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Av NpN-SURGICAL TREATISE 
 
 ON 
 
 DISEASES OF THE 
 
 PROSTATE GLAND AND ADNEXA 
 
 BY 
 
 GEORGE WHITFIELD OVERALL, A. B., M. D. 
 
 FORMERLY PROFESSOR OF PHYSIOLOGY IN THE MEMPHIS 
 HOSPITAL MEDICAL COLLEGE 
 
 CHICAGO 
 
 MARSH & GRANT COMPANY 
 
 PRINTERS 
 
£>©/. ^,<y*3 
 
 CLftSB ^XXc Me 
 
 T?&n? 
 
 
 Copyright, 1903, 
 
 BY 
 
 GEORGE WHITFIELD OVERALL 
 
CONTENTS 
 
 PAGE 
 
 Introduction 7 
 
 Chapter I. 
 
 The Non-Surgical Treatment of Diseases of the Pros- 
 tate Gland and Adnexa 11 
 
 Chapter II. 
 
 Acute Prostatitis 21 
 
 Chapter III. 
 
 Subacute or Chronic Prostatitis 24 
 
 Chapter IV. 
 
 Chronic Congested Enlargement of the Prostate 75 
 
 Chapter V. 
 
 Seminal Vesicles 91 
 
 Chapter VI. 
 
 Hypertrophy of the Prostate 115 
 
 Chapter VII. 
 
 Neuroses of the Prostate 152 
 
 APPENDIX 
 Chapter VIII. 
 
 Electro-Physics, Electrolysis and Cataphoresis. ...... 176 
 
 Chapter IX. 
 
 Electro-Physics — Continued ... ^ ....,, , 9 ............ . 181 
 
CLINICAL CASES 
 
 PAGE 
 
 I. Chronic Prostatitis and Prostatic Urethritis... 64 
 
 II. Chronic Prostatitis and Stricture 66 
 
 III. Prostatitis 68 
 
 IV. Prostatitis and Epilepsy 69 
 
 V. Prostatitis, Vesiculitis and Urethritis 71 
 
 VI. Prostatitis, Vesiculitis and Urethritis 73 
 
 VII. Prostatic Enlargement; Melancholia 102 
 
 VIII. Prostatitis; Vesiculitis; Rectal Ulcerations... 103 
 
 IX. Enlarged Prostate, Cystitis 105 
 
 X. Chronic Enlarged Prostate; Vesiculitis; Cys- 
 titis 107 
 
 XI. Congested Prostate; Rheumatic Arthritis 108 
 
 XII. Prostatitis; Cystitis; Rheumatic Arthritis.... 108 
 
 XIII. Prostatitis; Prostatic Calculi; Cystitis 103 
 
 XIV. Prostatitis; Cystitis; Calculi Ill 
 
 XV. Urethritis; Sympexia; Hemiparesis 112 
 
 XVI. Enlarged Prostate; Cystitis 113 
 
 XVII. Hypertrophy; Catheter Life 137 
 
 XVIII. Hypertrophy; Cystitis; Proctitis 138 
 
 XIX. Hypertrophy; Cystitis 140 
 
 XX. Hypertrophy ; Catheter Life 141 
 
 XXI. Hypertrophy; Paroxysmal Tenesmus 141 
 
 XXII. Syphilitic Prostatitis 143 
 
 XXIII. Incontinence; Paralysis 146 
 
 XXIV. Impotency; Prostatitis 147 
 
 XXV. Chronic Priapism; Prostatitis 148 
 
 XXVI. Chronic Priapism 149 
 
 XXVII. Chronic Priapism; Prostatitis 149 
 
 XXVIII. Chronic Prostatitis; Melancholic Mania 158 
 
 XXIX. Insomnia ; Melancholia 160 
 
 XXX. Sciatica; Spermatorrhea 16 1 
 
 XXXI. Impotency; Pollutions 172 
 
 XXXII. Pollutions; Prostatitis 172 
 
 XXXIII. Paresis; Prostatitis 173 
 
 XXXIV. Hemiparesis; Prostatitis 174 
 
 XXXV. Hemiparesis; Prostatitis 175 
 
 iv 
 
ILLUSTRATIONS 
 
 PAGE 
 
 I. Relation of the prostate to the bladder 12 
 
 II. Front view of bladder, urethra, prostate, Cow- 
 per's glands and openings of ejaculatory ducts 
 
 and prostatic ducts 14 
 
 III. Rear view of the same organs 15 
 
 IV. The mesenteric and solar plexuses of nerves sup- 
 
 plying the prostate, bladder, rectum, kidneys 
 
 and bowels 17 
 
 V. The spinal nerves distributed to the perineum 
 
 and external genitalia 18 
 
 VI. Subacute or chronic prostatitis, as common 
 
 among young men 25 
 
 VII. A battery and cystoscope 46 
 
 VIII. Urethral applicators and electrodes 53 
 
 IX. Urethral applicators and electrodes. 53 
 
 X. The application of urethral electrode 55 
 
 XI. The application of cataphoresis to the prostate 
 
 through the rectum 57 
 
 XII. A chronic congested, swollen prostate, as com- 
 mon among middle-aged men 76 
 
 XIII. Specimens of prostatic concretions 87 
 
 XIV. Rectal ulceration as due to chronic prostatitis... 91 
 XV. The position of the kidneys 93 
 
 XVI. The application of cataphoresis to the vesicles 
 
 through the rectum , 98 
 
 XVII. Electrode devised by the author 101 
 
 XVIII. An exaggerated form of prostatitis complicated 
 
 with senile hypertrophy. 114 
 
 XIX. Enlarged prostate with "third lobe." 129 
 
 XX. Modification of the Bottini cautery 133 
 
 XXI. Application of the cautery to the indurated third 
 
 lobe 134 
 
 XXII. The sciatic nerve and its branches as influenced 
 
 by prostatic disease 163 
 
 XXIII. Bipolar rectal electrode 169 
 
 XXIV. Application of the bipolar electrode 170 
 
 XXV. Construction of a faradic battery 191 
 
 XXVI. Electro-physical apparatus and wall cabinet 206 
 
 v 
 
INTRODUCTION 
 
 In presenting this book to the profession, the author 
 has, by avoiding theoretical discussion, endeavored to give 
 a plain, practical and concise summary of the methods and 
 results of the non-surgical treatment of Diseases of the 
 Prostate Gland and their sequelae as demonstrated by more 
 than twenty years of clinical experience. 
 
 Some of the matter contained herein has heretofore 
 appeared in the "Mississippi Valley Medical Journal" of 
 March, 1883, and August, 1887; "Medical Mirror" of 
 April, 1896, and the "Journal of the American Medical 
 Association" of January 21, 1899, etc. 
 
 A little over a quarter of a century ago the author 
 completed his course of medical instruction under two of 
 America's greatest surgeons, viz., Professors S. D. Gross 
 and Joseph Paneoast, The teachings in vogue at that 
 time (and there has been little improvement since) re- 
 garding the treatment of prostatic diseases were with 
 sounds, the knife, the Bottini cautery, etc. Having fol- 
 lowed the teachings of these eminent surgeons for some 
 years thereafter with very unsatisfactory results, I began 
 experimenting with local and constitutional medication, 
 electrolysis and cataphoresis, with varied results. At times 
 I would have the most "happy hits/ 5 to be followed by an 
 egregious failure. From time to time I devised and per- 
 fected instruments with which to apply the combined 
 properties of medicines, electrolysis and cataphoresis for 
 the purpose of stimulating vaso-motor contraction, reliev- 
 
8 INTRODUCTION. 
 
 ing thereby congestion and inflammation, dissipating 
 morbid tissue and chemically decomposing or breaking up 
 lime or earthy concretions that form in the ducts and 
 follicles of the prostate. 
 
 I do not wish to convey the idea that I limit the treat- 
 ment entirely to medicines, electrolysis, cataphoresis, etc., 
 as there are some neglected cases in which the use of the 
 knife becomes indispensable. I am fully aware of the 
 incredulity of the profession regarding electrolytic treat- 
 ment, since electricity has been so long in the hands of 
 empirics. It is also true that electricity, like most potent 
 therapeutic remedies, has been no exception to the rule of 
 having had over-enthusiastic advocates who, at first, when 
 its principles were little known, and before it had been 
 placed upon a systematic basis, claimed for it properties 
 beyond its field of utility, and would supplant therefor 
 every other mode of treatment. 
 
 There are others who, from lack of knowledge of the 
 science of electricity (clue to the fact that it was not taught 
 in the medical colleges at the time they graduated), are 
 prejudiced against its use in any form or for any purpose. 
 They are content to grope in the old, beaten path, how- 
 ever unsatisfactory may be the result. 
 
 I regret to have to state that the large majority of 
 works published upon electro-therapeutics are based upon 
 theory or are mere compilations, unreliable in their teach- 
 ings. Dr. S. H. Morrell in the "Times and Kegister," 
 March 16, 1895, on "A Plunge into Electro-therapeutics," 
 gives some wholesome advice to beginners, which thor- 
 oughly accords with my views. He says : "If you wish 
 to acquire skill in the use of electricity, don't set about it 
 alone and don't rely on what you find in text books. If 
 you can induce a reliable expert to take you as a student 
 for a few months, do so, no matter what it costs. As 
 
INTRODUCTION. 9 
 
 there are various branches of electrical work in which 
 special technique is employed, for instance, in genito- 
 urinary and gynecological practice, you should obtain a 
 short course of practical instruction in each. When you 
 have devoted six months to an apprenticeship of this kind 
 you will have laid the foundation for ultimate success." 
 
 While the use of electricity is harmless in the hands of 
 competent and experienced operators, yet I have seen some 
 serious results follow its application, even by intelligent 
 and prominent physicians who were not familiar with the 
 principles of electro-physics and methods of electrolysis. 
 It requires experience and tact as well as knowledge to 
 succeed in the treatment of these complicated diseases, 
 just as it does in any other line of special practice. 
 
 In brief, I shall state that after many years of research, 
 I have been enabled to devise both ways and means by 
 which to reach directly the seat of the disease. 
 
 The past decade has been made memorable by the stand 
 taken by some of our most distinguished medical and 
 surgical teachers, in favor of conservatism against the 
 indiscriminate use of the knife. Prominent among these 
 I may mention the venerable Professor A. Jacobi of Xew 
 York, one of the most profoundly erudite men in the 
 medical profession, and whose experience extends over 
 half a century in active practice. In an address delivered 
 by him at the International Congress at Pome, April -I, 
 1894, on a Xon-Xocere v (Do no harm), he said: "The 
 relative impunity of operative interference, accomplish. 8 & 
 by modern asepsis and antisepsis^ lias developed an undue 
 tendency to. and rashness in, handling the knife. The 
 hands tale too frequently the place of brains. Who does 
 n ot I- now. that the alleged safety in operating tempts some 
 of our skilled operators and the credulous public into use- 
 less, or even contraindicated procedure?" 
 
10 INTRODUCTION. 
 
 In the dedicatory address delivered in the Senn Hall, 
 December 17, 1902, by Sir William Kingston, Professor 
 of Clinical Surgery at Laval University, Montreal, he gave 
 warning that the surgeon's knife may be used too fre- 
 quently. In part he said: "The immunity with which 
 the most formidable operations are now performed has 
 given confidence — might I not say a recklessness, possibly 
 — which renders the staying hand of the physician of 
 priceless value. Especially is this true when, as it some- 
 times happens, the inexperienced surgeon hurriedly resorts 
 to a tentative operation to establish a diagnosis where one 
 more experienced would see no reason for the procedure. 
 J have more than once observed the meddlesomeness of a 
 surgeon to be in direct ratio to the measure of his inex- 
 perience/' 
 
 Damage once clone to the prostate by the knife is irre- 
 parable. "Better bear the ills we have than fly to those we 
 know not of." 
 
 The Author. 
 Chicago, III., Nov. 1, 1903. 
 
CHAPTER I. 
 
 THE NON-SURGICAL TREATMENT OF DISEASES OF THE 
 PROSTATE GLAND AND ADNEXA. 
 
 Of the various classes of diseases from which men suffer, 
 none is of more frequent occurrence, none has more 
 baffled the skill of the physician, or tried the patience of 
 the sufferer, than that of the prostate. The frequency 
 with which this gland is affected has been variously esti- 
 mated by genito-urinary specialists; some holding that 
 from twenty-five to fifty per cent of men suffer from its 
 disease, others claiming that it is an exception to find a 
 man past forty with a healthy prostate gland. 
 
 When we note the highly sensitive organization of the 
 gland, its psycho-sexual relation, its exposed position to 
 the bladder, rectum and seminal vesicles, and the fact 
 that it is pierced by the urethra and ejaculatory ducts, 
 and that, moreover, it is frequently subject to excessive 
 tax or abuse, we cannot wonder at the frequent functional 
 or organic diseases incident thereto, the various nervous 
 disturbances arising therefrom, and, owing to its inacces- 
 sibility, the obstacles to be overcome in its treatment. 
 
 The prostate is a musculo-glandular organ enveloped in 
 a fibrous capsule. It is situated at and embraces the neck 
 of the bladder. It is about the size and shape of a horse 
 chestnut, with its base directed towards the bladder and 
 its apex in front. It lies upon the rectum, being separated 
 therefrom only by loose fascia. Its transverse diameter at 
 the base measures one and one-half inches, its antero- 
 posterior diameter (which corresponds with the length of 
 
 11 
 
12 
 
 PROSTATE GLAND AND ADNEXA. 
 
 the prostatic urethra) is one and one-quarter inches, and 
 its depth three-quarters of an inch. 
 
 It consists of two lateral lobes of equal size. Some 
 writers mention a third or middle lobe, but this is re- 
 garded by most authorities (and it will be so considered . 
 by the author) only as a pathological condition. The 
 urethra passes through the anterior third of the gland, 
 though occasionally the posterior. 
 
 / 
 
 6S 
 
 £< 
 
 ~/0 
 
 -// 
 
 Pig. I. 
 
 Fig. I shows the relation of the prostate to the bladder 
 and prostatic urethra. The floor of the latter is a very 
 complicated and highly sensitive structure and bears an 
 important relation to the gland, both from a functional 
 
ANATOMY OF THE PROSTATE. 
 
 13 
 
 Fig. II. (R. W. Taylor.) 
 
14 PROSTATE GLAND AND ADNEXA. 
 
 and pathological viewpoint. In fact, it is really a part 
 of the prostate itself. 
 
 In the center and longitudinal direction of the floor is 
 a small eminence (9), the verumontanum, or caput galli- 
 naginis. Somewhat in front and in the middle of this 
 eminence is a small cavity, the utricle (11). On each 
 side there is a slight fossa, into which the ejaculatory (10) 
 and prostatic (12) ducts open. 
 
 The floor of the prostatic urethra is the most sensitive 
 part of the entire genito-urinary tract and is considered 
 the seat of the sexual orgasm. It is subject to pathological 
 lesion more than any other portion of the urethral canal, 
 owing to its complex structure, and to the fact that it 
 receives the irritative secretions of the prostate and semi- 
 nal vesicles, when these latter organs are affected. It is, 
 in fact, an index of no little importance to the condition 
 of the prostate. 
 
 The orifices of the ejaculatory ducts or utricle often 
 become dilated when disease of the prostate or vesicles 
 exists^ and are liable to engage the point of a small instru- 
 ment, in an effort to force an entrance into the bladder, 
 and becomes arrested, when a larger instrument will pass 
 over these orifices and enter the bladder with ease. 
 
 Dr. E. W. Taylor, of New York, gives two excellent 
 illustrations of these organs in his late work on genito- 
 urinary diseases. 
 
 Fig. II gives a front view, showing the bladder ,and 
 urethra opening upon the front surface: 1, the trigone 
 and orifices of the ureters; 2, prostate and prostatic 
 urethra; 3, bulb of the urethra with opening of Cowper's 
 glands ; 4, verumontanum with orifice of utricle ; 5, open- 
 ings of ejaculatory ducts; 6 and 7, openings of the pros- 
 tatic ducts. 
 
ANATOMY OP THE PROSTATE. 
 
 15 
 
 Fig. III. (R. w. Taylor.) 
 
16 PROSTATE GLAND AND ADNEXA. 
 
 Fig. Ill gives rear view of the same organs : 1, ureters ; 
 2, ampulla; 3, seminal vesicles; 4, prostate; 5, Cowper's 
 glands; 6, bulb or urethra; 7, membranous urethra. 
 
 Beneath the fibrous capsule of the prostate is a firm 
 band of unstriped muscular fibers surrounding the base 
 of the organ and reflected downwards towards the apex. 
 The same fibers radiate throughout the gland in the form 
 of trabecular forming meshes, through which the vessels 
 and nerves ramify. Interposed between these meshes 
 there are also numerous follicles that secrete a milky, 
 alkaline fluid, which passes out through the prostatic ducts 
 upon the floor of the urethra. 
 
 The arteries are derived from the internal pudie, vesicle 
 and hemorrhoidal, which are branches of the internal iliac. 
 
 The veins form plexuses around the base and fides of 
 the prostate, bladder and rectum, communicating freely 
 with the hemorrhoidal, spermatic, dorsal vein of the penis 
 and pampiniform plexus. Thus the organs from which 
 they arise, namely, the rectum, spermatic cord, epididymis 
 and penis, are brought into close physiological and patho- 
 logical relations with the prostate. Passive congestion or 
 stasis of the veins of the latter cause a clogging of the 
 veins of the rectum resulting in ulceration or hemorrhoids ; 
 or, when the spermatic veins are involved, varicocele 
 follows. 
 
 NERVES. 
 
 The nerves supplying the prostate are very numerous 
 and sensitive. Those derived from the sympathetic system 
 are supplied by the hypogastric and pelvic plexuses, as 
 illustrated in Fig. IV. 
 
 A double chain of sympathetic fibers, as illustrated by 
 Fig. IV, connect with the mesenteric, renal and solar 
 plexuses, bringing the bowels, kidneys and stomach 
 
ANATOMY OF THE PROSTATE. 
 
 17 
 
 Fig-. IV. (Quain.) 
 
18 
 
 PROSTATE GLAND AND ADNEXA. 
 
 specially into intimate relation with the prostate and other 
 pelvic viscera. 
 
 A large number of spinal filaments, arising mostly from 
 the sacral plexus, though some from the lumbar spinal 
 nerves, are distributed to the prostate and adjacent organs, 
 which communicate freely with the s} T mpathetic. Fibers 
 of the latter may be noted by reference to Fig. IV, as 
 passing to the great sciatic (cr') nerve, before it makes 
 its exit through the sacro-sciatic foramen upon the hips. 
 
 Fig. V. (Hirschfeld and Leveille.) 
 
 Fig. V shows the numerous branches of the spinal nerves 
 distributed to the perineum and external genitals, which 
 also communicate with the nerves of the prostate and 
 pelvic viscera. 
 
 FUNCTION. 
 
 The prostate is an important genital organ, possessing 
 the triple function: a, of expulsion of semen by means 
 
FUNCTION. 19 
 
 of the rhythmical contraction of its muscular fibers ; b, of 
 being the nerve center of the orgasm; c, of secreting. 
 through its glandular structure, a fluid essential as a 
 vitalizing agent to the spermatic germs. 
 
 It is in this gland that the pleasurable sensation of the 
 orgasm is located; the sensation being synchronous with 
 the expulsion of semen. It is by this gland that the 
 physiological impulse to gratify animal nature is indi- 
 rectly exerted through the sympathetic and cerebrospinal 
 nerve centers. In fact, the gland has been appropriately 
 called the seat of the sexual brain. The intimate recipro- 
 cal relations of the cerebrospinal centers and the prostate 
 are very marked, both in health and disease. 
 
 In health, excessive mental exertion, as by close study 
 or business cares, will lessen the sexual appetite; while 
 violent emotions, as grief, fright or anxiety, will tem- 
 porarily suspend all desire. 
 
 Men are by nature much more sensually inclined than 
 women; and when they cultivate libidinous impulses, and 
 associate with prostitutes, are liable to indulge their sex- 
 ual propensities to such an extent as to develop passions 
 that may lead to grave moral vices, like excessive inter- 
 course or masturbation, resulting in lesions of the prostate, 
 or some form of nervous disease. 
 
 Just as mental disturbances influence sexual conditions, 
 so in like manner do diseases of the prostate gland cause 
 such various forms of mental disorders as inactivity, de- 
 pression and numerous other neurotic aberrations. 
 
 I have especially noticed that men between the ages of 
 forty and seventy, suffering from chronic prostatitis lose 
 the keen mental activity they formerly possessed. Their 
 perceptive and reasoning faculties become sluggish and 
 inactive. 
 
 Owing to the contiguous relations, the direct source of 
 
\ 
 
 20 PROSTATE GLAND AND ADNEXA. 
 
 blood supply, and the intimate connection of the nerves of 
 the prostate, bladder, seminal vesicles and rectum, disease 
 of the prostate cannot exist any great length of time with- 
 out causing either functional disturbance or organic dis- 
 ease of the others. Besides, inflammatory disease of the 
 prostate often arises from chronic rectal troubles. 
 
PEOSTATIC DISEASES. 
 
 Diseases of the prostate gland will be considered under 
 the following heads: 
 
 ACUTE PROSTATITIS. 
 
 SUBACUTE OR CHRONIC PROSTATITIS. 
 
 CONGESTED, ENLARGED PROSTATITIS. 
 
 SENILE HYPERTROPHY. 
 
 TUBERCULAR AND SYPHILITIC PROSTATITIS. 
 
 NEUROSIS OF THE PROSTATE. 
 
 CHAPTER II. 
 
 ACUTE PROSTATITIS. 
 
 This form of disease of the gland usually results from 
 harsh treatment of gonorrhea, by means of strong injec- 
 tions, large closes of copaiba, turpentine or cantharides, or 
 from injudicious use of instruments. The gland swells 
 very rapidly and is extremely painful. The inflammatory 
 condition usually extends to the seminal vesicles, bladder 
 and entire pelvic viscera, giving rise to marked pain in the 
 region of the perineum, rectum and groins. 
 
 Dysuria is excessive and is often attended with incessant 
 tenesmus. The attack is usually ushered in with a chill, 
 which is followed by mild pyrexia. The desire to void 
 urine is frequent and uncontrollable, the patient passing 
 but a small quantity at a time. The irritation is often 
 
 21 
 
22 PROSTATE GLAND AND ADNEXA. 
 
 transmitted to the rectum, giving rise to a sensation of 
 fullness, and a desire to remain at stool. The latter symp- 
 tom is especially prominent when vesiculitis coexists. 
 Orchitis often supervenes which greatly increases the dis- 
 comfort of the patient. 
 
 Treatment. — The treatment consists mainly in pallia- 
 tive measures, by way of rest in bed, anodynes in the form 
 of hyoscyamus, opiates and hot hip baths. The diet should 
 be light and consist mostly of demulcents, as of barley 
 water, which is especially indicated ; soups and other light 
 nourishment. All injections or specific medication should 
 be discontinued. 
 
 Urethral instrumentation is strictly interdicted, unless 
 there are indications of retention of urine. Should it be 
 necessary to evacuate the bladder by catheter, which is 
 exceedingly rare, a full close of morphia should be admin- 
 istered half an hour previously thereto. Rectal supposi- 
 tories of boric acid, belladonna and opium give great relief. 
 The bowels should be maintained in a laxed condition by 
 means of saline cathartics. 
 
 In from five to fifteen days the urethral discharge is 
 re-established, unless complicated with orchitis, and gen- 
 erally becomes quite profuse. This is followed by defer- 
 vescence and the subsidence of all acute symptoms. At 
 this stage I advise the free use of a five per cent solution 
 of the aqueous extract of verbascum, to be injected deeply 
 into the urethra, from four to five times daily, with an 
 ordinary large sized gonorrheal syringe having a blunt 
 point. I never advise a long nozzlecl syringe, as it often 
 serves to perpetuate urethritis near the meatus. This 
 treatment readily relieves all acute symptoms. 
 
 Should the discharge continue excessively and longer 
 than a week, after the subsidence of acute symptoms, I 
 
ACUTE PROSTATITIS. 23 
 
 add one grain of sulpho-carbolate of zinc to the ounce of 
 the injection before mentioned. 
 
 When complicated by orchitis, rest in bed is imperative. 
 Local applications of belladonna and hamamelis with cold 
 
 applications to the swollen testicle give relief. Anodynes 
 internally should be the chief remedies. 
 
 All acute symptoms gradually subside under this treat- 
 ment, leaving a chronic gieetv discharge, which is a ''flag*' 
 to indicate chronic inflammation of the prostate or vesicles. 
 and will be considered in the succeeding chapter. 
 
CHAPTER III. 
 
 SUBACUTE OE CHROXIC PROSTATITIS. 
 
 This affection of the gland is one of the most common 
 diseases with which young men between the ages of twenty 
 and thirty-five suffer. It is quite distinct from chronic 
 congested enlargement, common to men of middle age, and 
 from senile hypertrophy. A strict boundary line, however, 
 cannot be drawn, with reference to age, in any class of 
 diseases of the prostate. There are occasionally cases of 
 chronic prostatitis that occur earlier than the twentieth 
 year, while others are met with even past thirty-five with- 
 out there being any perceptible enlargement of the gland. 
 
 Fig. VH illustrates this form of disease: the red parts 
 indicating the sites of the lesions. In the earlier stages 
 of the trouble the inflammatory condition is confined to 
 the ducts and follicles of the gland, but when of long 
 standing it becomes diffused and involves the entire organ. 
 Ordinarily there is little or no swelling of the prostate; 
 and the bladder, seminal vesicles and rectum are rarely 
 involved, as is common in the other varieties of prostatic 
 diseases. In some aggravated cases, however, the inflam- 
 mation extends to the vesicles, ampulla, vas deferens, 
 epididymis or the globus major and minor. When the 
 latter are affected small worm-like lumps can be felt at 
 each end of the testicle, which are usually tender to the 
 touch. 
 
 Congestion of the pampiniform and hemorrhoidal 
 plexuses of veins almost invariably result: the former 
 causing varicocele, especially upon the left side, while the 
 latter gives rise to a swollen condition of the rectal mucous 
 
 24 
 
SUBACUTE OR CHRONIC PROSTATITIS. 
 
 Fig. VI. 
 
26 PROSTATE GLAND AND ADNEXA. 
 
 membrane resulting in protrusion, ulceration or the for- 
 mation of pile tumors. These conditions are sequels to 
 prostatic inflammation and not idiopathic diseases; and 
 the cause producing them should bo remedied before treat- 
 ing the symptoms, or all phases of the disease should be 
 treated at the same time. 
 
 ETIOLOGY. 
 
 The most frequent cause of this form of disease of the 
 gland is chronic gonorrhea, but it is not, as many physi- 
 'cians believe, the only one. On a liberal estimate, about 
 seventy-five per cent of these cases are traceable to gonor- 
 rhea as the source of the trouble, while twenty-five per 
 cent are due to other causes. Moreover, it is not a fact 
 that the gland becomes affected only by mal-treatment of 
 gonorrhea, as is usually the opinion of the patient, who is 
 often encouraged in this view by rival physicians, as he 
 "goes the rounds." It generally follows treatment even 
 by the most skilled physicians, and, too, in cases where the 
 patient exercises the greatest care. 
 
 Prior to the discovery of the specific germ, by Neisser, 
 in 1879, for gonorrhea, which he christened "gonococcus," 
 the medical profession were very much puzzled as to the 
 cause, tenacity and complications of this disease. Such 
 early authors as Selle (1781), Hunter (1786), Fournier 
 (1806), Eicord (1836), Foucart (1846) and Brandes 
 (1851) claimed that there was a direct relation between 
 gonorrheal urethritis and rheumatism that occurred in 
 conjunction therewith. 
 
 Guyon (1836) and Thiry (1856) advanced the theory 
 that gonorrhea developed a latent rheumatic diathesis. 
 G-uerin (18-16) and Laseque (1876) held that gonorrhea 
 was a disease, sui generis, with a long period of incubation. 
 Lewin (1878) advanced the theory that gonorrheal rheu- 
 matism was due to reflex irritation from urethritis. 
 
SUBACUTE OR CHRONIC PROSTATITIS. 27 
 
 Bemultz and Noeggerrath, long before the discovery of 
 the specific coccus, held that chronic gonorrhea in men 
 was accountable for many of the ailments in women, who 
 never had a true gonorrhea and whose troubles could not 
 be traced to any other source. 
 
 Like most great discoveries, that of Xeisser was no 
 exception to the general rule, and was met with strenuous 
 opposition, until confirmed by the investigations of Bumm, 
 Baumgarten, Finger, and many others in rapid succession. 
 
 I shall not discuss here the various means of scientific 
 research leading to the final establishment of the fact, 
 which is now recognized as a proven postulate, that the 
 gonococcus is a facultative micrococcus (schizomycete), 
 found free in the purulent discharge of gonorrhea and 
 within the substance of the pus cells. The latter feature, 
 together with the fact that it does not stain with iodine, 
 are two of its most characteristic diagnostic points. 
 Various diplococci are often present, so closely simulating 
 gonococci that the different methods, as staining, culture 
 growths, etc., have all to be used before a definite differ- 
 ential diagnosis can be established. 
 
 The gonococci, in common with most of the other 
 micrococci, are anerobic and thrive only in a neutral or 
 alkaline medium, and at a temperature of from 30° to 
 40° C. They feebly resist an acid medium, and in such 
 have an ephemeral existence. Paradoxical as it may seem, 
 from the tenacious manner with which this microbe clings 
 to its victim, it is a delicate germ and readily succumbs 
 to the effect of many germicidal agents, when brought in 
 direct contact with them ; but the gonococcus is so minute 
 that it conceals itself within the pus cells, subepithelial 
 cells, the lacunae of Morgagni, Littres glands, the prostate 
 and vesicles, and is out of reach of germicidal remedies 
 as ordinarily used. 
 
28 PROSTATE GLAND AND ADNEXA. 
 
 Up to the time of the discovery of the gonococcus the 
 remedies in use were directed, mainly in an empirical 
 manner, towards controlling the purulent discharge, it 
 
 being unknown at that time that the pus cells carted 
 away millions of the gonococci, which were the true source 
 of the disease. 
 
 Keersmaecker and Yerhoogen (followers of Oberlander) 
 say, "the gonococcus is extremely sensitive to desiccation." 
 * * * "It is hidden in the depths of the tissues and is 
 protected against destructive agents." 
 
 The gonococci are first implanted, fostered and propa- 
 gated at or near the meatus, in a medium and locality 
 most favorable for their development. They multiply very 
 rapidly, work their way along the urethra, and, in spite 
 of all measures to prevent it, to the prostatic part; thence 
 directly into the ejaculatory and prostatic ducts and fol- 
 licles. The orifices of these ducts being open gateways, 
 though their walls are in apposition, offer no resistance 
 to the passage of the germs into the channels of the 
 prostate and ejaculatory ducts, where they become hidden 
 within the follicles of the gland, and are thereby pro- 
 tected from destructive agents as applied through the 
 urethra by the usual methods. The course is also an open 
 one to the seminal vesicles and vas deferens, to which 
 they occasionally gain access. 
 
 The cylindrical epithelium of the urethral mucous mem- 
 brane is the normal abode of the gonococci. Here they re- 
 main active and aggressive, but after leaving this their 
 indigenous soil for that of the prostatic and ejaculatory 
 ducts, they become lethargic and do not wander very far 
 upon alien ground. Hence they usually do not pass further 
 than the interior of the prostate. 
 
 The authoritative estimate of the proportion of all 
 gonorrheal cases where the germs invade the prostatic ducts 
 
SUBACUTE OR CHRONIC PROSTATITIS. 29 
 
 and follicles, is placed at from seventy-five to eighty-five 
 per cent; those that invade the vesicles, at from twenty 
 
 to thirty per cent; and the vas deferens from ten to fif- 
 teen per cent. This is about the proportion as demon- 
 strated by the author's clinical experience, though the late 
 fad of stripping the vesicles would place gonorrheal in- 
 vasion of the vesicles at a much higher ratio. 
 
 Since it is a positive fact, as proven by various pathol- 
 ogists in their examinations of prostatic expressions, that 
 the pro-rate is the chief abode of the latent gonococci : 
 authorities differ upon the subject as to whether the germs 
 themselves subsequently penetrate cellular tissue and the 
 walls of blood and lymph vessels ; or that they remain dor- 
 mant within the prostate secreting toxins, which latter are 
 absorbed by these vessels and carried to remote part- of 
 the body effecting metastasis; as manifested by rheuma- 
 tism, arthritis or neuralgic pains in various parts of the 
 body. Lindeman, Young and others claim that the affecte 1 
 nerves and joints are the result of the gonococci carried to 
 these parts by the blood currents from a lesion localized in 
 the genito-urinary tract. Bumm, Baumgarten. Xeisser. 
 Bochart, Gerbardt and Hartley maintain that metastatic 
 diseases of the joints and nerves are the result of mixed 
 gonorrheal infection. Guyon, Janet. Furbringer hold 
 that these diseases follow as a direct result of ptomaine 
 poisoning from the invasion of the gonococci in the tis- 
 sues. There are others who advocate similar views all tend- 
 ing to the same result. 
 
 The author concludes, after summing up the opinions 
 as expressed by the numerous investigators along this line. 
 and recounting his own investigations and clinical expe- 
 rience, that metastasis is the result, in the majority of 
 instances, of the toxins of latent gonococci that originate 
 within the prostate as result of the secretion of the germs : 
 
30 PROSTATE GLAND AND ADNEXA. 
 
 and it is only in those cases where an abrasion of tissue 
 in the genito-urinary tract ensues that the cocci themselves 
 enter the circulation and are carried by the blood currents 
 to remote parts of the body. When the latter occurs and 
 the cocci are deposited within the joints, nerves, etc., they 
 readily die, as it is a proven postulate that they cannot 
 live outside of mucous surface; and the disintegration of 
 their cadavers intensifies local metastasis. 
 
 Taking either view, however, the question of vital im- 
 portance is practically the same; which is, that the germs 
 are concealed within the prostate, vesicles, or urethra, and 
 if the gonococci can be destroyed in these organs, it stops 
 the generation of toxins or destroys the germs themselves, 
 as the case may be, and subverts their entering the sys- 
 tem. 
 
 Clinical experience has convinced me that both of these 
 views are correct. However, the metastatic diseases are 
 much more often the result of the toxins eliminated in the 
 prostate, than due to the presence of the gonococci them- 
 selves in the tissues. The latter condition rarely, if ever, 
 exists unless there is some marked abrasion in the mucous 
 lining of the urethra, prostate, or vesicles. 
 
 Many observers have reported the discovery of diplococci 
 resembling closely gonococci, and, too, that would decolor- 
 ize by Gramas Method, and where cultures would produce 
 a urethritis of three or four days' duration but not a true 
 gonorrhea. The writer has noted many similar cases, from 
 clinical observation, and has been thoroughly convinced 
 that these germs are non-virulent gonococci, rendered 
 sterile by their having remained dormant for so many 
 years within the prostate or vesicles. 
 
 During an acute exacerbation of prostatitis, causing ex- 
 cessive discharge within the urethra, these latent cocci are 
 swept along with the discharge and at times set up a ure- 
 
SUBACUTE OR CHRONIC PROSTATITIS. 31 
 
 thrifts of short duration, but they lack sufficient vitality to 
 create a true gonorrhea. But, should the cocci enter the 
 blood current, phagocytosis would be the most probable re- 
 sult ; or, coupled with the lethal effect of blood serum upon 
 the germs, they could scarcely escape destruction. More- 
 over, it is an indisputable fact that gonococci cannot live 
 except within a mucous membrane, and, should it be pos- 
 sible for them to escape the destructive agents before men- 
 tioned, in their transit along the blood currents, it would 
 seem impossible that they could live sufficiently long, out- 
 side of a mucous surface, to effect metastatic pathogenesis, 
 except by poisons resulting from their death and decay. 
 
 I dwell upon this point at some length because the ques- 
 tion is an important one and one that is presented almost 
 daily in active practice, in regard to obscure chronic dis- 
 eases. 
 
 Should these germs be carried to various parts of the 
 body, and, if it were possible for them to live indefinitely 
 as they do within the mucosa of the prostate, . but few who 
 have had gonorrhea could withstand their ravages. Be- 
 sides, it would be impossible to reach them, if scattered over 
 the entire body, with destructive agents that would not 
 prove fatal to the patient. 
 
 The columnar epithelium of the mucosa within the 
 prostate being in closer anatomical relation to that of the 
 urethra, serves to perpetuate the lives of these germs better 
 and longer than other mucous surfaces, though they do not 
 propagate therein. The mild alkaline reaction of the pros- 
 tatic secretion also ministers to the maintenance of their 
 lives. 
 
 Clinical results following the treatment of the prostate, 
 together with frequent examinations of the prostatic ex- 
 pressions, have convinced me that the prostate is the chief 
 abode of the latent gonococci. I have traced, in numerous 
 
32 PROSTATE GLAND AND ADNEXA. 
 
 instances, the origin of remote arthritic and neuralgic 
 pains indirectly to the prostate, by destroying the hidden 
 germs within the gland, which were evidently the fons et 
 origo mdlorum, and which was evidenced by the imme- 
 diate disappearance of all symptoms. The destruction of 
 the gonococci within the prostate having suppressed the 
 generation of the toxins, and the poisons being no longer 
 carried through the lymph and blood channels to the tis- 
 sues, all pain would disappear and recovery would be rapid. 
 On the contrary, were it probable that the gonococci had 
 lodged and remained alive, within the joints and other tis- 
 sues, instead of their toxins, local treatment of the prostate 
 would not relieve the condition, and it would be impossible 
 to do so where polyarthritis existed. 
 
 Serous and synovial membranes and nerves are - espe- 
 cially marked for the morbific effects of the toxins of 
 gonococci. The "pathological changes that occur as denoue- 
 ment of the toxins, in the joints and serous cavities pro- 
 duce conditions favorable for the development of diplococci 
 or streptococci, that closely simulate gonococci; which 
 have given credence to the extensive migration of the lat- 
 ter. 
 
 Owing to the tenacious sequels of gonorrheal infection, 
 and the metastasis resulting therefrom, it is the opinion 
 of many physicians that, when one once has gonorrhea, 
 it is never entirely eradicated ; and that it is attended with 
 greater fatality than syphilis. The latter view is generally 
 conceded, taking the sequels of gonorrhea into considera- 
 tion. 
 
 Prostatic expressions have shown gonococci to be pres- 
 ent in the fluid, thus forced out, for many years after 
 complete subsidence of all gonorrheal symptoms. Some 
 writers have discovered latent gonococci in the gland as 
 long as sixteen years after having had an attack. 
 
SUBACUTE OR CHRONIC PROSTATITIS. 33 
 
 The past decade has been prolific of much research 
 as to the habits, life and pathogenesis of these germs, which 
 has been the means of revealing obscure diagnosis in many 
 instances; and especially since the discovery of their hid- 
 ing place in the prostate. 
 
 Furthermore, these germs may remain dormant secret- 
 ing toxins that penetrate and maintain an inflamed pros- 
 tate, but not effect metastasis for a long period, yet cause 
 reflex neurotic disturbances. 
 
 When the gonococci have entered the prostate, they 
 begin the secretion of toxins, which at first cause suba- 
 cute, then chronic inflammation of the follicles and ducts, 
 and subsequently parenchymatous affection of the entire 
 gland; the result of which maintains a constant muco- 
 purulent discharge that is poured out upon the floor of 
 the prostatic urethra. This secretion must necessarily 
 pass along the canal toward the meatus. The discharge 
 may be so slight as to appear only as the "morning drop'' 
 or it may become desiccated by the warmth of the urethra, 
 and noted only by gluing together of the lips of the meatus 
 in the morning; or it may even escape observation alto- 
 gether. Then again, the discharge may become quite pro- 
 fuse at times as influenced by excitation, as by dissipation 
 or other causes, and continue, regardless of all injections, 
 sounds or other caustic applications to the deep urethra, 
 or constitutional medication; as such treatments do not 
 penetrate the ducts to reach the seat of the trouble. 
 
 The gonococci may remain hidden within these deep tis- 
 sues for years in a latent state, unless, by certain irrita- 
 tive conditions, as induced by "bacho et venere" when a 
 copious prostatic discharge is excited, and the germs are 
 carried by the excessive secretion into the urethra, where 
 they may become auto-inoculable, and set up a fresh al- 
 though mild attack of gonorrhea, or a plain urethritis. 
 
3-i PROSTATE GLAND AND ADNBXA. 
 
