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its more formidable-looking fellow. Commenting upon the relation of the histology of this affection to its etiology. Sir Henry Thompson has presented a theory which, to my mind, is so much Reputable Online Pharmacy Levitra more satisfactory than those of previous writers that I give it in full in his own words : It is an interesting fact that the prostate, male homologue of the uterus, should exhibit analogies in many points Reputable Online Pharmacy Levitra of view with the latter organ in regard to its tendency to overgrowth. The most obvious explanation, and the conclusion which, after a careful examination of the subject, is that which appears to Reputable Online Pharmacy Levitra me better supported than any other, seems to be offered in the simple fact, now completely establishefl, that the structure In both is exceedingly prone to develop among its component elements minute independent or isolated formations, possessing an organization identical with itself, which formations in the majority of cases do not increase beyond a certain very limited size, and do not Reputable Online Pharmacy Levitra interfere witli the performance of any known function in either sex, but which, in exceptional instances, continue to be developed for the most Reputable Online Pharmacy Levitra part only during a cer- tain limited period of life, say between thirty -five and fifty in the female, and between fifty and seventy in the male; in the one case appearing in the form of uterine hypertrophy or tumor, in Reputable Online Pharmacy Levitra the other in the form of prostatic hypertrophy or tumor. Whether the formation of these products is anything more than a contingency of structure — that is, whether it is to be con- nected with any functional action common to the structure in both cases — is more doubttul. In spite of this theor}', however, the author vigorously combats the idea that hypertrophy of the prostate or tumor is a necessary concomitant of old age. In fact — as has been proved by laborious investigations — it is an abnormal and exceptional condition occurring in about one out of every seven or eight males who have reached the age of sixty, perhaps one out of three having a slight tendency to en- largement scarcely recognizable during life, either by symp- toms produced thereby or on physical examination, so that, in general practice, the number of persons who actually suffer from forms of prostatic trouble, needing surgical re- lief, is much smaller than is generally supposed. The nature of the complaint, too, the insidious Reputable Online Pharmacy Levitra and gradual approach of its early symptoms, and the readiness with which old men apply all sorts of domestic and propri- etary remedies to the treatment of their ailments, all serve to keep the patient away from the surgeon until compelled to seek his aid by some new phase of the disease which de- velops its serious nature. This is peculiarly unfortunate, because it is at these very earliest stages that much can be done to prevent or favorably modify the course of the disease, and it is then that the family physician is usually consulted, or, at any rate, is made aware of facts which should arouse his sus- picions and lead to b Reputable Online Pharmacy Levitra thorough examination of the case. The first thing which usually attracts the patient's at- tention is an unwonted difficulty in Reputable Online Pharmacy Levitra commencing the act of micturition, and a decrease in the Reputable Online Pharmacy Levitra force with which the stream Reputable Online Pharmacy Levitra of urine is projected, so that, if water is passed in the standing posture, the stream falls almost directlv upon the feet. The patient also notices that, after he has appar- ently completed the act, small quantities of urine dribble away, soiling the clothing and giving rise to the idea that he is suffering from paralysis of the bladder or inconti- nence — an idea which is often confirmed by the symptoms which soon follow and will be spoken of presently. An- other very common symptom of this stage of the disease is pain, either in the lumbar or sacral region or along the sci- ' atic and femoral nerves. This so closely resembles the lumbagoes, rheumatisms, and sciaticas of advanced life that patient and physician are both deceived into inappropriate and, of course, useless treatment, during which increased frequency of micturition, aching pains, and fullness in the rectum and perinieura, or about the hypogastrium and neck of the bladder, with in- creased difficulty in starting the stream of urine, and changes in the appearance and odor of the fluid itself, all excite the patient's alarm and lead him to seek surgical assistance, if he has not before done so. Many patients, of course, present themselves who have, according to their habits of life and temperaments, compli- cations which at once arouse the suspicion of a watchful physician as to Reputable Online Pharmacy Levitra their origin in prostatic enlargement. Among these are hjemorrhoids, involuntary discharge of Reputable Online Pharmacy Levitra fpeces accompanying the act of micturition, prolapsus of the bowels, muco-purulent discharge from the urethra, swollen or irritable testis, frequent erections and involun- tary seminal discharges, generally occurring at night, hernia from the severe expulsive efforts required to empty the bladder, and various nervous symptoms of a reflex charac- ter. These disorders, however, are by no means constant, and are only mentioned because of the important fact I am trying to give prominence to — that the earlier stages of the disease are so easily overlooked by all interested as to be completely masked by the very complications they elicit. Assuming that (as in many typical cases) the disease has progressed to the point just described without alarming symptoms, a new feature now presents itself which merits special description, as upon its correct interpretation de- pend the proper treatment of the patient and his ultimate safety. This is retention of urine, either partial or com- plete. Partial retention is altogether the more frequent form at this stage of the disease, and is caused in the fol- lowing manner: The gradual enlargement of the prostate, which has been going on for months, possibly for years, before this condition obtains, has resulted in the elongation of the pro- static Reputable Online Pharmacy Levitra urethra and gradual elevation of the vesical outlet, so that the floor of the bladder, which normally is an inclined plane sloping toward the urethra, has now become a cup or July 10, 1886.1 ROCKWELL: PATHOLOaT AND TREATMENT OF ENLARGED PROSTATE. 31 cavity capable of containing several ounces of urine. The result of this is obvious. The vesical outlet being above the water-level of a portion of the bladder's contents, ounces of decomposing urine are continually in contact with its mu- cous membrane, and cystitis, with all its complications of calculus, dilated ureters, and diseased kidneys, is or may be added to the rapidly increasing list of the patient's suffer- ings. As a direct sequence of these, the contractile power of the bladder is steadily lessened, or, even if hypertrophy of its walls exists, it is incompetent to wholly overcome the re-