Related article: The second, suggested by Dr. Mears of Philadelphia, is ligature of the spermatic cords, with the hope of producing atrophy of the prostate, by a similar effect to that of cas- tration, but by a lesser operation. Of this method there is not sufficient experience to base a judgment upon at present. . The third seems likely to revolutionize the treatment, and may perhaps replace and make obsolete all the opera- tions which I have been describing to you. It is that of double castration, Clindamycin Cleocin proposed by Prof. William White, of Philadelphia, in June, 1893. This part of the subject will be presented by Dr.- Cabot, and I will therefore not enter upon it. Order Cleocin DISCUSSION. Dr. L. Bolton Bangs, of ]S T ew York City. It is need- less for me to say to you that the subject of prostatic en- largement and its treatment is, in my opinion, one of the most important surgical discussions of the day. When we consider the relation of enlargement of the prostate to human suffering, when we consider how many men of ad- vancing years, who ought to go down to their graves in comfort, are the subjects of it, you will readily see, and I am sure you will agree Cleocin 150 with me in my opening remark, that it is one of the most important surgical questions of to-day to know how best to deal with it. It has been stated by various teachers, by different sur- geons, that prostatic enlargement makes its appearance in one man in three after the age of fifty, as some have it ; and others state it after the age of sixty, and that one man in ten suffers from it. I once endeavored to make a record of all OF PROSTATIC HYPERTROPHY. 689 the men I examined to determine how many really had pros- tatic enlargement, and whether my statistics are in agreement with " one man in three " I am not sure at this moment, but I came to the conclusion after observing a great many cases of my own that we are wrong in stating that pros- tatic enlargement begins after the age of fifty. I believe that Cheap Cleocin it begins, not that it always shows symptoms, at an earlier age than fifty or thereabouts. At any rate, there are enough men sufferers from this condition. I Purchase Cleocin may have it ; you may have it. It comes to be a grim thing when we contemplate it from the personal standpoint, therefore there is sufficient Buy Cleocin Online cause to warrant taking every step, to balance with care everything presented to our attention, and to consider how best we shall treat these sufferers. In the main I agree with everything that has been said in the able presentation of this subject this afternoon, cer- tainly with regard to the palliative treatment, and for my comfort as well as for yours it should be borne in mind that the largest proportion of men with prostatic enlargement, even admitting the fact that it begins early in life, have no urinary symptoms, certainly not to a degree requiring the intervention of a surgeon. Now then as to palliation. Bearing in mind that a large proportion of men with enlarged prostate have no symp- toms, and that another proportion of them do have symp- toms, it is also a satisfactory fact, perhaps to you, certainly to me, that these can go through life with only palliative treatment, and require no operation whatever. Of course that statement is to be modified by the condition of the individual who presents himself to you, and may be modi- fied also by the stage of the disease at which he presents himself and by its progress. You all know men who seem so immune, whose tissues are so indifferent to the inroads of microbic bodies. I have in mind a man of eighty-two, strong, looking well, who never makes a drop of urine spontaneously, but carries his catheter in his hat and in the absence of any other more suitable lubricant spits upon his catheter when he wishes to urinate. That illustrates what we know of the immunity with which a certain number of individuals can go down to their graves with easy, comfort- able catheter life. 690 THE TREATMENT OF Besides palliative treatment or catheter life there is a consideration of the care Cleocin 150 Mg of the bladder in regard to which I think we ought to say a word or two, and that is a treat- ment of the individual himself. If you can only impress upon such a patient the fact that he is a ^prostatic" and therefore has a weak point, and that he ought to go to his doctor at certain regular intervals in the same way and with the same cheerfulness that he would pay his fire insurance premiums upon his house! He does not want. a fire nor does he want future damage to his bladder. If he will pay periodic visits to his doctor who will overlook his bladder, many of these individuals who have been compelled to find their way to the hospital or to the office of the surgeon for operative procedure will escape it I believe. If the same attention were paid to a man who has a prostatic enlarge- ment as is often paid to the heart of the individual who has such an organic weakness I believe many a man would live out his time with simply palliative treatment. Dr. Cabot in his admirable resume of the palliative treat- ment mentioned to you the cases which constantly arise in which the very first symptom calling the attention of the individual to the fact that he is a prostatic is retention of urine. Of course I admit that his statement is correct ; that is, there is a sudden congestion. In advancing life the valves in the prostatic and pelvic plexuses disappear and there is a direct flow of blood from the rectum and associated portions of the pelvis through the prostatic plexus. Hence conges-