 It has also been demonstrated by Oberlander, Verhoo- 
 gm, Finger and others that these germs may remain dor- 
 mant for three or six years, or even longer, when, under 
 certain conditions, they may become aroused to activity 
 and manifest their pathogenesis ; though not in as virulent 
 form as the prime attack. Xumerous instances have come 
 under the author's observation where, even among married 
 men, unmistakable evidence of latent gonococci had been 
 aroused to activity, developing an acute urethritis which 
 could not be traced to another origin than that of auto- 
 inoculation. 
 
 OTHER CAUSES. 
 
 During erotic excitement, whether normally or abnorm- 
 ally, the prostate becomes hyperemic, either synchronously 
 with or independent of penile erection. If this excite- 
 ment is unduly prolonged, by toying with women, indulg- 
 ing continuously in libidinous thoughts, association with 
 prostitutes, masturbation, continence or excessive inter- 
 course, it causes venous stasis or congestion of the gland, 
 resulting ultimately in subacute or chronic prostatitis; 
 which readily extends and involves the prostatic urethra 
 and adjacent parts. This condition provokes a prostatic 
 discharge similar to that of gleet and is often mistaken 
 for such. This discharge being poured out within the 
 urethra, induces prostatic urethritis in the same way as 
 that of the toxins of gonorrhea, and which may extend 
 the entire length of the urethral canal, rendering it tender 
 and supersensitive. Many times have I known such con- 
 ditions treated many years for gonorrhea, when there were 
 no indications of the latter. 
 
 It is somewhat difficult to define just what consti- 
 tutes excessive sexual indulgences, as individuals vary so 
 much in their physical organism and sexual propensities. 
 
SUBACUTE OR CHRONIC PROSTATITIS. 35 
 
 That. which would be excessive and injurious to one man, 
 might not be to another. 
 
 Masturbation. — In addition to its local baneful effect 
 upon the urethra and gland masturbation is attended with 
 an excessive drain upon the nervous system, and is, con- 
 sequently, more apt to provoke some form of mental dis- 
 turbance, owing to the absence of the natural psychical 
 stimulus of the opposite sex, than by the normal act. 
 
 The evil effect of masturbation upon the prostate and 
 vesicles primarily, and the nervous system secondarily, 
 has been over-estimated by many, and treated with too 
 much indifference by others. The fact of the almost uni- 
 versal practice, at some time of life, among males, renders 
 it a convenient source to which to attribute all the sexual 
 and nervous diseases, not traceable to that of gonorrheal 
 origin. 
 
 Charlatans reap a rich harvest among youths and, too, 
 older men, who, being over-sensitive, are too prudish or 
 secretive to consult their family physician and fall an easy 
 victim to their tenets and ruse. The family physician, 
 too, is often accountable for this, by not making a thor- 
 ough examination of the case when consulted, treating the 
 matter with too much indifference, dismissing him with a 
 tonic, or telling him it is "all in his head." The fact is 
 that most of those addicted to the habit are so ashamed of 
 it, that they will deceive the phvsician, in the large ma- 
 jority of instances, by denying the practice altogether, or 
 minimize the extent of indulgence so as to mislead him. 
 
 Objective symptoms alone, as revealed by an examina- 
 tion, can determine the extent of the lesion as induced by 
 the vice. I place bnt little credence in what one says about 
 the frequency or length of time he had indulged (as they 
 all say they have quit now). 
 
 Phimosis or an elongated prepuce often serves as an 
 
 / 
 
36 PROSTATE GLAND AND ADNEXA. 
 
 exciting cause, both towards precipitating and perpetuat- 
 ing the habit. The late Dr. S. W. Gross attributed the be- 
 ginning and continuance of masturbation as due largely to 
 the redundant foreskin. 
 
 The deleterious effects resulting from masturbation are 
 not due to the loss of semen, but to the nervous shocks 
 and the local irritation to the sensitive urethra, prostate 
 and vesicles, causing a congestion of these latter two or- 
 gans; and a subsequent disturbance of the cerebro-spinal 
 nervous system. While excessive sexual indulgence is de- 
 pressing to the nervous and physical organism, and causes 
 congestion and inflammation of the sexual organs, yet it 
 is devoid of the nervous shock that attends the unnatural 
 manner, as well as the local irritation resulting therefrom. 
 The latter provokes more frequent repetitions of the act. 
 
 Opportunity, too, also favors frequent indulgence, and 
 the sexual organ that suffers most is unquestionably the 
 prostate gland. 
 
 _Cold_Aveather or wet^fee±_aggravate all conditions of 
 the prostate and bladder, and it is often the case that one 
 affected with chronic prostatitis is comparatively comfort- 
 able through the summer, but begins to suffer on the ap- 
 proach of cold weather. Then again one may have been 
 conscious of the existence of some form of bladder trouble 
 for years, but of not sufficient gravity to consult a phy- 
 sician, until having gotten his feet wet, or exposed to se- 
 vere cold weather, when an acute attack is precipitated. 
 
 All forms of prostatic diseases are subject to acute ex- 
 acerbations and violent instrumentation; strong injections 
 within the deep urethra, large doses of turpentine or can- 
 tharides often provoke an inflamed condition of the gland. 
 
 Horseback and bicycle riding are etiological factors of 
 no small importance, and especially when the gland is ai- 
 readv tender or when there are other excitant causes. The 
 
SUBACUTE OR CHRONIC PROSTATITIS. 37 
 
 pressure of the saddle upon the perineum, and the jolting 
 of a misstep of the horse, or by a rough road for the 
 bicycle, is exerted upon the deep urethra or prostate. 
 .Many men, suffering from prostatitis, have told me that 
 they had observed the ill effects of a ride upon their wheels. 
 
 Continence. — A knotty problem, that often arises in 
 the treatment of diseases of the prostate, relates to the 
 effect, that totally refraining from sexual congress, has 
 upon the gland of robust persons not in position to nat- 
 urally indulge their sexual propensities. As before stated 
 it is a fact, recognized by all leading genito-urinary spe- 
 cialists, that the prostate in all healthy men normally be- 
 comes hyperemic during erotic excitement; and it is in 
 accordance with natural laws, that such excitement occurs 
 at certain intervals, regardless of whatever moral or 
 persuasive influence may be exerted to the contrary. While 
 this state may be greatly mollified by one^s habits, and by 
 surrounding influences to divert the mind in channels of 
 chaste morality; yet the intrinsic excitation, as exerted by 
 the sexual organs, in performing their normal functions, 
 is transmitted to the sexual brain or nerve center, which, 
 in turn, excites hyperemia, especially in the prostate gland 
 and penis. This local congestion or nervous excitation can 
 be controlled for a time without injury either to the gland 
 or nervous system; but by continual recurrences of sexual 
 erethism, engendering the accumulation of semen, over- 
 distending the vesicles to the extent of causing discom- 
 fort, and producing continuous prolonged prostatic 
 hyperemia, finally results in congestion, irritation and in- 
 flammation ; and, by reason of the highly sensitive nervous 
 organization of the gland, and the reciprocal relation it 
 bears to the sympathetic and cerebrospinal nerve centers, 
 various nervous disturbances of the latter are produced. 
 
 I have had under mv observation several cases of chronic 
 
38 PROSTATE GLAND AND ADNEXA. 
 
 priapism and different forms of neurotic aberrations, evi- 
 dently due to continence as the prime cause, and resulting 
 eventually in chronic prostatitis, and all the attending 
 sequels incident to the disturbance of the sexual organs, 
 and nervous disorders. 
 
 There are others where the surrounding influences, 
 united with lascivious readings, libidinous thoughts and 
 the intrinsic excitations of the normal functions of the or- 
 gans, produce chronic sexual and nervous disturbances at 
 a much earlier date and in a more aggravated form. For 
 this reason I have usually much less trouble in treating 
 married men than single. 
 
 Age, vocation and physical condition must also be 
 taken into consideration. It is not difficult for a man past 
 thirty, of delicate physique and whose business involves 
 mental exertion totally at variance with any lascivious im- 
 pressions, to abstain from sexual relations for an indefinite 
 period without injury resulting from violating natural 
 laws. But in the case of a young man of robust health, 
 whose occupation requires but little mental exertion, and 
 whose surroundings and associates tend to excite lust, con- 
 tinence would cause much prostatic irritation, congestion 
 and inflammation. 
 
 Alcoholic stimulants of all kinds tend to produce 
 erethism and congestion of the gland and should be avoided. 
 Beer and wines have particularly a baneful influence. 
 
 SYMPTOMS. 
 
 In most cases the symptoms are common in many re- 
 spects to those of stricture of large calibre, localized 
 urethritis, vesiculitis, or chronic gonorrhea; or all these 
 may coexist. In many instances these are apparently free 
 from any disease of the sexual organs, and are manifested 
 by mental depression, lack of confidence, melancholia, im- 
 
SUBACUTE OR CHRONIC PROSTATITIS. 39 
 
 potency, nervous dyspepsia, impaired memory or insomnia. 
 
 The eves are usually dull, and often become so disturbed 
 as to necessitate consulting an oculist, 
 
 Dysuria is rare unless complicated with stricture, gran- 
 ular urethritis or vesiculitis. In fact the urine being 
 normally an aseptic fluid resists the development of 
 pathogenic bacteria, although as many as thirty varieties 
 of non-pathogenic bacteria are often present therein. 
 
 GLEET. 
 
 A slight continuous discharge is a prominent symptom 
 of prostatitis. It unquestionably signifies the presence of a 
 pathological lesion in some part of the genito-urinary 
 tract. 
 
 The origin and source of this discharge has been the 
 subject of much comment and investigation, as well as 
 diversity of opinion among genito-urinary specialists. The 
 fact that such a discharge does arise from some ulcerated, 
 granular or inflamed surface is indisputable; and the 
 urethra, being the most favorable site for such, has suffered 
 the burden of caustic applications and operative procedure. 
 
 The writings of Dr. Otis, some years ago, attributing 
 this discharge to infiltration, coarctation or stricture of 
 large calibre, was followed by rash and indiscriminate cut- 
 ting of the urethra for almost every conceivable trouble of 
 the genito-urinary organs. Dr. Fuller states in his book 
 on "Disorders of the Male Sexual Organs," that a as a re- 
 sult of Dr. Otis^ writings on strictures of large calibre, he 
 had seen cases that had been cut for pus in the urine, which 
 were of pelvic origin. He also reports a case having come 
 under his care that had been cut seventeen times for stric- 
 ture, when the cause of the suffering was vesiculitis. 
 
 The author has seen quite a number of cases that had 
 been operated upon two or three times for stricture, where 
 
40 PROSTATE GLAND AND ADNEXA. 
 
 there were no indications of such, but whose symptoms 
 were cine to prostatitis or vesiculitis, causing a constant 
 gleety discharge. 
 
 While the author thinks the criticisms of Dr. Otis' 
 teachings are, at least, in part justifiable, yet any one hav- 
 ing read Dr. Fuller's book, before mentioned, would infer 
 that urethral discharges, as well as sexual disorders, were 
 traceable almost exclusively to vesiculitis. While the title 
 of his book is "Disorders of the Male Sexual Organs/' 
 yet I shall state that, with a conservative estimate, at least 
 five-sixths of its contents is devoted to vesiculitis and a 
 stripping of the vesicles. To state that the latter has be- 
 come one of the fads of today is placing it mildly; and I 
 shall venture the assertion that it will soon drop into as 
 utter disfavor as that of the Dr. White's castration en- 
 thusiasm as advocated a few years ago. 
 
 There are others who are ready to accredit most of these 
 symptoms to chronic urethritis. The book of Keersmaecker 
 and Yerhoogen, on chronic urethritis, is an excellent 
 treatise upon the subject, and especially from a diagnostic 
 point of view, evidencing extensive research, yet it appears 
 that too much stress is placed upon local lesions of the 
 urethra, alone. 
 
 Gleet is not a disease per sc, but a symptom of an exist- 
 ing lesion, and while it is generally understood to be a 
 sequel of gonorrhea, yet scant discharges from the urethra 
 occur from other causes so closely simulating it, that it 
 is difficult to draw a marked line of distinction. 
 
 The writer considers that when a persistent urethral 
 discharge, mild in character, resists all urethral treatment 
 it is symptomatic of prostatitis in some form. Vesiculitis 
 may coexist, and the vesicles should be examined, but, as 
 the large majority of cases of vesiculitis originate from the 
 urethra^ or prostate, whether due to gonorrhea, masturba- 
 
SUBACUTE OR CHRONIC PROSTATITIS. 41 
 
 tion or other causes, the infection or extension of the 
 inflammation must necessarily pass through the prostate 
 
 before reaching the vesicles, and hence must involve the 
 former. It is therefore irrefutable that the prostate, being 
 in closer proximity to the urethra, and owing to its ex- 
 posed position to the bladder, is much more liable to be- 
 come involved than the vesicles; yet the trouble, if of 
 aggravated form, often extends and affects the latter. 
 
 The urethra is still more exposed than even the prostate, 
 and never escapes disturbance when, disease of the latter 
 has existed any great length of time; as the irritative dis- 
 charge from the prostate or vesicles passing out into the 
 urethra — their only source of exit — would eventually pro- 
 voke urethritis: and upon examination, one finding a 
 sensitive or inflamed caiial, infers that the trouble was 
 confined to the latter instead of the prostate. In fact, 
 urethritis is often the most prominent subjective or ob- 
 jective symptom. It is evident, therefore, that by treating 
 and relieving the urethra for the time only, the symptoms 
 would recur, and continue to do so until the prostatitis or 
 vesiculitis was cured. The patient continues to. return and 
 report the same "morning drop," or forked stream, as 
 indicating the gluing together of the lips of the meatus, 
 as result of the drying of the discharge before escaping. 
 This continues until the patience of both the patient and 
 doctor becomes exhausted, and, to the great relief of the 
 latter, the former goes to another physician, through the 
 advice of a friend, with the same result — all dosing the 
 urethra and stomach, as it is evident, that, by simply treat- 
 ing the urethra, the trouble could never be relieved. Again, 
 should the disturbance have originated in the urethra and 
 extended to the prostate or vesicles, the same or similar 
 symptoms would appear; which would necessitate the 
 treatment of all three organ- as before. Urethritis would 
 
42 PROSTATE GLAND AND ADNEXA. 
 
 be aggravated and perpetuated by the prostatic discharge. 
 
 This chronic discharge has been the bete noire of the 
 profession from time immemorial, since they have mostly 
 confined their treatment to the urethra, or even should 
 they realize its source, their means of reaching it have 
 been inadequate. 
 
 The urethra has withstood sounds, injections, cauteries 
 and lavages for more than a century, and in many instances 
 with some relief, but never cured. 
 
 The objective symptoms reveal a red and often con- 
 tracted meatus: as before stated the lips of which are 
 frequently glued together, by the desiccated gleety dis- 
 charge. Upon passing a bougie a boule the first tender 
 point encountered is usually about six inches down the 
 urethra, at the juncture of the pendulous with the 
 membranous portion. Here there often exists an ero- 
 sion, granular surface or probably a stricture. ■ Should 
 one of the former exist, without a stricture, the instru- 
 ment may be arrested thereat, by the contraction of the 
 muscular fibers, or external sphincter, due to local irrita- 
 tion, as induced by the contact of the instrument with the 
 sensitive point. The membranous part of the canal is 
 quite tender, and the most favorable site for stricture, ex- 
 cepting that part near the meatus. On reaching the pros- 
 tatic portion of the urethra the instrument detects the 
 most sensitive part of the canal, which imparts the feel- 
 ing of roughness, indicating a granular surface over which 
 the instrument passes. Just as we regard the tongue as 
 an index to the condition of the stomach, so in like man- 
 ner do I consider the prostatic urethra syn^tomatic of 
 the state of the prostate or vesicles. The instrument, if 
 small, may enter the utricle and become arrested, or should 
 the prostatic urethra be excessively sensitive the bougie 
 may not pass on account of spasm; either of these condi- 
 
SUBACUTE OR CHRONIC PROSTATITIS. 43 
 
 tions may be mistaken for stricture, but it must be re- 
 membered that an organic stricture never occurs in the 
 prostatic portion of the canal. 
 
 At times, when the urine is acrid, there is some diffi- 
 culty in thoroughly evacuating the bladder. The irrita- 
 tive effect of the urine upon the tender part of the canal 
 causes a contraction of the circular muscular fibers of the 
 urethra at that point, which subsequently relax and allow 
 the passage of a few drops or a drachm of urine thereafter. 
 Some have slight pain just as the urine starts, others at 
 the close of urination, which is often attended with the 
 sensation of still more to pass. 
 
 The urethra, being the chief channel through which to 
 reach the prostate for direct treatment, and often too, its 
 local lesion provoking and maintaining prostataic affec- 
 tions in many instances, must necessarily receive especial 
 attention in the consideration of any form of the prostatic 
 disease. The secretions of the prostate or vesicles, passing 
 over the urethral mucosa, produce certain pathological 
 changes. These changes are not uniform throughout the 
 canal, but are generally confined to localized patches, 
 where the epithelial coating loses its smooth, moist surface 
 and becomes rough and hyperemic or granular. The most 
 favorable site for these patches is the prostatic urethra 
 (which never escapes involvement), the bulbo-membra- 
 nous junction and fossa navicularis. In some cases the 
 entire urethral canal is more or less affected. 
 
 By means of a flexible bougie a boule, passed slowly 
 along the urethra, the most inexperienced physician can 
 readily detect the rough, tender patches. Every general 
 practitioner should therefore supply himself with three 
 sizes of these bulbous bougies — Xos. 12, 14 and 16, Am. 
 The most accurate way of detecting the real character 
 of localized lesions within the urethra and bladder, as well 
 
44 PROSTATE GLAND AND ADNEXA. 
 
 as the condition of the prostate and its ducts, is by means 
 of a good urethroscope and cystoscope. 
 
 Much credit is due Oberlander of Dresden in achiev- 
 ing modern urethroscopy and cystoscopy. By his untiring 
 efforts he succeeded in constructing an instrument through 
 which a direct light could be transmitted to a localized 
 area within the urethra or bladder. But the platinum wire 
 used by him would become quite hot and it required a 
 cooling apparatus that rendered the instrument large and 
 cumbersome; besides encroaching upon the calibre of the 
 instrument^ limiting thereby the field of vision. So it fell 
 to the lot of an American (Dr. Henry Koch of Eochester) 
 to develop the mignon lamp, which consumes an energy of 
 only four or five volts and 0.2 of an ampere. This lamp 
 is practically devoid of heat, and can be inserted within 
 the urethra or bladder for an indefinite time without the 
 least inconvenience to the patient. / 
 
 Various improvements have been made within the last 
 few years until now localized sores can be easily detected 
 within the urethra, bladder or around the prostate, and 
 medicinal applications applied directly thereto. Besides, 
 there is no guessing at the morbid condition or its loca- 
 tion. 
 
 The size of the instrument I prefer is 26 F., and, if 
 the calibre of the urethra is too small to admit of its en- 
 trance, it is pathologically narrowed at some portion of 
 the canal and should be relieved before attempting an ex- 
 amination. 
 
 The instrument should be carefully examined, ren- 
 dered aseptic, and the light tested before it is introduced. 
 In some few cases the urethra is so callous to instrumenta- 
 tion that it is unnecessary to use an anesthetic, but where 
 it is unduly sensitive I always use cocaine locally, as it is 
 unpardonable to subject one to pain when it can be so 
 
SUBACUTE OR CHRONIC PROSTATITIS. 45 
 
 easily and harmlessly avoided. For this purpose I use 
 from three to twenty per cent strength of cocaine, de- 
 pendent upon the degree of sensitiveness of the urethra. 
 In most cases the prostatic portion of the canal is the 
 most sensitive, and the greater amount of the cocaine 
 should be applied thereto. By means of instrument No. 
 IX. the medicine can be applied to any portion of the ure- 
 thra or neck of the bladder as desired, and, by exercising 
 any degree of caution, with impunity. The cocaine is 
 drawn into the instrument by means of the bulb at the 
 upper extremity, similar to that of a medicine dropper, 
 and is pressed out in the same manner. If the upper por- 
 tion of the canal is not tender, or but slightly so, I do not 
 press the bulb until the instrument reaches the prostatic 
 portion, when slight pressure is made, but not sufficiently 
 to force out the entire amount of the fluid. The bulb is 
 then allowed to expand, when the surplus of the liquid is 
 again taken up. After waiting a minute or so the bulb is 
 again pressed as before. This is continued several times 
 before the entire amount is ejected. Should the pendulous 
 urethra be sensitive, it can be applied along its entire 
 length in the same way as before described. I use a bulb 
 on my instrument that only holds twenty or thirty minims, 
 so that a twenty per cent strength of cocaine can be used 
 with impunity and the parts thoroughly anesthetized, 
 whereas, by an ordinary syringe, as is generally used, it 
 w^ould be dangerous. 
 
 It has become a fad among some physicians to cathe- 
 terize the ureters, when more than one case of infection 
 has been carried from the bladder into these tubes, thence 
 to the kidneys. Besides, the cylinder of the plain cysto- 
 scope is larger and gives a better field of vision. 
 
 I also use a proctoscope or sigmoidoscope, which is 
 constructed upon the same general principle as that of 
 
46 
 
 PROSTATE GLAND AND ADNEXA. 
 
 Fig. VII. 
 
SUBACUTE OR CHRONIC PROSTATITIS. 47 
 
 the cystoscopc. This is a very useful instrument in de- 
 tecting the condition of the prostate, vesicles and rectal 
 mucosa. Before having procured this instrument I was 
 in great measure groping in the dark with reference to 
 the diagnosis as to the real condition of the vesicles, peri- 
 vesicuiitis and the rectal mucosa around the prostate. 
 
 I have found the best way to use the instrument is to 
 pass it gently into the rectum and up to the sigmoid flex- 
 ure; the obturator is then removed and the eye-piece, or 
 metal plug, is inserted, together with the air bulb. Gentle 
 pressure of the latter distends the rectum around the vesi- 
 cles, and also prevents the fecal matter from dropping 
 down within the tube. Mild distention of the rectum 
 with air discloses the condition of the vesicles and sur- 
 rounding tissues perfectly. The tube is slowly withdrawn 
 and at the same time continuing the air pressure when the 
 entire rectum and prostate can be accurately noted. 
 
 The pressure of the air should not be too great or it 
 will cause over distention of the colon and result in 
 colicky pains. 
 
 The voltage necessary for lighting these endoscopes 
 can be obtained from cell batteries, provided they are sup- 
 plied with suitable rheostats. The objection to cell bat- 
 teries, however, is that the cells deteriorate with use, caus- 
 ing, when much used, irregular current or voltage. 
 
 I prefer the current from the direct incandescent cir- 
 cuit, with a properly constructed controller, when the volt- 
 age is uniform, whether used five minutes or all clay long. 
 Fig. VII. illustrates a battery or controller that meets 
 all indications for this purpose. In fact, it is the best 
 apparatus upon the market, as it controls the current from 
 a fraction of a volt to that of fifty or more. It is not only 
 useful for lighting these delicate lamps, but can be used 
 for all electrolytic work and cataphoresis, besides supply- 
 
48 PROSTATE GLAND AND ADNEXA. 
 
 ing the primary and secondary faradic currents of any 
 desired strength. 
 
 XOCTURXAL EMISSIOXS. 
 
 Nocturnal emissions are not infrequent, and especially 
 when granular prostatic urethritis coexists with inflamma- 
 tion of the gland. Such lesion of the urethra inhibits its 
 normal elasticity, which, as a result, can not be accom- 
 modated to the elongated penis when erect, and produces 
 an undue drawing upon that part of the tender canal that 
 causes a fortuitous seminal discharge. One emission often 
 irritates the prostate or vesicles and thereby causes a second 
 or third in successive nights, and occasionally two in one 
 night. 
 
 In other cases there is a condition of atony, and a relaxed 
 state of the ejaculatory ducts and gland, when an emission 
 may take place without creating sufficient sensation to 
 arouse one from sleep. Again, these organs may be so 
 sensitive, by reason of these lesions, that in an effort at 
 sexual congress there is a premature ejection; even, at 
 times, this may occur before intromission. 
 
 There is frequently a prostatic discharge, that is mis- 
 taken for that of a seminal character. These chronic dis- 
 charges, from whatever source they may arise, rarely cause 
 noticeable systemic disturbances, unless they are very ex- 
 cessive. It is the pathogenic change in the prostate or 
 vesicles, that depresses the nervous system, disturbs diges- 
 tion and prevents in many instances proper assimilation, 
 Often there is little or no systemic disturbance, and one 
 may remain in apparent robust health for a long time, yet 
 he is conscious of something being wrong with his sexual 
 organs. There are others whose general health is very 
 much impaired as result of disorders of these organs, yet 
 have few subjective symptoms pointing directly thereto. 
 
SUBACUTE OR CHRONIC PROSTATITIS. 49 
 
 DIAGNOSIS. 
 
 The diseases for which chronic prostatitis is most liable 
 to be mistaken, are stricture and localized urethritis. The 
 latter two may either succeed, coexist with or be excitant 
 causes of the former. 
 
 The prostatic urethra is the most common site of 
 urethritis and is pathognomonic of prostatitis. As or- 
 ganic stricture never occurs in the prostatic urethra, one 
 familiar with passing of a bulbous bougie can easily de- 
 termine when it has passed the membranous and entered 
 the prostatic portion of the canal. This, too, can be de- 
 termined by the length of the channel and the distance 
 traversed by the bougie. Or, the operator may pass the 
 bougie into the bladder, and, by withdrawing it, measure 
 the distance and locate the points wdiere it meets with re- 
 sistance or roughness at the entrance of the prostatic 
 urethra. There is also, at the point of roughness, a slight 
 sensation of pain or irritation, which may not be felt at 
 any other portion of the canal, or if at all, but faintly. 
 
 Owing to the granulated and slightly swollen condition 
 of the prostatic urethra, it encroaches to some extent upon 
 the calibre of the canal, causing some narrowness. This 
 condition may be mistaken for stricture. Furthermore, the 
 channel being sensitive at an inflamed point, and the con- 
 tact of the instrument with the mucous membrane thereat 
 may produce reflex contraction of the circular muscular 
 fibers simulating stricture. This either causes a grasping 
 of the instrument or obstructs its passage for the time. 
 As previously stated, if an instrument of small size is used 
 it may enter the orifices of the ejaculatory ducts or utricle, 
 as they are frequently dilated in these diseases, and becom- 
 ing arrested thereby, create the impression that stricture 
 exists. I have known such mistakes made often and 
 urethrotomy performed therefor. 
 
50 PROSTATE GLAND AND ADNEXA. 
 
 The first morbific change that occurs within the prostate, 
 is chronic catarrhal folliculitis. This condition may last 
 for years, under strict observance of hygienic laws, and 
 temperate habits with little or no manifest symptom than 
 that of an occasional or persistent gieety discharge ; or the 
 discharge may be so faint as to become desiccated after 
 reaching the urethra, and noted by shreds in the first 
 voiding of urine. Subsequently the inflammatory con- 
 ditions extend to the interior of the gland and provoke 
 interstitial prostatitis, causing soft infiltration with slight 
 tumefaction of this organ; yet, there may be little or no 
 local or systemic disturbance, unless there occurs an 
 abrasion of tissue within the prostate, when the toxins or 
 cocci may become absorbed and engender metastasis. 
 
 It is quite common for some mem, as influenced by these 
 toxins, to become emaciated and delicate though suffering 
 no pain or marked constitutional disturbance; while oth- 
 ers remain in robust appearance, though suffering from 
 metastasis, or pains anywhere from that of the back of 
 their neck to their heels. Others become nervous from func- 
 tional involvement of the cerebro-spinal centers, causing 
 melancholia, impaired memory, sciatica, paraparesis or 
 many other forms of nervous disturbances. These changes 
 may develop so insidiously as to create no uneasiness upon 
 the part of the victim, unless the vesicles become involved, 
 or the inflammatory conditions encroach upon the ejacula- 
 tory ducts, narrowing their calibre or limiting their normal 
 elasticity to the extent of obstructing the passage of semen 
 altogether; or, should it pass through these narrow chan- 
 nels, during sexual congress, it would be followed by dull 
 pain, or marked nervous depression. 
 
 Long standing disease of the gland develops a congested 
 state and inflammatory complications of the bladder, rec- 
 tum, vesicles, and, at times, the kidneys, but the latter 
 are rarely affected to any serious extent. 
 
SUBACUTE OR CHRONIC PROSTATITIS. 51 
 
 TREATMENT. 
 
 Owing to the diversity of symptoms, both subjective and 
 objective, and the complications that exist with individual 
 cases, it is obvious that the treatment must necessarily vary 
 in accordance with the existing pathologic conditions and 
 indications. It is therefore impossible to establish a fixed 
 rule, by which to be governed in the treatment of all cases. 
 I can give here only a general outline of the course to be 
 adopted; whereas a more detailed account will be given in. 
 the clinical reports that will follow hereafter. 
 
 As the urethra and rectum are the only channels through 
 which to reach the prostate for direct treatment, these must 
 be rendered and maintained in a condition as free from 
 inflammation or irritation as possible. As the larger por- 
 tion of the prostate lies between and in contact with these 
 two canals, it would be impossible to relieve the gland as 
 long as these remain inflamed. 
 
 Any acrid condition of the urine, whether too acid or 
 alkaline, should be corrected. As before stated, in this 
 class of diseases of the gland, the urine seldom requires 
 special attention, since the bladder or kidneys are rarely 
 affected. 
 
 When there are no acute symptoms I usually give fluid 
 extract of Triticum repens to render the urine bland and 
 non-irritating. When over-acid, potassic citrate may be 
 added thereto with benefit. There rarely exists an unduly 
 alkaline urine in these cases, but when such is present, 
 and attended with vesical irritation, benz-ol capsules — 
 four to eight daily — has proven invaluable in controlling 
 this state. In excessive dysuria, or where there is an acute 
 inflammatory condition of the prostate, hyoscyamus is indi- 
 cated until all acute symptoms are relieved. For annoying 
 priapism, or marked erethism of the genitalia, bromide of 
 sodium, administered in ten or fifteen grain doses at night. 
 
52 PROSTATE GLAND AND ADNEXA. 
 
 gives temporary relief, until cure of the prostate is 
 effected. 
 
 There are other constitutional remedies that are espe- 
 cially useful in individual cases towards relieving the 
 annoying symptoms until the morbid condition of the 
 prostate is relieved. So much has been said and written 
 of late years, regarding the use of cystogen and urotropin 
 in genito-urinary diseases, that these drugs are given in a 
 routine way without reference to their specific action. 
 AYhile they have the property of correcting the excessive 
 alkalinity of the urine in some cases, yet the liberation of 
 formaldehyd in the urine is very irritating to the urinary 
 passages, and, if they are prolonged any length of time, 
 engender much vesical disturbance, dysuria and frequent 
 micturition. 
 
 Staphisagria, salol, thuja and oil of wintergreen are 
 useful in many cases. But the remedy that I have found 
 most efficient in relieving those distressing symptoms at- 
 tendant upon diseases of the prostate and bladder is benz-ol 
 capsules, the composition of which are benzoic acid and the 
 oil of gurjin. They are very soothing to the mucous sur- 
 faces and may be given indefinitely with impunity. 
 
 Kadical treatment of the gland should be delayed until 
 all acute symptoms of the urethra are allayed; unless, as 
 in some cases, there is urgent necessity for immediate re- 
 lief, or certain conditions of the gland provoke a continuous 
 urethritis. 
 
 In the large proportion of prostatic diseases urethritis 
 coexists, which generally aggravates the trouble. To allay 
 the sensitiveness of the urethra, I begin with the use of a 
 ten per cent solution of the aqueous extract of verbascum, 
 injected with an ordinary gonorrheal syringe, of large size. 
 This is forced into the deep urethra or even bladder. 
 Should a copious purulent discharge coexist, one grain of 
 
SUBACUTE OR CHRONIC PROSTATITIS. 
 
 53 
 
 sulpho-carbolate of zinc to the ounce is added thereto. I 
 not only avoid instrumentation until all acute urethritis 
 has subsided, but often defer my examination where sub- 
 jective symptoms indicate such condition, until the acute 
 symptoms have been allayed. The invariable result is re* 
 duction of the inflammation and relief of the tenderness, 
 so that a bougie may be introduced without pain. After 
 the injection has been used from two to three days and all 
 acute sensation in the urethra has disappeared, I then 
 insert a soft flexible bougie, previously annointed with an 
 
 Fig. VIII. Fig-. IX. 
 
 oil composed of one part of oil of eucalyptol to eight of 
 benzoinol. As the sensation in the urethra diminishes the 
 proportion of eucalyptol can be increased until it stings 
 sharply. This combination so applied makes a stimulating 
 yet soothing application to the canal. The bougie retains 
 sufficient of the remedy to apply thoroughly to the entire 
 mucous surface. The application should not be used more 
 
54 PROSTATE GLAND AND ADNEXA. 
 
 often than every second day, or in case of great tenderness, 
 every third day. The injection can be continued at the 
 same time until the acute symptoms have completely sub- 
 sided. I generally use this treatment from one to two 
 weeks, or in some rare instances longer before beginning 
 the radical treatment. Before proceeding with the latter, 
 I. shall describe briefly my instruments, together with 
 their modes of application. 
 
 Figures VIII and IX illustrate instruments devised by 
 the author for the special treatment of prostatic diseases. 
 The central part of the instrument is metallic, and in- 
 sulated throughout its length, except at the curved ex- 
 tremity (as shown) and the point to which the cord is 
 attached. A rubber bulb is fitted over the other hollow 
 end. The exposed part of the metal at the end is per- 
 forated, so that when the instrument is immersed in any 
 liquid medicine and the bulb is pressed, then relaxed, it 
 partially fills; when the bulb is again pressed the medi- 
 cine is forced out in jets through the small openings, as 
 illustrated. Xo. IX is used to apply the remedies to the 
 prostatic urethra and neck of the bladder; but as the 
 greatest trouble exists upon the floor of the urethra and 
 within the ejaculatory and prostatic ducts, instrument Xo. 
 VI 1 1 is used, as shown by reference to Fig. X. 
 
 In the two conditions illustrated by plates VI. and XII. 
 cataphoresis through the rectum and prostatic urethra, as 
 shown by figures X. and XL, is especially indicated. In the 
 latter the medicine is introduced through the curved, cup- 
 shaped opening at the lower extremity, and, by means of 
 a rubber-tipped syringe it is forced out through the open- 
 ings at the other end, as indicated. The electric current 
 and the medicine being limited to that part immediately 
 opposite the prostate are transmitted to the gland by cata- 
 phoric action. 
 
SUBACUTE OR CHRONIC PROSTATITIS. 
 
 oo 
 
 Fig. X. 
 
 By passing the electrode further up the rectum the 
 same cataphoric action is exerted upon the vesicles when 
 they are involved. 
 
 The instruments are so constructed as to meet all indi- 
 cations for applying medicine directly to localized ulcers. 
 or granulated patches, along the urethral canal, and effect 
 cataphoresis, interstitial electrolysis, vasomotor contrac- 
 tion, etc. 
 
 It must he remembered, however, that the properties of 
 the currents and remedies as used are limited to their ex- 
 posed metal ends and only within an area of a few inches 
 
56 PROSTATE GLAND AND ADNEXA. 
 
 therefrom and dependent upon the strength of current. 
 As the metal part (Fig. VIII) is in apposition to the floor 
 of the prostatic urethra, the full influence of the current, 
 for whatever purpose used, is concentrated upon that por- 
 tion of the gland tunneled by the ejaculatory and prostatic 
 ducts, and the parts that are always affected in this dis- 
 ease. The strength of the current, therefore, as well as 
 the remedy, when used for cataphoresis, should be very 
 mild. 
 
 For topical applications or cataphoresis the alcohol con- 
 tained in tinctures or fluid extracts is too irritating, so I 
 always use aqueous extracts, when using organic sub- 
 stances. For cataphoresis I prefer, in most instances, or- 
 ganic preparations to those of inorganic, as the latter are 
 more rapidly decomposed, do not penetrate the tissues, as 
 do the organic by electric-osmosis, and produce interstitial 
 electrolysis or their germicidal effects upon the micro- 
 organisms when such are suspected 
 
 For anoclal cataphoresis a non-oxiclizable electrode 
 should always be used, or the electro negative elements 
 will combine with it and form new compounds, which may 
 be very irritating or wholly inert. An oxidizable electrode 
 may be used in some instances with advantage to effect 
 metallic cataphoresis, when the result of such combination 
 and its properties are known. As, for instance, the anodal 
 use of a copper electrode results in the formation of oxy- 
 chloride of copper, which would be transfused throughout 
 the gland and be of marked benefit in some cases. On the 
 other hand, should a brass electrode be similarly used, a 
 double combination would result and the formation of 
 chloride of zinc would be very painful. 
 
 The treatment of cases of gonorrheal origin should be 
 somewhat different from those due to other causes. In 
 the former, germicidal remedies should be used, although 
 
SUBACUTE OR CHRONIC PROSTATITIS. 5? 
 
 I have clinically demonstrated in many instances phago- 
 cytosis by the attraction of leucocytes, and, aided by the 
 lethal effect of cataphoresis, all evidence of the germs dis- 
 appear. The cathodal attraction of blood serum is of easy 
 demonstration, both within and outside of the bodv. 
 
 Fig. XI. 
 
 Let a non-oxidizable electrode be attached to the anode 
 and passed into the urethra, and, even with a mild current, 
 it will soon become glued to the parts ; when, by reversing 
 the poles the cathodal attraction of serum will loosen it 
 very quickly. The experiment may be made by applying 
 the poles in a similar way to a fresh beefsteak, when moist- 
 
58 PROSTATE GLAND AND ADNEXA. 
 
 ure will rapidly accumulate on the cathodal side, while 
 the opposite side will become desiccated. 
 
 The electronic, cataphoric and dynamic properties of 
 the different currents are indisputable. These properties 
 can be used to effect synthetic or dialytic changes in both 
 organic and inorganic substances ; exert, by attraction and 
 repulsion, oscillation of molecules of bodies; and trans- 
 fuse liquids through animal tissue. While these agents 
 can be applied to destroy micro-organisms, dissipate mor- 
 bific tissue and invigorate the atonic organs; yet they can- 
 not be used without due reference to the condition of the 
 parts, the selection of the proper current and remedy to 
 be used therewith, intervals, strength and length of time 
 to be effectual and not engender harm. 
 
 Before the parts can be restored to a healthy state, the 
 morbid tissue or unhealthy granulations must be removed. 
 The most satisfactory way by which this can be accom- 
 plished, without direct or ultimate bad results, is, in my 
 opinion, by electrolysis or cataphoresis, accompanied with 
 suitable medicinal remedies. Xitrate of silver has been iu 
 use for that purpose from time immemorial, but it causes 
 excessive pain, fails to penetrate the ducts and gland, and 
 is often followed by cystitis, prostatis or epididymitis. The 
 patient is often confined to bed for weeks, and, on recover- 
 ing, is visited anew by the same trouble; which persists in 
 a chronic condition, as before. Moreover, the nerves, ves- 
 sels, follicles and parenchyma of the gland lack vitality 
 and recuperative power, and, even after the morbid prod- 
 ucts have been removed, require the invigorating influence 
 of the current in order to bring about healthy granula- 
 tions and a restoration of the organs to their normal state. 
 
 The most satisfactory method of treating these organs 
 is to thoroughly examine them with the cystoscope, and 
 locate the ulcerated patches within the urethra, see defi- 
 
SUBACUTE OR CHRONIC PROSTATITIS. 59 
 
 riitely the condition of the prostate and bladder. Then 
 the treatment can be applied directly to the diseased parts. 
 It is only after all the acute symptoms have been allayed 
 by the methods heretofore detailed, that the electric treat- 
 ment should be used. 
 
 As ultimate results depend largely upon the proper se- 
 lection, control and application of the currents, as well 
 as upon the suitable remedies to be used in connection 
 therewith, I shall take it for granted that the reader, be- 
 fore proceeding further with the detailed electric treat- 
 ment that follows, is thoroughly familiar with the subjects 
 of electro-physics, electrolysis and cataphoresis as described 
 in Chapter VIII. 
 
 Before beginning electric treatment, the operator should 
 carefully examine the battery and conducting cords, to as- 
 certain whether the former is in perfect working order, and 
 the latter are intact and connected with the proper poles. 
 The latter he should frequently test in order to be certain 
 as to their proper applications. This may seem an excess 
 of caution, but if the operator himself was being treated, 
 and had experienced the result of forgetting to turn off 
 one switch, or turn on another, or, still more important, 
 to note carefully the position of the commutator, he would 
 agree that these points can not be too forcibly impressed. 
 Even now, after many years of experience in manipulating 
 all kinds and makes of batteries and accessories, I never 
 fail to use these precautions. 
 
