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thritis will seek medical treatment, the physician will save himself the trouble of much examination or will be prejudiced in favor of the prostate in his examination ; therefore he will simply begin to treat the prostate by the usual means, that is, by massage, and very frequently he will continue to do so, even without any apparent results until Buy Viagra Online Australia Legally the patient's endurance becomes exhausted and some- body else discovers the real conditions after the precious loss of time and presumably of money. The predilection for the prostatic treatment is perhaps largely favored because it places the situa- tion entirely in the personal judgment of the physi- cian Buy Viagra Online Australia Legally himself and gives the patient hardly any con- trol of his condition. The diagnosis of Buy Viagra Online Australia Legally chronic prostatitis, or rather Buy Viagra Online Australia Legally of the participation of the prostate in the gonorrhoeal infection, is by no means as simple and definite as a great many physicians Buy Viagra Online Australia Legally seem to imagine. Subjective symptoms may be en- tirely absent, and when they are present, none is absolutely pathognomic of prostate afifecticns. Rectal palpation, although always necessary and of a certain value, in a number of cases is not reliable and often without the slightest significance with regard to infection. Surgical experience has shown that even Buy Viagra Online Australia Legally in decided chronic hypertrophy of the prostate palpation may fail to demonstrate the slightest abnormity. The size, shape, and consist- ence of the gland' vary within wide limits ; some- times there does not appear even a prominence in the prostatic region, or it is impossible to detect any circumscribed, resistant body there, and in no- torious cases of prostatic infection it is not possible to demonstrate any irregularity in shape, size, con- sistence, or sensitiveness. Much, of course, de- pends on the quality of the touch applied. Under these conditions I cannot Buy Viagra Online Australia Legally help feeling somewhat skeptical with regard to the reflex or sympathetic enlargement of the prostate which Huhner says to have observed in almost every case and in almost every stage of gonorrhoea. As to other means of diagnosis, the urine may be continuously and entirely free of shreds and clear, although usually it will present some not characteristic features of chronic gonorrhoea. It is therefore almost generally agreed that for the diagnosis of prostatic infection we have mainly to rely on the microscopical examination of the pros- tatic secretion, such examination to be very exact and to be repeated several times, eventually after a provocative injection of silver nitrate solution. The methods of obtaining the prostatic secretion as uncontaminated as possible have been amply de- scribed by different writers, generally with the ac- knowledgment of their difficulty and of their un- deniable uncertainty. This, however, may be re- duced so much in the hands of careful observers that its consideration may well be waived. The demonstration of the gonococci, either alone or ac- companied by other bacteria, establishes the diag- nosis at once ; but unfortunately this has been ac- compli.^hed only in a certain proportion of the cases. In their absence the Buy Viagra Online Australia Legally diagnosis depends on the pres- ence of other microbes and principally on at least a fair number of pus cells (.Saxe). With regard to the significance of the pus cells or multinuclear Buy Viagra Online Australia Legally round cells in the prostatic secretion opinions are not in full accord. Some authors declare that as long as even any single pus cells are present, there is still prostatic inflammation and no cure. Saxe states that he is satisfied of a cure, when all germs have vanished, when the number of pus cells has been reduced to a very small one, when the patient has no symptoms, and his urine is clear. My own experience has led to similar conclusions, perhaps slightly farther to the conviction, that a number of multinuclear round cells may be met with in every prostatic secretion even from perfectly healthy in- dividuals. Recently Bjorling, in an article on the Constitu- tion of the Prostatic Bodies {Archiv. fiir Derma- tologic, ciii, p. 37), states as the result of extensive investigations, that life leucocytes in the secretion of the prostate very likely do not establish a patho- logical condition, even if present in copious num- bers. "Leucocytes," he argues, "are never want- ing in the prostatic secretion ; their number varies between several single ones and large numbers. A distinction between a normal prostate, sexual neur- asthenia, and chronic gonorrhoea cannot be demon- strated by their relative number. It is impossible in the two last named conditions to prove a definite relation between the subjective symptoms and the relative frequency of leucocytes. In cases exam- ined with reference to these conditions only lift- leucocytes were found." Bjorling considers it as probable that the prostatic bodies are the product of cell degeneration, possibly of leucocytes. Bjor- ling's statements may need further confirmation by other investigators, still they add to the confinna- tion of the fact, that the diagnosis of chronic in- fection of the prostate is neither simple nor abso- lutely certain. As I have stated before, there is not much dan- ger that experienced urologists who are used to conscientious investigations should commit errors of diagnosis and treatment of chronic gonorrhoea cases. But as to those practitioners who do no: usually make microscopical examinations of the prostatic secretion, by which symptoms, by what principles will they be guided in the management of their patients? When will they begin to mas- sage the prostate and when will they stop doing so. as long as they are taught that the prostate is af- fected in every case of chronic gonorrhoea ? There is no rule or gauge for measuring the force which may be safely applied to the massage of the pros- tate ; so one may use sufficient pressure to squeeze some fluid out of the driest prostate and will con- sider the appearance of any secretion as sufficient evidence of a pathological condition and as a suf- ficient excuse for an indefinite Buy Viagra Online Australia Legally course of massage treatment. I cannot convince myself that it is con- tributive to the welfare of the prostate to be squeezed regularly with more or less energ)', the more so as it is generally Buy Viagra Online Australia Legally considered as the seat of various nervous symptoms which constitute or form part of that complex of symptoms usually de- scribed as sexual neurasthenia. Indeed. I firmly believe from actual observations of patients that unnecessary massage of the prostate, even if noi too severe, is liable to produce a more or less in-