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■ .. >F VI cost of renova : (ONTANUM. there are some diagnoses and treatments, generally pertaining to special organs, information concern- ing which ''goes into one ear and comes out of the other," leaving behind only the vaguest ideas upon the subject. The need of special instruments or special training of the eye or hand, or of both. deters the average physician from any adequate preparation for such work, even when his attention has been successfully fixed upon its importance buy renova online and, if he does attempt purchase renova online it, it is in a half hearted, un- it ientific manner, the results of which are nil. For example, in a case sent me for consultation, the leading physician in a large, neighboring town fondly imagined he was carrying out my suggestion to massage the seminal renova cream vesicles, by manipulating the tip of a order renova sound in the prostatic urethra. I do not believe it an exaggeration to state that not one physician out of fifty, even in the cities, really knows this part of the rectum with his fingers and brain and can expel seminal excretion unless the vesicles are greatly renova canada distended. Even the best sur- geons, whose discount renova vaginal and abdominal touch is mar- velously acute, fail in this particular. Every spe- cialty has just such untrodden fields. The subject of my paper, however, deals with a certain field of one specialty which is overlooked by most of the specialists themselves. Since the practical application of the urethroscope about thirty-five years ago. fairly numerous articles, forty at least, have appeared in renova prices English and German, de- scribing the method of examination of the veru- montanum, its anatomy, its diseases, and their treat- ment, and citing results which are simply startling in many cases. Nevertheless, few of the genito- urinary specialists are working along these lines. Indeed, this treatment has been described as bar- barous by one of the best known members of thi-. association. No textbook on genitourinary diseases devotes much more than a mention to the subject. The verumontanum is a protuberance, one eighth of an inch or more in height, arising from the floor of the prostatic urethra, and resembling a nipple in form as seen in the urethroscope. It is com- posed of muscular and erectile price of renova tissue, the latter, it is asserted, serving to prevent the back flow of the semen during the orgasm. On its anterior surface is a blind pouch, the sinus pocularis, at or within the margin of which the ejaculatory ducts emerge. Its color is a trifle paler than the surrounding mu- cous membrane. In the furrows on both sides air found the openings of the prostatic ducts. The appearance of the verumontanum when dis eased varies greatly, the. most frequent changi be in- that it is red and hypersemic, bleeding at the slightest touch. If it is not already discolored b\ lil» 'I when brought into view by the urethroscope, the first touch of the cotton swab causes hremor- rhage and frequently, as the urethroscope is with drawn, the part which falls into the opening bleeds profusely on account of the sudden relief from pressure. It often appears considerably enlarged and in other cases uneven also with irregular ex cresences resembling the surface of a blackberry. Its color becomes more fiery, according buy renova t' the ■grade of inflammation. Finger describes a later stage, a change into connective tissue thus con- tracting the ejaculatory ducts, hut this I have nol observed. Swinburne and Wossidlo have each de scribed the finding of two polypi projecting from its surface. To George K. Swinburne, of New York, belongs the honor of having been the first to devise an urethroscope which can be easily used without ex- cessive pain to the patient, to study and treat these pathological conditions. The introduction and re- tention of the straight urethroscope are exceedingly painful, even in a normal urethra. To overcome this. Doctor Swinburne devised in 1900 a tube with an angle like a stone searcher, which is a great deal easier and less painful to introduce and retain. The window is on the convex surface of the angle and is closed with an obturator. One great advantage of this instrument is that it is provided with an auxiliary tube which contains the light carrier. In the ordinary instrument the light renova online carrier must be removed before swabbing the urethra, and in doing this one is apt to withdraw the tube or to push it in farther, thus losing the area which he was observing from view. The manipula- tion of the instrument is very delicate at the best, and every extra disadvantage should be avoided. It may he asked why the swab may not be used in the ordinary -inule urethroscope tube, without re- moving the light carrier. If this is done the cotton will catch on the pointed end renova cost of the incandescent bulb when removing the swab, and buy renova cream is very likely to break it. The where can i buy renova danger of introducing fragments of renova uk broken glass into the posterior renova coupon urethra could hardly, of course, be overestimated. Another advantage of the auxiliary tube is cheap renova the avoidance of the confusing reflections of the light. The instrument is renova purchase introduced with the patient ly- ing on his back, the hips being slightly elevated. The fingers of the other hand press downward on either renova price side of the base of the penis to relax the sphincter muscle. A jerk will he felt as the angle passes the sphincter, and, if the instrument is advanced about one half inch farther, the verumontanum will be found projecting into the window upon withdraw- ing the obturator. The aetiology of disease of the verumontanum i- generally gonorrhoea!, although excessive masturb.. tion or coitus, prolonged sexual stimulation without gratification, as in hugging, withdrawal, or coitus interruptus or pri nay cause it without venereal disease. The symptoms which may be produced by disease

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