 In using the galvanic current for electrolysis or cata- 
 phoresis, it is important never to shock the patient. Al- 
 though probably no harm would result, yet the patient 
 would always be in fear of a repetition of the shock, even 
 if he did not discontinue treatment altogether. To avoid 
 this, a large sponge or carbon electrode, about eight inches 
 in diameter, is attached to the cord (which is previously 
 
60 PROSTATE GLAND AND ADNEXA. 
 
 connected with the indifferent pole of the battery), and 
 placed within easy reach of the patient — preferably upon 
 the stomach — that both hands may be used if necessary. 
 The active electrode is then placed in position for treat- 
 ment, and the cord attached thereto. Up to this time the 
 patient has not been allowed to touch the sponge, or in- 
 different electrode, with his hands. He is then instructed 
 how to touch it gently with the fingers of one hand, and 
 gradually bring them down until the palm is fiat upon it, 
 Should it be desirable to increase the efficiency of the ac- 
 tive electrode, the other hand can be placed upon the 
 sponge in the same way. The greater the surface of the 
 indifferent electrode, the greater, in direct proportion, is 
 the efficacy of the active electrode. Before removal of the 
 latter, the hands should first be removed, in the same man- 
 lier as they were applied. Should it be necessary to re- 
 verse the poles during the treatment, by means of the com- 
 mutator, or in any way. have the hands removed first and 
 then replaced in the same manner as before described. By 
 observing these precautions there will be no shock. 
 
 A battery should be so constructed that the current can 
 be gradually increased from the minimum to the desired 
 strength without interrupting the circuit. The suscepti- 
 bility of individual cases varies so greatly that I would al- 
 ways advise the use of the mildest current and the shortest 
 duration during the first few treatments. Whenever there 
 is an indication of pain, the treatment should be discon- 
 tinued at once. I rarely use local anesthesia, even in the 
 case of nervous patients with excessively hyperesthetic 
 urethras. The sensation is one of the best guides to the 
 strength of the current to be used, and the length of time 
 it is to be continued. 
 
 AYe must bear in mind the objects to be accomplished 
 by treatment, viz., the removal of morbid products and the 
 
SUBACUTE OR CHRONIC PROSTATITIS. Gl 
 
 relief of passive congestion by stimulating vasomotor con- 
 traction, thereby reducing inflammation. These can be 
 obtained without producing undue pain. Pain causes con- 
 gestion and inflammation, and it is impossible to state 
 just how many volts or milliamperes should be used in the 
 beginning or at any time during the treatment. A current 
 of sufficient strength to relieve one patient might be inert 
 in a second case or even harmful to a third. I begin with 
 from five to ten volts in the circuit, and never occupy more 
 than three or four minutes during the first or even second 
 treatment. Most beginners, and, in truth, nearly all, with 
 whose work I am familiar, try to do too much, and in too 
 short a time. 
 
 As to the selection of an instrument, I rarely use an 
 electrode smaller than No. 14 A, which, unless there is a 
 stricture, passes readily into the prostatic urethra, and 
 thence into the bladder, without engaging the openings 
 upon the floor of the prostatic urethra. I always begin the 
 electric treatment by using the electrode, as illustrated by 
 Fig. IX. With this I denude the prostatic urethra of the 
 unhealthy granulations, by means of cathodal applications. 
 These treatments are never made oftener than on alternate, 
 or, more frequently, third days. In some highly sensitive 
 cases I allow a week to elapse between treatments, and use 
 a bougie with benzoinol ointment, in the interval. It gen- 
 erally takes from three to five treatments to remove all the 
 granulations, which can be detected in the urine, if passed 
 in a bottle, for two or three days after each treatment. 
 
 In making a cathodal treatment, the kind of metal used 
 upon the point of the electrode is a matter of indifference, 
 as the electro-positive elements do not affect it. But in 
 anodal treatment the electro-negative elements, as oxygen, 
 acids, etc., combine with most metals very readily. In 
 these I always use an electrode of platinum or gold point; 
 
62 PROSTATE GLAND AND ADNEXA. 
 
 unless I wish to procure a local effect by means of the 
 metallic combination with the elements. For example, 
 after denuding the prostatic urethra of the granulations, 
 in order to bring about healthy action, I often make an 
 anodal application with an electrode having a solid copper 
 point, with very happy results. The action of the acids 
 of the electrolytes upon the metal, together with the tonic 
 effect of the anode, brings about renewed vigor of the tis- 
 sues. Those new combinations also penetrate the gland 
 by cataphoric action and have the same healthy effect upon 
 it. 
 
 The selection of remedies to be used by cataphoresis 
 within the ducts and upon the follicles and gland, must 
 be made with reference to the electrolytic effect of the cur- 
 rent. As water and salt enter largely into the composition 
 of animal tissue, free oxy-chloride can always be expected 
 in an anodal application. 
 
 So complex are the chemic constituents of many reme- 
 dies, the electrolytic effect of the current upon them, and 
 the recombinations resulting from the union of the electro- 
 negative elements with reference to their relative affinity. 
 that in many instances, it is difficult to determine exactly 
 what the changes are and the combinations formed thereby. 
 
 The frequency with which urethral instrumentation 
 should be used depends upon the condition of both the 
 prostate and urethra. Should the inflammation and su- 
 persensitiveness of the canal have been greatly allayed by 
 injections and bougies, as before described, then electrolysis 
 or cataphoresis can be employed every fourth or sixth day. 
 alternating with the use of the bougie the second or third 
 day. The interval between the use of the bougie and that 
 of the electrode should either be two or three days, depend- 
 ing upon the sensitiveness of the urethra and prostate. = 
 Should tenderness of the canal still continue, the injec- 
 
SUBACUTE OR CHRONIC PROSTATITIS. G3 
 
 tion should be used uninterruptedly. In some instances 
 urethral instrumentation should be used only once a week. 
 
 The advice of Sir Henry Thompson in this connection 
 is very valuable and should be rigidly observed. He says : 
 "Kemember that the introduction of an instrument is more 
 or less of an evil never to be resorted to unless a greater 
 evil be present which its employment may probably rem- 
 edy." 
 
 It is always better to err upon the conservative side, and 
 to do too little rather than too much. There is one other 
 point of special importance that I wish to impress forcibly 
 upon the minds of my readers — one that I learned by obser- 
 vation — and it is this : after a jDatient has been treated for 
 some four to eight weeks in succession it is better, in the 
 majority of cases, to discontinue all treatment for one, 
 two or even three weeks. This is in order to give ec vis 
 medicatrix naturae' a chance, and to rid the gland of the 
 disintegrated products which result from interstitial 
 changes, as caused by electrolysis or cataphoresis. In the 
 large majority of cases the improvement is more marked 
 than if the treatment had been uninterrupted. This fact 
 was noted in many instances where I was treating men 
 who lived at a distance, and who had to return to their 
 homes on account of business or for other reasons. On 
 their return I would find great improvement ; and in many 
 instances complete recovery would result, which obviated 
 the necessity of a return for further treatment. 
 
 Much depends upon the caution and skill of urethral in- 
 strumentation. I think it would be well for many physi- 
 cians to adopt the suggestion of Sir Henry Fen wick (sur- 
 geon to the London Hospital), where he says to his assis- 
 tants : "Every dresser should be induced to pass a full 
 sized steel bougie upon himself once or twice. He would 
 then appreciate the need of the utmost gentleness in ure- 
 
64 PROSTATE GLAND AND ADNEXA. 
 
 thral instrumentation.'* I have seen much harm result 
 from the injudicious use and rough handling of instru- 
 ments in the treatment of the prostate gland. 
 
 The treatment I have detailed does not interfere with 
 the patient's daily business. But. on the contrary, he be- 
 gins to feel better and fitter for work in a few days after 
 the treatment is begun. 
 
 I invariably interdict the use of alcoholic drinks, and 
 especially beer or fermented wines, during treatment; as 
 they have a tendency to increase local congestion and in- 
 flammation, and, besides, cause increased precipitation of 
 uric acid. I do not otherwise restrict the diet, in the ma- 
 jority of cases. 
 
 Case I. — Chroxic Prostatitis axd Prostatic Ure- 
 thritis. 
 
 Aged twenty-f our ; single; history, as given by himself, 
 is as follows : AVhen eighteen he had gonorrhea which 
 lasted about nine months. During the first stages of the 
 disease dysuria was excessive, the discharge from the ure- 
 thra being very copious, and followed by vesicular tenes- 
 mus, chorclee, etc. He had several succeeding attacks, 
 which, lasted only a few weeks, during which time there 
 was but little pain or disturbance of any character. A 
 gleety discharge followed, continuing up to his twenty- 
 first year, when he was pronounced strictured, and treated 
 for such by means of steel sounds. The treatment was 
 very painful and at first followed by bloody discharges. 
 This was continued for about a year, during which time 
 there was a continuous gleety discharge. His health was 
 much impaired; there was a dull aching sensation in the 
 region of the perineum, especially when walking or stand- 
 ing. He changed, physicians: sounds were used as before, 
 but larger, and producing hemorrhage attended with great 
 
SUBACUTE OR CHRONIC PROSTATITIS. 65 
 
 pain. His health continued to grow worse ; he became very 
 thin; suffered with anorexia, emissions and weakness of 
 the sexual organs, dull headache, despondency and lack of 
 confidence. 
 
 Upon examination I found the meatus red, inflamed, 
 and the lips glued together. There was a granular ulcer 
 in the fossa navicularis about an inch behind the glans 
 penis. On the introduction of a bougie a boule, there was 
 little sensitiveness of the urethra until the prostatic por- 
 tion was reached, where roughness offered a slight resist- 
 ance to the passage of the instrument, indicating a granu- 
 lar ulceration, and extreme tenderness. On withdrawal of 
 the instrument pus and mucus were found adhering to it. 
 Microscopical examination did not reveal any gonococci. 
 Upon pressure through the rectum there was very slight 
 tenderness of the gland and little or no swelling. 
 
 TREATMENT. 
 
 On the second day after the examination I made an 
 application of ointment composed of the oil of eucalyptol 
 one part to benzoinol eight. This was repeated on the 
 third day thereafter, when there was some less tenderness. 
 Two days afterwards the ointment was again applied and 
 the tenderness became still less apparent. Three clays 
 thereafter treatment by electrolysis was instituted, by 
 means of Xo. 14 electrode, with five m.a., lasting three 
 minutes. There was at the time a slight stinging sensa- 
 tion, followed hj a mild mucopurulent discharge. On the 
 second day an injection was given, one grain of sulpho- 
 carbolate of zinc to one ounce of a ten per cent solution 
 of verbascum, to be used four times daily. On the third 
 day after the electric treatment the ointment was again 
 used, the injection being continued in the interim. The 
 discharge became less, and three days afterwards electroly- 
 
66 PROSTATE GLAND AND ADNEXA. 
 
 sis was again applied with eight m.a., for three minutes; 
 slight watery discharge followed the treatment. Small 
 granules and shreds were noticeable in the urine. There 
 followed an improvement in every respect; discharge 
 scarcely perceptible. Cataphoresis was now applied 
 through instrument No. VIII, with five per cent solution 
 of verbascum, ten m.a., for five minutes; slight sensation, 
 little irritation following. The case was treated thereafter 
 by means of cataphoresis (a one per cent solution of thuja 
 — Aqueous — being used), an ointment, alternating every 
 third clay for one month. Treatment was then discontin- 
 ued for ten clays, when patient returned feeling greatly 
 relieved; no discharge, cataphoresis used with thuja, one 
 per cent strength, ten m.a., three minutes, causing slight 
 stinging; no ill effects following. Ten per cent solution 
 of verbascum was applied in the same way to the fossa 
 navicularis. The patient was then treated once a week by 
 means of cataphoresis, with twenty per cent strength of 
 verbascum for a month, when he was discharged — cured. 
 This case was under observation for several years after 
 dismissal and there was never any symptom of the former 
 trouble. In regard to the remedies used I may state that 
 thuja is a non-alcoholic extract of arbor vitae, which I 
 have specially prepared for me. The alcohol contained in 
 tinctures is too irritating, unless well diluted, when the 
 resin in thuja is precipitated, and the medicine is ren- 
 dered inert. 
 
 Case II. — Prostatitis, Stricture. 
 
 Gonorrhoeal history of seven years standing, with fre- 
 quent recurrences; gleet constant. Patient had stricture 
 in the membranous urethra, six and one-half inches from 
 the meatus — caliber 12 A. Immediately back of the stric- 
 ture and extending through the prostatic urethra was a 
 
SUBACUTE OR CHRONIC PROSTATITIS. 67 
 
 granulated ulcer. There was apparently no obstruction 
 to the flow of urine nor pain during the time, but at the 
 close of the act there would be slight pain and dribbling 
 of urine., lasting from three to five minutes. At times a 
 milky discharge preceded the flow. This preyed upon his 
 mind, as he believed it was spermatorrhea, for which, as 
 he said, "he had taken barrels of medicines." He was 
 troubled with sexual and moral hyperesthesia, insomnia 
 and hypochondriasis. The discharge proved to be a per- 
 verted prostatic secretion containing also mucus and pus 
 cells. He was in good flesh, though pale and easily tired 
 upon exertion. Sexual relations were very erratic. At 
 times several weeks would pass without the least desire or 
 even erection. Then again there would be an almost insati- 
 able propensity, but in attempting the act ejection would 
 occur before intromission, followed by a dull aching in 
 the region of the perineum. 
 
 Applications of benzoinal ointment were made on alter- 
 nate days three times. On the second day, after the last 
 ointment treatment, electrolysis was applied to the stric- 
 ture, a 14 A. electrode having been attached to the cathode. 
 The strength of the current was gradually increased from 
 five to twelve m.a., for five minutes, when the electrode- 
 passed the stricture. There was no pain until the stricture 
 was passed, and the electrode came in contact with the 
 granulated ulcer behind it, which was very sensitive and 
 somewhat painful. The circuit was immediately broken 
 and the electrode withdrawn. On the third day thereafter 
 a bougie No. 12 A. was introduced, and passed easily into 
 the bladder. Three days afterwards electrolysis was again 
 applied in the same manner as before with five m.a., for 
 three minutes. The electrode entered the bladder without 
 resistance, and with very little sensation. This was fol- 
 lowed as usual by a slight muco-purulent discharge. Cata- 
 
68 PROSTATE GLAND AND ADNEXA. 
 
 phoresis was then instituted with one per cent strength of 
 Ichthyol everj' fourth clay for three weeks. Complete re- 
 covery resulted. 
 
 Case III. 
 
 Single; aged thirty-f our ; consulted me for "nervous- 
 ness." He had been a very successful business man, hav- 
 ing charge of a large force of men in an extensive estab- 
 lishment. He was naturally very reticent with men and 
 timid with women. 
 
 He had never had any venereal disease, and in fact had 
 no subjective symptoms of sufficient importance to justify 
 an examination of the genital organs. Thinking that close 
 attention to business and long sustained tax of his mental 
 powers had given rise to the disturbance of which he com- 
 plained, I advised complete rest, and at the same time giv- 
 ing him a tonic, as he was somewhat anemic, though in 
 good flesh. He left my office in good spirits, intending to 
 spend a month or two in the Cumberland Mountains, fish- 
 ing and hunting. In about ten days, to my surprise, he 
 returned, saying that he believed, had he remained up 
 there a week longer, he would have gone crazy ; that, while 
 he was away, he did not think he had averaged two hours' 
 sleep in the twenty-four, and having nothing to do but 
 to think of himself and his condition made him worse than 
 when at work. The objective symptoms, as revealed by an 
 examination, showed an excessively hyperesthetic urethra, 
 so much so that the introduction of a soft bougie caused 
 him to partially swoon and break out into profuse prespira- 
 tion. He was allowed to remain upon the table, in recum- 
 bent position, for half an hour, when he fully recovered, 
 saying that the instrument did not pain him very much, 
 but that it caused a peculiar, indescribable sensation that 
 rushed to his head and caused blindness. The night fol- 
 
SUBACUTE OR CHRONIC PROSTATITIS. G ( J 
 
 lowing he had the best sleep that he had experienced for 
 six months. I had him inject a ten per cent solution of 
 verbascum three times daily for a week in order to allay 
 the hyperesthetic condition of the urethra before proceed- 
 ing further with the examination. 
 
 Upon questioning him further upon the subject, I was 
 able to elicit from him the fact that in his early youth he 
 had practiced masturbation to a very limited extent, but 
 had not done so for fifteen years prior hereto. He also 
 admitted that he had attempted intercourse twice only and 
 had such an utter failure, and was so disgusted with him- 
 self, that he had never had sufficient confidence to make 
 a third effort. He had noticed a milky discharge at times 
 just preceding the passage of urine, and also when at stool, 
 especially if costive. 
 
 Further examination of the gland showed it to be ex- 
 cessively sensitive both through the prostatic urethra and 
 rectum. A bougie was introduced every third clay into 
 the bladder, and a suppository composed of five grains 
 each of boric acid and aristol introduced into the rectum 
 at night. At the end of the third week urethral catapho- 
 resis w r as instituted. The treatment was similar to that 
 given in the former cases, except that only cataphoresis 
 was used and only once a week. Complete recovery fol- 
 lowed after four months 5 treatment. 
 
 Case IV. — Peostatitis, Epilepsy. 
 
 Married; aged twenty-eight, thin, nervous, wild eyed 
 and as restless a man as I think I ever saw. He was born 
 and raised in the country by an intelligent, well-to-do 
 widow. At about fourteen he began masturbating, and at 
 sixteen had epileptic fits. They assumed a periodicity and 
 at first recurred about every four weeks, then every two 
 weeks, often followed by two or three attacks in one or the 
 
TO PROSTATE GLAND AND ADNEXA. 
 
 succeeding day. They continued to grow more frequent 
 and severe until lie would have two or three attacks a week. 
 He was at first treated by his local physician with bro- 
 mides., which controlled them to some extent in frequency 
 and severity, but at the expense of his physical and ner- 
 vous system. He went the round of neurologists in Xew 
 York, Cincinnati and St. Louis for ten years. The last 
 physician, after having had him under treatment for more 
 than a year, trephined him, as he said, for too much blood 
 upon the brain. Still there was but little temporary re- 
 lief. He had taken bromides until he was almost an im- 
 becile, when he returned home. His local physician ad- 
 vised him to get married, which he did about nine months 
 before coming under my care. 
 
 The objective symptoms, as determined by an examina- 
 tion, revealed phimosis in a marked degree, the glans 
 penis and meatus being red and very sensitive. The ure- 
 thra was so extremely hyperesthetic that an attempt at 
 introducing a bougie almost threw him into convulsions. 
 My first step in the way of treatment was to circumcise 
 him, then by the use of injections of verbascum, to allay 
 the supersensitiveness until I was enabled to make an ex- 
 amination of the prostate, which was quite irritable and 
 sensitive. On account of the extreme tenderness of the 
 urethra and prostate I passed a bougie only once a week, 
 continuing the injection at the same time. The bromides 
 were also continued, but in smaller doses. He had been 
 taking the bromide of ammonium in scruple doses three 
 times daily. I gave him bromide of sodium in ten grain 
 doses three times daily, gradually diminishing to eight, 
 five, then five twice a day. The epileptic attacks became 
 less frequent and severe until they again assumed periodic- 
 it}', returning every twenty-eight days. I had him discon- 
 tinue the use of the bougie and began that of cataphoresis 
 
SUBACUTE OR CHRONIC PROSTATITIS. 71 
 
 with mild solution of verbascum. Patient was under 
 treatment fourteen months. For five months before he 
 was dismissed he had not had an epileptic attack, nor had 
 he taken a dose of bromide for three months. Eleven 
 and one-half months from the time he began treatment 
 his wife was delivered of a girl baby. The patient became 
 quite strong and corpulent, returned to his mother's farm, 
 and I have not heard from him since. 
 
 Quite a number of cases similar to the last two have 
 come under my observation. The}' were traceable to dis- 
 ease of the prostate and exhibited a variety of neurotic 
 disturbances as a result of masturbation, continence, or 
 excessive sexual indulgence. 
 
 In the treatment of this class of diseases, when I sus- 
 pect the lurking of gonococci, and that the prostatitis is 
 due to the toxins secreted by these germs, I use ichthyol 
 or other germicidal agents by means of cataphoresis, after 
 having allayed all acute symptoms by the process before 
 described. In those not due to gonorrheal infection, I 
 prefer aqueous extract of verbascum, thuja, echinacea, or 
 a combination of two per cent solution of equal parts of 
 the latter two, and used in the same way. 
 
 Case V. — Prostatitis, Vesiculitis, Prostatic Ure- 
 thritis. 
 
 Single; aged thirty-three. The only subjective symptom 
 of which this man complained was total impotency. Other- 
 wise he was in fairly good health, and attended his busi- 
 ness daily. He had never indulged in alcoholic drinking. 
 He had masturbated some in early youth, but abandoned 
 it quite soon for sexual indulgence, which he carried to 
 great excess. This inordinate indulgence was maintained 
 for five or six years, when an impairment of function was 
 noticeable. This condition continued to grow worse, until 
 
72 PROSTATE GLAND AND ADNEXA. 
 
 a physician was consulted, who prescribed aphrodisiacs. 
 Temporary excitement followed the use of the drugs, 
 which was soon followed by complete collapse. Other 
 drugs were tried without avail. The physician endeavored 
 to persuade him, as he had no apparent physical ailment, 
 that "it was all in his head." He never had gonorrhea, or 
 any kind of venereal disease. A second, third and fourth 
 physician was consulted; each of whom treated him simi- 
 larly to the first without the least benefit. Neither of the 
 doctors made a physical examination, as they took it for 
 granted, that, as he had never had gonorrhea, there was no 
 lesion of the genital organs causing the trouble. This 
 treatment extended over a period of six years, and, strange 
 to state, no quack remedies were taken in all this time. 
 
 Upon passing a bougie a boule, I noticed very little sen- 
 sitiveness until the prostatic portion of the urethra was 
 reached. Examination with the cystoscope revealed an in- 
 flamed and granular surface along the floor of the pros- 
 tatic urethra. The other portion of the canal was normal. 
 The prostate and vesicles were slightly tender upon pres- 
 sure. As revealed through the proctoscope the rectal mu- 
 cosa opposite the gland and vesicles was red and somewhat 
 inflamed, but not abraded. 
 
 . On the second day, after the examination, No. 14 A. 
 bougie was passed annointed with benzoinol ointment. It 
 entered the bladder quite easily, and with very little irri- 
 tation. Two days thereafter cathodal electrolysis, with 
 No. VIII electrode 14 A., using ten per cent strength of 
 verbascum, was introduced. This application was attended 
 with a current strength of ten m.a., and of five minutes 
 duration. Two days afterwards a sinusoidal treatment of 
 the prostate and vesicles through the rectum was given. 
 Applications w^ere given alternately through the rectum 
 and urethra for ten weeks. The nocturnal emissions oc- 
 
SUBACUTE OR CHRONIC PROSTATITIS. 73 
 
 curred only about once every three or four weeks. At 
 times he would pass six weeks without an emission, which 
 I did not consider abnormal, nor did they depress him. 
 This proved to be one of the most obstinate cases I ever 
 treated, which was due evidently to the long continued 
 use of aphrodisiacs. 
 
 Case VI. — Prostatitis, Vesiculitis and Urethritis. 
 
 Single; aged twenty-seven; gonorrheal origin. This 
 young man. had gone the rounds of first the druggists, then 
 the quacks. He was suffering intensely from dysuria, pain 
 in the back, perineum and left groin. There was a gleety 
 discharge, which, at times, was profuse, then again, very 
 scant. It was his first attack, and it had been running for 
 eighteen months. 
 
 His treatment had consisted of injections, systemic med- 
 ication, irrigations and sounds. The meatus was very 
 much contracted, and the urethra was tender throughout 
 its entire course. There were localized patches along the 
 canal much more sensitive than at other points. The rec- 
 tum was quite tender and often protruded while straining 
 to void urine when at stool. The parts were so tender that 
 I did not attempt a thorough examination at first. I had 
 him inject a ten per cent solution of aqueous extract of 
 verbascum five times daily. He was also instructed to in- 
 troduce a suppository of boric acid, ten grains, and extract 
 of belladonna, three-quarters of a grain, night and morn- 
 ing. After three days the acute symptoms had greatly 
 subsided, when the benzoinol ointment was begun. Exami- 
 nation was made at the end of a week, disclosing three 
 granular patches in the urethra ; the first at one inch back 
 of the meatus, the second at six inches and the last in the 
 prostatic portion. The rectum was inflamed and abraded 
 opposite the prostate and very red and tender high up and 
 about the vesicles. 
 
74 PROSTATE GLAND AND ADNEXA. 
 
 The treatment was similar to that before described, ex- 
 cept that ichthyol was used in cataphoresis, it being a more 
 decided germicidal agent. The injection was continued 
 during the first month's treatment to control the urethritis. 
 Kecovery followed three months' treatment. 
 
 There are many similar cases to these with various com- 
 plications. At times the bladder is involved but it very 
 rarely requires special treatment. It readily recovers as 
 soon as the other troubles are relieved. It is exceedingly 
 rare that the gonococci invade this viscus; and especially 
 with young men whose urine is almost invariably aseptic 
 and noxious to these germs. 
 
 Occasionally I find some cases where ulceration upon 
 the floor of the prostatic urethra resists the methods of 
 treatment before detailed. In such cases I bring the ulcer 
 into view by means of the cystoscope, which I prefer for 
 this part of the canal to the urethrascope, and touch it 
 with twenty per cent of ichthalgon or fifty per cent of 
 argyrol. 
 
 Where the prostate or vesicles are very tender, I often 
 suspend urethral treatment for some days, and apply 
 through the rectum to these organs the secondary faradic 
 current with from fifteen to twenty thousand ohms re- 
 sistance. This treatment acts as an analgesic and allays 
 local irritation. 
 
CHAPTEE IV. 
 
 CHRONIC CONGESTED ENLARGEMENT OF THE PROSTATE. 
 
 This affection of the gland is common in middle age, 
 and occurs more frequently between the ages of forty and 
 sixty. It is, however, not infrequent as early in life as 
 thirty-five and even past seventy without the existence of 
 senile or fibrinous hypertrophy. I have had three cases — 
 one seventy-two, another one year older and a third sev- 
 enty-nine — with congested enlargement, and inflammation 
 of the gland, seminal vesicles and neck of the bladder, 
 without fibrinous induration. 
 
 The idea, so generally prevalent among the profession, 
 that, when a man past forty or fifty has any disease of the 
 prostate, it is indurated hypertrophy and incurable, is er- 
 roneous. This disease of the gland is one of passive ve- 
 nous congestion, soft submucous infiltration and a swollen 
 enlargement of the organ, which generally results in in- 
 flammation not only of the gland itself, but of most all 
 the other pelvic viscera. It is somewhat analogous to the 
 congested and inflamed condition of the uterus and its 
 appendages. Not every woman that has venous stasis and 
 an inflamed womb has fibroid tumors developed within its 
 walls. In fact, the latter is rare as compared with the 
 number of cases of the former. In like manner fibrinous 
 tumors, or hypertroph}^ of the prostate, is rare as compared 
 with the numerous occurrences of congested enlargement. 
 
 I have treated quite a number of cases of this class of 
 prostatitis, that had been treated by different physicians 
 for many years, and pronounced hypertrophy and incura- 
 ble. Some of these cases had not only been treated by the 
 family physicians, but by many of the leading specialists 
 in this line. 
 
 75 
 
76 
 
 PROSTATE GLAND AND ADNEXA. 
 
 Fig. XII. 
 
ENLARGEMENT OF THE PROSTATE. 77 
 
 It is somewhat difficult in some cases to differentiate at 
 first between congested enlargement and fibrinous indu- 
 rated hypertrophy. The diagnosis will be considered more 
 at length under the head of diagnosis that will follow upon 
 this subject. I shall add here, however, that, basing a 
 statement upon my own clinical experience, at least twenty 
 cases of congested enlargement of the gland occur to one 
 of hypertrophy. I do not include in this estimate chronic 
 prostatic folliculitis common to young men. 
 
 Cause. — The most j^otent etiological factors, productive 
 of this form of disease of the prostate, are common with 
 those that excite chronic inflammation of the gland as de- 
 tailed in Chapter III. When folliculitis is not arrested and 
 it is permitted to extend and induce parechymatous pros- 
 tatitis and plastic exudation, interstitial infiltration is the 
 natural sequence. The exudate, thus produced, extends to 
 the muscular fibers, and its pressure upon the blood and 
 lymph vessels increases stasis, and chronic enlargement 
 and inflammation of the entire gland results. 
 
 Inordinate indulgence in alcoholic liquors, whether char- 
 acterized by excessive bouts of drinking or a moderate 
 though constant habituate, excites and increases congestion 
 of the gland: and. where any previous lesion of any part 
 of the genito-urinary tract exists, it is aggravated. Es- 
 pecially is this fact more apparent when beer or fermented 
 wine is employed. 
 
 Since it has become a proven fact that, in from seventy- 
 five to eighty-five per cent of gonorrheal cases, the cocci 
 invade the gland, and there remain dormant indefinitely, 
 producing poisons that maintain a slow though constant 
 irritation, besides that engendered by the germs them- 
 selves and the debris of their cadavers; chronic inflamma- 
 tory enlargement of the gland should receive more prompt 
 attention than is generally accredited it. One reason that 
 
78 PROSTATE GLAND AND ADNEXA. 
 
 it fails to arouse the uneasiness its importance demands 
 is because of the insidious manner of the progress of the 
 disease, and of the variable character of the subjective 
 symptoms. At times all symptoms may be entirely lacking, 
 or they may recur in a somewhat aggravated form necessi- 
 tating the consulting of the family physician, who may 
 not give it the significant attention requisite, and usually 
 dismiss the case, without examination, by prescribing a 
 diuretic, and permit the development of the gland until it 
 becomes quite serious. 
 
 Any form of dissipation aggravates the trouble; but 
 it has been particularly noticeable with that class of men 
 who have at some time of life been addicted to alcoholism 
 and its companion in crime, excessive venery. 
 
 Lesion of the gland, whether of gonorrheal origin or 
 due to other causes, is more easily excited by stimulants, 
 at least for a time, until a complete breakdown follows. 
 In other instances the irritation arising from lesion of the 
 gland, whether due to dissipation or other causes, creates 
 an insatiable sexual desire, that affects the central nervous 
 system to such an extent as to cause mental disturbances 
 of various kinds. Such persons are often too modest to 
 reveal all the facts to their family physician, and fre- 
 quently endeavor to deceive even the specialist whom they 
 may consult. It is much better, in such cases, for total 
 impotency to supervene than to provoke an immoderate 
 drain upon the nervous system, by excessive sexual con- 
 gress, which often results in paresis, impaired memory or 
 even insanity. It was no doubt due to this fact that only 
 a few years ago castration was advocated, and performed 
 quite frequently for insanity. It was claimed that marked 
 relief followed the operation in some cases, while others 
 were reported as cured. 
 
 Ulceration of the rectum, whether resulting from pros- 
 
ENLARGEMENT OF THE PROSTATE. 79 
 
 tatitis, is usually concomitant therewith, or, originating 
 from other causes, evidently provokes and maintains pros- 
 tatic congestion and inflammation, on account of its being 
 in such close proximity to the gland. 
 
 Horseback riding, and especially those who do very 
 much of it, aggravates an existing prostatitis, even though 
 it may not be the prime cause of it. I have found this 
 trouble quite prevalent among country physicians, who are 
 compelled to visit their patients on a horse. Bicycle rid- 
 ing has equally as bad, if not worse, effect upon the gland. 
 I do not think moderate riding either upon a horse or 
 wheel has any injurious effect upon the prostate, when it 
 is in a healthy condition, and the rectum free from ulcera- 
 tion. In fact, the irritation is transmitted to the gland by 
 the saddle through the rectum and lower urethra. 
 
 Cold often excites congestion of the prostate, and, when 
 prolonged or habitually exposed, it especially aggravates 
 an already inflamed gland. Violent and long continued 
 use of instruments are potent causes of enlargement of 
 the organ, and especially when large sounds are employed, 
 pressing upon the inflamed gland. The practice is a com- 
 mon one and is generally advised by surgeons ; and, in fact, 
 is almost universally used. Unless the sound is handled 
 by a skilled operator the end of it strikes the gland in 
 such way as to do much harm. 
 
 Strong injections and cautery applications to the pros- 
 tatic urethra often produce serious trouble. The admin- 
 istration of aphrodisiacs for impotency, which is a common 
 symptom of this disease, has a pernicious effect upon the 
 gland. The exciting by these medicines, of a diseased 
 gland, incapacitated for its normal function, to produce 
 an abnormal congestion and orgasm^ often provokes serious 
 trouble. It is a very general practice of giving these reme- 
 dies in a blind manner, without having examined the pros- 
 
80 PROSTATE GLAND AND ADNEXA. 
 
 tate with the view of discovering the real cause of the 
 trouble. 
 
 SYMPTOMS. 
 
 The symptoms are somewhat common to those of chronic 
 prostatitis of young men, except that, in this form of 
 disease, there are more complications, and, in some cases, 
 a higher degree of inflammation, as a result of the large 
 size of the gland impeding the free flow of urine. Often 
 vegetative growths spring up in the prostatic urethra, and 
 around the vesicle neck, which at times project into the 
 anterior part of the bladder. These may develop into 
 polypoid tumors, that flop about the neck of the bladder 
 like a valve, and shut off the flow of urine, for a time. 
 These tumors are very vascular and inclined to periodical 
 hemorrhages. 
 
 Prostatorrhea may be constant or periodical, and is 
 often mistaken for spermatorrhea. The former may be so 
 slight as to appear only in the form of gleet ; or it may pre- 
 cede the flow of urine, when it has accumulated within 
 the prostatic urethra, in the form of a milky fluid. Others 
 have the white discharge just at the cessation of the pas- 
 sage of the urine. When the latter occurs the discharge 
 accumulates within the prostatic ducts; and by spasm of 
 the prostatic sphincter in expelling the tardy urine, ejects 
 also this secretion. In other cases, and especially when 
 vesiculitis coexists, spermatic fluid may also pass. These 
 fluids are usually mixed with pus and mucus. 
 
 The urine in these cases is almost invariably abnormal. 
 Its changed condition depends mostly upon the extent of 
 lesion, the size of the gland, the length of standing, and 
 the bladder complications. The vesicle neck is the first 
 part of that viscus to become involved, and, in most cases, 
 it does not extend further, unless of very long standing. 
 The urine generally changes from its normal acid reaction 
 
ENLARGEMENT OF THE PROSTATE. 81 
 
 and aseptic condition to that of alkaline, and is no longei 
 innoxious to bacteria, but favors their development. The 
 action of bacteria upon exfoliated mucus favors pyogene- 
 sis and the production of ammoniacal urine. The latter is 
 exceedingly irritating to the bladder and especially at the 
 neck, causing frequent and painful urination. This is 
 particularly noticeable during the day, when standing or 
 walking, as the urine gravitates to the neck or tender part 
 of the bladder or prostate. The prostatic urethra, being, 
 as a rule, the most sensitive part of the genito-urinary 
 tract, is often rendered spasmodic by the acrid urine, and 
 the unpleasant sensation of still more to be voided even 
 after the evacuation of the bladder; or it may cut off the 
 flow for a few moments, when it again relaxes, and allows 
 the passage of a small quantity of the urine. The irrita- 
 tion of the gland or bladder is frequently reflected to the 
 kidneys, causing polyuria, that is mistaken by many for 
 diabetes or Bright's disease. This condition may last a 
 long time without effecting any organic disease of the kid- 
 neys. 
 
 Systemic disturbances are quite common, either as a re- 
 sult of metastasis, or as a direct sequel of the diseased 
 gland. Toxins or ptomaines emanating from the latent 
 gonococci, and carried by the blood currents to the joints. 
 nerves and serous membranes, induce metastatic rheuma- 
 tism, neuralgia, peritonitis, perityphlitis or various other 
 troubles from the back of the neck to a pain in the heel. 
 
 As a direct or reflect neurotic disturbance, arising from 
 disease of the gland, the sciatic nerve, or some of its 
 branches, is the most frequently affected. Pain over the 
 hip or in the calf of the leg is common. This may also ex- 
 tend to the back, and become so serious as to impair the 
 use of one or both legs. 
 
 There is often tenderness in the region of the perineum, 
 
82 PROSTATE GLAND AND ADNEXA. 
 
 or a dull heavy aching sensation, which is felt while stand- 
 ing or sitting. I have known some who could not ride in 
 a buggy with any degree of comfort; others who were ne- 
 cessitated to carry rubber cushions, hollowed out in the 
 center, around with them. 
 
 The objective symptoms revealed by examination through 
 the rectum is an enlargement of the gland, which gener- 
 ally protrudes as an oval mass upon its front wall. If in- 
 flammation of the gland coexists, there is either redness or 
 lesion of the mucous lining of the bowels at that point. 
 Upon examination with the sigmoidoscope (Fig. VII), the 
 same condition of the membrane may be noted higher up, 
 opposite the seminal vesicles, together with an inflamma- 
 tory complication of the latter. 
 
 Pressure upon the gland, through the rectum, deter- 
 mines the extent of the inflammatory state which is usually 
 reflected to the glans penis or perineum. It requires an 
 experienced touch of the finger to determine whether this 
 enlargement is due to a swollen condition (the result of 
 passive venous stasis and soft infiltration) or to indurated 
 hypertrophy. In the former, both lobes of the prostate 
 are usually about equally swollen and tender, and, while 
 somewhat firm to the touch, do not feel cartilaginous. The 
 lobes of the gland appear more symmetrical, and are not 
 nodulated. In indurated hypertrophy the portion of the 
 gland that is involved is quite firm and in most cases feels 
 nodulated, just as fibrous tumors as developed in any 
 other organ of the gland (as in the mammary) might re- 
 veal themselves to the touch. This subject will be con- 
 sidered more fully in the chapter of senile hypertrophy of 
 the prostate. 
 
 COXTPLICATIOXS. 
 
 The neck of the bladder invariably becomes involved 
 and is generally quite sensitive to the touch of an instru- 
 
ENLARGEMENT OF THE PROSTATE. 83 
 
 ment or to the effect of acrid urine coming in contact with 
 it. The inflammation is usually confined to a limited area 
 of the mucous lining of the bladder immediately adjacent 
 to the neck or base of the prostate, as illustrated in Plate 
 II. But in cases of long standing, attended with much 
 congestion and inflammation of the prostate, the trouble 
 extends and may involve the entire mucous lining of the 
 bladder. And as this condition of the bladder is the result 
 of prostatitis, the latter must be relieved before any per- 
 manent benefit can be expected in treatment of the former. 
 In fact, I have found that in the large majority of cases 
 the little benefit that would accrue from the antiseptic so- 
 lutions in washing the bladder is more than counteracted 
 by the ill effects of passing an instrument for the purpose, 
 over an inflamed prostate. Besides, when the bladder is 
 in the state to require such treatment, the urine is no 
 longer aseptic, but the putrefaction of the exfoliated mu- 
 cous favors pyogenesis. 
 
 Andrews and others have demonstrated that the bacilli 
 which inhabit only that portion of the urethra near the 
 meatus and in the fossa navicularis, is constantly present 
 and non-pathogenic in this region, but becomes pathogenic 
 when carried by instrumentation to the bladder, and sets 
 up a muco-purulent discharge, when the condition of the 
 urine favors such. . Andrews further states that the use 
 of antiseptic agents sufficiently strong to destroy bacilli 
 in the bladder would be injurious to the tissue with which 
 they come in contact. I have noticed in a great many 
 cases where muco-purulent matter existed in large quan- 
 tities in the urine, that the amount diminished as soon as 
 the wash was discontinued and the inflammation of the 
 gland was reduced. There are, however, cases in which the 
 catheter is necessary to evacuate the bladder, and in such 
 instances the use of some antiseptic solution in irrigating 
 it is of great value. 
 
84 PROSTATE GLAND AND ADNEXA. 
 
 The urine in these cases is usually of deep straw color, 
 of acid reaction and high specific gravity. Normally it is 
 of slight acid reaction, greater in the morning when first 
 voided after being retained through the night, less so 
 about two or three hours after breakfast, when it may 
 become neutral or slightly alkaline. Should it retain a 
 strong acid reaction throughout the day, the condition is 
 abnormal and irritating to any chronic or acute inflam- 
 matory tissue with which it may come in contact. The 
 abnormal acidity of the urine in these diseases is due 
 mostly to crystals of uric acid, which usually coexist with 
 those of calcium oxylate. Aside from their chemic action, 
 these fine needle-like crystals are mechanically quite irri- 
 tating to mucous surfaces. Epithelia, mucus and pus are 
 also present in proportions varying with the extent of 
 prostatocystic involvement. 
 
