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Cask VI. — A retired harness maker, aged eighty-one years!, senile, had marked cystitis and multiple calculi. Prostatic symptoms had been present for about ten years. These were much inore severe during the past year and were characterized by severe tenesmus, passage of am- moniacal, cloudy urine, and frequent urination of small quantities at a time. Catheterization by a physician was necessary three times within the last year. On admission to the hospital, the general examination was negative ex- cept for the usual evidences of senility. Systolic blood pressure was 175. Hemoglobin was go; leucocytes, 4,600. The urine was strongly alkaline and had an odor of am- monia. It contained nmch pus from which a colon bacil- lus was obtained in pure culture. There were thirty c. c. of residual urine. Examination per rectum showed a very large, rather soft prostate with no Do You Need A Prescription For Cialis In Uk evidence of malignancy. A phenolsulphonephthalein test showed a first appearance of the dye in eleven minutes, thirty-five per cent, excreted in tlie first hour and twenty-five per cent, in the second hour. The specific gravity of two specimens was 1016 and 1024 respectively. On the following day a suprapubic cystostomy was performed under novocaine anesthesia and twenty small stones v/ere removed from the bladder. There was no shock. One hour later the patient sat up in bed and ate his lunch. Four days later his systolic pres- sure had come down to 155. Eight days later a phthalein test showed the first appearance in eleven minutes and a total of sixty-two per cent, eliminated Do You Need A Prescription For Cialis In Uk in two hours. The specific gravity of the urine in the two samples now regis- tered 1030 and 1031. On the following day, nine days after the cystostomy, the prostate was enucleated imder light ether anesthesia. There was no appreciable hemor- rhage and no shock. The prostate was very large and was found to be a siinple adenoma. Convalescence was uneventful. Urination through the urethra occurred on the third day. The patient left the hospital at the end of three weeks after the prostatectomy with the bladder wound entirely healed and continence nearly completely es- tablished. SUMMARY. Twenty consecutive prostatectomies without a fatality, performed by the two stage supraptibic method, many of which were on patients who would ordinarily be considered as bad surgical risks, bear witness to the relative safety of this method. When properly controlled by functional and other tests, it minimizes much of the risk. A preliminary cystostomy has the advantages of providing the best possible drainage, thereby afiford- ing relief of back pressure on the kidneys and an opportunity greatly to improve an existing cystitis before performing the more radical operation of enucleation of the prostate. REFERENCES. 1. JOHNSON: Operative Thcrapcush, p. 676. quoted l)y Squier. . 2. Ibid. ,1. DEAVER: Enlargement of the Prostate, etc., 1905, p. 208. 4. PEAVER: Vrost.itectomv. Annnla of Surgery, 1917, Ixvi, 371. ?. ROWNTREE and CERAGHTV: Jcur„al of Pharmacology and Experimental Therapeutics, iqio, i, S7<). 6. CRABTREE and CABOT: Colon Bacillus PvcloncpliritLs. Journal A. M. A., 1917, Ixvii, 5S9. 7. E. A. GRAHAM: Late PoisoninR with Chloroform and O'her Alkyl ILiIides in Relationship to the Halogen Acids Formed by Their Chemical Dissociation, Journal of Experimental Medicine, 191 5. xxii, 48. Manometric Determination of Arterial Tension. — Antonio I'"ulchiero {La Riforma mcdica, Decem- ber 15, iQi/) declares that systolic manometric measurements liave no definite significance and that the diastolic reading is the index of the sum of the peripheral circulatory resistance. Pulse pressure has no relation to the volume of the cardiosystolic wave. FXZEMA DUE TO DEFICIENT THYROID SECRETION.* Report of a Case in Which the Administration of Tliyroid Extract Acted as Do You Need A Prescription For Cialis In Uk a Specific. I5y M. H. Edelman, M. D., New York, Adjunct Pcdiatrist, Sydenham Hospital; Instructor in Post -Graduate Hospital; Assistant in Pediatrics, Post-Graduate Hospital. Case. — The patient in this case was a boy, three and one half years of age. The family history was as follows: The father was forty years of age, negative for syphilis, insanity, tuberculosis, and alcoholism. The mother was ' thirty-seven years old. She became gray at the age of twenty years ; her sister was also gray at twenty years of age. The parents were not related ; they had been married ten years. The mother was pregnant five times, having had three living children and two spontaneous miscarriages. All the children were normal except the patient, who was Do You Need A Prescription For Cialis In Uk the third child. While pregnant with the patient, the mother was said to suffer from gravel in the bladder, for which Do You Need A Prescription For Cialis In Uk she was under treatment. Diet during pregnancy consisted of cooked fruits, cereals, fresh vegetables, and milk ; no red meats were taken. Diet was the same dur- ing nursing. The mother's condition during nursing was normal. Delivery of the patient was normal ; he weighed eleven pounds. He had none of the Do You Need A Prescription For Cialis In Uk diseases of childhood ; he had furunculosis at six months of age. He was breajl fed for ten months, regularly every two hours. He was weaned at ten months and was then given milk, cereals, and fruit juices. His present diet consisted of fruits, cereals, vegetables, skimmed milk, no red meats, eggs, sugar, and butter in moderation. Bowels were very con- stipated ; his appetite was good. He slept very poorly. Urination was normal. Until four months of age the patient was well, physi- cally anj mentally. Since then he had had a scaly and weeping eruption, involving the checks, forehead, chin. scalp, neck, shoulders, chest, and upper and lower ex- tremities. He had been treated by pediatrists and der- matologists at many clinics of this city. Treatment wa< mainly local and dietetic. In spite of consistent treatment lastmg three years the eruption became more extensive. It has always been very itchy, worse at night. For the past year, the mother noticed the child looking old ; he was not as playful as formerly, seemed extremely quiet, and masturbated. The withdrawal or modification of the diet had no cfl'ect upon this eruption. The patient was able to hold up his head at three months, to sit up alone at six months, and to stand up at twelve months. He began to walk at sixteen months, and to talk at nineteen months: the first teeth appeared at six months. He was always