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received, except that he was given an ordinary cleansing spray. When he first came to us, his voice was very rough and hoarse, and it almost entirely ceased after three or four minutes' conversation. Since his return he tells me that liis voice slowly improved during his ocean trip to Europe, but that it became much worse the first few days he was in Paris. He remained in Paris a week and traveled slowly during the following two months. During this time his voice gradually recovered and at pres- ent it is low pitched and somewhat roughened in quality ; but he is able to transact his business with- out special vocal fatigue. In the Journal of the American Medical Associa- tion, August II, 1905, Prof. Beard in a short article on trypsin and amylopsin in malignant growths says that "this particular treatment has been in use for about six months and naturally it is still in the ex- perimental phase of its existence." Further on Beard briefly outlines this method of treatment: "After a few prehminary injections of small amounts, that is, one-half ampoule of the injectio buy trazodone online no prescription trypsini, the course should be : ist — Injectio trypsini daily up to two ampoules for three or four weeks. 2nd — Then one ampoule of injectio trypsini on a certain day, followed by an ampoule of injectio amylopsini on buy trazodone hydrochloride the next day, and so on alternately for about four weeks. 3rd — Lastly, one or even two ampoules of the new injectio amylopsini daily for about four weeks, or longer, in the judgment of the physician. "The injectio amylopsini, therefore, is meant to replace the injectio trypsini in the later periods of the treatment, and also even from the start to meet any bad symptoms, such as nausea, vomiting, pain in the back, drowsiness, albuminuria, high arterial tension, edema, etc. If any injections buy trazodone be still not well borne, the injections should be further diluted and given more frequently, generic trazodone hcl but so that the total daily amount is not thereby diminished. It is easy enough to kill every cell of a cancer with injections of tryp- sin, but for its removal, and to prevent formation of poisonous products from its degeneration, injections of the diastatic ferment of the pancreas gland, amyl- opsin, are absolutely necessary." Beard thinks that the injections should be made into sound tissue as close to the growth as possible. We consider it eminently proper to present these notes on the treatment of the case of supposed carcinoma of tl'.e left vocal band by pancreatic in- jection, the so-called trypsin treatment of Beard, for the reason that the results obtained left no ground for doubt that this treatment exerted a very prompt action upon the growth and was accompa- nied by certain well-marked local and constitutional symptoms. I am informed that there is a grave question as to the quality of the preparations which have been frequently employed in this treatment in London. We can readily believe that the slightest chemical change in, or the smallest degree of de- composition of the buy trazodone online uk pancreatic extract would render them inert or inefficient and harmful. In this con- nection I can but express, as I know Dr. Beard has done, our debt to .Mr. Fairchild as a specialist in the chemistry of the digestive ferments. No fixed rule as to the exact method of treatment has been formulated. The buy trazodone hcl quantity of injection which I employed, from seven to ten minims trazodone cost without insurance every day, is much less than that employed by Dr. Beard and others. buy trazodone uk We have at the office treated four cases in all. Our successful case was the first one. Our second patient was a woman of sixty or more who was very near death when we first saw her. She had a cancerous growth involving the posterior wall of the larynx and the esophagus. She how much does trazodone cost had been un- able to swallow food for many weeks. It was a hopeless case from any standpoint, and although we gave the injections of trypsin no benefit resulted. The third case was the one already referred to, in which the growth, which seemed to be a simple fibroma, was removed by snare and forceps. After such removal the trypsin injections were used with- out benefit. The buy trazodone sleep growth recurred and the entire larynx was removed. The fourth case we are treat- trazodone discount coupon ing now. This is probably an epitheliomatous growth attached to the lowerpharynxon the right side which pushes the larynx and the epiglottis to the left. We thought for a time thRt we were getting marked benefit from the trypsin injections in this case, as the growth seemed smaller and softer and the swal- lowing was easier, but for the last two weeks there 8i6 MEDICAL RECORD. [Nov. 24, 1906 seems to be no improvement. We are giving him a full ampoule every day. He is a poor man and has to come some distance to our office every day. He ought to be under better conditions in the way of eating and home living in order to give the treat- ment the best possible chance. There may be one particular form of growth, and only one, which can be cured by the injections of trypsin, and it may be that the growth which we have seen removed is the particular type which can be controlled by pancreatic injections. What the exact quality of such a growth is, I do not know. All of these points must be ascertained by further study. It is just as remarkable that the injection of tryp- sin will disintegrate one form of growth as another. In conclusion common sense would teach us that the earlier a case of cancerous growth is put under the trypsin treatment, the greater the chance of success. We feel, with Professor Beard, that the doses should quickly be made as large as the .patient can judiciously bear. The unsatisfactory cases, so far as I have observed, have been those which have come under treatment in very advanced stages of the disease, consequently when the general health of the patient was very much undermined. We certainly are not giving the trypsin treatment of cancer a fair trial, unless we are conserving the general health of the patient by the best of care in the way of food, sanitary surroundings, and healthful living. 