 In other cases phosphatic urine predominates. Here 
 the urine is over alkaline and more than neutralizes the 
 normal condition of acidity or even the excess as caused 
 by uric acid. It is exceedingly acrid in its local effect, 
 and, in connection with mucus and pus, favors the devel- 
 opment and propagation of bacteria. It is usually of light 
 color and, upon standing, has a flocculent mass of mucus 
 and pus which are readily deposited. After some hours it 
 has an exceedingly offensive odor; and, if urea be present 
 in large quantity, ammonia is given off. Urea often exists 
 in large quantities and is deposited in red or blood like 
 crystals on the sides and bottom of the vessels. 
 
 While these abnormal constituents of the urine are irri- 
 tating and aggravate prostato-cystitis, yet they are the re- 
 sult and not the cause of prostatitis. 
 
 With alkaline phosphatic urine, some neurotic compli- 
 cation is usually concomitant, especially in the case of pa- 
 
ENLARGEMENT OF THE PROSTATE. 85 
 
 tients who notice the deposit in the urine and associating 
 it with Bright's disease, contemplate an early demise. 
 
 As these abnormal conditions of the urine are only symp- 
 toms, and not an idiopathic disease, the trouble which 
 gives rise to them must be relieved before any permanent 
 benefit will result. It is necessary however to remove, as 
 far as possible, all properties of the urine that are irri- 
 tating to the prostate, until the latter can be restored to 
 its normal condition. 
 
 Variations of the urine are symptoms of much import- 
 ance in this disease, and should be given more than passing 
 observation and chemic test. The epithelial cells, Bott- 
 chers crystals, sympexia, and spermatozoa as revealed by 
 the microscope, are symptomatic of special lesions, and in- 
 dicate the complications that attend disease of the pros- 
 tate. Thompson's and Goldenberg's two glass test, as well 
 as Jadassohn's three, may be misleading unless subjected 
 to microscopical examination. The first part of the urine 
 passed into a vessel may contain a large quantity of float- 
 ing shreds or glary mucus, and the latter part voided into 
 a second vessel may be free from any debris. It would be 
 evident that these shreds were washed from the urethra, 
 but it is by no means proof that they originated there. 
 Secretions from the prostate or vesicles escape into the 
 urethra, pass along that canal until they become dried and 
 cling to its walls. Mucus and other abnormal secretions, 
 being of sticky material, form shreds of various size and 
 shape. Treatment confined to the urethra alone would 
 never relieve the condition. In many cases treatment of 
 the prostate alone would clear them up, while in others 
 the vesicles too require treatment. In many instances. 
 where the bladder is affected, a large quantity of mucus 
 and pus appear in the urine, and especially when the 
 gland is swollen or enlarged so as to interfere with the 
 
86 PROSTATE GLAND AND ADNEXA. 
 
 thorough emptying of the viscus. Blood ma} 7 - also be pres- 
 ent, either escaping from the prostate or urethra, or mixed 
 with the urine. Dark colored urine indicates its presence, 
 and signifies, in the majority of cases, the existence of a 
 polypoid or vegetative growth protruding from the pos- 
 terior prostatic wall. 
 
 PROSTATIC CALCULI. 
 
 There are certain concretions, so called prostatic calculi, 
 that form in the prostatic follicles and ducts after adult 
 life. Sir Henry Thompson, who has described them fully, 
 reports that, "of one hundred prostates examined, these 
 bodies were found in all of them/ 5 In younger subjects 
 they are very small and can be detected only by the aid 
 of the microscope, while in older prostates they can be 
 readily seen with the natural eye. They are entirely dis- 
 tinct from renal or urinary calculi, which begin to form 
 either in some part of the kidney or bladder and continue 
 to develop, by accretion, until they may reach considerable 
 size. The concretions of the prostate are usually small 
 and rarely develop to a size larger than a pea. Inflamma- 
 tory conditions of the gland, preventing the normal se- 
 cretions, tend toward developing these bodies, just as a 
 catarrhal condition of the bladder, and cystitis, produce 
 urinary calculi. They are less firm than the latter, and 
 are composed mainly of calcium and sodium phosphate, 
 both of which substances are electrolytes, and are readily 
 dissipated by interstitial electrolysis. 
 
 Owing to their exceedingly small size, they very rarely 
 give rise to trouble in young men; but in older men with 
 swollen inflamed prostates, they act as foreign bodies press- 
 ing upon the different portions of the sensitive gland, and 
 give rise to irritation, which is manifested by frequent 
 micturition, vesicle tenesmus and pain in the region of the 
 
ENLARGEMENT OF THE PROSTATE. 87 
 
 prostate, perineum, glans penis or fossa navicularis. They 
 are usually rough upon their surface, and, when they de- 
 velop to the size of a pea, often give rise to prostatic ab- 
 scess. 
 
 Fig. XIII. shows a photo engraving of specimens of these 
 concretions, that were passed by a patient sixty-one years 
 of age, with an exceedingly tender and irritable prostate, 
 during the evening following a treatment by cataphoresis. 
 The urine was passed into a porcelain vessel, and allowed 
 
 Fig. XIII. 
 
 to remain over night. On the following morning it was 
 poured off, the residue adhering to the vessel. The vessel 
 was then rinsed with clear water and the residue was 
 scraped from the bottom of the vessel, and preserved. It 
 was firmly glued together by a muco-purulent admixture, 
 which was broken apart in pieces of different sizes, as 
 shown. There was quite a large quantity of these pieces, 
 making in all about a drachm. The large majority of 
 these were destroyed by experimenting upon them with the 
 combined properties of different chemicals and electrolysis, 
 in order to determine the agents that would be most active 
 in their disintegration, and, at the same time, the least ir- 
 
88 PROSTATE GLAND AND ADNEXA. 
 
 ritating to the gland. The remaining pieces were pasted 
 to a piece of dark paper and a photo engraving, or "half 
 tone," made from it, as illustrated. 
 
 These experiments were carried out with a one per cent 
 solution of chloride of sodium and water, as the conduct- 
 ing medium, which is practically the same as that of the 
 prostatic urethra, when the solution is applied to the gland. 
 
 The experiments were first made with non-oxidizable 
 electrodes, without medical agents, first the anode, then 
 the cathode being used as active electrodes. These were 
 made with mild currents of long duration, then strong for 
 a short period, w T ith due heed to the electrolytic changes of 
 the conducting medium, and the presence of oxy-chloride 
 at the anode as a result. Oxidizable electrodes, of various 
 metals, with the anode as active pole, were next tried. I 
 then experimented with various medicaments, using both 
 oxidizable and non-oxidizable electrodes, affecting thereby 
 changes upon these deposits by means of cataphoresis and 
 interstitial electrolysis. The conclusions at which I ar- 
 rived by the experiments and chemical observance were 
 that the concretions are subject to electrolysis. Cataphoric 
 medicaments are only required to reduce any inflammatory 
 condition of the gland which served to increase the cal- 
 careous deposits. 
 
 SYMPEXIA. 
 
 In addition to the calcareous formations that are so 
 generally present in the ducts and follicles of the con- 
 gested prostate, there exists occasionally a lumpy, gelatin- 
 ous substance of a whitish or light red color, called sym- 
 pexia. These bodies vary in size from that of a small pea 
 to twice that amount. They frequently become quite firm 
 and provoke much local irritation of the gland and vesicle 
 neck, causing frequent and painful micturition, and even 
 abscesses in the prostate, when thev become too firm and 
 
ENLARGEMENT OF THE PROSTATE. 89 
 
 large to pass off through the duets. They have also been 
 detected in the seminal vesicles, where doubtless most of 
 them begin to form from pent up, unhealthy semen and 
 the morbid secretions that result from the inflammatory 
 condition of the vesicles. They no doubt assume their 
 firmness in their tardy course through the prostate, where 
 they mingle with the calcareous matter as formed in the 
 latter. 
 
 They do not pass at regular intervals, seldom daily, and 
 usually follow the emptying of the bladder or the dis- 
 charge of fecal matter while at stool. I have noted some 
 eases where they would pass once or twice a week, then not 
 again for a month. When they pass often, they are of 
 lighter color and less firm than those that have been pent 
 up in the gland for a longer time. Their mere presence 
 causes great annoyance to many men who mistake them 
 for semen. They may occur in any stage of prostatitis, in 
 young men as well as older. I have noted them more fre- 
 quently in young men, leading a life of continence, or in 
 middle aged men of long standing prostatitis. 
 
 THE LIVER. 
 
 Just what relation the liver bears toward the prostate I 
 am unable to state, but in common with other investigators, 
 I have noticed that there is a functional disturbance of 
 the former following disease of the latter. The liver per- 
 forms the important role of being the chief organ in con- 
 verting the insoluble uric acid into soluble urea; and, 
 whenever there is a disease of the prostate, crystals of uric 
 acid, often in large quantities, make their appearance in 
 the urine. It is claimed by some that this arrest of the 
 function of the liver is due to nervous reflexes provoked 
 by disease of the prostate. 
 
CHAPTEE V. 
 
 SEMINAL VESICLES. 
 
 The seminal vesicles and prostate, owing to their con- 
 tiguous relations and allied functions, and to the fact that 
 the latter is tunneled by the ducts of the former, are in 
 close pathologic relations. As the swollen prostate must 
 inevitably encroach by pressure upon the ejaculatory ducts, 
 limiting thereby their elasticity and diminishing their cal- 
 iber, increased exertion is necessarily required to expel the 
 semen through the narrow channels; and, should these or- 
 gans be inflamed or tender, pain would follow the ejection 
 of semen during or immediately succeeding sexual inter- 
 course. The pain is usually felt in the region of the perin- 
 eum, lower part of the rectum, or along the course of the 
 vas deferens in one or both sides of the groin. 
 
 RECTUM. 
 
 With the exception of the neck of the bladder and sem- 
 inal vesicles, the rectum is most frequently involved as a 
 result of chronic prostatitis. The part most often affected 
 is the front surface immediately opposite the prostate. 
 Inflammation of this organ, owing to its close proximity 
 to the rectum, readily extends to the latter. The plate 
 shows the position where it most often occurs. If the in- 
 flammation is of short duration and the gland is only 
 slightly affected, the rectum at this point will show a con- 
 dition of redness, with only a limited protrusion of the 
 prostate, and without abrasion of the surface of the mu- 
 cous membrane. In cases of long standing prostatitis, 
 where there is considerable protrusion of the gland into the 
 
 90 
 
SEMINAL VESICLES. 
 
 91 
 
 rectum, there is, as an almost invariable result, lesion of 
 the mucous surface, and this being constantly irritated by 
 the passage of fecal matter, in turn reacts upon the pros- 
 tare, serving to increase the irritation and inflammation 
 of the latter. 
 
 Fig. XIV. 
 
 KIDXEYS. 
 
 The kidneys are very rarely involved, although the pain 
 in the lumbar region of the spine, together with the turbid 
 urine, often leads one to suspect such disease. 
 
 The pain felt in the lumbar region, at about the fourth 
 or fifth vertebra, has no connection with the kidneys, 
 though it is usually spoken of as "pain in the kidneys." 
 This pain is in the center of the back and very low down. 
 while that of the kidneys is much higher, on each side, 
 and beneath the borders of the lower ribs, as illustrated 
 by Fig. XV. 
 
92 PROSTATE GLAND AND ADNEXA. 
 
 The inflammation occasionally extends from the pros- 
 tate to the bladder, thence through the ureters to the 
 pelvis of the kidneys, provoking pyelitis, and even inter- 
 stitial nephritis. 
 
 Some twelve years ago I attended a case, of fifteen years' 
 standing, suffering with stricture, prostatitis, cystitis and 
 nephritis. The trouble extended to the pelvis of the left 
 kidney, and subsequently to the entire organ. Suppura- 
 tion ensued, which was followed by an abscess on the back 
 over the left kidney. The abscess had formed, and had 
 been evacuated three times during the preceding two 
 years, before I saw the patient. He had suffered constant 
 pain in that kidney, and was in very bad health. The 
 abscess formed, and was evacuated only once during the 
 early stage of my treatment. He afterwards became 
 strong and healthy, and lived eight years. I never saw 
 him during his last illness. His death was reported as 
 due to nephritis, though no autopsy was made. 
 
 TREATMENT. 
 
 The treatment of chronic congested enlargement of the 
 prostate gland is somewhat similar to that described in 
 the former chapter on prostatitis. One must take into 
 consideration the age and health of the patient, the degree 
 of discomfort to which he is subject, the extent of com- 
 plications, tenderness or inflammation of the gland itself, 
 urethra or rectum, and the urgency or necessity for the 
 relief of any conditions from impending danger to life. 
 
 There are only two ways by which we can reach the 
 prostate for direct treatment, viz., through the urethra or 
 rectum; and as these organs are so closely related to the 
 prostate, both by contiguity and continuity of structure, 
 and are in such close sympathetic relation with it, they 
 are generally pathologically involved. They therefore 
 
SEMINAL VESICLES. 
 
 93 
 
 Fig-. XV. 
 
94 PROSTATE GLAND AND ADNEXA. 
 
 require treatment in order that the prostate may be 
 reached without causing pain or inflammation to these 
 channels, for the inflammation is liable to extend and in- 
 crease the already existing trouble of the gland. So my 
 first step is to give relief to all symptoms of an urgent or 
 dangerous nature; then allay, in so far as possible, all 
 inflammation of the urethra and rectum, by rendering the 
 passage of urine and fecal matter over these tender, and 
 probably abraded surfaces, as non-irritating as possible. 
 
 Diet. — In ordinary cases I rarely restrict my patients 
 in their diet, except in regard to particularly indigestible 
 food, such as cabbage, pork, cucumbers and the like. I 
 do prohibit alcoholic liquors while the patient is under 
 treatment, and especially fermented ale, beer or wine, as 
 they directly tend to disturb the circulation, liver and 
 kidneys, causing an excessive precipitation of uric acid, 
 and biliary discharges, and increasing local irritation to 
 the urinary and rectal passages, and in particular to the 
 prostatic urethra, and neck of the bladder. 
 
 I have mentioned in a former chapter that I began the 
 radical treatment with my urethral electrode No. 14, A, 
 which is passed clown the urethra gently, after having 
 previously made the electric connections before described, 
 and with three to five milliamperes in the circuit. During 
 the first treatment the application should not last over one 
 or two minutes, and the electrode should be passed over 
 the entire surface with the current in the circuit, to rid 
 the canal of whatever granulations might exist at any 
 point in its course. Cataphoresis should not be used dur- 
 ing the first treatments, and if the urethra or prostate is 
 very tender, the electric treatment should not be given 
 oftener than every third, fourth or even seventh day. 
 Cathodal applications should always be used during the 
 first few times. 
 
SEMINAL VESICLES. 95 
 
 As a rule blood will not be produced by these treatments, 
 if the preliminary steps are attended to. But it occasion- 
 ally happens that some highly congested granulations or 
 vegetative growths are denuded from the surface of the 
 prostatic urethra ; in which case a drop or two of blood 
 may follow. No harm will result, but the operator should 
 be warned thereby not to apply the electric treatment too 
 often or with too great strength. I usually follow up such 
 a condition with an injection of verbascum, if it had been 
 discontinued; then two days afterwards with the bougie, 
 with benzoinol, or an ointment of the extract of verbascum 
 and benzoinol, which is quite soothing. At other times I 
 use with mild electrolytic applications a mixture of ben- 
 zoinol and verbascum with electrode No. VIII. Cata- 
 phoresis is only slightly effected by this means, as osmosis 
 of oils without emulcification does not take place. Only 
 a local soothing effect is produced, but the oil has the 
 additional property of protecting the surface for a time 
 from the irritating secretions that may occur. 
 
 It is also essential to have the patient void urine just 
 prior to the treatment, then to remain upon his back for 
 a few minutes afterwards, that the urine, by gravity, may 
 remain away from the vesicle neck, or prostate, until what- 
 ever irritation may have been caused by treatment has 
 subsided. All of these points, however trifling they may 
 appear, require careful consideration in view of the tender 
 and inflamed condition of the gland and adjacent organs. 
 
 After the acute symptoms have subsided, cataphoresis 
 can be employed with impunity. This is effected in two 
 ways, first by means of liquid medicines, as illustrated by 
 Fig. X; secondly, by anodal applications of oxiclizable 
 electrodes. The latter is accomplished by using a metal 
 point to an electrode of copper, zinc or iron, when there 
 will form the oxy-chloride of copper, zinc or iron. Each 
 
96 PROSTATE GLAND AND ADNEXA. 
 
 of these excites a quite sharp, burning sensation and 
 should be applied only directly to the seat of the trouble, 
 which is usually on the floor of the prostatic urethra. 
 These new substances of oxy-chlorides of copper, zinc or 
 iron, after forming, will penetrate the gland by following 
 the direction of the current, from positive to negative, and 
 cause a dull aching sensation throughout the region of the 
 prostate, perineum or rectum. They should be given only 
 a short time and with a mild current, especially during 
 the first few treatments. The electrode will adhere to the 
 tissue, and should not be removed until the current has 
 been reversed for one or two minutes, when it will loosen. 
 
 An acute discharge often follows such applications, and 
 the patient should be advised of the fact, or he may sus- 
 pect that he has an attack of gonorrhea or that he has been 
 infected by the instrument. Obstinate chronic cases are 
 much benefited by this method of treatment and yield more 
 readily through conversion of the chronic into an acute 
 state for the time. Injections of ten to fifteen per cent of 
 verbascum or argyrol readily allays the acute condition. 
 
 Instruments should never be passed into the urethra 
 daily, and from the very beginning of treatment the rec- 
 tum should be carefully examined. Should it be very 
 tender, as is often the case at first, suppositories of boric 
 acid and aristol, five grains each, inserted night and 
 morning, will soon put it in condition for examination by 
 speculum or sigmoidoscope without anesthetising the 
 patient. I alternate the treatment by giving rectal appli- 
 cations, as illustrated by Fig. XI, on the days following 
 the urethral treatment. I began the rectal treatment by 
 using the secondary faradic current, interposing at the 
 time, into the circuit from two thousand to twenty-five 
 thousand ohms resistance. This treatment is very sooth- 
 ing, and, in most cases, affords instant relief from any 
 
SEMINAL VESICLES. 97 
 
 uncomfortable feeling that may exist in the region of the 
 perineum, rectum or prostate. Medicinal applications are 
 made to the rectum at the same time. 
 
 While the oscillating molecular movements, as induced 
 by the current, favor absorption of the medicines, yet 
 eataphoresis is not effected thereby. The benefit accruing 
 from the secondary faradic current is chiefly, if not 
 wholly, that of its mechanical action; and, owing to the 
 close proximity of the pole to the gland, as shown by Fig. 
 XI (the current being concentrated and flowing only in 
 that direction), the extremely rapid vibratory motions 
 exerted upon the molecules of the morbid tissues so dis- 
 turb them as to cause their absorption by capillary attrac- 
 tion. This may be illustrated by placing medicine of any 
 kind upon the skin of any part of the body and rapidly 
 rubbing it, absorption takes place much more quickly than 
 if the medicine remained quiescent. 
 
 Fig. XVI illustrates the application of a longer elec- 
 trode to the seminal vesicles. Gentle backward pressure 
 exerted by the fingers upon the lower end of the electrode 
 causes similar movement of the upper end upon the vesi- 
 cles, and produces mild contraction of the latter. This 
 has a soothing effect upon these sacks, and at the same 
 time rids them of their morbid contents, reducing the 
 inflammation of the organs, and that, too, without pain. 
 To procure the best results, this application must be made 
 with ten thousand ohms resistance interposed. 
 
 After all acute tenderness of both the prostate and vesi- 
 cles has subsided, I apply to both organs the sinusoidal 
 current in the same w T ay, and with high resistance inter- 
 posed, as before described. This current as explained in 
 Chapter VIII both acts mechanically as the faradic, and 
 also exerts a magnetic influence upon the atoms of the 
 tissues, causing molecular disturbance by the attractive 
 
98 PROSTATE GLAND AND ADNEXA. 
 
 and repulsive power of unlike and like, so as to favor 
 their solubility and absorption, and their expulsion through 
 the medium of discharges from the gland. It also exerts 
 a strong germicidal effect. 
 
 Fig. XVI. 
 
 Whatever causes the pathological condition of the pros- 
 tate — whether it is the inhabiting of its mucosa or cellular 
 tissue by latent gonococci, or bacteria adapted to the 
 locality of its special epithelial lining — it is certain that 
 diffusion of medicinal agents by cataphoresis, and inter- 
 stitial electrolysis within the gland, disturbs these germs 
 by rendering their habitat inimical to their existence. 
 
SEMINAL VESICLES. 99 
 
 Just how this is accomplished it is somewhat difficult to 
 explain; but bacteriologists have demonstrated that the 
 gonococci favor an alkaline medium, but whether they are 
 destroyed by cataphoric diffusion of anions, as of acids, 
 oxygen, etc., or die from lack of a suitable medium, when 
 the gland is aroused to activity, or the dynamic effect 
 especially of the sinusoidal, or directly as the result of 
 electrolysis as induced by cataphoresis, I cannot state; 
 but I do know, as a fact demonstrated by numerous re- 
 sults of such treatment, that the pathogenic condition is 
 changed, the morbid discharges are arrested, and the 
 patient is restored to health. To know the precise result 
 of such treatments is more gratifying to me than to dis- 
 course at length upon some far-fetched scientific theory. 
 
 The method as here detailed effects all that can be 
 accomplished by digital manipulation of the prostate or 
 vesicles; and, too, without irritation, I often have com- 
 plete emptying of the vesicles follow rectal treatment by 
 means of the sinusoidal application. Infiltration or thick- 
 ening of the rectal mucosa also occurs around both the 
 prostate and vesicles, when the disease is of long standing, 
 which is readily dissipated by this treatment. 
 
 Treatment of the prostate and vesicles through the rec- 
 tum can be given oftener, stronger, and of longer duration 
 than through the urethra. 
 
 MEDICINAL TREATMENT. 
 
 But little constitutional medication is requisite. In 
 some cases where acute symptoms exist, it is necessary to 
 control them for the time until the cause is removed. An 
 acid condition of the urine serves to maintain it in an 
 antiseptic condition, unless the acidity be in excess of 
 0.43 as determined by acidemetry. In such cases citrate 
 of potassium, or some lithia water or salt, gives relief. I 
 
100 PROSTATE GLAND AND ADNEXA. 
 
 concur in the view, as expressed by Finger, that the indis- 
 criminate use of alkaline mineral waters in these cases is 
 pernicious. There is a tendency, after passing middle age, 
 to the accumulation of earthy salts in the body (which is 
 conducive to senility, and the constant use of such waters 
 adds to the evil). Besides changing the urine from its 
 normal acid reaction to that of alkaline, it favors the 
 development of bacteria. 
 
 When the urine is of light color, and alkaline in reac- 
 tion, whether due to excessive phosphates or to the decom- 
 position of mucus and pus, cystogen, in five-grain doses, 
 three or four times daily, is indicated. When it is admin- 
 istered it liberates formaldehyde, and acts by controlling 
 to a limited extent the development of bacteria. It should 
 not be continued any great length of time, as it becomes 
 irritating to the bladder and vesicle neck. These remedies 
 are only intended to give temporary relief until the cause 
 is removed, which is the relief of the prostate and vesicular 
 troubles. 
 
 The bladder is very rarely diseased per se, but is almost 
 invariably the result of the extension of inflammation 
 from the prostate and urethra, or to the obstructive flow 
 of urine by the enlarged gland. 
 
 Diuretics are only indicated where there is an appear- 
 ance of symptoms of uremic toxemia, scantiness of urine 
 or an excessive quantity of urea. 
 
 Many suffering from long-standing diseases of the pros- 
 tate become anemic, and the necessity for hemogenic agents 
 arises. For this purpose I have relied upon citrate of iron, 
 which is less irritating to the stomach than most of the 
 other chalybeates. 
 
 These remedies are only intended as valuable adjuncts 
 temporarily until radical relief of the gland is effected. 
 
 Fig XVII. illustrates an electrode, as devised by the 
 
SEMINAL VESICLES. 
 
 101 
 
 author, that marks a new era in the treatment of varico- 
 cele, orchitis and their sequels, impotency, etc. It con- 
 sists of an insulated cup-shaped receptacle, near the 
 bottom of which is a metallic binding post for the attach- 
 ment of a cord from a battery. On the inner side of the 
 cup and attached to the binding post is a copper plate, 
 
 XVII. 
 
 which serves the purpose of diffusing the current through- 
 out the fluid as contained within the cup. When in use 
 the electrode is filled to about four-fifths with plain or 
 medicated water, and the entire scrotum and testicles are 
 immersed therein. That portion of the electrode to which 
 the cord is attached is placed in the rear and pressed 
 firmly against the perineum to prevent the escape of the 
 fluid. A large sponge electrode, seven or eight inches in 
 
102 PROSTATE GLAND AND ADNEXA. 
 
 diameter, is placed over the lumbar region of the spine. 
 This is better accomplished by the patient sitting in a 
 chair with a thick book at the back so as to press the 
 electrode to the spine. The current is then increased to 
 the desired strength, care being observed not to cause 
 shock. 
 
 The current thus applied charges the fluid in the elec- 
 trode, which passes up through the spermatic cords and 
 other organs, acting as a tonic to the muscular and dis- 
 tended coats of the veins, causing their contraction, there- 
 by relieving their turgescence and tenderness, and giving 
 tonicity to the cords and scrotum, which enables them to 
 support the testicles and maintain them in their normal 
 position without the aid of a suspensory bandage. 
 
 Where there still remains impotency or depression of 
 the genital organs after relief of prostatitis, the current 
 thus used, passing through the genito-spinal center and 
 the genital organs, will often restore their normal func- 
 tions after everything else fails. 
 
 This method of treatment does not act as a stimulant or 
 excitant of the genital organs, as do some medicines, to 
 be followed by subsequent depression, but serves as a tonic 
 and restores natural vigor. 
 
 Case VII. — Prostatic Enlargement and Melancho- 
 lia, Obscure Origin. 
 
 Bachelor; forty-eight years of age; weight one hun- 
 dred and seventy pounds. He had practiced masturbation 
 in early life moderately — never had gonorrhea. Always 
 lived in a small town and had been successful in business. 
 Up to his forty-fifth year he had been in good health. 
 About that time he began occasionally to pass sleepless 
 nights, and grew gradually worse. This continued for 
 about one and one-half years, when he became melancholy 
 
SEMINAL VESICLES. 103 
 
 and despondent about his business. His brother had 
 noticed, at times, mental aberration, and, after consulting 
 the family physician, decided upon placing him in a sani- 
 tarium. The patient tacitly consented to go, but on the 
 evening before the day of departure, he surreptitiously left 
 his home, and wandered about from place to place for more 
 than a month, when, upon inquiring for a physician, he 
 was directed to me. 
 
 He was very secretive as to his family and home, but 
 talked very intelligently and freely about himself, his 
 wanderings, habits and the foolish things he did that 
 induced his brother to think he was verging upon lunacy, 
 and of which he himself was cognizant. The subjective 
 symptoms pointing to disease of the gland were quite 
 meager, and he was loth to submit at first to an examin- 
 ation. 
 
 The urethra was very sensitive throughout its length, 
 and, in the prostatic part, quite painful to the touch of 
 the flexible bougie. The gland protruded into the rectum 
 to the extent of flattening fecal discharges. Digital pres- 
 sure upon the prostate through the rectum caused an 
 aching pain in the region of the perineum and bladder. 
 
 He was treated alternate days with a flexible bougie 
 that entered the bladder easily. The faradic current was 
 used, each intervening day, through the rectum with ten 
 thousand ohms resistance. The inflammation of the pros- 
 tate and urethra readily subsided after ten days' treat- 
 ment, when cataphoresis to the prostate was instituted, 
 both through the urethra and rectum with ten per cent 
 strength of aqueous extract of verbascum. His recovery 
 was rapid, and at the end of the first month he was sleep- 
 ing normally, and his mind restored. The treatment was 
 continued two months to reduce the enlarged gland. Ee- 
 covery was permanent. 
 
104 PROSTATE GLAND AND ADNEXA. 
 
 Case VIII. — Prostatitis, Vesiculitis, Rectal .Ulcer- 
 ation. 
 
 Bachelor ; aged forty-four, had first attack of gonorrhea 
 at twenty-two, which was quite severe, and continued for 
 several months, finally terminating in gleet, and, as he 
 thought, stricture. He had several mild attacks of acute 
 gonorrhea, the gleet continuing during the interim. He 
 had been treated several times for stricture with sounds. 
 He suffered constantly with his hack and limbs, and had 
 made several trips to Hot Springs, Ark., for rheumatic, 
 arthritis. He was always benefited by the Hot Springs 
 baths, but the pains would recur in from four to six 
 months thereafter. Upon examination I found the urethra 
 slightly tender an inch back of the meatus, and upon the 
 lower surface. The other portions of the canal were 
 healthy, except the prostatic; which was very much in- 
 flamed. There was no organic stricture, nor do I think 
 he ever had any, though he had been advised several times 
 to submit to an operation for such. The long standing 
 granular inflammation of the prostatic urethra, with the 
 enlarged gland, had encroached upon the caliber of the 
 canal at that point, narrowing it and obstructing the free 
 flow of urine, at times, when it was acrid; and also the 
 free entrance of an instrument to the bladder. 
 
 The gland was swollen as determined through the 
 rectum, and painful upon pressure, which was reflected 
 to the glans penis. Both lobes of the gland were equally 
 involved. Immediately opposite the prostate, upon the 
 front rectal surface, was an elliptical ulcer an inch and 
 one-half long and three-fourths of an inch wide. The 
 vesicles were also tender, and the rectal mucosa opposite 
 them was inflamed and thickened but not abraded. After 
 several examinations of prostatic expressions gonococci 
 were finally discovered. 
 
SEMINAL VESICLES. 105 
 
 The acute symptoms were treated as before detailed, 
 which was followed by cataphoresis, using one per cent 
 solution of ichthyol, through the prostatic urethra. The 
 prostate and vesicles were treated at first with the second- 
 ary faradie, followed with the sinusoidal current. 
 
 The ichthyol had a very happy effect in this case, and 
 was the only remedy used. Recovery w r as rapid, and there 
 has been no return of pains ; it has been three years since. 
 
 Case IX. — Enlarged Prostatitis, Cystitis. 
 
 Bachelor; aged sixty-nine; robust, had led an outdoor 
 life. He had gonorrhea in early manhood, and quite a 
 number of attacks thereafter. He had suffered w T ith his 
 bladder and prostate for fifteen years, and had been treated 
 by massage of the gland, sounds, irrigation and cautery 
 applications to the deep urethra. He had just left a 
 genito-urinary specialist when he consulted me, who had 
 treated him with large sounds daily for six weeks. 
 
 He was suffering with frequent and painful urination, 
 voiding it on an average of every thirty minutes during 
 the day, and hourly at night. The urine was of light 
 color, laden with mucus, pus, urea and of ammonical odor. 
 I did not attempt an examination at this stage, but gave 
 him five grains of cystogen every four hours, alternating 
 with twenty minims of the normal tincture of hyoscyamus 
 to the drachm of triticum repens. In conjunction with 
 this, a suppository, containing ten grains of boric acid and 
 one-half grain of belladonna, was introduced into the 
 rectum night and morning. Eest in bed was also enjoined. 
 After three days the acute symptoms had been allayed, 
 when an examination revealed a congested enlargement of 
 the prostate, prostatic urethritis, and cystitis. He had been 
 washing out the bladder with boric acid daily, which I had 
 him discontinue. 
 
106 PROSTATE GLAND AND ADNEXA. 
 
 He was treated similarly to those before described, after 
 acute symptoms had been allayed. His improvement was 
 rapid, and at the end of the third month the urine was 
 cleared up, and voided about four times during the day 
 and once through the night. He would occasionally pass 
 the night without having to get up, then again he would 
 have to pass his urine twice in the night. After his return 
 home he continued to improve until conditions were about 
 normal for a man of his age. 
 
 Five years later he began having some difficulty in start- 
 ing the flow of urine ; then periodical hemorrhages would 
 occur. By cystoscopie examination I detected a small 
 vegetable growth, almost the size of the end of one's small 
 finger, attached to the lower part of the neck of the blad- 
 der. It was highly vascular and would bleed freely when 
 touched. Its free extremity floated about the vesicle ori- 
 fice and acted as a valve that at times shut off the flow of 
 urine. I had an electrode made, the metal part of which 
 hooked around the tumor, so as to affect it only ; the metal 
 end of the electrode was perforated that medicinal reme-. 
 dies could be applied, thus procuring the combined effects 
 of electrolysis and cataphoresis. After the third week's 
 treatment it ceased to bleed, became less tender and showed 
 much atrophy. Six months afterwards hemorrhage again 
 recurred. Cystoscopie examination revealed a short pedical 
 of the tumor with an abraded surface. This was promptly 
 healed and he has had no further trouble with it. 
 
 Similar patients have come under my care, suffering 
 with vegetative, polypoid, vascular or semi-fibroid tumors 
 protruding from the base of the prostate into the bladder, 
 which act as a valve to obstruct the passage of urine. Some 
 of these cases have yielded readily to the treatment as 
 described; others have been persistent and unyielding. 
 Those that have proven so rebellious to treatment have 
 been of fibrinous character. 
 
SEMINAL VESICLES. 107 
 
 It has been necessary, in some of the latter, to use the 
 electric cautery, as illustrated. (Fig. XVI.) 
 
 Case X. — Chronic Enlarged Prostatitis, Vesiculitis, 
 and Cystitis. 
 
 The patient was seventy-two years of age. costive, con- 
 stant pain in back and perineum, the latter necessitating 
 his using a rubber cushion, hollowed out in the center, to 
 sit upon. The urine was alkaline, heavily laden with 
 mucus and pus, one-fifth of which would be a semi-solid 
 mass upon settling; and, at times, strongly ammoniacal. 
 Fecal matter passed in lumps or flattened. He had been 
 treated by the usual methods, with sounds and irrigations. 
 The prostate was very large but not tender upon pressure. 
 The vesicles were similarly affected. The prostatic urethra 
 was quite tender. He had a constant urethral discharge. 
 
 Urethral and rectal applications were used to the pros- 
 tate for six weeks. The improvement was most marked in 
 every way. He returned home, where he remained two 
 months, then came back for further treatment. He was 
 now able to ride about in his buggy, dispensed with his 
 cushion, but was still unable to evacuate his bowels with- 
 out the use of medicines. There was only a trace of sedi- 
 ment in the urine, and the urethral discharge was scarcely 
 perceptible. He remained under treatment four weeks at 
 this time. The prostate was reduced almost to nofmal, 
 the urine had changed to an acid reaction, free from sedi- 
 ment, and with specific gravity of 22. He was free from 
 pain. He returned home and I did not see him again for 
 two years. He had been comfortable during all this time, 
 with the exception that he occasionally had quite copious 
 and irritative -urethral discharge. Upon examination at 
 this time I found the prostate, about normal in size and 
 non-sensitive. The vesicles were tender, and the rectal 
 
108 PROSTATE GLAND AND ADNEXA. 
 
 mucosa surrounding them thickened, and unduly red. 
 Applications of five per cent strength of picric acid was 
 used directly to the vesicles with the sinusoidal current 
 daily. The first treatment was followed with diminution 
 of the urethral discharge. This discharge had also ren- 
 dered the prostatic urethra tender, which required similar 
 treatment. At the expiration of two weeks he was dis- 
 missed. I heard from him some time after he returned 
 home, stating that there had been no return of the dis- 
 charge, and that he was riding horse-back averaging fifteen 
 miles, almost daily. 
 
 Case XL — Congested axd Enlarged Prostate, Ureth- 
 ritis, Rheumatic Arthritis. 
 
 Married; good physique; aged forty-eight. He had 
 been confined to bed for four or five months prior to seeing 
 me, with polyarthritis. He had been dosed with all the 
 rheumatic remedies about which the profession have any 
 knowledge, with only temporary relief, There was little 
 or no swelling of the joints, but they were attended with 
 much pain and creaking when moving them. He was 
 unable to dress himself, but was able to walk about. The 
 prostate gland was very tender, both through the urethra 
 and rectum. There was no apparent urethral discharge, 
 though the prostatic part of the canal was very sensitive. 
 He began improvement after the first week, and the stiff- 
 ness and pain in the joints left him at the end of three 
 months' treatment of the prostate and vesicles by cata- 
 phoresis. 
 
 Case XII. — Enlarged Prostatitis, Cystitis, Rheu- 
 matic Arthritis. 
 
 Bachelor; aged thirty-eight, of robust physique. Had 
 gonorrhea at twenty-two, followed by several attacks. For 
 
SEMINAL VESICLES. 109 
 
 eight years lie suffered with frequent micturition, both 
 day and night. There was little or no discharge. He 
 began suffering at first with pains in his hips and calves 
 of legs; then in his wrists and shoulders. There was no 
 swelling of the joints. He was occasionally troubled with 
 fortuitous seminal discharges, which was followed by 
 impotency. 
 
 The prostate was only slightly enlarged, but quite ten- 
 der, both through the urethra and rectum. He was treated 
 at one time with sounds, but more recently by massage of 
 the prostate. The latter was very painful to him. Four 
 weeks' treatment by means of cataphoresis effected a per- 
 manent cure. 
 
 Case XIII. — Enlarged Prostatitis, Cystitis, Pros- 
 tatic Calculi. 
 
 A mechanic, aged sixty-two, married. No gonorrheal 
 history. He had never taken a drink of alcoholic liquors 
 nor used tobacco in any form. Up to his fifty-fifth year 
 he was free from any symptoms of disease of the bladder, 
 prostate or kidneys. About that time he began passing 
 urine more frequently than normal and it became notice- 
 able when chilled, or his feet were wet, that it irritated his 
 bladder, which necessitated him to evacuate his bladder 
 more frequently, both day and night. He resorted to the 
 ordinary domestic remedies with temporary relief. Sub- 
 sequently he began, during paroxysms of dysuria, to pass 
 some blood at the cessation of the flow. The hemorrhage 
 became more marked in time, and was accompanied with 
 pain in region of the perineum and bladder. All symp- 
 toms increased in severity, compelling him to seek relief. 
 He then consulted a genito-urinary specialist, who began 
 the use of sounds. This aggravated his symptoms. He 
 next underwent the Bottini cautery operation. This was 
 
110 PROSTATE GLAND AND ADNEXA. 
 
 followed by some temporary relief, when he relapsed into 
 still worse condition than before the operation, and was 
 confined to his bed for several weeks with some form of 
 fever. On recovering from the fever he came to me for 
 treatment. 
 
 He was very much emaciated, anemic, and voiding urine 
 on an average, during the day, of every fifteen minutes, 
 and at night about every forty minutes. He suffered with 
 constant pain in his back. The urine was strongly alkaline 
 and contained a heavy sediment of mucus and pus, of 
 ammoniacal odor, and occasionally tinged with blood. 
 
 I began treatment by giving him five grains of cystogen 
 three times daily, and ten minims of normal tincture of 
 hyoscyamus every three hours during the day. Locally, I 
 applied benzoinol to the urethra, and the secondary faradic 
 current, with fifteen thousand ohms resistance, to the pros- 
 tate through the rectum. He was also given a suppository 
 containing ten grains of boric acid and three-fourths of a 
 grain of extract of belladonna at night. This treatment 
 rendered him much more comfortable, and prolonged the 
 intervals of micturition. At the expiration of two weeks 
 his condition was so much improved that I began the use 
 of cataphoresis through the urethra, and the sinusoidal 
 applications to the gland per rectum. This treatment was 
 continued regularly for two months, with marked improve- 
 ment. 
 
 He returned to work handling heavy machinery, and I 
 did not see him again for three months, when he returned 
 with the same symptoms somewhat aggravated. Treatment 
 was again resumed with variable results: at times there 
 would be much improvement, then he w T ould relapse into 
 bis former condition. During all this time, however, he 
 was continuously at work carrying heavy machinery. One . 
 day following a treatment of urethral cataphoresis to the 
 
SEMINAL VESICLES. Ill 
 
 prostate he passed quite a quantity of prostatic concre- 
 tions, varying in size from a pin point to a mustard seed, 
 as illustrated by Fig. XIII, page 87. 
 
 He finally became discouraged with my treatment and 
 sought the advice of another physician. 
 
 I did not hear anything further from him, but about 
 one month thereafter I incidentally noticed an account of 
 his death in a hospital as a result of an operation. I never 
 learned the nature or purpose of the operation. 
 
 Case XIV. 
 
 Was similarly affected to that of the foregoing. He, 
 too, had been operated upon with the Bottini cautery and 
 by the same physician. On the fifth day after the opera- 
 tion he had a violent hemorrhage which lasted several 
 hours, rendering him unconscious and almost pulseless. 
 The hemorrhage was finally controlled after many hours' 
 work by the physician. This patient was treated in similar 
 way to the preceding one, and improved more rapidly. In 
 fact, he was so far relieved of irritation about the bladder 
 and prostate that I thought at one time he would ulti- 
 mately recover, but he, too, had some operation performed 
 upon his bladder or prostate, and I have never since 
 learned the result. 
 
