to increase the nutrition. Among the most frequent
causes of this affection, are excessive venery, masturbation, disease of
the bladder, stricture of the urethra, horseback exercise, gonorrhea,
and the employment of strong, stimulating diuretics. Some of the worst
cases that we have had to deal with have occurred in old men, and, in
fact, the malady is more common to those advanced in life; but it is
frequently produced in those of middle age by the causes enumerated.

Among the earliest symptoms of the disease is an uneasy feeling in the
region of the base of the bladder. There is a more frequent desire to
urinate than usual, and, in the course of time, this frequency becomes
more urgent; still no particular notice may be taken of it, it being
considered as "only a slight inconvenience." After several months, or it
may be years, the discomfort increases, and nightly calls to empty the
bladder become habitual. By and by the patient begins to find the
discomfort of getting out of his warm bed very troublesome; still no
notice to taken of it. He does not consider it worth his while to
consult a doctor for "such a trifle." In the course of time the patient
is obliged to get out of bed twice during the night instead of once.
Afterwards, the calls become still more frequent and urgent; the
inconvenience more evident; finally, pain is substituted for
inconvenience, and then the doctor is consulted. Unless a specialist of
experience be consulted, the bladder will most probably be examined, and
medicine will be prescribed only to excite the kidneys to secrete more
urine, which does harm instead of good; the disease slowly, but surely
progressing. Patients often write us that they have had something wrong
with the bladder for a number of years, having to urinate more
frequently than they ought; sometimes having to do so three and four
times during the night; in extreme cases even every half hour or so, and
that they are not able to pass it freely, but only in small quantities,
and attended with much pain. These symptoms are not always constant, but
let up for a few weeks and then appear again. Things go on in this way
for a year or two, perhaps, when the passage of the urine is completely
shut off for several hours, and the patient is in great agony until the
bladder is relieved by the use of the catheter. After such instrumental
relief, for a day or two the urine may be natural again, coming at
first, perhaps, in very small qua