. If only two or three ounces are withdrawn, emptying the bladder once a day will suffice, say before retiring ; if double the quantity, twice daily; if more is retained than is habitually expelled by voluntary eftbrt, then three times a day — say at 6 a. m. and 4 and 12 p. m. — thus giving the pa- tient longer hours of sleep than he might otherwise pro- cure. I have several patients who use the catheter five or six times a day or oftener; but the rule is as I have just stated. No harm, however, follows the frequent use of a properly selected instrument, as the urethra is wonderfully patient, and, like the bladder, tolerates a quantity and va- riety of treatment wonderful to contemplate. Should de- composition of urea have occurred before the case comes under treatment, irrigation of the bladder should be prac- ticed as in cystitis. Sooner or later, however, in all cases which have not July 10, 1886.] ROCKWELL: PATHOLOGY AND TREATMENT OF ENLARQEI) PROSTATE. 33 been treated early, and in some of those which have, the latter disease makes its appearance and must be managed, so far as general treatment goes, on ordinary principles. Each practitioner has his own favorite formulas. My own preferences Donde Venden Levitra Generico En Mexico are decidedly in favor of the uva ursi, or triticum repens, in combination with buchu, where it will agree with the stomach. Better results are obtained in some of these cases by giving the alkalies, citrate or bicar- bonate of potassium, or liquor potassse, largely diluted ; or, where great Donde Venden Levitra Generico En Mexico irritability exists, a strict diet of milk and Vichy, or milk and limewater (equal parts). Irrigation of he bladder by the Donde Venden Levitra Generico En Mexico apparatus of Van Buren and Keyes has, however, given better results than any other treatment with ■which I am acquainted. A modification which I have used for some years seems