123 East^Ninteenth Street. TREATMENT OF PROSTATIC ENLARGE- MENT.* By JAMES PEDERSEN, M.D., NEW YORK. MEMBER OF THE NEW YORK ACADEMY generic trazodone online OF MEDICINE; AMERICAN MEDI- CAL association; new york state medical society; American ASSOCIATION OF GENITOURINARY SURGEONS, ETC. My purpose in this paper is to discuss the subject broadly, to indicate, if possible, what leads up to prostatectomy and what away from it, to cite cases in illustration and avoid the technical details of the operation in its several modifications. These details have been discussed sufficiently, sometimes to the exclusion of the more important considerations. The subject should be the patient, not prostatec- tomy ; our object should be to net him the best re- sults, not alone to perform an operation seductive because of the skill required and radicalism implied. Perfection in technique does not justify an opera- tion not indicated. The first of the important considerations is : When shall surgical intervention be advised? The second, logically : Which is the operation of choice in the patient under treatment? As to the time for surgi- cal intervention, three teachings are recognized : ( i ) Immediately upon the first retention; (2) as soon as catheter life has to be buy trazodone 50 mg begun 1(3) when catheter life fails. As to the operation of choice we have to consider, in the order of our preference, (i) perineal prostatectomy; (2) suprapubic prostatectomy; (3) prostatotomy by means of either a bistoury applied through a perineal incision or Bottini's galvano- cautery incisor. At the present stage of our knowledge it is not possible, in my opinion, to say categorically when surgical intervention should be advised. We need more detailed, descriptive, and searching statistics, especially as to end results, on both the conservative and the radical sides. The exclusive advocacy of *Read before the American Association of Genito- urinary Surgeons at its twentieth annual meeting, June, 1906. one operation as the operation of choice, I beg to submit, is unwarranted and futile. The variations in the state, degree, and complications of the patho- logical condition to be cheap trazodone relieved should preclude a fixedly preconceived operation of generic trazodone 50 mg choice. Recent statistics of significant value are contained in the comprehensive paper by Belfield in Vol. IV of "Progressive Medicine," December, 1905. Further condensed they would show that the English and French, the former especially, advise the suprapubic operation ; that the Germans are almost evenly di- vided, the slight though important preponderance being, however, on the same side ; that with us the apparent choice is the perineal ; that the mortality abroad and at home practically agree at about 9 per cent, as to the perineal operation and at about 5 per cent, as to the suprapubic, making about 7 per cent. for all cases. This differs from Watson's statistics based on an exhaustive analysis of 2,627 cases vari- ously operated by 100 different operators (Annals of Surgery, June, 1904). He gives the mortality in 530 cases of perineal prostatectomy cheap trazodone no prescription as 6.2 per cent. ; in 243 cases of suprapubic prostatectomy as 1 1.3 per cent.; in 1,086 cases of Bottini's operation as 6.3 per cent., and in 207 cases of catheterism at y.y per cent. I would agree with Belfield in commending Whiteside's paper (American Journal of Urology, July and August, 1905), in which a timely protest is entered against excessive enthusiasm for operating and a just criticism is made of the lack of ante- operation details. In a group of 238 mixed cases, Whiteside finds "absolutely good results in only 30 per cent.," a mortality in perineal prostatectomy of 20 per cent, in 36 cases reported by nine operators, of 8 per generic trazodone cost cent, in Alurphy's 51 cases, of 5 per cent. in Young's 75 cases, and of 3 per cent, in Goodfel- low's 75 cases. He pointedly remarks that the aver- age of these mortality figures is not much better than the 13 per cent, given as the mortality twelve years ago, and he rehearses the "untoward results" found among the 36 cases already cited. While commending both his protest and his criticism, I cannot agree with his comparison. A just compar- ison cannot be drawn except from the statistics of a longer series of cases furnished with ante-opera- tion details and "end-results" by several operators of more nearly equal skill. Supporting my point is the fact that Freyer's mortality of 10 per cent, in no suprapubic prostatectomies falls to 5.8 per cent. if his first 23 operations are thrown out and the results of the remaining 85 alone are computed. I would next buy trazodone generic comment upon Albarran's report, the conclusions in which are drawn from his study of how much do trazodone cost the end-results in his cases of perineal prostatec- tomy, 44 of which were inspected a year after opera- tion and 15 after from three to four and one-half years had elapsed. All but 7 are regarded by him as complete successes in that they totally empty the bladder. Of these 7 failures (4 partial and 3

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