 In these cases there were no indications for the Bottini 
 operation ; and I do not hesitate to state that it was made, 
 as I have known of others, in an empirical manner, with- 
 out reference to the exact diagnosis of the condition of the 
 prostate. The bleeding, as result of the operation, relieved 
 for a time the congested state of the gland, and it, together 
 with long rest in bed, relieved temporarily the inflamma- 
 tion, but at the expense of the irreparable injury to the 
 gland, as denouement of the cut and cicatrix. The only 
 indication where such an operation is at all justifiable is 
 
112 PROSTATE GLAND AND ADNEXA. 
 
 in those cases where an obstruction forms at the neck of 
 the bladder by way of a firm fibrinous band ; or, in other 
 words, where there is a development of the third or middle 
 lobe of the prostate. When the latter condition exists to 
 such an extent as to obstruct the flow of the urine, it may 
 be severed with little danger to life, either directly or 
 indirectly, and especially after the case has been prepared 
 for such an operation by the reduction of acute congestion 
 and inflammation. This treatment will be considered more 
 at length in the succeeding chapter under the treatment 
 of the hypertrophied prostate. 
 
 Case XV. — Prostatitis, Vesiculitis, Prostatic 
 Urethritis, Sympexla, Hemiparesis. 
 
 Merchant; married; aged fifty-five; gonorrheal his- 
 tory. He had been treated several times by means of 
 sounds, massage of the prostate, internal medication, etc., 
 — the same result. 
 
 Examination showed an enlarged and inflamed prostate, 
 perivesiculitis and inflammation of the neck of the bladder. 
 The right leg became impaired and grew gradually worse; 
 then the arm and hand on that side followed after a year's 
 existence of the trouble. There were various shaped lumps 
 of a tenacious character that passed from the urethra, at 
 times following the evacuation of the bladder in the last 
 efforts to expel its contents and again on evacuating the 
 bowels when costive. There was a perverted sexual pro- 
 pensity, often a previous discharge of semen during sexual 
 congress, then again a condition of inertia. 
 
 The gland was enlarged and inflamed, the rectal mucosa, 
 around the vesicles, was thickened and unduly red. The 
 prostatic urethra was very tender. The lumpy discharges 
 (sympexia) consisted of mucus, calcareous matter and 
 disintegrated semen. 
 
SEMINAL VESICLES. 113 
 
 He was anemic, emaciated, costive and dyspeptic. 
 Caseara was given to relax the bowels. Cataphoresis was 
 given by way of urethra and rectum, through the prostate, 
 after the preliminary course to relieve acute symptoms. 
 Complete recovery followed five months' course of treat- 
 ment. The lame leg was somewhat sluggish and heavy 
 for a year afterwards, but finally regained its normal 
 condition. 
 
 Case XVI. — Enlarged Prostate, Cystitis. 
 
 Farmer; aged sixty-one; married. He had gonorrhea 
 in early youth, but recovered from it with little incon- 
 venience. He had little or no trouble until about in his 
 fifty-fifth year, when he noticed the necessity of evacuating 
 the bladder more frequently than natural through the day ; 
 and having to arise once or twice during the night. This 
 continued, worse at times, then better, until he began pass- 
 ing some blood with the urine, during the periods of 
 exacerbation. In addition to the enlarged and con- 
 gested gland the cystoscope revealed some small vegetative 
 growths about the size and shape of the tip of a sharpened 
 pencil. These were touched with a very small quantity of 
 crystal phenic acid, then dried with a piece of absorbent 
 cotton so as not to smear the acid over a large area. Cata- 
 phoresis was then used, and recovery followed. The man 
 grew to be quite robust. 
 
CHAPTER VI. 
 
 HYPERTROPHY OF THE PROSTATE. 
 
 True hypertrophy of the prostate consists chiefly in 
 indurated enlargement, as an outgrowth of the muscular 
 fibers of the gland. The pressure as exerted by this adven- 
 titious tissue upon the blood vessels and gland tissue per- 
 verts their function, and ultimately induces parenchy- 
 matous inflammation of the entire gland. This form of 
 disease is characteristic of old age. It rarely occurs in 
 men under fifty-five, and more frequently after having 
 passed sixty. Sir Henry Thompson places the time of life 
 at which it most frequently occurs at from fifty-five up to 
 seventy, but that it rarely develops after seventy. Dr. 
 Keys places the time of its usual appearance after fifty. 
 It must not be inferred, however, that in all men past 
 fifty-five, who suffer with prostatic disease, it is senile 
 hypertrophy; but on the contrary, more men suffer from 
 congested enlargement, during that period of life, than 
 from a hypertrophic induration of the gland. 
 
 While this disease is characteristic of old age, yet except 
 tional cases occur at a much earlier period of life. It is 
 quite common among physicians to accredit all forms of 
 diseases of the prostate to hypertrophy and place the time 
 of its occurrence anywhere from twenty-one up. In fact 
 many chronic urethral diseases that have proven rebellious 
 to the ordinary methods of treatment have been pro- 
 nounced hypertrophy. It might be likened to FothergilFs 
 interpretation of rheumatism, which, as he states, "in- 
 cludes the lightning pains of locomotor ataxia to the 
 boring sensations of syphilitic ostitis." 
 
 114 
 
115 
 
 Fig. XVIII. 
 
 Fig. XVIII. illustrates a condition of true hypertrophy 
 
 of the prostate, showing extensive growth of the third lobe, 
 which so encroaches upon the neck of the bladder as to 
 occlude the flow of urine. It also shows an extension of 
 inflammation to the bladder, vesicles and rectum. 
 
116 PROSTATE GLAND AND ADNEXA. 
 
 Clinical experience has demonstrated that the large 
 majority of men troubled with prostatitis even past fifty 
 do not suffer from hypertrophy of the gland, but of con- 
 gested enlargement, I haye treated and cured many men 
 suffering from the latter, that had been treated for senile 
 hypertrophy and pronounced incurable. Such errors have 
 not been confined to the general practitioner, but many 
 had been treated by some of the leading genito-urinary 
 specialists 
 
 CAUSES. 
 
 The etiology of the disease has never been definitely 
 determined. Several of the French writers have consid- 
 ered it analogous to the atheromatous condition of blood 
 vessels, heart and other structures of the body, due to old 
 age, and as result of undue accumulation of the earthy 
 salts from the impaired functions of the eliminative 
 organs. The various hypotheses as advanced by different 
 writers upon the subject are wholly speculative. It cannot 
 be due to over use of the organs, congestion, or inflamma- 
 tion of the gland of long standing, though the latter evi- 
 dently tends in some instances to convert soft infiltration, 
 as a result of such inflammation, into firm fibrinous struc- 
 ture; yet I have known of numerous men who suffered 
 more or less with prostatitis for twenty-five or thirty years, 
 but were free from fibrinous induration of the gland. Dr. 
 Keyes says : "The prostate is analogous to the uterus in 
 the female, in regard to the nature of the muscular tissue, 
 which composes it, and this analogy is further borne out 
 by the tendency of both organs to develop fibrous tumors 
 (so called) after middle life/ 5 
 
 The morbific changes that take place are not uniform, 
 as in congested enlargement of the gland, but are usually 
 nodular, or one lobe may be affected, independently of the 
 
HYPERTROPHY OF THE PROSTATE. 117 
 
 other. The muscular band at the neck of the bladder is 
 almost invariably involved, sooner or later, forming a firm 
 bar which serves to obstruct the flow of urine. This often 
 marks the chief subjective factor in the first stage of the 
 disease. Later this bar may develop to such an extent as 
 to cause retention of a part of the urine, which undergoes 
 decomposition, inducing thereby local irritation of the 
 bladder, tendency to the development of calculi, or 
 sepsis. Subsequently as the induration increases, it presses 
 upon the vessels and gland structure until congestive 
 inflammation supervenes. 
 
 The abundant anastomosis of the veins of the prostate 
 and bladder, with those of the hemorrhoidal, causes venous 
 stasis in the rectal mucosa resulting in the formation of 
 tumors, or an abraded mucous surface within the rectum. 
 
 SYMPTOMS. 
 
 The symptoms must necessarily vary with the extent of 
 the disease, and most of which are similar to those of con- 
 gested enlargement of the gland as heretofore described. 
 The enlarged gland generally presses upon the rectum and 
 interferes with the free evacuation of the bowels, causing 
 constipation, and often flattening of the fecal matter, as 
 it passes the obstruction. It is also somewhat difficult to 
 start the flow of urine, at times, or even to thoroughly 
 evacuate the bladder. The residual urine may dribble 
 away, even after cessation of the flow, onto the clothing, 
 to the great annoyance of the man. 
 
 Pressure upon the nerves of the prostatic, hypogastric 
 and sacral plexuses provokes various reflex disturbances. 
 Prominent among these are pains in the back, hips and 
 limbs, disturbance of the stomach, which is a very common 
 sequel of any form of prostatic disease. 
 
 The bladder often becomes largely distended, from an 
 
118 PROSTATE GLAND AND ADNEXA. 
 
 over-accumulation of urine, impairing the detrusor urinae 
 to the extent that they are unable to expel all the urine. 
 This residuum increases as the disease progresses, and 
 becomes offensive from the decomposition of mucus and 
 urea. Bacteria develop in large quantity and the patient 
 is in constant danger of septic poison. , Sepsis is especially 
 liable to a catheter habit, inasmuch as the microbic flora, 
 always present about the meatus or fossa navicularis, are 
 carried by the catheter into the bladder where conditions 
 are favorable for their development and engendering of 
 septic poison, as clinical investigation has proven, that it 
 has been impossible to maintain an antiseptic urethra. 
 
 The catheter life of a patient has been estimated at an 
 average of from four to five years. Sir Eeginald Harrison 
 gives this as the average time. There are exceptional 
 cases on record, where men have lived fifteen or twenty 
 years using the catheter several times during the twenty- 
 four hours. 
 
 DIAGNOSIS. 
 
 The disease, for which hyperthrophied prostate is most- 
 likely to be mistaken, is congested enlargement of the 
 gland, as before described; and, it is not easy, in many 
 instances, to differentiate between them, since each occurs 
 during the same period of life, and many of the subjective 
 symptoms and complications are concomitant. 
 
 In the early stage of hypertrophy the diagnosis may 
 easily be made. In this the gland is much less sensitive, 
 unless it has been subject to harsh treatment by sounds, 
 caustic applications or other procedures, when acute in- 
 flammation may have been the result thereof instead of 
 the disease, per se. 
 
 In extreme old age, where the disease had been of long 
 standing, or complicated with cystitis, vesiculitis or rectal 
 lesions, it becomes somewhat difficult to differentiate 
 
HYPERTROPHY OF THE PROSTATE. 119 
 
 between the two conditions. The points upon which I 
 rely, after taking age into consideration, are (a) the 
 length of time of the noticeable existence of the trouble; 
 (b) the presence or not of a urethral discharge and its 
 character; (c) the general contour of the gland as deter- 
 mined through rectal examination; (d) the condition of 
 the prostatic urethra and bladder. 
 
 In view of the first consideration, should the patient be 
 under fifty-five years of age, the indications would favor 
 congested enlargement, rather than indurated hypertrophy. 
 Should the patient, on the other hand, be over fifty-five 
 and the trouble had been noticeable prior to fifty, it would 
 also be a negative point to hypertrophy. The long stand- 
 ing existence of a urethral discharge, whether perpetual 
 or intermittent, favors congested enlargement. Micro- 
 scopical examination revealing latent gonococci or Bottch- 
 er^s crystals indicates the latter. 
 
 In hypertrophic conditions of the gland it appears firm 
 and unsymmetrical to digital examination, through the 
 rectum. It may be nodular from the presence of tumors 
 in one or both lobes. Both lobes of the gland are rarely 
 of the same size and consistency, and there is little or 
 no tenderness upon pressure, unless inflammation has 
 extended to the gland from complications of the bladder 
 or rectum, or the extreme size of the organ has obstructed 
 the flow- of urine and caused a congested inflammatory 
 state of its glandular structure and bladder. When such 
 condition exists, there is often a profuse discharge both 
 from the gland and vesicles. 
 
 In enlargement from chronic congestion the lobes of 
 the prostate are uniform in size, less firm, unless it is very 
 much swollen and the capsule is subjected to extreme 
 tension. It is also tender upon pressure; the tenderness 
 extending to the gland penis or perineum. 
 
120 PROSTATE GLAND AND ADNEXA. 
 
 The bladder in the hypertrophied state, and advanced 
 stage of the disease, becomes sacculated as result of some 
 of the detrusor urinae becoming partially paralyzed from 
 over distension. In these sacs calcareous matter is often 
 deposited, forming at times stones of such size as to be 
 detected easily by the cystoscope, when not covered by folds 
 of the muscular walls of the bladder. In the majority of 
 instances, where calculi have become imbedded within 
 these sacs, distension of the walls of the bladder by air 
 reveals them through the cystoscopy 
 
 Another valuable diagnostic point is that the prostatic 
 urethra is almost invariably elongated. It is somewhat 
 difficult to describe just how to determine the elongation. 
 
 One familiar with urethral instrumentation can detect 
 the passage of the triangular ligament and membranous 
 urethra, and the entrance of the prostatic portion of the 
 canal, and, therefore, the distance traversed by the instru- 
 ment before reaching the bladder. 
 
 The differential diagnosis with reference to these two 
 diseases of the gland are very important, inasmuch as one 
 condition is curable and the other is not, and the curable 
 one is so often mistaken for the other, and the patient sub- 
 jected to dangerous and useless operations, that are irre- 
 parable. 
 
 TREATMENT. 
 
 Hypertrophic prostatic diseases, owing to their intracta- 
 bility, have been made, by the ambitious surgeon, the ob- 
 ject of many operative procedures, each of which chal- 
 lenges its predecessor in the endless suffering entailed 
 upon its victims, or in its lethal dangers supplying topic 
 for lengthy discourses upon the superior claims of each 
 operation as revealed by the autopsy. 
 
 Before proceeding to describe my method of treatment 
 in cases of senile hypertrophy, I shall briefly refer to 
 
HYPERTROPHY OF THE PROSTATE. 121 
 
 some aspects of the surgical operations by which a radical 
 cure of the disease is attempted. 
 
 The prevalence of the disease has offered a tempting field 
 for the exploitation of surgical ingenuity and the innumer- 
 able methods proposed; those of Tobin, Mercier, Bottini, 
 Harrison, Dittell, McGill, Belfield, Treves, Whitehead, 
 Dolbean and others, have one and all found enthusiastic 
 followers and formed the subject of our medical literature 
 upon this subject. 
 
 Surgical operations for the relief of urinary troubles 
 resulting from enlargement of the prostate fall into two 
 classes. The first consists of the various methods by which 
 the gland is attacked directly; the second embraces the 
 procedures that aim at reduction of the blood supply of the 
 swollen organ and consequently atrophy thereof. 
 
 The direct interference of the diseased organ is effected 
 through the urethra (as in the Bottini operation), or by 
 the perineal route (so-called lateral prostatectomy), or by 
 means of suprapubic incision. By the latter method, the 
 gland, especially the middle lobe, is removed bit by bit 
 with the rongeur forceps, or a wedge is cut out with scis- 
 sors, or the organ is destroyed with Paquelnr's cautery or 
 the galvano-cautery. Prostatectomy by combination of 
 suprapubic and perineal methods has also its followers. 
 
 The operations undertaken for the purpose of reducing 
 the blood supply of the gland and so bringing about an 
 atrophied condition, are either direct or indirect in charac- 
 ter. The direct consists in ligating the arteries which feed 
 the prostate, i. e., simultaneous ligation of both internal 
 iliac arteries. The indirect method is orchidectomy. The 
 theory on which this procedure is based being, that the 
 hyperemic condition of the genital system is produced by 
 nervous reflex through the presence and secretions of the 
 testicles. 
 
122 PROSTATE GLAND AND ADNEXA. 
 
 This multiplicity of surgical methods of dealing with 
 the hypertrophied prostate has its parallel in the variety 
 of theories that have been propounded as to the cause of 
 the disease, as, for instance, that of Guyom who regards it 
 as simply a part of the constitutional condition peculiar to 
 old age and characterized by arterial sclerosis; or that of 
 Harrison, who regards the growth as compensatory in 
 character and secondary to certain bladder changes. Others 
 believe that prolonged, ungratified sexual excitement 
 causes enlargement of the prostate. But here we are met 
 with the difficulty of distinguishing cause from effect, for 
 there is plenty of evidence to show that the enlarged pros- 
 tate is a cause of abnormal sexual excitability, in some 
 cases, while in the majority it has the opposite, of causing 
 impairment or total impotency. Therefore it is clear that 
 cause and effect may be transposed. In general it may be 
 said that nothing whatever has been demonstrated as to the 
 real cause of senile hypertrophy. 
 
 Each and every one of the surgical methods to which 
 I have referred is open to the most serious objections. It 
 must be remembered that the patients upon whom they are 
 practiced are generally very much reduced in health, that 
 the surgical operation is of a particularly painful nature, 
 and that the results have been either utterly unsatisfactory 
 or at least equivocal. 
 
 On account of the celebrity of Bottmfs operation and to 
 show the dangers which lurk in it, I will here say a word or 
 two regarding it. Enrico Bottini's galvano-cautery radical 
 operation for hypertrophy of the prostate was first per- 
 formed in 1875. The instrument as used was catheter- 
 shaped, of medium caliber with short beak carrying a 
 platinum plate (f inch in length) on a porcelain disc. 
 The plate, rendered red-hot by electric current, was used 
 to cauterize the prostate. In a short time this cauterizer 
 
HYPERTROPHY OF THE PROSTATE. 123 
 
 was discarded for a prostatic incisor, the instrument con- 
 sisting of a male and female arm. A platinum knife (| 
 inch long) in the male arm leaves the female arm on work- 
 ing an outside screw, and a cooling mechanism prevents 
 burning of the parts by any other portion of the instru- 
 ment than the knife. The incisor removes the mechanical 
 obstruction to the outflow of the urine by slowly burning 
 a groove or grooves through the enlarged prostate. Con- 
 siderable modification of this instrument was effected by 
 Freudenberg, who made the knife of an alloy of platinum 
 and iridium, increasing thereby its hardness and power 
 of resistance. 
 
 The technique of uie operation is of the most delicate 
 nature, involving the length, direction and number of cuts 
 to be made, the rapidity with which they ought to be made 
 and the amount of current necessary for heating the knife. 
 Besides all this there is the danger of the knife's bending 
 sideways and the difficulty of removing it without the 
 consequent pain and hemorrhage. It is obvious, there- 
 fore, that even if the operation had proved effective and 
 free from dangerous consequences, it would, from its at- 
 tendant difficulties, be absolutely lethal in its nature save 
 in the hands of the most skillful and experienced electro- 
 surgeon. 
 
 But even where all the details of the operation are per- 
 fectly understood, where the utmost care and skill are 
 brought to bear upon it, where there is clear knowledge 
 on the part of the operator of the exact conditions exist- 
 ing in the bladder neck, the dangers are too numerous to 
 allow of anything but a theoretic interest in the Bottini 
 cautery. Among the dangers that attend its employment 
 are : absolute retention of urine, hemorrhage which is apt 
 to occur from five to ten days after the incision when the 
 sloughs are thrown off, perforation of the urethra, drib- 
 
124 PROSTATE GfLAND AND ADNEXA. 
 
 bling and sepsis. The latter risk forms the most seriou& 
 objection to the Bottini method. Infection may take place 
 not only through the wounds of the prostate, but also 
 through the kidneys. Soluble and insoluble matter 
 ascends from the bladder through the ureters to the pelvis 
 of the kidney, enters the lymphatic veins and uriniferous 
 tubules and is hence conveyed to the right ventricle. The 
 foreign substance is then carried by the current of blood 
 into the other organs, principally the lungs and liver. The 
 risk of sepsis may be imagined when it is remembered that 
 cystitis, or the conditions preliminary to its development, 
 are present in every case of enlarged prostate. Numerous 
 pathological changes are present in the bladder lining as 
 well as in the prostate gland and adjoining organs, and a 
 wound caused by the Bottini instrument is all that is 
 necessary to produce serious inflammatory conditions. 
 
 Even such an enthusiastic advocate of this operation 
 as Dr. Willy Meyer admits that the dangers attending it 
 are real and numerous and closes a discussion of them 
 with the following significant remark: "At present, it 
 would seem, we are justified in stating that the larger the 
 prostate, the greater its blood supply, especially the more 
 enlarged its venous plexuses, the more pronounced the 
 purulent catarrh of the prostatic urethra as well as of 
 the bladder and even of the pelvis of the kidney — the more 
 dangerous is the operation." 
 
 The Bottini operation might be justifiable in some in- 
 stances were it true, as the operation purports, that the 
 disease is confined to the indurated bar at the neck of 
 the bladder. But such is not the fact and on the contrary 
 the lateral lobes also present pathological changes. Should 
 the patient even survive the operation it practically pre- 
 cludes any other treatment for radical relief, except pros- 
 tatectomy, when it would be extremely rare to survive two 
 operations. 
 
HYPERTROPHY OF THE PROSTATE. 125 
 
 Eegarding the other surgical methods above referred to 
 but little need be said here. Prostatectomy, whether by 
 the suprapubic or perineal route, or by combination of 
 these methods, is always accompanied by the danger of 
 sepsis, hypostasis, and above all of uremia. This opera- 
 tion has become quite popular of late years. 
 
 I fully concur in the opinion expressed by Dr. Orville 
 Horwitz, as published in the Medical Times of August, 
 1901. In summarizing the results of one hundred and 
 sixty-one operations for the relief of senile hypertrophy 
 of the prostate, he says : "With the exception of ligation 
 of the internal iliac arteries, prostatectomy is the most 
 dangerous of any operation that has been recommended 
 for the relief of prostatic obstruction, due to hyper- 
 trophy/' Orchidectomy, objectionable on real as well as 
 sentimental grounds, is doubtful in its results. Only a 
 few years ago, when the operation was enthusiastically 
 advocated by Dr. J. Wm. White, it was quite frequently 
 performed. ISTow, like others that have their day, it is 
 very rare. In three cases upon whom I have noted the 
 operation they have suffered intensely from hysteria, 
 melancholia and various other reflex nervous conditions. 
 Ligation of the iliac arteries is spoken of with hesitancy 
 by those who have performed it. Of three cases reported 
 by Meyer, he says that one was partially improved, one 
 was not improved at all and one died. Suprapubic drain- 
 age (which is recommended by Sir H. Thompson) is 
 distressing to the patient and wholly unsatisfactory, for 
 not only is the wearing of a urinal a source of constant 
 annoyance, but no device that has been tried can prevent 
 leakage, while there is a standing danger of infection 
 through the constantly open communication with the air. 
 
126 PROSTATE GLAND AND ADNEXA. 
 
 THE AUTHOR'S METHOD OF TREATMENT. 
 
 Having reviewed the pathology, complications, and ob- 
 stinacy of this most formidable disease, also the opera- 
 tions that have been devised for its relief, I shall give 
 an outline of the methods I have found most effective, (a) 
 for impending dangers to life, (b) to mollify distress- 
 ing symptoms, (c) in removing the morbid products of 
 the gland, without jeopardizing the life of the patient. 
 
 There are many symptoms and conditions of this dis- 
 ease, that are common to congested enlargement of the 
 gland, which require similar treatment. The methods 
 advised for the relief of acute complications are espe- 
 cially indicated in hypertrophy. Individual cases, how- 
 ever, necessarily require special treatment, to meet indi- 
 cation that arise at different stages of the disease. One 
 of the most difficult problems to combat, in connection 
 with hypertrophy, is the impediment to the flow of urine; 
 which engenders most of the dangerous sequels of the 
 disease; and, unfortunately, the patient defers seeking 
 relief until some serious or distressing symptoms prompt 
 him. This is generally followed by the indiscriminate 
 use of the catheter, and is often repeated from clay to 
 day until prostatic urethritis, and cystitis, is provoked, 
 and paresis of the detrusor urinae results. The latter con- 
 dition makes the bladder so dependent upon the catheter 
 as to render it. difficult to overcome the habit even when 
 the cause of obstruction is removed. 
 
 - The first indications for treatment is to relieve, in so 
 far as possible, all acute symptoms. As this method of 
 treatment has been fully described in the preceding chap- 
 ter, I shall deem it unnecessary to repeat here. As the 
 acute symptoms begin to subside the calls to evacuate the 
 bladder will become less frequent, and the necessity for 
 the use of the catheter will correspondingly be diminished. 
 
HYPERTROPHY OF THE PROSTATE. 127 
 
 It is impossible to prevent a condition of urethritis, just 
 so long as a catheter must be passed over an inflamed 
 surface for the purpose of the evacuation of the bladder. 
 The oftener it is passed the more trouble it provokes. I 
 do not wish it understood, however, that I advise the dis- 
 pensing with the catheter altogether, as it is required, at 
 times, for the over-accumulation of urine. The bladder 
 should be encouraged to expel its contents whenever it 
 can be accomplished without much effort or straining. 
 As the acute symptoms are relieved the normal evacuation 
 of the bladder becomes more easy. When the catheter 
 habit has been established, the bladder becomes sacculated 
 and the detrusors in state of inertia. It is not wise to 
 defer the use of the catheter too long; it is also better 
 not to permit the bladder to become too much distended, 
 as it serves to impair its muscular walls. When the 
 bladder is very much distended, from the accumulation of 
 a large quantity of urine, it should never be entirely 
 evacuated at one time, as it is liable to cause shock that 
 might prove fatal. 
 
 In the early stage of hypertrophy, where the urine is 
 not wholly retained, but somewhat impeded in its flow, 
 and the prostatic urethra has not been rendered acutely 
 sensitive from congestion or instrumentation, I begin the 
 use of cataphoresis both through the urethra and rectum. 
 The effect of the current alone revives the lethargic con- 
 dition and softens the indurated tissues. The medicines 
 as used in connection therewith aid in the reduction of 
 the existing inflammation and decomposing the abnormal 
 products, that form as result of unnatural growth of the 
 parts. 
 
 After having allayed the acute symptoms, I "hammer" 
 at the prostate both through the rectum and urethra until 
 the indurated tissue begins to soften, then atrophy. It 
 
128 PROSTATE GLAND AND ADNEXA. 
 
 takes quite a long time in some cases, where the gland has 
 become quite large, complications of the bladder and rec- 
 tum exist, and the health of the patient impaired. In 
 some cases from six to twelve months of treatment is 
 necessary to reduce the gland to that extent where the 
 urine can be voided without the use of the catheter. I 
 do not advise continuance of treatment uninterruptedly 
 during all this time, — I generally advise constant treat- 
 ment for six weeks or two months after the subsidence 
 of the acute symptoms, then the patient is instructed to 
 wait one or two months when it is again resumed. The 
 amount of reduction of the gland thus effected is per- 
 manent. 
 
 There are certain pathologic changes that take place in 
 the bladder walls as a denouement of the obstructed flow 
 of urine, which, in some instances, cause paresis of a 
 part of its muscular fibers that form sacs, which retain 
 a certain amount of residual urine. In other instances, 
 from long and continued use of the catheter, atrophic 
 degeneration of the muscular coats of the bladder occurs 
 that so impairs its force as to render it useless for the 
 expulsion of the urine. Whenever such conditions of the 
 bladder exist, fermentation of the residual urine is inevit- 
 able, which results in the development of pyogenic bac- 
 teria and ammonuria. When this trouble of the bladder 
 is clue to impaired function, it can be relieved by applica- 
 tions of the sinusoidal or primary faradic currents, which 
 restore its tonicity, and enables it to expel its contents. 
 But, when it once becomes sacculated, it can never be en- 
 tirely restored. 
 
 In the majority of cases of true hypertrophy the bar 
 at the neck of the bladder, or the so-called third lobe of the 
 prostate, is the chief offensive factor. This muscular band 
 is, usually, the first to become indurated and enlarged, 
 
HYPERTROPHY OF THE PROSTATE. 
 
 129 
 
 and, owing to its position, it serves as the most effective 
 barrier to the outflow of urine, by mechanically obstruct- 
 ing its exit. This condition exists, frequently at its in- 
 ception, without tenderness or any inflammatory symp- 
 toms. Fig. 17 illustrates this condition. 
 
 m 
 
 Fig. XIX. (Coulson.) 
 Showing enlarged prostate with "thtrd lobe," 
 "through the base of which a false pas- 
 sage has been made. 
 
 The Bottini operation was devised, more than a quarter 
 of a century ago, for the special relief of this trouble. The 
 operation, as originally purported, properly used, and, 
 with strict reference to this pathologic condition, was 
 scientific and gave much temporary relief. But. like most 
 all valuable procedures, it has been ffreatlv abused, bv 
 
130 PROSTATE GLAND AND ADNEXA. 
 
 blind and indiscriminate use, for almost every inconceiv- 
 able disease of the prostate without, in many instances, 
 the first semblance of diagnosis. I have seen several men 
 upon whom the operation had been performed where un- 
 mistakable evidence of a congested enlargement of the 
 gland existed instead of indurated hypertrophy. 
 
 The objections to the Bottini operation are that it gives 
 only temporary relief, even when properly used, and the 
 condition of the gland correctly diagnosed. This bar, as 
 before stated, is usually devoid of acute sensitiveness; but 
 the cicatricial tissue following the operation is always 
 exceedingly tender and inflamed. It also favors develop- 
 ment of vegetative and polypoid growths. Some of these 
 form quite large tumors, which evidently result from 
 lesion by the Bottini operation. The cut by the cautery, 
 at the entrance of the bladder, is constantly bothered by 
 septic urine, on account of its gravitating to this point. 
 The injury once performed is irreparable. The same may 
 be said of all other operations upon the gland; but there 
 are some instances where neglect of timely treatment 
 necessitates an operation for the relief of impending dan- 
 ger to life. 
 
 I do not wish to be understood as taking the stand 
 against all operations, as there are some few that are 
 imperative, and I advise them; but the tendency of the 
 day is too much in favor of indiscriminate cutting, with- 
 out reference to correct diagnosis. Delay of treatment is 
 often responsible for serious pathologic conditions necessi- 
 tating the use of the knife ; but, as expressed by the vener- 
 able Jacobi: "The knife takes too often the place of 
 brains." 
 
 In regard to the Bottini operation I shall quote Dr. 
 Joseph B. Bissell, in Medical Record of November 10, 
 1900. He writes: "Bottini's operation does not adequate- 
 
HYPERTROPHY OF THE PROSTATE. 131 
 
 ly appreciate the cause of the obstruction. It does not 
 treat the condition complicating the hypertrophy. It does 
 not allow for drainage of a dirty wound. In a word it is 
 unscientific and unsurgical. Bottini reported five success- 
 ful cases in two years with this instrument. Later he 
 modified it, so that at present it resembles a lithotrite, in 
 having a male and female blade. In the former is a plati- 
 num knife, which leaves and returns to the groove of the 
 female blade by the turning of a screw, and is connected 
 to an electric current. A scale at the outer extremity 
 shows the depth of groove cut. A cooling apparatus sur- 
 rounds the instrument so that it is kept free from heat 
 while the knife is raised to a white heat. Freudenberg 
 modified the instrument by making the blade of iridium 
 alloy, rendering it firmer and less difficult to heat, and 
 also in various other ways changed it greatly to its advan- 
 tage." He further says : "Dr. Willy Meyer, to whose 
 writings on this procedure I am indebted, has carried out 
 almost to perfection the methods and manner of using 
 this instrument. He prefers the street current with a 
 rheostat, but a fifty ampere storage battery can be taken 
 to the patient's house, if necessary. Dr. Meyer's personal 
 cases, twenty-four in number, show eight per cent mortal- 
 ity directly due to the operation, with thirty-eight per cent 
 of cures." 
 
 The Bottini operation is not so simple or easy as, at 
 first sight, one would expect. It is an operation of de- 
 tail, and one which requires care and skill and an inti- 
 mate and clear knowledge of the exact condition of affairs 
 in the bladder neck. It is an operation by no means de- 
 void of danger. Death, following suppression of urine 
 immediately succeeding this procedure, has occurred sev- 
 eral times to my personal knowledge. Freudenberg re- 
 ports a case in which he cut through a fold at the base of 
 
132 PROSTATE GLAND AND ADNEXA. 
 
 the bladder ; sepsis and death resulted. Perforation of the 
 urethra and sepsis are reported. Pulmonary emboli have 
 been found at autopsies. Hemorrhage is a constant 
 danger, and all the greater, in that it comes on at the time 
 the sloughs are thrown off, about five or ten days after the 
 incision. It may take place earlier. Cystotomy and tam- 
 poning have been necessary in a number of cases, in order 
 to save the patient's life. Absolute retention is not an in- 
 frequent immediate result of the operation. In one of 
 Meyer's cases he was obliged, for this cause, to tap the 
 bladder over the pubes for three days. Pain and severe 
 tenesmus, almost unbearable, are not infrequent complica- 
 tions. Dribbling is an occasional sequel which may be 
 permanent. But the most serious of all the objections to 
 Bottini's method is the risk of sepsis. In every case of 
 enlarged prostate which comes to us for treatment there 
 is already a cystitis, or all the elements preparatory to its 
 development. There are present a number of pathological 
 changes in the mucus and other coats of the bladder as well 
 as the tissues of the prostate gland and its adnexa. A 
 trauma, such as is done by the Bottini instrument, is all 
 that is needed to light up an inflammation in these tissues. 
 The destruction of a considerable amount of tissue in a 
 closed sac, and leaving it there without a drainage, seems to 
 me to be a surgical negligence without any excuse. To say 
 that it is done with every antiseptic precaution is saying 
 what is impossible. The cicatrization produced by Bottini 
 is said to prevent or complicate seriously any further 
 radical operation upon the gland. Moreover, this pro- 
 cedure does not take into account the real cause of the 
 obstruction and its sequences, or at least affects only a 
 small proportion of them. If the retention, cystitis, and 
 their results were caused by a bar or a collar or other 
 obstruction at the lower portion of the vesical opening 
 
HYPERTROPHY OF THE PROSTATE. 133 
 
 only, the Bottini apparently would be the indicated oper- 
 ation always, provided free drainage afterward could be 
 instituted to prevent septic infection. A catheter tied 
 into the urethra, to my mind, is a brutal and painful relic 
 of the dark ages of genito-urinary surgery. Most of the 
 cases which have come under my observation, that had 
 been operated upon by the Bottini method, have been com- 
 plete failures ; in all of these, however, with the exception 
 of one case, the operation has been contraindicated. One 
 of these cases, I can recall, was reported at a meeting of a 
 medical society as a remarkable cure, when in less than 
 a week thereafter, I noticed his name in the death list, 
 followed by "uremic poison." 
 
 Fig. xx. 
 
 Fig. XX. illustrates an instrument devised by the 
 author for relieving this indurated enlargement at the 
 neck of the bladder. It is similarly constructed to that 
 of the Bottini instrument, except that the cauterizing part 
 is flat instead of a blade. It is not intended to cut, but 
 sear the indurated surface, as illustrated. This operation 
 is attended with practically no danger, and converts the 
 hard resilient tissue into a soft granular surface, that 
 admits the action of cataphoresis, and atrophy of the 
 obstruction, without danger to life. In fact, it seldom 
 requires confinement of the patient to his room more than 
 one day. Many never discontinue work more than an hour 
 or two, but I always advise at least a day's rest. 
 
 Fig. XXI. shows the application of the cautery to the 
 indurated third lobe. 
 
134 
 
 PROSTATE GLAND AND ADNEXA. 
 
 The technique of this operation is first to produce local- 
 ized anesthesia of the prostatic urethra. This is accom- 
 plished by applying, with instrument shown in Fig. IX, 
 
 Fig. XXI. 
 
 a twenty per cent solution of cocaine; to intensify the 
 localized action of the cocaine I use anodal cataphoresis. 
 I then wait ten minutes for the action of the anesthetic. 
 The cautery should always be tested before its introduction 
 
HYPERTROPHY OF THE PROSTATE. 135 
 
 into the urethra, in order to note carefully the required 
 amperage and to see that the apparatus is in perfect work- 
 ing order. The cautery surface should be of deep red color 
 and never at a white heat. It is held in apposition to the 
 enlarged bar, at first, only one or two minutes. The 
 patient should be retained in a recumbent posture for at 
 least one hour, and, better still, two or three hours after 
 the operation. The bladder should always be evacuated 
 prior to the operation, and a soft catheter passed to see 
 that it is thoroughly emptied. The urine should be main- 
 tained in an antiseptic condition, and if of alkaline re- 
 action, benz-ol cps or cystogen should be given. Thuja is 
 especially soothing to the genito-urinary tract in some 
 cases, and can be administered in combination with potas- 
 sium citrate with much relief when the urine is unduly 
 acid. The cautery application can be repeated within a 
 week or ten days. Cystoscopic examination of the gland 
 should be made to note its condition just before the 
 cautery is applied. 
 
 After, the second or third cautery application cata- 
 phoresis through the prostatic urethra should be instituted 
 about every second or third day by means of a one per 
 cent solution of thuja or aqueous extract of hydrastin. 
 These treatments should be given very mildly at first and 
 discontinued if attended with much pain or hemorrhage. 
 In many cases a copious muco-purulent discharge follows 
 the cautery application, as a result of the disintegrated 
 enlargement. If such discharge becomes very profuse or 
 irritating to the urethra, an injection of two grains to the 
 ounce of sulphocarbolate of zinc should be used. 
 
 Softening and atrophy of the gland becomes quite 
 noticeable in from one to two months, and the urine is 
 voided more easily, less frequently and becomes free from 
 the heavy muco-purulent sediment. 
 
136 PROSTATE GLAND AND ADNEXA. 
 
 After the second month I usually discontinue all treat- 
 ment for a certain length of time, varying from three 
 weeks to two months. By this means the natural restora- 
 tive processes are favored, after discontinuance of the 
 irritation provoked by the treatment. 
 
 The majority of men who suffer from hypertrophy of 
 the third lobe require treatment as heretofore described, 
 for at least a j T ear, when the gland becomes reduced to 
 such an extent as to render them comfortable the remain- 
 der of their lives. Others require treatment occasionally, 
 every one, two, or three years ; and only for a short period 
 at a time. This treatment gives them an option on living 
 many years in comfort, rather than endure the suffering 
 entailed by the obstructed flow of urine, or the dangers 
 directly attending the knife, or its subsequent effects. 
 
 There are many cases of hypertrophy, where a vege- 
 tative or polypoid growth springs from the posterior part 
 of the middle or third lobe at the neck of the bladder, and, 
 floating in the urine, serves as a valve to impede its free 
 exit. Such conditions are especially suitable for this oper- 
 ation. The instrument is passed well into the bladder and 
 towards the front surface ; it is then reversed and brought 
 backwards and forwards, when the concave surface (con- 
 taining the cautery) engages the tumor. It is held in 
 contact with the tumor about one and one-half to two 
 minutes. The patient should remain in bed for some days 
 after the operation. 
 
 Case XVII. 
 
 A lawyer; aged sixty-eight; married; no venereal 
 history. He had observed some slight difficulty in voiding 
 urine for about five years. There was no pain attending 
 the act, but it required longer time than normal, and some 
 effort to thoroughly evacuate the bladder. This condition 
 
HYPERTROPHY OF THE PROSTATE. 137 
 
 gradually became more manifest, until he observed that 
 he could not entirely empty the bladder. He then con- 
 sulted his physician, who began the use of sounds, and the 
 catheter. The urine became turbid, ammoniacal and very 
 offensive after standing. Washing of the bladder was 
 resorted to, without any relief. 
 
 When he consulted me he had to use the catheter from 
 four to five times during the twenty-four hours. He was 
 enabled to expel by force, at times, from one to four 
 drachms. It contained a large quantity of mucus and 
 pus, strongly ammoniacal in odor, and alkaline in re- 
 action. 
 
 Both lobes were hypertrophied — the left one more 
 marked. The bar at the neck of the bladder was especially 
 large, and firm. There was no tenderness upon pressure 
 of the gland through the rectum. Its large size obstructed 
 the fecal discharge, causing constipation. There was very 
 slight tenderness in the prostatic urethra, notwithstanding 
 the long use of the catheter. 
 
