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Society "^tpovts. NEW YORK ACADEMY OF MEDICINE. Stated Mectirig, Decemlier ij, iSgS. E. G. viagra buy manchester Janeway, M.D., President. The meeting was in charge of the Section on Genito- urinary Diseases. Observations upon the Pathological Anatomy of Chronic Enlargement of the Prostate, with Special Reference to the Causes of Muscular Insufficiency of the Bladder. — Dr. Samuel Alexander presented a communication viagra buy manchester with this title, and illustrated it freely with lantern slides. He said that when there was a distinct and more or less pedunculated nodule, one might be sure that the trouble began in the acces- sory glands at the internal urethral orifice. The cause of the prostatic pouch was to be found viagra cost tablet in the fact that the muscle covering the trigone was viagra cost tablet very rigid and com- pact, while the muscle lying behind the bladder was loose and easily dilated. When, therefore, pressure was brought to bear behind the trigone, as occurred in viagra cost tablet cases of obstruction, this portion behind the trigone gave way and sank down behind the trigone, thus form- ing a post-trigonal pouch, often improperly called a " post-prostatic pouch." There might be very marked enlargement of the posterior isthmus without interfer- ence with urination. Obstructive disease of the pros- tate when due to the lateral lobes was purely mechan- ical at the beginning, the bladder being simply called upon to overcome the obstruction which the pressure downward of the lateral lobes had produced on the urethra. When the lateral lobes projected into the bladder, and deformed and narrowed the urethra, the same viagra buy manchester thing occurred. When, however, the obstruction occurred on the floor of the canal only in one place — i.e., above the veru montanum, and between that and the internal urethral orifice — it might be due to one of three causes. When there was enlargement of the anatomical median lobe itself, there was simply hy- pertrophy of the muscle covering the trigone, owing to its attempt to overcome the obstruction by elevating the lower end of the internal urethral orifice. A sec- ond cause was to be found in the cases in which the accessory glands which lay along viagra cost tablet the course of the urethra in many normal prostates grew out into the urethra, forming an intra-urethral tumor arising from the floor of the canal. This was usually con- nected also with enlargement of the so-called anatom- ical median lobe. A third cause was to be found in those cases in which the median enlargement and en- largement of the floor of the canal occurred as a result of hypertrophy of the accessory glands at the internal urethral orifice and the formation of a separate viagra buy manchester tumor. This was separated at first from the anatomical median lobe by the muscle of the trigone, but later on, as the disease advanced, it became continuous with the third lobe. In all of these three classes of cases, and espe- cially in the last two, the cause of the loss of power was the destruction of the insertion of the vesical muscle into the prostate and the consequent inability of the bladder to empty its posterior fold. Dr. Willv Meyer said that the treatment of pros- tatic hypertrophy could not viagra buy manchester fail to be greatly benefited by such studies as that just presented. He had been especially impressed with the manner in which the lateral lobes press viagra cost tablet down upon the urethra in such a remarkable wav. In his recent paper on the Bottini operation he had referred to a case in which catheter- ism had been extremely easy, and yet there was a con- siderable quantity of residual urine. viagra cost tablet viagra cost tablet In this case with the cystoscope he was able to demonstrate the existence of a small growth within the viagra cost tablet urethra, which evidently caused the obstruction. It was a counter- part of what had been presented on viagra cost tablet the screen this evening. The accessory glands, about which so much had been said in the paper, could be well seen by means of the cystoscope. The part played by the lateral lobes in the production of obstruction, as de- monstrated in the specimens just exhibited, brought out the fact that, in the Bottini operation, instead of rais- ing the handle of the instrument it should be depressed. Dr. Alexander, in closing, said that he desired to express his great obligation to the members of the pathological staff of the Carnegie Laboratory for their kindness in connection with this work, and also to Mr. O. Mason, the distinguished photographer of Bellevue Hospital who had spared no pains in the production of the lantern slides. A Very Rare Book. — Dr. A. Jacobi announced that a very viagra cost tablet rare and valuable book had just been pre- sented to the library of the Academy by Lothar Voss, one of its honorary fellows. Dr. Voss returned to Germany thirty years ago, being at the time a surgeon of note. He was the second person in New York to introduce tracheotomy as a part of the systematic treat- ment of croup. He had been collecting rare and val- uable books all his life, but the one just given by him to the Academy was the best "find" of them all. The book is on the lymph vessels, and is by Caspar Asellii, who discovered these vessels on July 23, 1623. He also discovered the valves, and noted that they ran in the opposite direction to those of the veins. Asellii was born in 1581, and died in 1626. The book was printed in 1627, and was the first one giving colored anatomical plates. Tlie book was reprinted twice, the third edition appearing in viagra buy manchester 1640, but these two later editions were decidedly inferior to the first one. The work had been considered almost extinct. There was one copy in the University of Leipsic, and a defective copy in the library of the University of Breslau. The book just given to the Academy was one of the two copies now known to be in existence, and was one of the first edition. Tiie Surgeon-Gen- eral's Library, Washington, D. C, contained a copy from the inferior viagra cost tablet third edition of 1640.