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WASHINGTON, Aygestin 5 Mg D. C. It was no less distinguished surgeon than Freyer of London who in his admirable textbook on "Surgical Diseases of Buy Aygestin the Urinary Organs" said: "The disgusting practice of massage of the pros- tate, advocated by some surgeons in America and on the Continent, should never be had recourse to. It is useless and has grave objections at- tached to its employment." It is the purpose of this paper to invite to the members of the society a renewed interest in this often overlooked dis- ease, chronic prostatitis, and to detail some of the brilliant results obtained by this "disgusting and dangerous practice," prostatic massage. No prac- tice which affords relief to distressing symptoms can possibly be disgusting and I am still looking for immediate or remote dangers from this im- portant addition to therapeutic measures. The name, chronic prostatitis, implies its own definition but is also usually understood to include chronic catarrhal processes in the seminal vesi- cles and ampullje of the vasa deferentia. The most potent etiological factor Buy Norethindrone Acetate is gonorrheal in- fection. This is the probable cause in a majority of cases. A study of 50 cases in my practice has shown a history of gonorrhea in 32 or 64 per cent, and no history of gonorrhea in 18 or 36 per cent. This is, I believe, closely in accord with the ob- servations of others. A further study of my cases has convinced me of the growing importance of other factors, notably, masturbation and long con- tinued sexual excitement without intercourse. A study of the gonorrheal cases impresses me that in many of them a chronic catarrhal process Aygestin Tablets had been existent before the invasion by the gonococ- cus and that in these cases gonorrhea runs a more protracted and severe course. Other causes of less importance are injury, descending infection, and excessive intercourse. A recent communication by Hichens and Brown of the Mulford laboratories has given us our most exact information on the bacteriology of chronic prostatitis. The decreasing importance of the gonococcus and colon bacillus and the prominence of the various staphylococci, streptococci, and bacilli of the diphtheroid type are strikingly illus- trated by their work. It is undoubtedly true that the prostatic mucous membrane is an excellent host for a great variety of organisms. The essential tissues of the prostate are the glandular and the muscular tissues, the stroma, *Read before the George Washington University Medical Society, January 17, 1914. nerves, blood-vessels, and lymphatics. The stroma and muscular elements arise from the capsule and ramify around the gland acini. The glandular ar- rangement has all the complexity of the acinous and tubular types. It is only natural that infec- tions of the posterior urethra must invade the prostatic Aygestin Cost ducts and this practically always oc- curs. The infection may travel to any or all parts of the gland and give rise to various degrees of inflammation. Young, Geraghty, and Stevens have described the tissue changes as involving both the parenchymatous and periacinous elements, the periacinous infiltration appearing to be most prominent. The gland acini may in some cases be dilated ajid filled with desquamated epithelium and leucocytes, in other cases only vestiges of the gland elements remain, the predominant tis- sue here being of a fibrous nature. The muscular elements are thinned out from pressure by the dilated gland sacs. Grossly the gland may ap- pear normal in size and Norethindrone Acetate Tablets appearance or show en- largement and irregularities. Palpation may re- veal areas of induration or softening. Associ- ated with these changes are found various de- grees of inflammation in the seminal vesicles and ampullaj of the vasa deferentia. The normal se- cretion of the prostate consists principally of lecithin and this in chronic prostatitis is largely or wholly replaced by pus. Generic Aygestin The nerve elements in the prostate command the greatest attention. Sensory fibers reach the prostate from the Aygestin Price tenth and eleventh dorsal, the five lumbar, and the first, second, and third sacral nerves. The secretory fibers come from the sac- ral plexus of the sympathetic. Large ganglionic areas are found underneath the capsule. The rea- son for this Aygestin 5mg remarkable and abundant nerve sup- ply is not understood. Undoubtedly it concerns in large degree the sexual function and plays an important part in the various sexual disturbances of the Aygestin Online male. Certain it is that inflammatory dis- turbances in the prostate gland may cause most remarkable symptoms. The symptoms of chronic prostatitis are usually Buy Aygestin Online classified as urinary, sexual, and referred, follow- ing the designation of Young, Geraghty, and Stev- ens. While most cases may be grouped under these headings I have frequently encountered cases which had no other complaint than a ure- thral discharge, and others which had no signs or symptoms whatever of chronic prostatitis and which on rectal examination and examination of the expressed Buy Cheap Aygestin secretion showed marked inflam- mation of the gland. The sexual symptoms are usually closely identified with disease of the col- liculus or verumontanum. Space will not permit a discussion of this interesting and important condition. In detailing the symptoms of chronic prostatitis the author asks the reader's indulgence in an analysis of 50 cases gathered from his practice. Although the number of symptoms appears large it will be noticed that there is a similarity in dis- tribution and character and one soon learns to suspect the existence of this disease when a new symptom presents itself. An example of this oc- curred recently: Case I. — J. H. O., aged 25. Had gonorrhea five

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