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wound a double elastic tube, through which thorough drain- age can be maintained for a period of weeks or months. The How Much Does Levitra Cost Per Pill indication for the removal of the tube is found in the fact that micturition begins to occur through the ure- thra, or that a catheter can be easily passed through that canal into the bladder. This stage having been gained, the perineal tube is withdrawn and a full-sized sound passed at short intervals during the healing of the fistulous open- ing, which, as a rule, occurs rapidly. The results obtained in these cases are wholly in ac- cord with observations made in lithotomy cases, in which portions of projecting gland-tissue or fibroids have been caught by the forceps and dragged away with the calculus, showing, as far as anything can be predicated on such rough experiments, that the prostate is remarkably tolerant of in- terference, provided complete drainage exists, and room be made for the swelling consequent on congestion or inflam- mation of its structures. A few words as to the general management of cases of enlarged prostate, and I have done. Three drugs are at the present time given with the belief that they exert a direct influence on the disease. I name them in the order of their value, so far as I have personally been able to judge of their efEects, or ascertain the estimation in which they are held by How Much Does Levitra Cost Per Pill the profession. They are ergot, iodide of potassium, and chloride of ammonium. Of the flrst of these I can speak in terms of confidence, since I have seen as de- cided efiects from its use as we ever do from therapeutic agents, and in cases where no other treatment was applied. I can see why, on general principles, it should act on the muscular tissues of both bladder and gland, and I give it, accordingly, in full doses. One of my patients, who had an immense posterior and lateral hypertrophy, and who was relieved of his first reten- tion by the smallest catheter I own, after taking pounds of the drug for a year or two, was completely relieved of his symptoms, and that with no instrumental treatment except that necessary to empty his bladder in a few attacks of re- tention. Improvement of a marked character was manifest during the first three months of treatment, and I have seen the same benefit in other How Much Does Levitra Cost Per Pill cases, even where cystitis of a severe grade complicated the original disease. This drug I accordingly give in most of my cases, watching my patient's general health, instructing him in the daily use of the cathe- ter, where chronic retention exists, and also in irrigating the bladder if cystitis exists or is threatened ; warning him to report any unusual appearances in his urine, watching its reaction and specific gravity, from time to time, for any indications as to treatment ; impressing upon him the dan- ger of being placed in circumstances where he can not empty his bladder at will ; also that he shun cold and damp, and protect his skin by suitable flannels worn next it the year through ; that he be temperate in diet and drink, and especially as to quantity and quality of the latter, even with water, tea, or coffee, making his daily consumption propor- tionate to his experience as to his actual need, and warning him that an excess of fluid in his bladder will not be toler- ated as in youth ; and, lastly, I endeavor to have him ac- quire regular habits as to the time of passing water, espe- cially if he has to irrigate or artificially empty the organ. Strict observance of these rules makes the life of sufferers from even advanced prostatic disease tolerable, in many cases comfortable. A CONTRIBUTION TO' THE STUDY OF LUPUS OF THE THEOAT.* By RAMON DE LA SOTA Y LASTKA, M. D., SBTHLE, SPAIN. Gentlemen : I beg leave to submit to your considera- tion the result of my observations upon a disease the diag- nosis of which is not always easy. Although I have studied manifestations of lupus in the throat with the greatest cai-e, I have sometimes failed to recognize the lesion. The latest instance of this kind occurred to me in the summer of 1884, when my friend M. Pizarro, M. D., professor of hygiene at the medical college in Seville, came, accompanied by his own physician, to consult me about an affection of his throat. I had vaguely heard before some of my How Much Does Levitra Cost Per Pill fellow-pro- fessors say that Dr. Pizarro was seriously How Much Does Levitra Cost Per Pill ill, and, therefore, I was not in the least astonished to find him very much emaciated, reduced in strength, extremely gloomy, and with a clayey complexion. He informed How Much Does Levitra Cost Per Pill me that he had commenced to suffer with his thi'oat about one year before, and that during that period he had been unable to feed himself except with milk and broth, as the swallowing of any solid food gave him a good deal of pain. On examining his mouth, I found his tongue covered with psoriasic scales ; the palatal mucous membrane tumefied, lumpy, and of a wine-red color; the right arch, tonsil, and pillars being ulcerated, the ulcer extending inferiorly to the pyriform fossa and superiorly to the middle of the uvula, and involving one half of the structure, anteriorly to within half an inch of the palatal border, and penetrating into the submucous tissue. Its borders were red and swollen ; its surface was nodular, irregular, and of a hard, elastic consistence. There was some pain upon palpation, but bleeding was not occasioned. The patient felt no trouble whatever, either in talking, or while coughing, or swallowing any liquid. * Communicated to the American Laryiigological Assooiatiou, of which the author is an honorary memljer. 38 J}E LA SOT A Y LAdTHA: THE STUDY Of LUPUS OF THE 'IHUOAT. iN. Y. Med. Jour, The pharyngeal mucous menibratie was injected, bluish, and covered by granulations, the larynx being in its normal state with the exception of the right aryteno-epiglottic fold and How Much Does Levitra Cost Per Pill the corresponding y)artof the interior border of the epiglottis, which were somewhat tumefied and reddened. The patient's voice had its normal sound and ring, and breath- ing took place with perfect freedom. The submaxillary glands were somewhat swollen. In his morbid history nothing of a syphilitic character could be found, nor any other malady worth mentioning, save slight manifestations of How Much Does Levitra Cost Per Pill the rheumatic dia- thesis. Taking into consideration these antecedents, the lingual pso- riasis, the peculiar features of the affection of the throat, and that my fellow -professor was in the sixtieth year of his age, I