 I began the use of cataphoresis with one per cent solu- 
 tion of thuja through the prostatic urethra on alternate 
 days. The sinusoidal application was made to the gland, 
 through the rectum, the intervening day, making therefore 
 daily treatments to the indurated prostate. The thuja was 
 gradually increased to ten per cent strength. Five and 
 ten per cent solutions of potassium iodide were also used. 
 I had him discontinue washing the bladder. Five-grain 
 doses of cystogen were given three times daily. The use 
 of the catheter was continued as required to evacuate the 
 bladder. At the end of the first month's treatment, it 
 w^as necessary to use the catheter on an average of every 
 second day. At times he would not use it oftener than 
 the third or fourth day, then again daily for a few times. 
 The urine remained normally acid without the use of 
 
138 PROSTATE GLAND AND ADNEXA. 
 
 medicine and had become much less offensive, and the 
 sediment reduced to one-fifth the quantity it formally 
 contained. 
 
 This condition continued, with some interruptions, for 
 four months. He would occasionally go two weeks without 
 using the catheter, then again having to use it daily for a 
 few days. His general health was much improved, having 
 gained fifteen pounds in weight. The treatment was dis- 
 continued for a month, and again resumed, and continued 
 two months longer, when he returned home. The first 
 letter I received from him, a month thereafter, he was 
 somewhat discouraged. I will quote his second letter, 
 which followed about a month later: 
 
 "Dear Doctor : Since I wrote you, I have improved 
 in health, and seem to be almost well. The day after I 
 wrote my last letter, the improvement commenced in a 
 marked degree, and the gain has been steady and well 
 sustained. I have gained in weight and strength. My 
 digestion is good and my bowels are working in a natural 
 way. There is no heavy or thick sediment in my urine 
 and no pain in the bladder." 
 
 I have not heard from him since. 
 
 Case XVIII. 
 
 Hypertrophy of prostate, cystitis, proctitis. Physician, 
 aged sixty-nine; married; had gonorrhea in early man- 
 hood, from which he readily recovered. He had ridden 
 horse-back a great deal up to his sixty-fifth year, without 
 discomfort. About that time he began to feel an uneasi- 
 ness in the region of the perineum. The flow of urine 
 had also become sluggish, and somewhat difficult to start. 
 He abandoned the saddle for a buggy, when he soon found 
 it necessary to use a pneumatic rubber ring for a seat, and 
 to empty the bladder with catheter. The catheter had 
 
HYPERTROPHY OF THE PROSTATE. 139 
 
 been in use for more than a year when I first saw him. 
 His general health was very much impaired. 
 
 Upon examination I found the left lobe very much 
 enlarged, the right less so, but quite nodular. There was 
 very slight pain upon pressure of the gland. The adjacent 
 tissues were somewhat congested and tender, from ob- 
 structed venous circulation. The muscular bar at the neck 
 of the bladder was very large and firm. 
 
 Failing to procure much relief by means of cataphoresis, 
 I restorted to cauterizing the bar at the neck of the blad- 
 der, with my modified Bottini instrument (Fig. XX). 
 This was accomplished by placing the patient in the lith- 
 otomy position, with the knees drawn back, and the limbs 
 held in position by means of leg rests. The hypertrophied 
 bar was thoroughly cocainized, using a twenty per cent 
 solution, with instrument (Fig. IX.) prior to the opera- 
 tion. The cautery band of the instrument was tested, be- 
 fore its introduction, and only carried to a deep red heat, 
 not white. It was moved slightly to each side of the in- 
 durated bar in order to act upon a large surface. It was 
 allowed to remain two minutes, when the circuit was 
 broken and the instrument removed. 
 
 The patient was kept upon his back for some hours, to 
 prevent the urine from gravitating to the cauterized sur- 
 face, and twenty minims of deodorized tincture of opium 
 were administered. There was no hemorrhage following 
 the operation, and very little pain. Elixir lithamine was 
 given for the purpose of maintaining the urine in an anti- 
 septic condition. 
 
 The catheter was used as often as required to evacuate 
 the bladder. The bowels were maintained in a lax condi- 
 tion. The patient was permitted to go out on the third 
 day. One week after the operation cataphoresis was in- 
 stituted alternate days for tw T o weeks. The patient then 
 
1-10 PROSTATE GLAND AND ADNEXA. 
 
 passed from half to one and one-half ounce of urine at 
 times. The catheter was used from two to three times 
 a day. Cauterization was again used in the same manner, 
 three weeks after the first treatment,, followed by cata- 
 phoresis. Improvement in general health was very marked. 
 The urine at times would flow quite freely for two or three 
 days, then become sluggish, requiring the catheter. At the 
 end of four months he returned home. I have heard from 
 him several times since. He writes that he is compara- 
 tively comfortable, and uses the catheter on an average 
 every thirty-six hours; occasionally he goes two or three 
 days without using it, then again once daily. 
 
 Case XIX. 
 
 Married, aged sixty-three; obstinate flow of urine had 
 begun two years previous; prostatic urethra was very 
 tender. Frequent use of catheter caused daily hemorrhage. 
 Urine, heavily laden with pus and mucus, was very of- 
 fensive upon standing. 
 
 The first cauterization gave great relief, and checked the 
 hemorrhage very materially. After the second treatment 
 there was only a trace of blood. The case was treated 
 similarly to the preceding one for five . months, when he 
 was able to dispense with the catheter altogether. I still 
 use cataphoresis once or twice a month. The urine is normal 
 some days; at other times somewhat cloudy. 
 
 Case XX. 
 
 Widower, aged seventy-one; very sallow complexion and 
 emaciated. He had been troubled with evacuating the 
 bladder for at least ten years. He had been a very active 
 business man, though of sedentary character. The disease, 
 developed very slowly. He had led a catheter life for three 
 
HYPERTROPHY OF THE PROSTATE. 141 
 
 years. During the first year he only used the instrument 
 about once every second or third day, then daily, and, 
 finally, four to eight times in the twenty-four hours. 
 
 He was very costive, dyspeptic and anemic. At times 
 there was only a trace of blood following the use of the 
 catheter. The urethra was not sensitive. Rectal and 
 urethral treatment were applied regularly for three weeks 
 with the view of restoring tonicity to the organs. Nutri- 
 tive tonics and massage were also given at the same time. 
 
 Six cautery applications were made during the period 
 of seven months, cataphoresis was used between these treat- 
 ments during the interim. At the expiration of that time 
 he had gained twenty pounds in weight; his mental vigor 
 was restored, and he could void urine during the day with- 
 out the use of the catheter, but at night was necessitated 
 to draw it once and occasionally twice 
 
 Case XXI. 
 
 Aged seventy; married. For about seven years he had 
 been periodically annoyed with his "kidneys and bladder,'' 
 as he expressed it. At first he was troubled only about 
 every four or five months, the attacks lasting two or three 
 days, but not hindering him from his business. The 
 paroxysms continued to become more frequent until he 
 consulted his physician. He suffered excruciating pain 
 and vesicle tenesmus, and the physician resorted to the use 
 of morphia for its relief. These paroxysms had recurred 
 so often that the patient had become addicted to the use 
 of the opiate. When sent to me by his physician he was 
 taking from two to three grains of morphia daily and was 
 using the catheter every twenty to thirty minutes when 
 not under the influence of the drug. 
 
 I placed him in a hospital so as to obtain the best care, 
 gradually cur down the amount of morphia each day, sub- 
 
142 PROSTATE GLAND AND ADNEXA. 
 
 stituting the following prescription for its sedative prop- 
 erties : 
 
 E. Fluid ext. hyoscyamus one ounce. 
 
 Opium deod. tr two drams. 
 
 Triticum repens, q. s four ounces. 
 
 M. Sig. — Teaspoonful in water every two or three hours. 
 
 When the local irritation in the prostate and bladder 
 had somewhat subsided I used the cautery instrument as 
 in the preceding case. 
 
 I kept the patient at a hospital for a month, during 
 which time the use of morphia had been completely abol- 
 ished, and the use of the catheter had been reduced to once, 
 occasionally twice, in the twenty-four hours. His general 
 health had so much improved that he removed to a hotel, 
 but still had an attendant. He showed marked improve- 
 ment from that time on ; using the catheter less frequently 
 and having little or no pain. 
 
 Upon calling to see him one morning, I found he had 
 a high fever, severe vesicle tenesmus and paroxysmal pain 
 every few minutes, his condition being much worse than 
 at any previous time. The reverse in his condition was 
 the result of his attendant deserting him to attend a ball 
 the night before; the weather was exceedingly cold, the 
 fire had completely gone out, and the patient was forced 
 to get up into the cold room to use his catheter, becoming 
 thoroughly chilled through, and the fever followed. The 
 condition increased in severity, ending in the patient's 
 death on the third day. 
 
 The majority of cases of hypertrophy of the prostate that 
 have come under my observation have been so amenable to 
 cataphoresis and local applications as not to necessitate the 
 electric cautery. It is only in those cases where the bar at 
 the neck of the bladder has become so large as to obstruct 
 the flow of urine, that it has been necessary to use the 
 cautery. 
 
HYPERTROPHY OF THE PROSTATE. 143 
 
 There are other cases, of rare existence, however, where 
 a pedunculated tumor forms from the posterior border of 
 the prostate and protrudes into the bladder, in which the 
 electric cautery is especially indicated. 
 
 Many cases, too, are presented where vegetative or poly- 
 poid growths occur around the vesicle neck, demonstrable 
 by means of the cystoscope, which yield readily to local 
 applications, and that do not require electro-cautery. I 
 could continue to report numerous cases with various com- 
 plications in this connection, but deem it unnecessary to 
 prolong the list. 
 
 SYPHILITIC PKOSTATITIS. 
 
 Little mention has been made by authors of syphilitic 
 prostatitis. I, too, had overlooked it as a prominent etiologi- 
 cal factor of prostatitis until two very characteristic cases 
 had come under my observation. There is no reason, to 
 my mind, why the prostate should not become subject to 
 the influence of constitutional syphilis as well as the tes- 
 ticles. All cases of syphilitic prostatitis that I have noted 
 have resulted from the tertiary form of the disease. 
 
 Case XXII. 
 
 Aged forty-four ; single ; sailor. He had had several at- 
 tacks of gonorrhea, the first at about twenty. At about 
 thirty he had syphilis. He had no recollection of secondary 
 symptoms. He took constitutional treatment for only about 
 six months, and even then not regularly. 
 
 There were blotches upon the lower and outer portion of 
 his shin bone, simulating syphilides. His rectum was 
 badly ulcerated, extending about three inches from the 
 anus. The prostatic urethra was excessively tender. In 
 fact, he had most of the symptoms attendant upon chronic 
 enlarged prostatitis. 
 
144 PROSTATE GLAND AND ADNEXA. 
 
 I teated him by the usual methods for prostatitis, rectal 
 ulceration and vesiculitis, ignoring the syphilitic history 
 of the case. He improved readily for six weeks under the 
 local treatment, and then remained about the same for two 
 weeks without further improvement. I then discontinued 
 all treatment for two weeks, when he returned, suffering 
 with syphilitic orchitis. There was no pain in the testicle, 
 nor did it exhibit any inflammatory symptoms. There 
 were no indications of its swelling during the time he was 
 under treatment by the urethra, nor were there any acute 
 symptoms of the prostate or bladder. He was advised to 
 apply lotions of hamameiis, alternating with acetate of 
 lead, and report at the end of the week. By this time the 
 testicle had become quite large, but not the least tender. 
 He also began complaining of pains in his lower limbs. I 
 now placed him upon potassium iodide constitutionally 
 and applied ten per cent strength of oleate of mercury 
 locally to the scrotum. This treatment was continued reg- 
 ularly for a month, when the pains had subsided in the 
 limbs and the testicle was much reduced in size; besides, 
 the local irritation of the prostate was much ameliorated. 
 The same or similar constitutional treatment was continued 
 at regular intervals for two years, which controlled pros- 
 tatic irritation better than anything else. A second case, 
 very similar to the foregoing, except that the tertiary symp- 
 tims were more marked in the outset, yielded in like man- 
 ner and was kept under control by constitutional treat- 
 ment alone, after the local trouble had been relieved. 
 
 TUBEBCULOSIS OF THE PEOSTATE. 
 
 Of all diseases of the genito-urinarv organs, it requires 
 greater elasticity of the imaginative fee I es to diagnose 
 this form of disease of the gland than thai of any other 
 organ of the body; yet there are writers who describe ac- 
 
TUBERCULOSIS OP THE PROSTATE. 145 
 
 ornately the tubercular nodules as detected by examina- 
 tion through the rectum. Of late I have come to look upon 
 it only as a loop-hole through which to escape the respon- 
 sibility of failure to relieve an intractable case of chronic 
 prostatitis by the means usually in vogue — namely, the 
 sound, cautery, massage. 
 
 The diseased prostate, as much or more than any other 
 organ of the body, often provokes mental and physical de- 
 pression, which results in emaciation, a hacking cough, and 
 prepares favorable soil for the development and propaga- 
 tion of pulmonary tuberculosis. Many of such cases have 
 come under my care that have yielded readily to treatment 
 of the gland, and restoration to perfect health. 
 
 ASPERMATISM. 
 
 This is a peculiar and rare condition, in which there is 
 a competent erection, and, at times, a slight orgasm, with- 
 out ejection of semen. Taylor says: "Lesion of the pros- 
 tate being so often the cause of aspermatism, I always ad- 
 vise an examination of the gland through the rectum." He 
 claims also that aspermatism is caused by the ejaculatory 
 ducts becoming plugged up by sympexia, preventing there- 
 by the escape of the semen into the urethra. He mentions 
 a typical case, as reported by Beliquet, where relief fol- 
 lowed the escape of a large quantity of sympexia through 
 the urethra. Occlusion of the ejaculatory ducts by pros- 
 tatic calculi have been reported by different authors. 
 
 I have observed two cases of aspermatism following 
 chronic prostatitis, one of which was of especial interest 
 owing to some novel symptoms connected therewith. 
 
 Case XXIII. 
 
 A young man, thirty- two years of age ; single ; traveling 
 salesman. He had been very dissipated for ten or twelve 
 
146 PROSTATE GLAND AND ADNEXA. 
 
 years by way of hard drinking and excessive sexual indul- 
 gence. He rarely became intoxicated, however, but drank 
 continuously. He had had gonorrhea quite often, followed 
 by gleet, with which he had suffered for the past ten years. 
 During one of these carousing bouts he was stricken with 
 paraplegia and incontinence of urine. He had been in 
 this condition for twelve hours before I saw him. The 
 urine was passing involuntarily from overflow of the blad- 
 der, indicating paralysis of sphincter urinae. 
 
 I treated him for the prostatic trouble, and in about two 
 weeks he began showing improvement, which continued 
 steadily until, at the end of the third month, he was able 
 to stand upon his feet and pass urine normally. He went 
 home and I did not see him again for more than a year, 
 when he returned to my office walking with a cane. He 
 laid his cane aside to show me that he was not forced to 
 use it, as there was but little indication of his former 
 paralysis. He reported that he had had no trouble in void- 
 ing urine for some months; but that one peculiar symptom 
 was that he was able to have an erection and intercourse 
 normally without passing semen, and without any sensa- 
 tion in the way of orgasm. He also stated that the erec- 
 tion could be produced at will and maintained for an in- 
 definite period, often several hours, enabling him to com- 
 plete the act of intercourse several times with no ill effects 
 except prostration from physical exertion. I have heard 
 from him several times during the past five years. He re- 
 ports his condition about the same as when he saw me 
 last. His health otherwise is good. 
 
 Case XXIV. 
 
 Was that of a man of forty-eight years of age ; married ; 
 very corpulent ; healthy and in perfect condition up to two 
 years before seeing me. He had then begun to suffer with 
 
ASPERMATISM. 147 
 
 chronic enlarged prostatitis and from that time was totally 
 impotent, manifesting all the symptoms usual in such 
 cases. He was treated, and practically relieved of the symp- 
 toms. There was a normal recurrence of the functions of 
 the sexual organs, enabling him to have intercourse with- 
 out discomfort. About a year thereafter, he reported to 
 me that he had begun to have trouble in the way of lack 
 of emission of semen during intercourse. It would pass 
 about midway the urethra, where it would stop, apparently 
 from lack of force in the muscles to expel it. There was 
 slight orgasm during the ejection. 
 
 There are other cases of aspermia that result from oc- 
 clusion of the ejaculatory ducts as result of cicatrix fol- 
 lowing prostatic abscess; other cases have been reported 
 where the ducts were closed by prostatic calculi, thereby 
 obstructing the passage of semen. 
 
 CHBONIC PEIAPISM. 
 
 In some cases we meet with the converse of impotence 
 (impotentis coeundi) as due to chronic prostatitis and 
 prostatic urethritis. While the initial causes, in most in- 
 stances, of the inflammatory conditions are the same, yet 
 it is often found that these have been aggravated by the 
 use of sounds, caustic applications to the deep urethra, or 
 other violent measures. 
 
 The localized inflammatory focus, situated usually in the 
 prostate and caput gallinaginis, reacting upon the sexual 
 brain independently of mental influences, cause prolonged 
 irritative erections that are exceedingly wearing upon the 
 nervous system. These distressing erections more frequently 
 occur during sleep, arousing the man by their irritative 
 effects and disturbing his sleep for hours at a time. Para- 
 doxical as it may appear, men so effected are generally im- 
 potent and are incapable of obtaining an erection under 
 
148 PROSTATE GLAND AND ADNEXA. 
 
 normal influences. There are others similarly affected 
 where one sexual congress only intensifies the desire for a 
 repetition, which is repeated until complete mental and 
 physical collapse results. 
 
 Case XXV. Chronic Priapism, Prostatic Inflam- 
 mation. 
 
 Man, aged fifty-four; healthy from all external appear- 
 ances; very temperate and a good business man. He had 
 had one attack of gonorrhea, from which he had appar- 
 ently recovered. For four years he had been annoyed with 
 persistent erections at night, which would often last two 
 or three hours at a time, necessitating getting up and walk- 
 ing the floor to get relief. On attempting intercouse there 
 was a complete collapse of the organ and utter failure, re- 
 gardless of all efforts and remedies used for the purpose. 
 
 He had been subjected to the use of sounds, aphrodisiacs, 
 bromides and massage of the prostate without benefit. 
 
 Immediate relief followed restoration of the inflamed 
 gland and prostatic urethra to their normal condition. 
 
 Case XXYI. 
 
 A minister, bachelor, aged forty-two, and an exceedingly 
 intellectual man, consulted me for chronic priapism. He 
 had been annoyed with the erections for about five years. 
 At first, it only disturbed him at night, but for the past 
 three years it had annoyed him both clay and night. He 
 had consulted many physicians regarding the trouble, and 
 several had given him different forms of bromides, which, 
 as he said, had only served to impair his mental faculties, 
 without giving any relief to his embarrassing condition. 
 He requested me not to give him anything that contained 
 any of the bromides, as it was necessary for him, in his 
 line of work, to maintain an active brain. He further 
 
CHRONIC PRIAPISM. 149 
 
 stated that these erections often remained hours at a time, 
 even during the day, which maintained the organ in a ten- 
 der and often painful condition. He stated that he had 
 lived a perfectly virtuous life, and there was no reason to 
 question it. I explained to him that the symptoms indi- 
 cated a local inflammation of the prostate and adjacent 
 organs, and that systemic medication could never relieve 
 it. The gland was very sensitive, and quite rebellious to 
 treatment, owing, doubtless, to his abstemious habits. 
 
 After six months of irregular treatment of the prostate 
 and prostatic urethra the irritation subsided and there was 
 no further trouble with the erections. 
 
 Case XXVII. 
 
 Physician; single; age thirty-eight; never had gonor- 
 rhea. He began having trouble when about twenty years 
 of age. He was treated with sounds at first, without re- 
 lief, then injections and systemic medications. "For the 
 past twelve years," as he states, "he has been tortured with 
 erections, the organ remaining erect for hours at a time. 
 There has also been a gleety discharge for fifteen years; 
 at times it is scarcely noticeable. Seminal emissions, too, 
 occur, at times, even two or three within a week, then again 
 not for a month. Emissions now occur without much sen- 
 sation. They make me dreadfully weary, causing pain in 
 back and back of neck. I can't stand mental work, and my 
 memory I find is perceptibly failing. I have treated my- 
 self, and was treated in Xew York by two physicians for 
 two years, one of whom gave me bromide of sodium and 
 ergot for the annoying erections without the least benefit, 
 The other used cold sounds and massage of the prostate — 
 all of which gave no relief." 
 
 In case of this nature the prostatic urethra and the 
 gland itself are very tender and much inflamed, which on 
 being relieved, all other symptoms are allayed. 
 
150 PROSTATE GLAND AND ADNEXA. 
 
 MAEEIAGE. 
 
 The question of when a man should marry, who has had 
 chronic gonorrhea, prostatitis or any perverted sexual func- 
 tion, has been one of paramount importance, and has 
 elicited much discussion and various expressed opinions 
 among geni to-urinary specialists throughout the world. 
 
 Men suffering from one or more of these troubles are 
 frequently advised to marry before procuring relief, which 
 has entailed untoward misery, unhappy unions and often 
 separation. This subject was discussed at great length at 
 the Sixth Congress of the German Dermatological Society, 
 at Strasburg, in 1898, and it was the concurrent opinion of 
 those present that just so long as gonococci could be de- 
 tected in the secretions, they were infectious. 
 
 One other point upon which all agree is that the gono- 
 cocci do hide and remain dormant for an indefinite period 
 within the prostate and aclnexa, and, while it has been 
 proven that these germs are especially susceptible to ger- 
 micidal agents when brought into direct contact with them, 
 how are you going to reach them ? As Weiss says : "What 
 means do we possess to entice these parasites to the sur- 
 face?" There is no means known to the profession of en- 
 ticing them from their hiding places, and the only way 
 to get rid of them is to destroy them within the gland by 
 cataphoresis or electro-magnetic influences. 
 
 There are other diseased conditions of the prostate, how- 
 ever, not dependent upon gonococci, that are equally as es- 
 sential to relieve before marital relations should be ad- 
 vised. The cause and treatment of these have been given in 
 a previous chapter. 
 
CHAPTER VII. 
 
 NEUROSES OF THE PROSTATE. 
 
 The sexual organism, of which the prostate is one of the 
 chief factors, is so intimately blended with the central and 
 sympathetic nervous systems, that disease of this gland 
 provokes the most varied neurotic disturbances. 
 
 The lumbar spinal center, sacral plexus and great sciatic 
 nerve of the cerebro-spinal system and the hypogastric 
 plexus of the sympathetic, are in such close reciprocal rela- 
 tion to the nerves of the prostate, that disturbances in the 
 organs to which the former are distributed are frequently 
 the first precursors of disease of the gland. 
 
 Often have I seen men who had been dosing their stom- 
 achs for dyspepsia, their livers for torpor, their bowels for 
 constipation, their heads for neuralgia, treating sciatica for 
 malaria, plastering their backs for Bright's disease, taking 
 sea voyages for melancholia, when the origin of their trouble 
 was centered in the prostate, and the relief of which cured 
 their other ailments. There are many of these cases, too, 
 that have no subjective symptoms directly pointing to dis- 
 ease of the gland, yet upon examination the objective symp- 
 toms would be most marked. 
 
 The erroneous idea that prevails among many physicians 
 and the majority of laymen that disease of the prostate 
 only results from some venereal disease, or is a sequel of 
 senility, deters them from an examination of the gland for 
 these obscure troubles. 
 
 151 
 
152 PROSTATE GLAND AND ADNEXA. 
 
 NEUKASTHENIA. 
 
 This is one of the most prominent symptoms in diseases 
 of the prostate and is manifested in almost every conceiv- 
 able form of nervous disturbance. The disease so com- 
 monly referred to as "nervous prostration" might, in the 
 large majority of instances, be traced to the prostate, should 
 the attending physician take the care to examine the 
 patient for this trouble. The examination is easily made, 
 and even should such trouble not exist, it is better to be 
 aware of the fact, and so dismiss one probable etiological 
 factor than to continue groping in the dark and dosing the 
 patient "ad nauseam." Because of the almost universal 
 belief of both doctors and laymen, that to suggest disease of 
 this gland would imply that at some time in life the patient 
 had had some form of venereal disease, the physician is 
 loth to make such suggestion. And, even should he muster 
 courage to do so, he would, in all probability, be met with 
 the prompt reply, "Why, doctor, I never had any disease 
 there in my life.*' It has been difficult for me at times to 
 convince people that these troubles are not always the re- 
 sult of venereal disease. But, when the patient understands 
 that the doctor's desire to know positively that no such 
 disease of the gland exists is in order to discard it as a pos- 
 sible cause, the patient will, in almost every case, submit to 
 an examination, and, by means of the bougie a loule the 
 trouble in the prostatic urethra will be detected. The ex- 
 amination through the rectum or by cystoscope could be 
 made at the time, or on some other day, should ob- 
 jection be made. Many cases of nervous troubles of an 
 obscure origin have been cleared up in this way. 
 
 Sexual neurasthenia is not an idiopathic disease, and 
 rarely, indeed, can it not be traced to the prostate or genital 
 organs as the prime cause. 
 
NEUROSES OF THE PROSTATE. 153 
 
 I remember hearing a lecturer, at the Blockley Hospital, 
 Philadelphia, say that he had often declared that he would 
 not vote for any man to graduate in his elasss who failed 
 to suggest examination of the prostate in answer to the 
 following question: "What would you do if a man pre- 
 sented himself with an obscure nervous disease ?" At the 
 time I considered the statement absurd — especially as the 
 lecturer w r as not a Jefferson professor — but I have since 
 often thought it a very wise utterance. 
 
 Genito-urinary diseases of men as result of prostatitis 
 and the various functional nervous disorders related there j 
 to, wdiether as cause or effect, are in the same condition 
 that diseases of women were in fifty years ago. At that- 
 time the nervous symptoms that accompanied such dis- 
 orders in females as lacerations of the cervix or perineum, 
 congestion and displacement of the uterus and ovaries, were 
 succinctly, if unscientifically, grouped under the head of 
 hysteria, and these symptoms treated without reference to 
 the cause and often without the least effort to arrive at a 
 correct diagnosis. And today the nervous maladies result- 
 ing from a morbid condition of the prostate gland, such as 
 mental depression, morbid fears, nervous dyspepsia, pal- 
 pitation, deficient mental control, headache and backache, 
 are generally dismissed in the same easy fashion to the 
 category of hypochondriasis. 
 
 Considering the immense importance of the problem in- 
 volved in the relation of the genital function to the nerv- 
 ous system, and the vast amount of suffering entailed upon 
 mankind by the ignorance of the patient and the indiffer- 
 ence of the physician in regard to these problems, remark- 
 ably little effort has been expended in their solution. 
 Whether there is or is not such a disease as spermatorrhea ? 
 and if there is, what is its nature and effect ; when are in- 
 voluntary emissions pathological; what are the various 
 
154 PROSTATE GLAND AND ADNEXA. 
 
 kinds of impotence, and how should they be treated; how 
 are morbid conditions of the prostate gland and urethra 
 reflected to the nervous system ; how do nervous and other 
 diseases affect the genital functions? — these and other 
 problems of great practical interest have only within very 
 recent years begun to attract the attention of the inves- 
 tigator, while the profession at large are as yet almost blind 
 as to their importance. 
 
 While the excitant cause of sexual neurasthenia is trace- 
 able in the majority of instances to disease of the prostate. 
 yet there are other exacerbating etiological factors that 
 should be taken into consideration. Prominent among 
 these are excessive cigarette smoking, alcoholic stimulants, 
 business cares, domestic worries and climatic condition.-. 
 All these have to be taken into account as concomitant fac- 
 tors in genital neuroses. 
 
 The symptoms of sexual neurasthenia are so protean in 
 nature, that, according to the prominence of one or other- 
 stage of its development, it is frequently diagnosticated as 
 oxaluria, lithemia, or disease of the imagination. 
 
 Its real and tangible cause is either overlooked, or an 
 attempt to discover its source neglected. The physician is 
 usually content to guess at the cause, prescribe some in- 
 noxious remedy and await the result. Others resort to nux 
 vomica or its alkaloid, combining or alternating it with 
 various other aphrodisiacs, which serve to excite an already 
 tender or diseased prostate. The man returns from time 
 to time and reports some better, then worse ; when, in fact, 
 he is growing gradually worse all the time. This condition 
 may continue for a long time, until the man finally be- 
 comes aware of a twitching of the muscles of the lower 
 limbs; in others the fingers tingle or there is an impair- 
 ment in the use of an arm, noticeable in writing or hand- 
 ling a knife or fork while eating. In others, the lower 
 
NEUROSES OF THE PROSTATE. 155 
 
 limbs feel heavy or numb, requiring an effort to raise 
 them in walking. 
 
 Many men begin with pains in their back, which extend 
 over their hips, down to the calves of the legs. The latter 
 is a very common symptom, owing to the close relation of 
 the sciatic plexus to that of the prostatic plexus and asso- 
 ciate ganglia. 
 
 Melancholia is a very common sequel of prostatic dis- 
 ease, and it, just as other neuroses resulting from disease 
 of the gland, assumes a periodicity at first; subsequently 
 it may become continuous. I have clinically observed in 
 men suffering from prostatic neuroses that the periodicity 
 is markedly analogous to the menstrual epoch of women, 
 in that it first appears in paroxysms of about four-week in- 
 tervals; and, as the disease becomes more aggravated, it 
 assumes a periodicity of two weeks ; when, as the gravity of 
 the disease becomes serious, it is daily or continuous. I 
 would advise, in these obscure nervous diseases, or even 
 in any chronic condition, where a monthly exacerbation 
 appears, the examination of the prostate. In some cases 
 the periodicity is manifested in bouts of drinking. 
 
 It may seem absurd to some ; and, if on examining the 
 gland it is found to be healthy, there is no harm done; 
 when you can then dismiss it as being the most probable 
 etiological factor. ^ 
 
 Clinical observation has demonstrated that young men 
 suffering from prostatitis of the sub-acute form, are more 
 subject to paraparesis; while middle aged and old men 
 affected with congested enlargement of the gland are more 
 subject to hemiparesis. While this is not an invariable rule, 
 vet in the very large majority of cases, if the prostate is 
 examined in these paralytic diseases, it will be found to be 
 diseased. Melancholia and mania may follow either char- 
 acter of the disease, but it is rare in senile hypertrophy. 
 
156 PROSTATE GLAND AND ADNEXA. 
 
 The innumerable symptoms that result from reflex ir- 
 ritation of the prostate are brought about by the sympa- 
 thetic system or vaso-motor nerves as well as by those of 
 the cerebro-spinal system. The more highly developed the 
 nervous system of the individual, the wider the effect pro- 
 duced by the shock of any disease of the gland. But in 
 the spreading of the effect, the intensity at any given 
 point is diminished. This furnished the explanation of the 
 seeming paradox that strong constitutions are more liable 
 to severe local disease than are neurasthenics. The mole- 
 cular changes produced by disease meet with far less re- 
 sistance in highly involved organizations which are good 
 conductors of every kind of motion, while the resistance 
 offered by a strong constitution tends to produce local 
 functional disease. Thus it is that functional excesses in 
 the strong tend to produce excessive functional nervous 
 diseases. 
 
 The same fact serves to explain another apparent para- 
 dox, that nervous hysterical patients, who run the gamut of 
 nervous disorders every day of their lives, are frequently 
 long lived ; disease, as it were, proving an antidote to dis- 
 ease. The destructive force of disease which meets with 
 vigorous resistance in a strong body, concentrates itself 
 locally with lethal violence, while in the weak, nervous 
 constitution, it is conducted away, attenuated and rendered 
 comparatively innoxious. 
 
 MELANCHOLIC MANIA. 
 
 This is one of the most distressing as well as varied in 
 its manifestations of any of the neurotic diseases follow- 
 ing prostatitis. Among the incidents of most every phy- 
 sician, long in practice, the proverbial phrase that "It never 
 rains but it pours" has been tangibly presented at 
 some time of his professional career. It fell to my lot 
 
NEUROSES OF THE PROSTATE. 157 
 
 some years ago to have had quite a number of these cases 
 of melancholia following in close order to one another. 
 
 Case XXVIII. Chronic Prostatitis and Melancholic 
 
 Mania. 
 
 Merchant; aged forty-four; very emaciated, though 
 strong and an active business man. For two years he had 
 suffered with occasional attacks of nervous depression fol- 
 lowed by hot, alternating with cold, flashes. These "spells" 
 as he termed them, had gradually grown more frequent 
 and aggravated. At first they would occur every three 
 months, then monthly, and finally every two weeks. His 
 temperature would never rise more than one-half degree, 
 even when he said he felt as though he was burning up. 
 I inquired as to the condition of his kidneys, bladder and 
 sexual organs. He was very reticent regarding them and 
 at first strenuously objected to an examination. Finally 
 upon submitting to an examination, the prostate was found 
 to be exceedingly sensitive and slightly swollen. It was 
 so sensitive that he refused to have it treated. He con- 
 tinued to grow worse until he was advised by his wife and 
 friends to take a rest. He went to a country town and en- 
 gaged rooms at a hotel. He had been there just about ten 
 days when he had "one of his spells." His wife sent for 
 a physician, who, after having examined the man, pre- 
 scribed some innoxious remedy and left. After having 
 taken one dose of the medicine, the man conceived the idea 
 that his wife had connived with the doctor to poison him 
 for the purpose of procuring his money. He violently op- 
 posed taking another dose of the medicine, to avoid which, 
 having been persuasively urged to do so, he leaped from his 
 bed and ran out of his room in his night clothes down 
 the stairs from the sixth floor to the office, screaming 
 "murder." He maintained that I, only, knew his constitu- 
 
158 PROSTATE GLAND AND ADNEXA. 
 
 tion and was capable of prescribing for him. He had his 
 wife wire me to come and see him (some two hundred 
 miles distant). Several telegrams were sent daily for three 
 days, when I finally decided to go. On my arrival at noon, 
 and making myself known to the clerk at the hotel, he 
 said that my patient was in the dining room, across from 
 the office, and for me to walk in and get my dinner. I was 
 cordially greeted by both man and wife, who requested 
 me to order my dinner. Questions were immediately pro- 
 pounded by the man regarding incidents at home, evidently, 
 as I understood, to avoid mention of his health. He was 
 quite cheerful, apparently, and discussed different sub- 
 jects intelligently. The subject of his health was not men- 
 tioned until on leaving the dining room, he requested me 
 to go with him to the parlor, where he narrated the inci- 
 dents before mentioned, in a very quiet and rational man- 
 ner, explaining his reasons therefore. He stated that he 
 had had "one of his spells," and that the first dose of 
 medicine was poison, and that he had acted in that way 
 to attract the attention of the police, that they might arrest 
 and lock him up until I could arrive to treat him. I re- 
 mained with him several hours and left him in the best of 
 spirits; he consenting to remain there several weeks until 
 he regained his health. On the following morning I heard 
 that he had returned home and was violently insane. He 
 was arrested by the police and incarcerated. He sent 
 for an attorney, to whom he explained that he had been 
 arrested and imprisoned for sinister purposes. He was 
 released, as he was as rational, apparently, as any one. 
 In a few clays thereafter he again became violent and 
 was placed in custody at his home. During these at- 
 tacks he would suffer with continuous priapism both day 
 and night. During the rational intervals he would be 
 comparatively free from the annoying erections. He 
 
NEUROSES OF THE PROSTATE. 159 
 
 was carried to the asylum in this state, where he re- 
 mained a few months and died. 
 
 Case XXIX. Ixso^ixia, Melancholia, Prostatitis. 
 
 Clerk; aged thirty-eight; married. Very large and ap- 
 parently in robust health. I was called in consultation 
 to see the man, when the attending physician gave the 
 following history : The patient had never had any ven- 
 ereal disease, but had been addicted to excessive venery 
 in early youth, and, at times, until within the past two 
 years. He has paroxysmal periods of excessive sexual 
 desires. One sexual congress seemed to intensify the 
 propensity for a second or third in rapid succession. This 
 would last for three or four days, when he would lapse 
 into a state of melancholy and insomnia. He had first 
 noticed the attacks monthly, attended with only slight 
 depression of spirits; but for six months prior hereto he 
 would be scarcely relieved of one attack before the recur- 
 rence of a second. He would not average more than five 
 hours^ sleep during the twenty-four, and only then under 
 the influence of a narcotic. There were few symptoms 
 indicating prostatic trouble. The urine was voided more 
 frequently than normal at times, and contained an ex- 
 cessive quantity of phosphates and some uric acid. 
 
 I advised an examination of the prostate; this was op- 
 posed by the patient and not encouraged by the attending 
 physician. I did not hear from the patient again for six 
 months, when I was again called to see him with his phy- 
 sician. He had grown steadily worse and, though taking 
 from sixty to eighty grains of sulphonol daily, he was 
 sleeping not more than three hours during the twenty- 
 four. He had developed a religious mania and was sing- 
 ing and praying much of his time. He had now become 
 totally impotent. I again insisted upon an examination 
 
160 PROSTATE GLAND AND ADNEXA. 
 
 of the genital organs, which revealed both chronic pros- 
 tatitis and vesiculitis. Immediate improvement followed 
 treatment of the gland and vesicles, and today he is a 
 healthy, active business man. 
 
 I could report several other similar cases with various 
 complications that have come under my observation, where 
 relief of the prostate and vesicles was followed by com- 
 plete recovery of all other nervous symptoms. 
 
 The pervertion of the sexual organs, as cause of lunacy, 
 gave rise to the advocacy and practice, in some of our asy- 
 lums a few years ago, of castration for its relief. 
 
 Melancholia as a result of prostatitis does not always 
 develop insanity. I have noted its manifestations in the 
 most varied phases of hysteria, mental and physical weak- 
 ness, obstinate pessimism, and occasionally extreme op- 
 timism. 
 
 One hysterical patient that I can recall would lie down 
 upon the floor and roll over and cry for a time and then 
 laugh. He was forty-four years old, married, had three 
 children, and never had gonorrhea. His prostate was so 
 tender that he fainted when it was gently touched. He 
 recovered entirely from his nervous symptoms after the 
 relief of the prostatic trouble. These cases all have an 
 exceedingly sensitive urethra, even those that never had 
 gonorrhea. 
 
 Dyspepsia and constipation are common sequels of pros- 
 tatitis, often, too, when there are no indications of dis- 
 ease of the gland. I recall one case that was brought to 
 me by a former patient who had suffered with indigestion 
 and flatulency for several years. During this time he 
 had consulted many physicians and had taken all the indi- 
 gestion remedies advised by both physicians and drug- 
 gists. He was existing solely upon milk and some form 
 of Battle Creek food. There was not an objective symp- 
 
NEUROSES OF THE PROSTATE. 161 
 
 torn pointing to any form of disease of the gland, and 
 I hesitated very much to suggest an examination of it. 
 
 He readily submitted to an examination, to my surprise, 
 when I found the gland slightly affected. I had him dis- 
 continue the use of medicines and eat sparingly for a 
 few weeks. I treated the gland through the urethra and 
 rectum on alternate clays and did not give him a single 
 close of medicine. He fully recovered and gained twenty 
 pounds in weight within two months and has never had 
 a symptom of his former trouble since, though he eats 
 anything he wishes. 
 
 Other cases of indigestion, with pronounced symptoms 
 of disease of the gland, have been, quite common. 
 
 Sciatica or affections of some of the branches of the 
 sciatic nerve are common sequels of prostatitis. 
 
 Fig. XXII. illustrates the nerve and some of its branches. 
 Those distributed to the muscles of the calf of the leg are 
 more frequently affected, even when the great sciatic es- 
 capes. I recall one man fifty-two years old, who had 
 sharp, darting pains in the calves of his legs, and, at 
 times, in the thigh. He had been treated with "goat 
 lymph*' and otherwise for locomotor ataxia several years. 
 His prostate was exceedingly sensitive. After the third 
 treatment of the gland his pains disappeared and never 
 returned. 
 
 I have seen several cases who had pain only in the heel. 
 One of these had been suffering intensely for about a 
 week, both day and night. He never had gonorrhea, nor 
 had he any prominent symptoms of prostatitis. The pain 
 immediately disappeared after the first treatment of the 
 gland. It returned some days afterward, but finally left 
 him entirely, after the gland had been relieved. 
 
162 
 
 PROSTATE GLAND AND ADNEXA. 
 
 ,<4jfl! 
 
 Pig. XXII. (Gray.) 
 
NEUROSES OF THE PROSTATE. 163 
 
 Case XXX. Sciatica, Prostatitis, Spermatorrhea. 
 
