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April 22, I9'>] OGILIY: CHROXIC BACKACHE. 773 tense and lasting irritation of that gland sometimes with considerable pain and followed by those neu- rasthenic symptoms, whether the individual had been infected Cheap Viagra Overnight with gonorrhoea or not. In the for- mer instance the patients are exposed to another danger, namely, that the prostate in consequence of its treatment may actually be infected with gono- cocci which might be present in the posterior ure- thra without so far having entered the prostatic ducts themselves. It is obvious that an organ of the structure of the prostate, surrounded by a rather resistant capsule, when compressed by some force from the outside, will have the tendency to assume its former shape and volume as soon as the pressure ceases to act. The relaxation from the pressure will therefore be followed by a negative pressure in the prostatic ducts and by the aspira- tion of whatever fluid may surround their openings Cheap Viagra Overnight in the prostatic urethra and into the ducts and far- ther up in the prostatic vesicles until the pressure is again equalized. In this way the deeper portions of the gland may become infected with gonococci which were Cheap Viagra Overnight present Cheap Viagra Overnight in the mucous membrane of the posterior urethra or had previously entered only the larger ducts from which they had been swept out by the massage. I had for some time come to the conclusion that this danger certainly existed in connection with prostatic massage when my attention was directed to a paper by Carl Schindler, of Berlin, a former assistant of Neisser, who, in Cheap Viagra Overnight a paper on the Sig- nificance for the Pathology and Therapeutics of Gonorrhoea in Men of the Contractions of Invol- untary j\luscles and their Dependence on Atropine {Berlitier kUnischc Wochensckrift, 1909. p. 1691), writes as follows: The confidence that you can free a prostate from gono cocci by massage is founded on physically wrong concep- tions. On the contrary, gonococci still localized are dif- fusely spread over the entire prostate by massage, not only in consequence of the mechanical friction and of the auto- contraction of the glandular muscles, but also through the autonomous action of the coUiculus seminalis, the automat- ism of which is increased by ref^e.x action during massage. At Cheap Viagra Overnight the moment of relaxation of the colliculus aspiration takes place, so that some of the secretion which runs out duringthe Cheap Viagra Overnight massage, flows back into all the terminal vesicles of the gland, as can be demonstrated on a section of the prostate. If the secretion which flows out during the massage is contaminated with gonococci which perhaps pre- viously had been localized in a single terminal vesicle, now the gonococci during the moment of reaspiration, may easily reach all the terminal vesicles. I object on principle, Schindler continues, to massage of the prostate during the acute and subacute stages of gon- orrhoea, and now for a year I have seen a remarkably rapid cure not only of severe prostatitis but also of the gonorrhoea although, or perhaps because, I left the prostate absolutely undisturbed. I also, as a rule, omit during the acute stage the probatory expression of the prostate, lie- cause at this stage of the disea.se the microscopical proof of the presence of the gonococci is immaterial to Cheap Viagra Overnight the cure of the patient and likely to do harm. A single negative finding does not prove anything and through Cheap Viagra Overnight Cheap Viagra Overnight repeated c\ plorator>' massage only too easily an originally ^till local- ized prostatitis can turn into a diffuse one. .^b5cesse? or ';oftened foci, which are not absorbed, must be expressed also toward the end of the treatment if a complete resorption of Cheap Viagra Overnight the prostatic infiltrations fias not taken place: gentle massage of the prostate mav be useful not only in order to eliminate gonococci with t'^e Cheap Viagra Overnight secretion but solely to stimulate the tonus of the bloodvessels and muscles and therebv the absorption itself. In chronic gniiorrhcea or before giving our consent to marriage the repeated energetic expression of the prostate cannot be dispensed with, because it Mas to be demonstrat- ed, whether the candidate for marriage is a latent carrier of gonococci and whether a reinfection of the urethra from the prostate or the seminal vesicles has still to be appre- hended. I have cited Schindler the more fully believing that some colleagues may be more readily inclined to give some consideration to this question if it is sup- ported by some foreign authority, although it would seem that the unprejudiced e.xamination of the facts would make the latter speak for themselves. CONCLUSION. In conclusion I wish to einphasize: 1. That the prostate is not affected in all cases of chronic gonorrhoea, but that various conditions of the anterior urethra are just as liable to cause the prolongation of the gonorrhoeal infection. 2. That the doctrine that the prostate takes part in every case of chronic gonorrhoea is a mischiev- ous and dangerous one because it will lead to Cheap Viagra Overnight neg- lect and oversight of the chronic lesions of Cheap Viagra Overnight the an- terior urethra, because it favors the indiscriminate application of prostatic massage with the incidental! opjjortunity for spreading the infection of the pros- tate. 3. That massage of the prostate should be re- stricted as much as possible, because its populariza- tion is liable to corrupt public morals. 6x6 M.^DisoN Avenue. CHRONIC BACKACHE. .ETIOLOGY. TREAT- MENT.* By Ch.\rles Ogilvv, M. D., New York, OrthODadic Surgeon, New York City Children's Hospital; .Assistant Cheap Viagra Overnight Orthopaedic Surgeon, New York Postgraduate Hospital, etc.