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stages. However, in the earlier stages the diagno- sis is considerably less certain on account of the difficulty of obtaining the prostatic secretion iso- lated from the urethral one. Still, accepting all the statistics simply on their face they show that in a number of cases of Viagra Generico Brasil chronic gonorrhoea the prostate was not affected. This implies that in Viagra Generico Brasil a certain number the chronicity of the gonorrhoea did not de- pend on the infection of the prostate and that in these the cause of the chronicity must be located somewhere else within the Viagra Generico Brasil genitourinary tract. In mv own experience I have successfully treated a large number of patients with chronic gonorrhoea in whom the posterior urethra evidently was not infected and who were cured without any treat- ment of the prostate, although usually the Viagra Generico Brasil condi- tion of the Viagra Generico Brasil gland was examined. Some of these cases date back to the period preceding the discov- er)' of Viagra Generico Brasil the gonococcus when its absence was not available as a criterion of a cure. At that time, when a Viagra Generico Brasil patient was discharged from treatment, usually after a longer period of observation with- out any treatment, I was well aware that I could not absolutely say that the patient was cured. But when I found, sometimes after years, either through direct observation or through indirect reports, most- ly from patients who had been recommended to me by the former, that they were in good health themselves, had been married for a number of years, had healthy wives and two, three, or more healthy children, I felt entitled to the assertion of having cured them. I know very well that on and Viagra Generico Brasil ofif cases have been reported in literature in which a man, apparently cured from gonorrhoea, married, had a healthy wife and several children, and after twenty years or more without exposure suddenly was at- tacked with a virulent gonorrhoea with which he in- fected his wife. I am not inclined to accept such a case as one of autoinfection without doubt, but would much rather assume an accidental infection, even one contracted on a water closet, from a towel, etc. It Viagra Generico Brasil is true that in exceptional cases gonococci have been found after such a long period of latency, and it can well be maintained that as long as gono- cocci are present a man may infect his wife and that in her a virulent gonorrhoea may develop. But as a rule the bearer of the latent gonococci either is entirely free from discharge or other symptoms or shows an extremely mild affection of the urethra; hence the great danger in married life and the fre- quent infection of the wives. In reality there arc various conditions in the an- terior urethra in the course of gonorrlnca which are favorable to the retention of the gonococci in the tissues and to the indefinite prolongation of the infectious process entirely independent of in- fection of the prostate, although they may appear simultaneously with it. Among the vari'ius types of chronic anterior urethritis attention must first be callt'l to thrise cases in which the seat of the infection and gonococcus retention is Viagra Generico Brasil located in the region nearest to the meatus externus. Occasional- ly the narrowness of the Viagra Generico Brasil meatus itself may be the immediate cause of the continued presence and ac- tivity of the gonococcus. either by the formation of a pocket below which favors the retention of some of the secretion, or by the drawing of the mucous membrane into more or less deep folds, like the wrist band of a shirt sleeve, the bottom of which can be expanded only with difficulty, in or- der to make it accessible to the gonococcocidal so- lutions. Paraurethral cavities, channels, and sin-^ uses may also be responsible for the chronicity of the infection, particularly in the presence of mod- erate or slight conditions of hypospadias Viagra Generico Brasil and epispa- dias. Here you may find several openings, some- times so fine that they can be observed only if you succeed in finding thein filled with secretion and squeeze out the discharge. Viagra Generico Brasil Another type of obstinately returning attacks of .gonorrhoea depends on the infiltration of the mu- cous membrane and the submucous tissue of the bulbar region, acknowledged to be the most fre- quent seat of urethral stricture. This condition represents the early stage of the formation of stric- ture. By far the most common type, however, is the infection of the lacunie Morgagni, which are found mostly in the middle portion of the pendu- lous urethra, with subsequent deepening and widening of their cavities into more or less deep pits. The retrograde direction of these glands and their valvelike covering render the successful treat- ment sometimes Viagra Generico Brasil extremely difficult, particularly if Viagra Generico Brasil they are imbedded in tissue in a state of progressive sclerosis. In such cases it may become necessary to split open the cavities in order to exterminate the gonococci. It is evident that such conditions can be demonstrated and successfully treated only through the urethroscope, and the means of such treatment have been described already by the earl\ writers on endoscopy, like Gruenfeld. In refer- ence to cases of these types I cannot understand the position of Swinburne i.-lnnals of Suri^ery. September, 1908), who declines to use the urethro- scope as long as gonococci are present. It is true that endoscopic treatment may be and frequently is followed by a more or less acute exacerbation of the symptoms. This has Viagra Generico Brasil to be considered in the same light as the effects of the provocative instilla- tion of silver solutions in the deep urethra, and, be- sides, it is commonly ea.sy enough promptly Viagra Generico Brasil to ob- tain the former Viagra Generico Brasil quiescent stage again by the usual methods of treatment if the exacerbation does not subside by itself as it usually does. The conditions of the anterior urethra just men- tioned may indeed occur simultaneously with in- fection of the prostate, but they are met with with- out even the slightest participation of that gland. In the former instance it is naturally of the great- est importance to clear the prostate of the gono- cocci to prevent the reinfection of the anterior urethra. It can be stated, though, if the symptoms of chronic gonorrhoea are definitely and permanent- ly removed by treatment of the anterior urethra alone, that the' seat of the gonococci had been in that portion alone. Now, as long as the assertion stands undisputed, that the prostate is infected in KLOrZ: MISUSE OF PROSTATE. every case of chronic gonorrhoea, it is quite proba- ble that if such patients with anterior chronic ure-