 Clerk; aged twenty-six; single. He had gonorrhea of 
 a severe type when twenty-one, which was long continued. 
 He thought that he had never fully recovered from the 
 attack. Some two years after the prime inception of the 
 disease, he noticed a continuous oozing from the penis, 
 vital depression and impaired function and erections. 
 Subsequently pain in the back and left hip developed. 
 It grew worse when sitting for a long time. Exercise re- 
 lieved the pain for the time. He would pass several weeks 
 frequently without noticing any special inconvenience, 
 when, suddenly, he could scarcely arise from his chair. 
 The attacks became insidiously more severe from month to 
 month, until he had a severe paroxysm that confined him 
 to bed for six weeks. During this time he suffered in- 
 tensely, necessitating the use of large doses of opium for 
 relief. The muscles along the course of the sciatic nerve 
 became very much atrophied, leaving a depression in the 
 limb. He had taken almost every conceivable remedy, 
 together with a course of baths at Hot Springs, Arkansas, 
 which only gave temporary relief. The direct static spark 
 over the spine and along the course of the nerve gave 
 the most relief, for the time. 
 
 Upon examination I discovered a slight stricture in the 
 membranous urethra, chronic prostatitis and vesiculitis. 
 
 The sciatic pain w T as permanently relieved soon after 
 beginning treatment of the gland. Massage of the limb 
 restored it to its normal size. 
 
 IMPOTEXCY. 
 
 Impotence may exist in a modified degree, or amount to 
 total functional incapacity. There may be only a defi- 
 
164 PROSTATE GLAND AND ADNEXA. 
 
 ciency of erectile power, or desire and capacity may both 
 be lacking. Or, again, erectile power may be normal at 
 times, when free from erotic excitement, and then be- 
 come flaccid and useless in the presence of women. Some- 
 times an erection takes place at the proper time, but it 
 does not last sufficiently long for intromission, much to 
 the disgust and chagrin of the man. Sometimes prema- 
 ture ejaculation occurs, but often no emission takes place. 
 
 I shall not attempt here a discussion of the mechanism 
 of erection, but it is chiefly under the influence of the ner- 
 vous system, which is controlled mainly through the "sex- 
 ual brain" as situated in the prostate, or, as many think, 
 in the caput gallinaginis. There is no paralysis or loss 
 of power in the muscular or vascular conditions of the 
 organ that affect the mechanical part of the erection. 
 
 Failure to perform the act, at some one time, often be- 
 comes so impressed upon the mind of the man that eYen 
 after the restoration of the prostate to its normal condi- 
 tion, it requires several efforts to restore confidence. 
 
 I recall the case of a libertine, who, suffering from 
 prostatitis, had made repeated failures with his mistress, 
 and after having been restored, would still fail with her, 
 yet complete the act perfectly with other women. 
 
 There is often diminished sensibility of the penis and 
 scrotum, which appear also cold and lifeless. 
 
 Impotency due to disease of the prostate and vesicles 
 is almost invariably attended with seminal loss in some 
 form; that is, in young or middle aged men. The terms 
 in general use for unnatural seminal discharges are some- 
 what confusing, as they are often used synonymously. 
 Those to which I adhere are nocturnal or involuntary sem- 
 inal discharges, pollutions and spermatorrhea. 
 
 The first occurs in one's sleep and is attended with an 
 orgasm that generally arouses him. Pollutions may take 
 
NEUROSES OF THE PROSTATE. 165 
 
 place at any time, but more frequently during sleep, and 
 emissions occur in a similar way to the former, but in a 
 passive form, and not attended with an orgasm, which 
 rarely arouses one from sleep. 
 
 Spermatorrhea takes place in a slow, dribbling man- 
 ner, without erection or orgasm. It produces the sensa- 
 tion as though something was running from the peni^. 
 The latter may be concomitant with either of the acute 
 forms. Moreover, it is often the case that prostatorrhea 
 only exists, which is mistaken for spermatorrhea. 
 
 Nervous depression or moodiness is not usually due to 
 the loss of semen, even when seminal discharges are promi- 
 nent, but to the incessant reflex nervous irritation to the 
 cerebro-spinal centers as result of the diseased gland. 
 Should an emission occur when asleep, and not oftener 
 than ten days or two weeks, in a man of vigorous habits, | 
 it should not be considered pathological, when the man 
 had abstained from all sexual relations during that time. 
 Ultzman and S. W. Gross concur in this view. 
 
 I cannot impress too forcibly the importance of an ex- 
 amination of the gland in these obscure cases, as I know 
 too well that physicians are prone to neglect such, and 
 yield too readily to an obduracy upon the part of the pa- 
 tient to submit to an examination because of over prudery, 
 or that it suggests venereal disease. 
 
 I can recall several suicides of prominent business men, 
 who, if their prostatic conditions had been properly diag- 
 nosed and relieved, could have been saved an untimely 
 death. 
 
 Men suffering from melancholia, as a result of pros- 
 tatitis, are much more able to resist the evil effects of the 
 disease when employed than when idle. It is very unwise 
 to advise such men to go away for a rest. I have known 
 of several instances where men were so advised, and who, 
 
166 PROSTATE GLAND AND ADNEXA. 
 
 having no other mental employment than to brood over 
 their ailments, became maniacal or suicidal. 
 
 The simple knowledge of impotency so preys upon the 
 minds of some men as to aggravate their physical and 
 mental condition, impair their digestion, disturb their 
 sleep and wreck their health. 
 
 STEEILITY. 
 
 Potentia coeundi does not always imply potentia gen- 
 erandi. The latter depends entirely upon the procreative 
 power of the semen, while the former implies the ability 
 of the man to complete the act of coitus. 
 
 It is a well-known physiological fact that healthy pros- 
 tatic fluid is essential to perpetuate the lives of the sper- 
 matic germs until they reach their destination of impreg- 
 nating the ovum. The vesicles, too, are important factors 
 towards maintaining the vitality of these germs. The 
 prostate and vesicles are in such close proximity and so 
 allied in their physiological relations, that disease of one 
 readily extends and involves the other. 
 
 It is not infrequently the case that men are able to 
 complete the act of coitus, yet the spermatozoa may be 
 lifeless or so impaired in vitality from perverted prostatic 
 secretions as to render them sterile. The wives of such 
 men are too often subjected to all kinds of treatment and 
 operations for barrenness, when the fault lies with the 
 men. Several cases of this kind have come under my care, 
 where relief of the prostate was followed by fruitful re- 
 sults. 
 
 PBOSTATOKBHEA. 
 
 Ultzmann says: "With every sexual excitement as 
 soon as erection of the penis has occurred, long before 
 ejaculation of semen has taken place, a clear, transparent, 
 
NEUROSES OF THE PROSTATE 167 
 
 viscid drop, like white of egg, oozes from the meatus. 
 This clear, viscid drop represents the secretion of the ac- 
 cessory glands of the urinary and genital tracts and con- 
 sists of the secretions of the prostate, of Cowper's glands 
 and the glands of Littre. Since the prostate is the largest 
 gland in this connection, it is evident that the mass of 
 this fluid must be the prostatic secretion. If this clear, 
 viscid fluid is secreted in greater amount, indeed continu- 
 ally and without sexual excitement, this condition is called 
 prostatorrhea." 
 
 The fact is that the normal viscid secretion attending 
 sexual excitement and erections, is often mistaken for a 
 pathologic state, when it really indicates a healthy con- 
 dition of the gland and is premonitory to a seminal ejec- 
 tion. This prostatic secretion serves to lubricate the chan- 
 nels and favor the passage of semen, besides its aid in 
 maintaining the lives of the spermatozoa. 
 
 Prostatorrhea is due to an inflamed condition of the 
 gland as a result of gonorrhea, masturbation or other sex- 
 ual excitements. Prostatic calculi or rectal diseases may 
 serve as exciting causes, but they are more frequently the 
 effect and not the cause of the trouble. 
 
 The differential diagnosis between prostatorrhea and 
 spermatorrhea depends largely upon microscopic exami- 
 nation of the secretion. The presence in the secretion of 
 Bottcher's crystals and amyloid bodies would point strongly 
 to prostatorrhea, while the presence of spermatozoa would 
 not exclude that condition as a possibility, as spermator- 
 rhea often accompanies prostatorrhea, though the latter is 
 much more common. 
 
 Azoospermia is a common sequel of prostatitis and vesic- 
 ulitis, as the perverted secretions of these organs tend to 
 devitalize and destroy the spermatic germs and render the 
 man sterile. 
 
168 PROSTATE GLAND AND ADNEXA. 
 
 The urine in these cases is variable in quantity, and is 
 usually of light color, containing small shreds or hook- 
 shaped flakes. 
 
 TREATMENT. 
 
 Successful treatment of these conditions depends upon 
 proper diagnosis and the removal of the cause. As the 
 etiological factors are almost invariably traceable to the 
 diseased prostate and vesicles, these organs must neces- 
 sarily be relieved before any permanent benefit can be 
 procured. As the treatment has been discussed in previ- 
 ous chapters, the reader is referred thereto for full details. 
 
 There are some cases, however, of long standing disease 
 of the prostate where, even after the gland had been cured, 
 
 Fig. XXIII. 
 
 there remains an impaired function of the genitalia, due 
 to lack of nervous energy. For relief of this condition I 
 have devised a bipolar rectal electrode, Fig. XXIII. 
 
 Fig. XXIV. shows the application of this electrode, one 
 pole being directed to the prostate in front and the other 
 to the sacral and hypogastric plexuses of nerves that min- 
 ister to the pelvic organs. By passing the electrode fur- 
 ther up the rectum the poles are in apposition to the vesi- 
 cles in front and the genito-spinal center posteriorly. I 
 have found this treatment very efficient in such cases. 
 
 It is a common practice among physicians of giving 
 aphrodisiacs in these cases, without attempting to ferret: 
 out the cause of the trouble, which serves to aggravate 
 an already serious condition. I was surprised to note that" 
 the distinguished Dr. Ultzman (professor of genito-uri- 
 
NEUROSES OF THE PROSTATE. 169 
 
 nary diseases in the University of Vienna) advises the 
 stroking of the external genital organs with electricity for 
 impotence yet further states (page 41) : "This method 
 of treating impotence is not infrequently accompanied by 
 the most excellent results, only it has its shady side, and 
 
 Fig. XXIV. 
 
 that is that nocturnal emissions are promoted, i. e., in- 
 creased." 
 
 Impotency, which is most often the result of prostatitis, 
 should never be treated by exciting the genital organs 
 either with medicines or electricity, until the diseased con- 
 dition of the gland is relieved, when, in the large majority 
 
170 PROSTATE GLAND AND ADNEXA. 
 
 of cases, the normal function is restored without the use 
 of any exciting agents. 
 
 There are some cases, however, in whom stimulating 
 aphrodisiacs arouse transient genital activity which is 
 usually followed by total impotence and seminal losses. 
 
 Prostatic Facies. — Just as Kelly describes an ovarian 
 face in women, there is an analogous expression in most 
 all men suffering from chronic prostatitis. It is quite 
 noticeable in many men, which readily disappears upon 
 restoring the gland to its normal condition. 
 
 Glycosuria and albumen often appear in minute quan- 
 tities where neurotic symptoms are prominent; but they 
 are of transient nature and readily disappear as soon as 
 the local trouble is relieved. Neither of these conditions 
 implies disease of the kidney. Since Claude Bernard 
 demonstrated that puncturing the floor of the fourth ven- 
 tricle would produce albuminuria or glycosuria, it is now 
 a well known fact that many nervous shocks cause them 
 to temporarily appear. 
 
 Imaginary Impotency. — Much has been written and 
 spoken of impotence existing only in the head. Many of 
 these expressed opinions have originated from some of 
 the most prominent surgeons and genitourinary special- 
 ists, who had either failed to locate the cause of the 
 trouble or to relieve it after having discovered the source. 
 But very few of these cases are really imaginary. 
 
 Case XXXI. 
 
 Aged thirty-two; single. Never had gonorrhea. He 
 had been addicted to sexual abuses followed by frequent 
 emissions and chronic discharge. The first physician 
 treated him with tonics, or constitutionally; the second 
 with sounds ; the third with both. After having gone the 
 rounds for six years, trying to get in shape to marry, he 
 
NEUROSES OP THE PROSTATE. 171 
 
 was advised to do so, and that he would then become 
 normal. The trouble continued. Two years after his 
 marriage he came to me for treatment. I discovered an 
 inflamed prostate and urethra. Normal functions re- 
 turned just as soon as these organs were relieved, and 
 without taking a dose of constitutional medicine. 
 
 Case XXXII. 
 
 Aged twenty-eight; strong and robust in appearance. 
 He was not sure whether he had ever had gonorrhea or not, 
 as some physicians had told him he had, and others that 
 he had not. He was annoyed with excessive pollutions. 
 Different physicians advised him to marry and that his 
 trouble was in his head alone. He recovered his sexual 
 powers when relief of his prostate was effected. 
 
 PAEAPAEESIS. 
 
 This condition especially calls for a thorough exami- 
 nation of the prostate gland and adnexa. For the past 
 fifteen years, since I have had my attention more espe- 
 cially directed to the prostate as an etiological factor in 
 this trouble, I have not seen a single case of paraparesis 
 or impaired function of the lower limbs where the gland 
 was not involved, unless due to syphilis or lesion of the 
 spine. This condition occurs more often in young men 
 who have been subject to excessive masturbation or sexual 
 indulgence. 
 
 The onset of the trouble is usually manifested by a 
 sensation of heaviness or weight about the lower limbs, 
 which, as the disease progresses, becomes so marked as to 
 interfere in climbing stairs. There is rarely any pain in 
 these cases at first; and should it supervene at all, it is 
 usually manifested by a few darting pains in some of the 
 branches of the sciatic nerve, in the region of the popliteal 
 space or calf of the leg. c 
 
172 PROSTATE GLAND AND ADNEXA. 
 
 The progress is usually of an insidious nature, and 
 especially if due to masturbation. If due to excessive 
 sexual indulgence and accompanied with a bout of drink- 
 ing, it is liable to be sudden. I have seen cases of the 
 latter where sudden paraplegia resulted. In rare in- 
 stances of this affection, the pains, as before described, have 
 been the prominent premonitory symptoms. Others still 
 have described sensations as though something was creep- 
 ing up their limbs. 
 
 Case XXXIII. 
 
 I recall the case of a man, twenty-eight years of age, 
 who had been suffering eighteen months with paresis. 
 There was no pain in the limbs, but the impaired function 
 became more perceptible from week to week until there 
 was total loss of power. During this time the young man 
 had been treated by several physicians, some of whom diag- 
 nosed the case as that of locomotor ataxia. Not one of 
 them suspected the prostate as the cause of the trouble, or 
 even examined it. When I first saw him he had no more 
 use of his lower limbs than if they were made of rubber. 
 I found him totally impotent, with a persistent prostator- 
 rhea and occasionally nocturnal pollutions. 
 
 I directed my treatment entirely to the prostate, when 
 improvement began at once. In six weeks time he could 
 stand upon his legs, and after six months he was back at 
 work, and one could scarcely detect any defect in his gait. 
 
 HEMIPAKESIS. 
 
 This trouble is very common among older men suffering 
 from enlarged inflammation of the prostate. The first 
 manifest symptom is a dragging of one foot in walkings 
 scraping of the pavement. This is often noticeable by one's 
 companion before the person himself has observed it. 
 
NEUROSES OF THE PROSTATE. 173 
 
 Case XXXIV. 
 
 I recall one case who said the first time he had his 
 attention called to any defect in his left foot was by his 
 wife, when walking upon the street, when she said: "Will ! 
 for goodness sake quit scraping your foot on the pave- 
 ment." He had never noticed it before, and wdien his 
 attention was called to the fact he went along for some 
 distance without doing so again; but his mind being with- 
 drawn from his walking, he was again reminded of it by 
 his wife. When dressing the next morning he first noticed 
 that the sole of his left shoe was much worn out at the 
 toe, while the other was not. From that time on he no- 
 ticed a perceptible impairment of his left side. This was 
 followed by loss of co-ordination in writing. 
 
 This case applied to me for treatment eighteen years 
 ago. I did not know as much about the cause of these 
 troubles then as now, so I treated his spine by electricity, 
 massage and mechanical movements for several months, 
 which gave him temporary relief; but he was gradually 
 growing worse from month to month. He finally men- 
 tioned certain symptoms implicating the sexual organs 
 that led to an examination of the prostate, which revealed 
 the seat of the trouble. Noticeable improvement followed 
 the treatment of the gland within two weeks from the 
 time of its beginning. Three months thereafter he w r as 
 able to resume his work and left the city. I did not see 
 him again for nine months; when upon his return he was 
 so far well that his defect was almost imperceptible. 
 
 Case XXXV. 
 
 Merchant; aged fifty-six; married. Up to his fifty- 
 third year he had been quite active. About that time he 
 began to notice that he would scrape his right foot upon 
 
174 PROSTATE GLAND AND ADNEXA. 
 
 the pavement when walking. He could prevent this scrap- 
 ing, at first, when his attention was directed to it; but 
 immediately on withdrawing his mind from the sluggish 
 foot, the scraping of the pavement would recur. He next 
 noticed an impairment of his right hand when attempting 
 to tie a bundle. He was unable to grasp a string suffi- 
 ciently tight to tie a knot. This condition grew worse, by 
 degrees, until he could not use his knife while eating. The 
 leg was equally impaired. Both hand and leg began to 
 improve after the second week's treatment of a congested 
 enlarged prostate. The gain was steady for two months; 
 but there was still an impaired function. I then began 
 the application of the bi-polar electrode as illustrated 
 (Fig. XXIII. ), passing the current through the prostate in 
 front, and the sacral plexus and lower part of the spinal 
 cord behind. Marked relief followed this treatment. 
 
 I recall another similar case of a harness maker, whose 
 right hand became so impaired that he could not draw a 
 thread in stitching. His right leg was also impaired. 
 After being treated in a similar way to the foregoing case 
 for six weeks, he was enabled to resume his work. The 
 treatment was continued for six months, at irregular in- 
 tervals, when he fully recovered. 
 
APPENDIX. 
 
 CHAPTER VIII. 
 
 ELECTRO-PHYSICS, ELECTROLYSIS AND CATAPHORESIS. 
 
 I shall treat these subjects in their chemic, physiolog- 
 ical and therapeutic relations only in so far as they pertain 
 to my subject. 
 
 Introduction. 
 
 A knowledge of the construction of batteries and acces- 
 sories, the manner of producing the different currents, 
 together with their various modifications, is as essential to 
 their proper understanding and scientific applications as 
 is that of chemistry, physiology and anatomy to the prac- 
 tice of medicine and surgery. Anyone capable of using 
 these potent agents in a scientific and practical manner 
 with impunity should be able to make, or have constructed 
 by his own directions, batteries, accessories and electrodes 
 to meet all indications that arise. I have know T n of fre- 
 quent instances where physicians were using the galvanic 
 current who did not know, positively, which was the anode 
 or cathode, yet there is as much difference in their effects 
 as that of calomel and opium. Others regard the sinu- 
 soidal and faradic currents as the same or similar in effect, 
 when their properties are almost as different as that of 
 the two poles of the galvanic. 
 
 The empirical use of the currents is not confined to the 
 country physicians, but it is often so used by some of our 
 leading specialists, and so-called professors of electro- 
 therapeutics. 
 
 175 
 
176 ELECTRO-PHYSICS. 
 
 I have had quite a number of physicians consult me who 
 had diplomas in electro-therapy, that were ignorant of 
 its first principles, and, too, where most of their teachings 
 had been erroneous. A physician, a few months ago, called 
 to see me, who was taking a course of instruction in electro- 
 therapy. I asked him what were their teachings regarding 
 the properties of the sinusoidal current. He said that one 
 of his professors had said that it was the same in effect as 
 the faradic currents. I then gave him a list of questions 
 to ask his professors regarding the properties of the direct 
 and alternating incandescent currents, the sinusoidal and 
 induced. On the following day be reported at my office, 
 and stated that he had propounded the queries, as I had 
 suggested, to each of the lecturers, and that neither of 
 them agreed upon any point. 
 
 A lack of knowledge of physics and the properties of the 
 different electric currents, as evidenced by teachers and 
 writers upon the subject, has evidently given rise to the 
 following from Dr. S. H. MorrelL, in the Times and Reg- 
 ister, March 16, 1895, on "A Plunge into Electro- 
 Therapeutics, 7, who gives some wholesome advice to be- 
 ginners which thoroughly accords with my views. He 
 says : "If you wish to acquire skill in the use of electric- 
 ity, don't set about it alone, and don't rely on what you 
 find in text-books. If you can induce a reliable expert to 
 take you as a student for a few months, do so, no matter 
 what it costs. As there are various branches of electrical 
 work in which special technique is employed, for instance 
 in genito-urinary and gynecological practice, you should 
 obtain a short course of practical instruction in each. 
 When you have devoted six months to an apprenticeship 
 of this kind, you will have laid the foundation for ultimate 
 success/ 7 
 
 I mention these facts onlv to illustrate why electro- 
 
ELECTRO-PHYSICS. 177 
 
 therapy is still regarded by many of our leading physicians 
 as sub judicc. who have not given it special attention or 
 clinical study. 
 
 Many of the most scientific physicians in the world at- 
 test the fact that by the proper selection of the currents 
 and accessories, and its appropriate application to certain 
 pathologic structures, it relieves the morbific conditions 
 with the impunity that cannot be effected by any other 
 means known to science. 
 
 The proper use of so intricate and yet so w 7 orthy a 
 remedy could not be brought to perfection by a merely 
 superficial series of experiments, nor can at present a pass- 
 ing glance at a standard author warrant sufficient knowl- 
 edge for successful treatment by its use. The different 
 currents and different strengths, each are studies in them- 
 selves that demand careful perusal on the part of the 
 student, of each and every form separately, as though it 
 were an independent study bearing only a distant relation 
 to the common subject. This accounts for, in part, why 
 the general practitioner too frequently wholly neglects the 
 agent that will bring about the best results in the treat- 
 ment of his patients suffering from prostatitis, and resorts 
 to the use of drugs that will frequently do infinitely more 
 harm than no treatment at all. Not that it is a willful 
 neglect on the part of a conscientious physician who always 
 tries to do the best by his patients, but rather because, even 
 though he would have sufficient time amid his numerous 
 duties to study thoroughly the applications of the different 
 currents, facilities for their use and necessary equipment 
 in order to justify gratifying results would be wanting. 
 In short, electrical treatment is a specialty that demands 
 for the successful management of cases a specialist who 
 can devote the greater part of his time to the supervision 
 of special apartments and special equipments that cannot 
 
178 ELECTRO-PHYSICS. 
 
 receive necessary attention in the busy routine of a general 
 practice. In the hands of such a one sufficiently skilled to 
 cope with the various forms of chronic prostatitis, and 
 possessing all requisite appliances, the efficacies of electrical 
 treatment cannot fail to prove itself as being far superior 
 to all agents that may be employed for the relief of this 
 form of disease. 
 
 Electricity, like all other potent remedies, has its limit 
 of utility, and it is only within these bounds that its bene- 
 fits are claimed by the author. 
 
 Electricity yields negative results wherever its applica- 
 tion is not thoroughly understood, as where the galvanic 
 current is applied where the faradic or sinusoidal should 
 be used ; or when too weak or too strong a current — either 
 has no effect or irritates the parts ; or when it is made to 
 comprise the whole treatment, and no pains are taken to 
 ascertain the underlying cause of the disease and that also 
 judiciously treated, nor to build up the general system in 
 conjunction with this treatment. As is the folly of treat- 
 ing a patient with tonics with a view of adding weight to 
 his body, and still denying him the proper food for the 
 accomplishment of that purpose obviously evident, so also 
 should be the treatment of a patient by electricity without 
 attention to general hygienic principles. The efficacies of 
 electro-therapeutics are denied by many physicians who, in 
 good faith, have never devoted sufficient time to the study 
 of its proper application, and hence every trial has been 
 attended by failure; and those who, skeptically biased, 
 have never directed their attention to its uses, and in 
 order to smother its growing popularity declare it harmful 
 in effect and too dangerous for use. 
 
 Because a remedy is not rightly understood and its use 
 is not attended with success merely for want of knowledge 
 on the part of those who deny proper time to its study, it 
 
ELECTRO-PHYSICS. 179 
 
 does not necessitate abandonment on the part of others 
 who are thoroughly versed in its effects, and in whose 
 hands it does not fail; and much less should it be under- 
 valued because subtle charlatans with medical pretenses 
 ensnare unwary victims by its improper uses. In the 
 hands of an incompetent physician most all therapeutic 
 agents are dangerous, be it an opiate, massage or mustard ; 
 and electricity is no exception to the rule ; yet who would 
 decry the beneficial effects of an opiate prescribed by an 
 able physician. And since, therefore, most of our worthy 
 remedies have a dangerous side, if carelessly employed^ 
 why then should the use of the electrical current be aban- 
 doned when other agents, infinitely more dangerous, still 
 maintain full sway in the treatment of diseases ? 
 
 Electrical treatment is a method of treatment that has 
 come to stay. Prejudice cannot uproot it, nor bungling 
 usage soil successful records. Yearly, as new and more 
 efficient methods and apparati are brought into use, its 
 range of employment grows larger and its triumphs of 
 success become more apparent. And today, from among 
 all the various agents for the successful treatment of dis- 
 eases of the prostate, electricity, in conjunction with suit- 
 able medicinal remedies, incontrovertibly stands in the 
 front rank. 
 
CHAPTER IX. 
 
 ELECTRO-PHYSICS. — CONTINUED. 
 
 All substances, whether organic or inorganic, are capable 
 of electric excitation. The electricity thus excited affects 
 bodies differently. This difference in -the electric condi- 
 tion of one body as compared with that of another consti- 
 tutes what is termed electrical potential. Bodies are not 
 under all circumstances of the same electrical potential; 
 in fact, they vary very much in this respect. An element 
 of higher potential is positive to one of lower negative, yet 
 negative to another still nigher. For instance, zinc is 
 positive when coupled with copper, yet negative with 
 sodium. The term potential, therefore, is a relative one. 
 The earth is usually taken as the standard, and assumed 
 to be at zero potential. 
 
 All energy or chemic action exerted upon bodies of 
 different potentials evolves electricity, and there is a con- 
 stant tendency toward the establishing of an equilibrium 
 between them, by the passing of the current from the 
 positive or higher potential to the negative or lower. 
 
 There being no absolute non-conductors, all bodies would 
 soon be brought to an electric equipoise were it not for 
 the constant generation, or evolution, of electricity by 
 energy or chemical action as exerted upon bodies of dif- 
 ferent potentials. It is a mistaken idea, as expressed by 
 many, that the energy exerted by the diurnal and annual 
 revolutions of the earth produces an inexhaustible supply 
 of electricity. As the earth revolves through ethereal space 
 there is no friction, no energy exerted ; hence there could 
 
 180 
 
ELECTRO-PHYSICS. 181 
 
 be no electricity evolved. Astronomers agree that the 
 earth has not lost a fraction of a second of time for hun- 
 dreds of years; this would be impossible were there suffi- 
 cient friction or energy exerted to evolve electricity. 
 
 There are three ways by which electricity is transmitted 
 between bodies, viz., conduction, induction and convection. 
 It flows in direct proportion to the conducting media and 
 inversely as to the resistance; though always, other things 
 being equal, in the direction of the least resistance. 
 
 Conduction is the property possessed by bodies of trans- 
 mitting electricity from positive to negative., when the 
 conductive body is brought in direct contact with each pole. 
 
 A knowledge of the relative conductivity and resistance 
 of bodies, used in the construction of batteries and appur- 
 tenances, is indispensable to a thorough understanding of 
 electro-physics, electro-physiology, electro-therapy and 
 electro-surgery. 
 
 The best conductors for all practical purposes are copper, 
 zinc or silver. The size of the wire in the conducting 
 cords must also be considered, as the conductivity of the 
 current is influenced markedly thereby. Especially should 
 this precaution be observed when using a current of large 
 volume or amperage, as in applications of the cautery 
 current. Those of high tension and low amperage, how- 
 ever, do not require such large cords. 
 
 The term conduction is a relative one. The best con- 
 ductors give a certain amount of resistance, and the longer 
 the distance the current traverses from the generator or 
 battery, the greater is the resistance, or impaired force of 
 the current, other things being equal. As before stated, a 
 lar^e collection or size of wires overcome this to a great 
 extent. There are also certain very poor conductors, or 
 practically non-conductors (yet in fact there are no non- 
 conductors so far known to science), that are used as 
 
182 ELECTRO-PHYSICS. 
 
 insulators. Insulation means the prevention of the escape 
 of electricity from a conducting body, or wire, by so-called 
 non-conductors. Glass, rubber, silk, wool, German silver 
 and graphite are those in general use. 
 
 Owing to the great resistance offered by German silver 
 to the flow of the electric current, and, too, its property to 
 withstand heat, it is very much used in the construction of 
 rheostats. Graphite is also extensively used for the same 
 purpose. These two substances are used almost exclusively 
 in the manufacture of rheostats for utilizing the incandes- 
 cent currents, both direct and alternating, for medical and 
 surgical purposes. 
 
 Induction is the force exerted upon bodies brought 
 within the held of an insulated electric current, or magnet. 
 This force is exerted by the attractive and repulsive prop- 
 erties of atmospheric molecules, interposed between the 
 insulated current, or magnet, and the body in close prox- 
 imity thereto. 
 
 By way of illustration, suppose a positive or negative 
 pole of a magnet is brought within close relation to a 
 plate of soft iron, though not in contact. The latter would 
 become magnetized by induction. This is accomplished by 
 the well-known law of physics, that unlike attracts and 
 like repels. The magnetic pole, whether negative or posi- 
 tive, attracts the atmospheric molecules interposed between 
 it and the iron plate. The molecules thus attracted be- 
 come charged with the same magnetism, and are immedi- 
 ately repulsed (like repels like) ; they are driven from the 
 magnetic pole and strike the iron plate and impart to it 
 the force obtained from the magnet. These molecules are 
 so numerous and rapid in their course that they maintain 
 magnetic properties in the iron plate just so long as it is 
 retained within the field of the magnetic influence. 
 
 A somewhat similar experiment of induction may be 
 
ELECTRO-PHYSICS. 183 
 
 given by the passage of a continuous electric current 
 through an insulated wire surrounding a soft iron core, 
 when a second insulated wire is wound over the first, but 
 having no direct connection with it. A current is pro- 
 duced in the second wire by induction, and passed always 
 in the opposite direction to that of the primary current. 
 
 Magnetism and electricity are interchangeable forces, or 
 different manifestations of the same force, as they are 
 readily convertible one into the other. The earth being 
 the reservoir or store house of all unused electricity, it 
 therefore constitutes one great magnet, to which all over- 
 charged bodies of a higher potential tend to unload, as is 
 illustrated by the lightning from the clouds passing to the 
 earth. Moisture favors conductivity; hence the zig-zag 
 form of lightning in its passage to the earth. 
 
 Medical Electricity. 
 
 Electric currents are produced in different ways. Chief 
 among these, in so far as this work is concerned, are those 
 generated by d} T namos, cell batteries and static machines. 
 Dynamos are so constructed as to produce two different 
 forms of current, the direct incandescent or Edison cur- 
 rent, and the alternating. The direct incandescent current 
 and the galvanic current, as generated by cell batteries 
 (not the cautery) are the same in effect. 
 
 Whenever the direct incandescent current of the 110 
 volt circuit is accessible, I would advise it to be used always 
 in preference to that of any cell battery, for several rea- 
 sons. First, because it is regular and constant. Whether 
 used five minutes daily, all day or even a year, the current 
 is invariable, accurately measured and of known electro- 
 motive force. The cell battery must necessarily become 
 weakened by use, as caused by the corroding of the positive 
 element and exhausting of the excitant fluid. 
 
184 ELECTRO-PHYSICS. 
 
 There are various kinds of apparati, or batteries and 
 accessories, made for the purpose of utilizing the direct 
 incandescent current, by modifying them in various ways, 
 for therapeutic purposes. They all tend to produce the 
 same result of so harnessing the currents as to use any- 
 where from one to one hundred volts, and so modifying 
 them as to meet therapeutic indications. 
 
 Anyone thoroughly familiar with the mechanism, the 
 separate uses of the apparati and the different properties 
 of the currents can handle them with impunity. A novice 
 is much less likely to do harm with the direct incandescent 
 current than with a cell battery constructed to produce the 
 same electro-motive force. Still another advantage is that 
 it gives only two-fifths of an ampere, while cell batteries 
 give from one to one and a half ampere, and are, in con- 
 sequence, much more iritating in procuring the same 
 current strength. Cell batteries are troublesome and ex- 
 pensive to keep in order, even by an expert; and often 
 just at the critical moment there occurs a break in the 
 circuit from an exhausted cell or from other causes. Good 
 work, however, can be accomplished by means of them, 
 although they require constant attention and testing to 
 insure their being in good working order. While the 
 electro-motive force, or voltage, as produced by cell bat- 
 teries, depends upon the number, quality and condition of 
 the cells in the circuit, yet the amperage, or volume 3 
 remains about the same whether one cell is used or one 
 hundred ; that is, when the positive and negative elements 
 are alternately connected. 
 
 Galvanic Cell. 
 
 If two elements, metallic or non-metallic, differing in 
 electrical potential, be connected at one extremity by a 
 conductor and immersed in a fluid capable of chemic 
 
ELECTRO-PHYSICS. 185 
 
 action upon the higher, there is at once produced an elec- 
 tric current which passes from the higher or positive ele- 
 ment to the lower or negative. Substances so arranged in 
 a cup constitute a galvanic cell. 
 
 The more the elements composing a galvanic cell differ 
 in electrical potential, all other things being equal, the 
 greater in direct proportion is the electro-motive force 
 arising therefrom. For example, a cell constructed of 
 zinc and carbon generates a stronger current than one 
 constructed of zinc and copper. 
 
 Galvanic cells are constructed with regard both to cost 
 and utility. Zinc is used almost exclusively as the positive 
 element; carbon or copper as the negative. The cells in 
 most general use are the Bunsen, Leclanche, gravity and 
 dry, with their various modifications as made by different 
 manufacturers. For all practical purposes, the open 
 circuit cell is best suited for stationary office batteries, as 
 there is but little action or deterioration of elements except 
 when in use. The only disadvantage attached to it is tha* 
 it cannot be used for any continuous length of time, since 
 it requires rest to recuperate after an hour or more of 
 constant use. Only a few minutes are required, however, 
 to restore its activity. It is now the only cell used for 
 stationary office batteries, where the direct incandescent 
 current is inacessible. 
 
 The positive electricity arises from the zinc plate, passes 
 through the fluid to the carbon, and out through the wire 
 attached thereto, as the anode or positive pole, although it 
 is the negative element. The wire attached to the zinc 
 (the positive element) is the cathode or negative pole. 
 When these wires are brought together there is formed a 
 close circuit; when they are not connected there is an 
 open circuit. 
 
 The Bunsen cell is composed of zinc and carbon ele- 
 
186 ELECTRO-PHYSICS. 
 
 ments, with dilute sulphuric acid as the exciting fluid and 
 bichromate of potash to prevent polarization. It was for 
 a long time the principal one used in galvanic and faradic 
 batteries, but, being objectionable to use on account of the 
 fumes and corrosive properties of the sulphuric acid, it has 
 been supplanted by the open circuit cells. Besides, the 
 Bunsen cell is troublesome to use, inasmuch as the elements 
 must be removed from the fluid when not in use; other- 
 wise they will be destroyed. 
 
 The open circuit cells (which include the dry, Leclanche, 
 and their various modifications) of zinc, carbon, with 
 muriate of ammonia as the exciting fluid, are the ones 
 now in general use. They are less troublesome, require 
 less repairing, and give a more constant current. The 
 elements are not removed from the cups after using, and, 
 with ordinary use, require attention less often than any 
 other form of cell. 
 
 The Galvaxic Battery. 
 When two or more cells are so arranged that the zinc of 
 one is connected with the carbon of another, there is formed 
 a compound circuit, or galvanic battery. The different 
 kinds of cells are all similarly connected in this arrange- 
 ment for a battery. 
 
 The Galvaxic Currext. 
 
 The current that flows through these various cells, when 
 in proper connection, is known as the continuous or gal- 
 vanic current. It is a current that traverses the circuit 
 uninterruptedly and with a uniform strength varying in 
 proportion to the power and endurance of the cells. 
 
 In considering the construction of the galvanic battery 
 we must call attention to the two closely allied yet distinct 
 forms of current capable of being generated by the bat- 
 teries properly constructed for each. They are intensity 
 
ELECTRO-PHYSICS. 187 
 
 and quantity currents, or, in other words, the continuous 
 current, as produced by an ordinary galvanic battery or 
 dynamo and the cautery current. 
 
 By way of differentiating these two forms, and in order 
 to demonstrate their distinct utility, let us imagine two 
 streams of water taking their origin from two separate 
 reservoirs at the top of a mountain. The reservoirs are 
 equal in dimensions, and capable of an equal supply; they 
 lie on the same level, and the descent of their streams is 
 similarly gradual throughout their separate courses to the 
 point where they diverge to turn water-wheels. Suppose 
 that the orifice through which one of these reservoirs feeds 
 its stream should become partly occluded. As a result 
 the outward flow would be in a proportionate degree shut 
 off. The accumulation of pent-up water would produce 
 within the reservoir a pressure that in turn would cause 
 the stream to gush forth with greater impetus. Sweeping 
 along it would strike its wheel with much greater force, 
 but, lacking the volume of the other stream, by reason of 
 the occlusion at its source, would accomplish the same work 
 differently. 
 
 So it is with the currents of the intensity and quantity 
 batteries. The intensity current, by virtue of its cell con- 
 struction (the elements being smaller and alternately 
 connected, and the distance between these elements and 
 between the different cells being greater), like the stream 
 impeded at its source, is resisted in its flow from one 
 element to another and also from one cell to another. 
 Thus it loses in quantity but gains in impetus or intensity. 
 This is the form of galvanic current employed in medical 
 treatment. 
 
 The quantitative current, by reason of the proximity of 
 its elements, the greater dimensions and exposure in sur- 
 face of these elements, and the comparatively little resist- 
 
188 ELECTRO-PHYSICS. 
 
 ance offered in its course, like the unimpeded stream, 
 flows through the circuit in greater quantity and gives 
 virtually more power when used for motor or heating 
 purposes. It differs from the intensity current in that its 
 volume, passing through the circuit at a given time, is 
 greater and more uniform, while that of the latter is less, 
 yet more violent in form and of greater impetus. 
 
 If these two forms of the galvanic current were succes- 
 sively passed through a cautery knife, it would he dis- 
 covered that while the current from the quantity battery 
 would produce a white heat in the platinum blade, the 
 passage of a current from an intensity battery would 
 produce no perceptible effect and probably not even warm 
 it. To explain this let us again refer to our illustration. 
 Should the channels of both streams become similarly 
 narrowed in their onward flow, it is evident that the stream 
 whose progress had thus far been unimpeded would, by 
 reason of its greater quantity of water, be more powerful; 
 while the other, with far greater impetus, would again 
 lack the volume to be of any avail. In flowing through 
 the cautery knife, the quantitative current traverses a 
 platinum wire, or blade, too small to carry the volume of 
 current without great resistance in its j)assage; as a result 
 the current at this point is impeded in its flow, compressed 
 into less area, rendered more compact, and hence heats the 
 platinum point. The intensity current, however, lacking 
 in volume, is not rendered sufficiently compact to even 
 warm the blade, and it is only when this is passed through 
 an intensely resistant and equally slender film (as bamboo 
 in the incandescent light) that the current will be suffi- 
 ciently condensed to produce heat and light. 
 
 This is the reason why we cannot have a battery that 
 will serve for both medical and cautery purposes without 
 change of construction. An intensity battery may, how- 
 
ELECTRO-PHYSICS. 189 
 
 over, be converted into a quantity battery by connecting all 
 the zincs of the different cells to one another, so also 
 joining all the carbons, and finally closing the circuit by 
 connecting the first zinc with the last carbon. But this 
 arrangement is impractical and never used. 
 
 Another simple illustration of the difference between the 
 two currents is as follows: Suppose an ordinary hose, one 
 inch in diameter, is attached to a water plug of great 
 pressure, and the water turned on. While it would throw 
 a stream of water some thirty or forty feet by means of the 
 force exerted by the high pressure, yet should this stream 
 of water be thrown against a water-wheel four or five feet 
 in diameter, it would have no effect upon it. On the other 
 hand, a stream of water two feet in diameter, of small 
 force — even one-twentieth of that from the hose — if turned 
 upon the water-wheel would, because of its volume and 
 weight, begin to move it immediately. 
 
 The units of measurement of these two forms of electric 
 currents will be hereafter given. 
 
 Construction of Batteries. 
 
 There is a great difference in the quantity of current 
 generated by both the galvanic and faradic batteries. 
 Very many bateries of cheap construction are annually sold 
 to the profession and laity. The currents in these are so 
 intensely irritating and irregular that it is impossible to 
 obtain any uniform results by their use. 
 
 The quality of the galvanic current depends largely 
 upon the cells used and the condition in which they are 
 kept, while that of the faradic depends mainly upon the 
 construction of the coil. In regard to the current as 
 taken from the direct incandescent circuit, it is regular and 
 invariable. Apparati are also constructed by means of 
 which this current can be converted into great volume or 
 
190 
 
 ELECTRO-PHYSICS. 
 
 increased amperage, whereby it can be utilized for cautery 
 purposes. This is first accomplished by means of a motor 
 so constructed as to convert the direct into an alternating 
 current, thence from the alternate by means of a second 
 apparatus, called a transformer, into increased amperage, 
 which can be used for cautery. 
 
 The Faeadic Currents. 
 
 When a current from one or more cells passes around a 
 bar of soft iron through an insulated wire, it magnetizes 
 this bar or helix by induction. This remains magnetized 
 as long as the circuit is closed, but is immediately demag- 
 netized when the circuit is broken. 
 
 Fig. xxv. 
 
 Fig. XXV. illustrates the construction of a faradic bat- 
 tery, from which we obtain the induced or faradic currents. 
 
 By tracing the current from the carbon element c, fol- 
 lowing the arrow up to the post, out to the point of the 
 screw, and from there down the spring a, to which is 
 attached an insulated wire that passes up and around the 
 bar of soft iron and back to z, we have a closed circuit 
 which attracts the piece of iron attached to the spring at 
 a and drawn it to &. In so doing it removes the spring 
 
ELECTRO-PHYSICS. 191 
 
 from the tip of the screw (as is shown by the dotted Lines) 
 and breaks the circuit at this point. The circuit being 
 
 broken, the bar of soft iron becomes demagnetized, ami, 
 the induction in the coil of wire being severed, the spring 
 flies back to its former position. As soon as the spring 
 strikes the point of the screw, the circuit is again closed ; 
 but also as quickly broken when the bar of soft iron again 
 becomes magnetized. Thus by rapid making and break- 
 ing of the circuit, a current is produced, which is synony- 
 mously termed the induced, faradic or interrupted current. 
 
 The Secondary Ixduced or Faradic Current. 
 
 If a second insulated wire is wound around this first or 
 primary cell, but not connected with it, and the current is 
 passed through the primary wire, there is generated at the 
 same time in the superadded coil a second current which 
 flows through it in an opposite direction. As this second 
 coil is entirely independent of the first, so far as direct 
 connection is concerned (the wire merely running from 
 the right S, around the primary coil and back to the left 
 post S), the current is therefore produced solely by in- 
 duction, and is known as the secondary induced, faradic 
 or interrupted current. As compared with the primary, 
 it is much more intense, yet with great resistance inter- 
 posed it is soothing and acts as an analgesic. 
 
 In regard to the question so frequently asked me. **T\ hat 
 kind or make of battery would you advise me to get?"" one 
 should first decide whether the battery is intended exclu- 
 sively for the office or for portable use also. A good gal- 
 vanic battery, with sufficient number of cells to give de- 
 sired force, must necessarily be cumbersome to carry 
 around. One constructed with dry cells is lighter and 
 more convenient; yet I would never advise the procuring 
 of a portable galvanic battery for general use. 
 
192 ELECTRO-PHYSICS. 
 
 Units of Measurement of Currents. 
 
 Cells vary greatly in regard to their current, strength 
 or electro-motor force, so that it would be very indefinite, 
 in denominating the electro-motor force of a current, to 
 speak of so many cells or such a cell power. In order, 
 therefore, to express more definitely the force or current 
 strength, certain units of measurement have been adopted. 
 They are the volt, ampere, milliampere and ohm. 
 
 The volt is the unit of electro-motor force or pressure, as 
 represented in a Daniel cell, which is taken as a standard 
 and is usually designated by E. 
 
 The ampere is the unit of quantity or volume of current 
 strength, and is designated by A. 
 
 The ohm is a unit of resistance, and is equal to that 
 offered by the passage of a current through eight feet of 
 Xo. 35 copper wire. It is designated by the letter E. 
 
 The milliampere is the unit of current strength thai- 
 passes through one's body when applied thereto; it is 
 represented by M.A. The resistance includes that offered 
 by the milliampere meter, conducting cords, the electrodes 
 and the body of the patient. 
 
 The resistance offered by the body varies in its different 
 parts, and bears reference to its moisture or dryness; the 
 mucous membranes offering the least resistance, and the 
 palms of the hand, when dry, the greatest. The resistance 
 of the current diminishes in direct projDortion to the 
 moisture of the surface of the body to which the electrode 
 is applied, and also to the increased size of the electrode. 
 By way of illustration, suppose we apply as indifferent 
 electrode a sponge or spongiopiline, only one or two inches 
 in diameter and moderately moist, to the palm of the 
 hand; the resistance would be so great that scarcely any 
 current strength would be registered upon the M.A. meter, 
 
ELECTRO-PHYSICS. 193 
 
 though fifty or seventy-five volts were brought into the 
 circuit. Now suppose the same size electrode was rendered 
 quite moist and the hand again applied as before, the 
 meter would register slightly more and the hand would 
 begin stinging and be rendered very uncomfortable; at 
 the same time but little work or effect would be accom- 
 plished at the active electrode. On the other hand, sup- 
 pose that an indifferent electrode is used, eight or ten 
 inches in diameter instead of one or two, and well mois- 
 tened, and that both hands are placed upon it; then fifteen 
 or twenty volts brought into the circuit would diverge the 
 needle of the m. a, meter more than thrice as much as 
 when the small electrode was used; there would be no 
 discomfort in the hands, and the active electrode would 
 accomplish more than treble the work. It is, therefore, 
 evident that a large electrode should always be used at the 
 indifferent pole. 
 
 The different manufacturers of electric apparatus have 
 so vied with each other in constructing cheap instruments 
 to sell that a large majority of those placed upon the 
 market give rise to more irritation in many instances than 
 relief. It is impossible to procure uniformly good results 
 with improperly constructed apparati. I have all my bat- 
 teries, accessories and electrodes made to order, so that I 
 know just what to expect from their use. 
 
 In the applications of any of the electric currents, except 
 certain forms of the static, there must be a closed circuit 
 with the patienf s body. And in these applications there 
 are always an active and an indifferent electrode. These 
 are used with especial reference to the effect it is desired 
 to produce. The active electrode is applied to the dis- 
 eased organ or part affected, while the indifferent electrode 
 may be placed in contact with any portion of the body 
 that is most convenient. 
 
194 ELECTRO-PHYSICS. 
 
 In order to render the active electrode more efficient to 
 a local lesion or diseased area^ the electricity must be con- 
 centrated upon the part affected. To accomplish this all 
 the other portion of the electrode must be insulated except 
 that in immediate contact with the diseased organ. By 
 this means the healthy tissue is protected from the electro- 
 lytic action of the current. The localized effect of the 
 active electrode may be still further increased by counter- 
 acting the resistance interposed at the indifferent electrode. 
 This may be accomplished by increasing the surface of the 
 latter, and having it quite moist. The surface of the skin 
 gives marked resistance to the passage of the current when 
 dry. This can be overcome, for all practical purposes, by 
 means of a moist and large size electrode. The latter 
 should be at least six or eight inches in diameter. 
 
 The conductivity of any tissue of the body is in direct 
 proportion to its moisture. Hence the mucous surfaces 
 are much better conductors than the skin. The current 
 passes from the positive to the negative pole and in the 
 direction of the least resistance, which is usually the short- 
 est route between the two poles. That portion of the body 
 through which the electricity passes, except in the imme- 
 diate vicinity of the poles, is very little influenced by the 
 current, as it mainly acts as a conductor. 
 
 Physiological Effects of Electric Currents. 
 The properties of all electric currents, just as that of 
 magnets, are limited at or near their poles. I do not mean 
 that only that part of the electrode which is in immediate 
 contact is active, but the activity is greatest when exerted 
 nearest the pole, and, as it recedes therefrom, diminishes 
 in direct proportion to the strength of the current used, 
 and inversely as to the distance from the poles. This area 
 may. therefore, vary from one to twelve or more inches. 
 The polar effect of certain currents, however, may be 
 
ELECTRO-PHYSICS. 195 
 
 exerted upon an organ and transmitted to some remote 
 part of the body. For instance, a nerve may be stimulated 
 at or near its origin by the sinusoidal or the interrupted 
 galvanic current, when the muscles to which it is distrib- 
 uted are made to contract several feet distant. 
 
 The effect of the anode of the galvanic current, aside 
 from that cf the electro-negative elements, is soothing 
 contracts capillaries and acts as a hemostatic; while that 
 of the negative is stimulating, dilates capillaries and tends 
 to induce hemorrhage. 
 
 Labile or stable applications of the continuous galvanic 
 current acts mainly by way of electrolysis, cataphoresis 
 and its stimulating effect upon the skin and circulation at 
 its poles. 
 
 The sensation of slight burning at either of these poles 
 is due to the action of the chemic elements as result of 
 electrolysis, and not to any heat in the electrodes, since 
 there is no elevation of temperature in the latter. 
 
 The interrupted galvanic current is exceedingly stimu- 
 lating to nerves, muscles or any organ to which it is ap- 
 plied. It is more penetrating than the induced currents, 
 and is especially indicated in the treatment of the deep- 
 seated organs. The rapid interruptions cause contractions 
 and relaxation of the unstripped muscular fibers of blood 
 vessels, which restores their tonicity, relieving thereby 
 engorgement of congested organs. 
 
 The physiological effects of the faradic currents, both 
 primary and secondary, are stimulating tonics. They have 
 no chemic or electrolytic action, and they exert their tonic 
 properties chiefly in a mechanical way. These properties 
 might be likened to a gentle though rapid massage. While 
 they have neither cataphoretic or chemic effect, yet their 
 action favors medicinal absorption by mechanical excita- 
 tion. By way of illustration, suppose a medicine is applied 
 
196 ELECTRO-PHYSICS. 
 
 to any portion of the body, its absorption can be facilitated 
 by rubbing it within the skin. This illustrates the action 
 of the faradic currents, except that they penetrate several 
 inches within the tissue. The secondary induced current 
 when applied with from ten to twenty-five thousand ohms 
 resistance has marked analgesic effect. This is a property 
 that is of special importance in the treatment of an ex- 
 ceedingly tender or irritable prostate, as it can be used 
 through the rectum and applied directly to the gland. Be- 
 lief from such treatment is often very noticeable and 
 instantaneous. Its effect upon atonied vaso-motor nerves 
 is quite pronounced. By restoring tonicity to the circular 
 muscular fibers of the vessels the engorgement is relieved 
 and inflammation reduced. These currents should never 
 be given with sufficient force to cause pain or any un- 
 comfortable sensation, for that counteracts the benefit that 
 would accrue from their use. 
 
 These currents have a remarkable effect towards restor- 
 ing tonicity to the genital organs when they have remained 
 in a state of atony or impotency for so long a time that, 
 even after the cause is removed, they fail to respond to 
 normal conditions. 
 
 Dr. de TVattervill had advocated the use of the combined 
 faradic and galvanic currents; but such has always ap- 
 peared to me in the same light as a "shotgun prescrip- 
 tion." I have always obtained better results by applying 
 the currents for specific effects, and alternating them as 
 occasion required ; for instance, instead of giving the com- 
 bined galvanic and faradic currents, as he suggests, for 
 tonic purposes, I have always gotten better results by 
 applying the faradic one day and the interrupted galvanic 
 or sinusoidal the next. 
 
 While there is a marked difference in the effect of the 
 poles of the galvanic currents (and they should always be 
 
ELECTRO-PHYSICS. 197 
 
 used with special reference thereto), yet the difference in 
 the effect of the poles of the primary and secondary in- 
 duced currents is so slight that it matters very little which 
 pole is used as active or indifferent in treatment. 
 
 The sinusoidal is one of the most valuable currents at 
 our command for restoring tonicity to any organ of im- 
 paired vitality. It also possesses in mild degree electro- 
 lytic, cataphoretic, germicidal and mechanical properties. 
 
 The rapid alternations of this current so act upon any 
 molecular body within several inches of its poles that it 
 magnetizes and demagnetizes the molecules composing the 
 body, and, by the combined magnetic and mechanical prop- 
 erties of the currents, so change their relative molecular 
 positions as to alter their tissue. These properties are 
 especially effectual following the electrolytic changes as a 
 result of interstitial cataphoresis. 
 
 Chemical Effects. 
 
 The galvanic current has the power of decomposing 
 chemic compounds both within and without the body, and 
 breaking them up into their original elements. This can 
 be demonstrated by passing the current through a solution 
 of potassium iodide, when iodine will appear at one pole 
 and potassium at the other. So also may water be de- 
 composed into its two elementary gases. This property 
 renders the current of great value both in decomposing 
 morbid products and eliminating them from the body, but 
 it is limited in its effect to, or adjacent to, the poles. 
 Hence, in applying the current, an active and an indiffer- 
 ent polar effect should always be taken into consideration. 
 The active pole should be applied where it is desired to 
 produce a specific effect, while the indifferent pole (usually 
 a broad sponge, so as to spread the current over greater 
 area, and consequently render it inactive at that pole) 
 
198 ELECTRO-PHYSICS. 
 
 should be referred to some remote part of the body. The 
 greater the surface of the indifferent electrode, other 
 tilings being equal, the more effective is the active pole. 
 The large majority of physicians use an indifferent elec- 
 trode of too small a size. It should not be less than eight 
 inches in diameter. 
 
 In most morbid tissue formation, as in the fibrous de- 
 posit of stricture, and prostatic hypertrophy, the vital 
 activity and reparative processes are much below normal 
 and are especially subject to electrolytic action, whereby 
 the electrolytes composing the tissue are decomposed into 
 their original chemic elements and the parenchyma of the 
 growth is destroyed. 
 
 Only certain compounds are capable of disintegration 
 by means of the galvanic current, which are known as 
 electrolytes. As, however, electrolytes form the chief con- 
 stituents of the body, electrolysis is possible in any of its 
 tissues, but more especially in morbid tissue of low vitality, 
 that is incapable of reparation except by abnormal 
 processes. 
 
 This property of the current is of advantage to the 
 surgeon in the removal of morbid growths, especially in 
 such parts of the body or under such circumstances where 
 surgical procedure by any other means would be injudi- 
 cious, and at the same time attended with no little amount 
 of risk, on the part of the operator, to the life of the 
 patient. 
 
 The products of this decomposition are called ions; 
 those collecting at the anode, anions, and those at the 
 cathode, cations. Frequently the actual ions are not given 
 off as such, especially the anions, which often combine with 
 other substances forming new compounds. As a rule, 
 however, the ions proper to each pole may be distinctly 
 recognized. In inorganic substances this may be easily 
 
ELECTRO-PHYSICS. 199 
 
 demonstrated by passing the current through sodium 
 chloride; the anion will appear in bubbles at the positive, 
 while sodium, the cation, will collect at the negative pole. 
 Similar changes in organic substances may be produced 
 by passing the current through a piece of meat, when firm 
 albuminous coagula will form at the positive pole, and 
 gases will be seen to escape at the negative. It will also 
 be observed that the meat upon the side of the anode will 
 be dry, while the other side will be moist. 
 
 As the tissues of the body are composed largely of water 
 and salt, or chloride of sodium, the decomposition of these 
 proximate principles by chemic action always results in 
 the production of oxygen, chlorine or hydrochloric acid at 
 the anode. The other constituents of the tissues are so 
 insignificant as not to be taken into consideration. These 
 elements (the anions) have a strong affinity for most all 
 of the metals except platinum or gold. Hence, should a 
 copper electrode be introduced into the urethra and at- 
 tached to the anode, with a closed galvanic circuit, the 
 oxy-chloride of copper would result. Should, on the other 
 hand, an iron electrode be similarly used, chloride of iron 
 would follow its use. When electrodes are used where the 
 electro-negative elements 'attack and combine with them 
 they are termed oxidizable electrodes; those not attacked 
 by these elements are noted as non-oxidizable electrodes. 
 
 The electro-positive elements that occur at the cathode 
 do not combine with any metal used as an electrode. 
 
 Polar Effects. 
 
 If an ordinary steel needle be attached to each pole of 
 the battery, and, with a current adapted for electrolysis, 
 an experiment be made upon a piece of meat, it will be 
 noticed that the products accumulating around either of 
 the poles will be entirely different from those surrounding 
 
200 ELECTRO-PHYSICS. 
 
 the other; that, while the one needle is readily withdrawn 
 and entirely unaffected, the other will stick with great 
 firmness, and, after being removed, will show effects of 
 having been subjected to some chemic change. If now 
 the two parts from which the needles were withdrawn be 
 subjected to microscopical examination, it will be seen that 
 the part from which the unaffected needle was taken shows 
 evidence of molecular changes, and suggests the fact that 
 some disorganizing process has lessened the normal com- 
 pactness of its tissue; while in the other (anode) in which 
 the needle was acted upon, it will be found that there is 
 an increase of material surrounding the pole, due to the 
 coagulation of the albuminous constituents, and that in 
 consequence the tissue is by far more compact than nor- 
 mally. On testing the chemical reaction of these products, 
 those of the coagulated tissue will be found to be acid, 
 while the others are alkaline. These different phenomena 
 are invariably proper to their distinctive poles, and if the 
 needles are left intact and the poles reversed, their action 
 upon the tissues of the meat will also be reversed. 
 
 The experiment demonstrates two distinct effects of the 
 current, each of w T hich may be taken advantage of, inde- 
 pendent of the other, by the use of electrodes especially 
 adapted to this end; and from it we may also deduce the 
 following important principles of electrolysis as a guide 
 to the use of the proper pole. 
 
 The positive pole coagulates albumen, causes fibrinous 
 deposits and attracts electro-negative elements, such as 
 acids, oxygen, chlorine, etc. 
 
 The negative pole, in drawing to itself alkalies or bases, 
 collects atoms that have no tendency toward combination, 
 but, being absorbed and carried away by means of the 
 circulation, lessens the amount of tissue within the electro- . 
 lytic field. 
 
ELECTRO-PHYSICS. 201 
 
 Electrolysis. 
 Electrolysis is the process of producing chemic decompo- 
 sition and disorganization of tissue by means of the gal- 
 vanic current. In all compound fluids, dissolution, either 
 slight or in a marked degree, is constantly taking place by 
 reason of the breaking up of the molecules composing the 
 fluids into their primal atoms. Under normal circum- 
 stances nature provides for this disintegration by its 
 various processes of waste and repair, and no perceptible 
 changes are effected. Experiments demonstrate, however, 
 that by the aid of the electric current this normal decom- 
 position can be promulgated to such a degree that nature 
 will be able no longer to counterbalance the overdrain upon 
 her recuperative powers, and hence there will be a loss of 
 compounds and subsequently of constituents in the parts 
 where the high amount of dissolution is made to take place. 
 This change occurs more readily and to a greater extent 
 in morbid tissue because of its defective vital activity and 
 its poor nutritive supply. 
 
 Cytaphoresis, or Electric Osmosis. 
 
 Cataphoresis is the process by which fluids are trans- 
 fused through animal tissue by means of the galvanic cur- 
 rent. The passage takes place mostly in the direction of 
 the current, viz., from the anode to the cathode, or from 
 the positive to the negative pole. In order to pass by this 
 process, all substances must be in a state of solution. 
 Thickness of animal tissue is no barrier to the passage of 
 fluids as induced by this means. 
 
 Diffusion of medicines by means of the galvanic current 
 is not new ; it has been demonstrated by various physicians 
 both in this country and in Europe. But it is only within 
 the past decade that it has been systematically used and 
 with a knowledge of its actual effects. 
 
202 ELECTRO-PHYSICS. 
 
 T. A. Edison read a paper before the International 
 Congress at Berlin in August, 1900, in which he reported 
 a case where he had employed cataphoresis for gout, show- 
 ing that the current carries lithium salts into the body 
 and gives great relief to a swollen joint. His method was 
 to put one hand into a vessel containing a solution of 
 chloride of sodium, in which the cathode was inserted, and 
 the other into a vessel containing chloride of lithium, in 
 which the anode was inserted. The lithium salt passed 
 into the body, being detected afterward in the urine. 
 
 As I have previously stated, the action of the currents, 
 just like that of a magnet, is limited to their poles, and 
 there is a middle line of neutrality between the poles. 
 
 Fluids, therefore, do not pass entirely through the body 
 by means of cataphoresis, but having penetrated the tissues 
 at the poles they may be absorbed and enter the general 
 circulation, as has been demonstrated by Edison and 
 others. 
 
 Medicines applied by the active electrode directly oppo- 
 site and in close proximity to diseased organs penetrate 
 them thoroughly, those nearest the pole becoming saturated 
 with the medicine. 
 
 In order to procure the best results in the way of cataph- 
 oresis, unoxidizable electrodes, as platinum or gold, 
 should be used; otherwise the electro-negative elements, 
 as oxygen and the acids, would attack the metal and form 
 new compounds at the anode, lessening thereby the cataph- 
 oric action. With reference to the use of the cathode, it 
 does not matter what metal is used, as hydrogen and the 
 alkalies do not combine with it. Electrolysis and catapho- 
 resis are always, to a limited extent concomitant, yet when 
 an electrode is used that is not attacked by the electro- 
 negative elements cataphoresis is more marked. 
 
 Sulphuric, phosphoric and hydrochloric acids always 
 
ELECTRO-PHYSICS. 203 
 
 appear at the anode when applied to animal tissue, though 
 the latter (hydrochloric acid) is in greater abundance. 
 There is a tendency of the anode to stick closely to animal 
 tissues when applied with an oxidizable electrode, such as 
 copper, zinc or iron. This is due to the action of the 
 electro-negative elements upon the metals, forming new 
 combinations that adhere firmly to the tissue. In order 
 to release the electrode, the current is reversed for a few 
 minutes, when it again becomes loose and can be with- 
 drawn. These elements are somewhat irritating to the 
 tissue. They sting to an extent dependent upon the 
 strength of the current used, but do not, as many believe, 
 burn or cauterize the parts, 
 
 AVhile it is evident that electrolysis takes place in the 
 large majority of remedies of multiple elements in the 
 process of oataphoresis, yet some of the medicine passes 
 with the flow T of the current without being chemically 
 changed. This is in accordance with the law of attraction 
 and repulsion of atoms as induced by magneto-electric 
 properties, — that unlike attracts and like repels. 
 
 So complex are the analytic and synthetic changes that 
 occur in the tissues and remedies, as the result of the 
 electrolytic and catalytic actions of the galvanic current 
 upon them, that in many instances it has been only by 
 numerous experiments that I have been able to determine 
 just what chemic changes take place, and, in view of these 
 changes, to select the best remedy for certain conditions 
 and complications. 
 
 In the use of any medicine for cataphoresis its chemic 
 elements should be known, unless one decides upon a blind 
 experiment or groping in the dark. 
 
 Electrolytic action may be expected, at least to some 
 extent, and some of the medicine used is decomposed into 
 its chemic elements; so, instead of getting the effect of 
 
204 ELECTRO-PHYSICS. 
 
 the medicine as used, one gets that of one or more of its 
 chemic elements. Let us take iodide of potassium for 
 illustration, it being an electrolyte, and suppose the active 
 electrode to be an unoxidizable metal, as platinum; then 
 there could be no chemic action upon the latter by any of 
 the elements set free by electrolysis. Now suppose we use 
 the cathode as the active electrode; the iodide of potas- 
 sium would be decomposed into iodine and potassium, and 
 iodine, being the electro-negative element, would tend 
 toward the anode, which would be the indifferent electrode, 
 and if the cathode is in apposition to the prostate the 
 iodine must necessarily pass through the gland before 
 reaching the neutral point between the electrodes. But 
 suppose, on the other hand, that the anode is used as the 
 active electrode; then the greater part of the iodine, as a 
 result of the electrolytic action, would remain at the pole, 
 and only a limited amount of it, together with the electro- 
 negative elements, as potassium, hydrogen, etc., would be 
 diffused through the gland on their way toward the cath- 
 ode, and but little change would take place within the 
 gland as a result of interstitial electrolysis, by means of 
 these elements alone. 
 
 The action of the poles of the galvanic current does not 
 destroy tissue as does the cautery, unless the cautery cur- 
 rent especially devised for that purpose is used ; but when 
 applied to any part of the tissue, it decomposes it into its 
 original chemic elements. The tissue, possessing no longer 
 its normal anatomical constituents, becomes atrophied, and 
 the parts disorganized are absorbed, as stated before. 
 More especially do these changes take place in morbid 
 tissue, defective in vital activity or recuperative power. 
 
 As water and the chlorides of sodium, potassium, etc., 
 constitute a large part of all tissue, oxy-chlorides are al- 
 ways present at the anode when galvanic applications are 
 
ELECTRO-PHYSICS. 
 
 205 
 
 Pig. XXVI. 
 
206 ELECTRO-PHYSICS. 
 
 made; and, as these constituents have a strong affinity for 
 metallic bases, they will attack any oxidizable metal used 
 as an electrode for that pole, and form new compounds, 
 even when medicines are not used. For example, should 
 a solid copper electrode be applied to the prostatic urethra, 
 the oxy-chloride of copper results. I often use this treat- 
 ment, alternating with other remedies, when there is a 
 rebellious tendency of the parts to healing. In some cases 
 it has an almost magical effect, when the parts have re- 
 sisted all other applications. If it is used very strong or 
 for a long time, it causes a sensation of stinging or burning, 
 due to the action of metallic electrolysis, and not to heat 
 in the electrode, as might appear. For there is no eleva^ 
 Hon of temperature in the electrode. 
 
 It should be remembered that the electrode thus used 
 will adhere tightly to the tissues. It should not be forcibly 
 removed; but when the current is reversed, as before 
 stated, the electrode slides away with ease. 
 
 While a thorough knowledge of the properties and thera- 
 peutic action of the different electric currents are pre- 
 requisite to successful treatment of the prostate, yet it 
 is impossible for one familiar with these to procure satis- 
 factory results without suitable apparatus. Manufacturers 
 have so vied with one another in placing cheap electric 
 paraphernalia on the market that therapeutic failures are 
 often traceable to trashy apparatus. Especially is this 
 true since so few physicians have any knowledge of electro- 
 physics and can tell when a battery, coil, rheostat or any 
 other part of the outfit is properly constructed, but must 
 rely upon what the manufacturer tells them. Fig. XXVI. 
 illustrates a wall cabinet for use on the direct incandescent 
 circuit that is as near perfect as is made. The resistance 
 is effected through metallic wire and not graphite, and it 
 is uniform, durable and reliable. It has a perfectly regu- 
 
ELECTRO-PHYSICS. 207 
 
 lated galvanic current, varying in force from a fraction 
 of a volt to any desired strength required, which can also 
 be used for lighting diagnostic lamps. It has the primary 
 and secondary faradic currents, galvanic interrupter, etc. 
 I have my sinusoidal apparatus wound specially to order 
 in shunt, as before described. 
 
INDEX. 
 
 A. 
 
 Abrasion of urethral mucosa 29,30, 50 
 
 Abscess of kidney 92 
 
 Age — in hypertrophy 113, 114, 118 
 
 Alcoholic stimulants — causes of prostatitis 38, 77, 78 
 
 Forbidden 64, 94 
 
 Amperage 156 
 
 Ampulla 16, 24 
 
 Anatomy — of bladder 16 
 
 Of prostate 11 
 
 Anesthesia, local 61, 134, 141 
 
 Anodynes 22 
 
 Aphrodisiacs 72, 79, 154, 168 
 
 Arteries — prostate 16 
 
 Arthritis 29, 32, 108 
 
 Asepsis — of urine 38, 75 
 
 Aspermatism 145, 146 
 
 Atony of gland 48 
 
 Azoospermia 167 
 
 B. 
 Batteries , 176, 183 et seq. 
 
 Construction of 189 
 
 Baumgarten 27, 29 
 
 Beer — Cause of prostatitis 38, 77 
 
 Prohibited 94 
 
 Bicycle riding as a cause of prostatitis 36, 79 
 
 Bladder 14, 37, 50, 74, 79, 80, 81, 82, 83, 84, 85, 109 
 
 Bochart's theory on metastasis 29 
 
 Bottcher's crystals 85, 119, 167 
 
 Bottini cautery 109, 110, 111, 121, 122 
 
 Dangers of 122, 123, 128, 129, 130, 131 
 
 Bougie 53, 61, 62, 63, 69 
 
 Bougie a boule 43, 49, 65, 72 
 
 Bowels — relation to prostate 16, 17 
 
 Bumm 27, 29 
 
 i 
 
ii INDEX. 
 
 C. 
 
 Calculi— prostatic 85, 86, 87, 145, 146, 167 
 
 Renal 86 
 
 Vesicle 86, 111, 120 
 
 Caput gallinaginis 14 
 
 Castration 78, 121, 125, 160 
 
 Cataphoresis 54, 201, 202 et seq. 
 
 Catheter life 118, 123, 126, 127, 139, 140, 141 
 
 Cautery— Bottini. .109, 110, 111, 121, 122, 123, 128, 129, 130, 131 
 
 Galvano 79, 122, 142 
 
 Paquelin's 121 
 
 Circumcision 70 
 
 Cocaine 134 
 
 Cold — effect on diseases of prostate 36, 79 
 
 Conduction 181, 182 
 
 Congestion — venous stasis. 
 
 Of prostate 34, 37, 38, 50, 64, 76, 78, 82, 113 
 
 Of vesicles 35, 37 
 
 Constipation 117, 141, 160 
 
 Continence 37 
 
 111 effects of 34, 71 
 
 Cowper's glands 14, 16 
 
 Currents — applications of 192 
 
 Chemic action of 197 
 
 Faradic 74, 96, 97, 103, 105, 110, 176, 191 
 
 Galvanic 175, 176, 186 
 
 Ignorance of 177 
 
 Intensity 175, 187 
 
 Physiological effects of 193 
 
 Polar effects of 59, 199 
 
 Properties of 57 
 
 Quantity 187 
 
 Sinusoidal .176, 197 
 
 Study of 176, 177 
 
 Units of measurement 192 
 
 Cystoscope — description of 44 
 
 Use of 44, 58, 74, 106, 120, 135 
 
 D. 
 
 Desiccation — of discharge 33, 41, 50 
 
 Of gonococci 28 
 
 Diet 22, 94 
 
INDEX. iii 
 
 Diplococci — resembling gonococci 27, 30, 32 
 
 Discharge— gleety 23, 39, 41, 50, 57, 64, 67, 73, 78 
 
 Milky 45, 48, 57 
 
 Muco-purulent 18, 51, 64, 67, 83, 93, 135 
 
 Of prostate and vesicles, irritative to urethra. .40, 41, 43 
 
 Presence of gonococci 30, 33 
 
 Prostatic mistaken for seminal 67 
 
 Dysuria 21, 39, 51, 64, 73 
 
 E. 
 
 Ejection, premature 48, 67 
 
 Electricity (see Currents). 
 
 Electrical potential 178 
 
 Electric treatment — Technique of 59, 60, 61 
 
 Frequency of 61 
 
 Electrodes— Active 61, 62, 88, 94 
 
 Carbon 59 
 
 Metals used in 203, 204, 205, 206 
 
 Non-oxidizable 56, 58 
 
 Oxidizable 56, 58 
 
 Special 77, 133 
 
 Electrolysis 201 
 
 Electro-physics 59, 175, 181 
 
 Electro-therapy — Ignorance of 176 
 
 Study of 175 
 
 Emission 48, 164, 170 
 
 Epididymis 24 
 
 Inflammation of 58 
 
 Epilepsy 69, 70 
 
 Epithelium — In urine 85 
 
 Normal abode of gonococci 29, 30 
 
 Erethism 37, 38, 33 
 
 Erotic excitement — 111 results of 35 < 
 
 Eucalyptol 53, 65 
 
 Examinations of rectum — With sigmoidoscope 44, 82, 96 
 
 Examinations of urethra — With bougie a boule 42, 49, 65 
 
 With cystoscope and urethroscope 72, 102, 110, 120 
 
 With sigmoidoscope 82 
 
 Expressions, prostatic 29, 32, 105 
 
 Eyes — Involved in prostatitis 39 
 
 P. 
 Faradic Current 176, 191 et seq. 
 
iv INDEX. 
 
 Follicles — Chronic catarrh of 50 
 
 Inflammation of ; 50, 53 
 
 Prostatic 16, 24, 29, 62, 85, 88 
 
 Fossa Navicularis — Ulceration in 65, 83 
 
 Frequent urination 21, 81, 105, 108, 1C3, 111, 113 
 
 Fuller 40 
 
 Functions — Of prostate 18 
 
 Of prostatic fluid 19 
 
 Functional disorders — Of bladder 19 
 
 Of liver 89, 90 
 
 Of prostate 19 
 
 Of rectum 19 
 
 Of seminal vesicles 19 
 
 Furbringer's theory on metastasis 29 
 
 G. 
 
 Galvanic current 175, 186 
 
 Cells 184 
 
 Poles of 198 
 
 Genital electrode 101 
 
 Gerbardt's theory on metastasis 29 
 
 Gland (see Prostate). 
 
 Gleet 22, 39, 40, 50, 64, 66, 73, 80, 104, 146 
 
 Gonococcus 26, 27, 28, 29, 30, 32, 101, 104 
 
 Latent 29, 30, 31, 32, 80, 101, 119, 150 
 
 Gonorrhea — As cause of prostatitis 
 
 26, 64, 66, 73, 77, 104, 105, 108, 112, 113 
 
 Chronic 27, 28 
 
 Gonorrheal rheumatism 26, 29, 80 
 
 Late theories as to cause 29 
 
 Old theories as to cause 26 
 
 Granular patches 43, 55, 72 
 
 As cause of gleet 39 
 
 In chronic prostatitis 49, 66, 67, 73 
 
 Removal of 56, 61, 62 
 
 Guerin's theory on rheumatism 26 
 
 Guyon's theory on metastasis 29 
 
 Guyon's theory on rheumatism 26 
 
 H. 
 
 Hamamelis— In orchitis 23, 144 
 
 Hartley's theory on metastasis ^ 29 
 
 Hemiparesis 156, 172 
 
INDEX. T 
 
 Hemorrhage, ....... 80, 106, 109, 111, 140 
 
 Hemorrhoids a » • , . 26, 117 
 
 Horseback riding as cause of prostatitis 36, 79, 138 
 
 Hyoscyamus 22, 51, 107, 110 
 
 Hyperemia of prostate following excesses 34, 37 
 
 Hypertrophy — Author's treatment 126, 127, 128 
 
 Senile 24, 76, 82, 114 et seq. 
 
 Hypochondriasis 67 
 
 I. 
 
 Impotency 39, 67, 71, 78, 109, 146, 147, 163 et seq. 
 
 Imaginary 170 
 
 Indigestion 160, 161 
 
 Infiltration of gland 50, 75, 77, 81, 116 
 
 Injections 22, 52, 62, 70 
 
 Insanity 55 
 
 Insomnia 23, 67, 68, 102, 159, 160 
 
 Instrumentation — Sir Fenwick's advice 63 
 
 Sir H. Thompson's advice 63 
 
 Instruments — Special of author's 53, 54, 106 
 
 Size of 61 
 
 Instrumentation— Faulty .21, 36, 63, 78, 120 
 
 Avoid during acute stage 22 
 
 Frequency of use 61, 62 
 
 Intercourse — Excessive 35, 71, 78 
 
 Iodide of potassium in syphilitic prostatitis 141 
 
 K. 
 
 Keersmaecker — On chronic urethritis 40 
 
 On gonococci 28 
 
 L. 
 
 Lascivious readings 38 
 
 Latent gonococci 29, 30, 31, 32, 77, 81, 150 
 
 Libidinous thoughts . . , .34,^8 
 
 Lindeman's theory on gonococcal metastasis. ....... . . e . . 29 
 
 Littre's glands ..*.<......... 27 
 
 Liver — Disorder of . = o e „ . 89 
 
 Relation to prostate c . , . . , 89 
 
 M. 
 
 Maltreatment — As cause of prostatitis 29 
 
 As cause of urethritis 41 
 
 Mania 156, 157, 159 
 
vi INDEX. 
 
 Marriage — After gonorrhea 150 
 
 Married Men — Treatment of, 38 
 
 Massage 1C9, 112, 115 
 
 Masturbation .....19, 35, 69, 71, 102, 172 
 
 111 effects of 35, 49 
 
 Frequency of habit 35, 36 
 
 Symptoms 36 
 
 Melancholia 39. 50, 102, 155, 156, 157, 158, 159, 165 
 
 Melancholic mania 156 
 
 Mental depression 39, 50 
 
 Mental disorders 19, 78, 102 
 
 Caused by masturbation 35 
 
 Mercury — In syphilitic prostatitis 144 
 
 Metastasis of gonorrheal infection 29, 30, 31, 50, 81 
 
 Mixed infection 29 
 
 Morning drop ,. 33, 41 
 
 Morphine 22, 141 
 
 Muscular spasm — Of urethra 43, 49 
 
 Of prostate 80 
 
 N. 
 
 Nerves — Of prostate 16, 151 
 
 Of perineum 17 
 
 Of external genitalia 18 
 
 Pressure upon 117 
 
 Nervousness 68, 69 
 
 Neisser's theory on metastasis 29 
 
 Neurasthenia 152, 153, 154 
 
 Neuralgic pains 29, 31, 81 
 
 Neurotic aberrations 19 
 
 Neurotic disturbances, reflex... 32, 37, 50, 70, 81, 84, 117, 151 
 
 Neuroses of prostate 152 
 
 Nitrate of silver — Improper use of 58 
 
 O. 
 
 Opiates . . . ; 1, 22, 141 
 
 Orchitis „ 22, 23, 143 
 
 Orchidectomy — For hypertrophy 121, 125 
 
 Orgasm— Seat of 14, 19 
 
 Otis— On gleet 39 
 
 P. 
 
 Pains from metastasis 29, 30, 31, 32 
 
 Paraparesis 112, 171 
 
INDEX. vii 
 
 Paresis 50, 78, 171 
 
 Paraplegia 145, 146, 155, 172 
 
 Phagocytosis — Action on cocci 31, 58 
 
 Phimosis 70 
 
 As cause of masturbation 36 
 
 Pollutions 164, 170, 171 
 
 Polypoid growths 80, 85, 106, 130, 135, 143 
 
 Potassium iodide 138 
 
 Potentia coeundi 166 
 
 Potentia generandi 166 
 
 Priapism, chronic 38, 51, 147, 158 
 
 Premature ejection 48, 67 
 
 Prostate — Anatomy of 11 
 
 Compared to uterus 75, 116 
 
 Relation to cerebro-spinal centers 37 
 
 Relation to viscera 11, 84, 88 
 
 Prostatectomy 121 
 
 Dangers of , 123 
 
 Prostatitis 21 
 
 Acute 21, 30 
 
 Classification 21 
 
 Chronic 22, 36, 37, 64 
 
 Congested enlargement 75, 77, 108, 115 et seq. 
 
 Frequency 11 
 
 Senile hypertrophy 24, 75, 77, 114 et seq. 
 
 Sub-acute 24, 34 
 
 Syphilitic 143 
 
 Tubercular 144 
 
 (See Treatment.) 
 
 Prostatic expressions 29, 32 
 
 Prostatorrhea . . . 80, 166, 167 
 
 Ptomaine poisoning from gonococci 29, 81 
 
 Pus — In discharge 67, 80 
 
 In urethra 65 
 
 In urine 84, 85, 107, 137, 140 
 
 R. 
 
 Rectum — Relation to prostate 11, 12, 51 
 
 Rheumatism 26, 29, 30, 31, 32, 81 
 
 S. 
 
 Sciatica 163 
 
 Sciatic nerve 18, 50, 81 
 
viii INDEX. 
 
 Sciatic nerve — Irritation of 161, 162 
 
 Secretions — Action on gonococci 32 
 
 Of glands of Littre 167 
 
 Of Cowper's glands 167 
 
 Prostatic 16, 19, 29, 167 
 
 Semen — Expulsion of 18, 50 
 
 Over-accumulation of 89, 91 
 
 Seminal discharges — Classification of 164 
 
 Seminal vesicles 16, 89 
 
 Relation to prostate 91 
 
 Stripping of 29 
 
 Sexual appetite 19 
 
 Erratic 67 
 
 Excessive 78, 158 
 
 Sexual brain 19, 164 
 
 Sexual indulgence, excessive 35, 71, 78 
 
 As compared to masturbation 35 
 
 Sexual perversion 112 
 
 Shreds in urine 168 
 
 Desiccated discharge 50, 85 
 
 Removal of granulations 61, 65 
 
 Sounds— Injudicious use of 64, 79, 104, 105, 109, 112 
 
 Spermatorrhea 67, 80, 163, 165, 167 
 
 Spermatozoa 85, 165, 166, 167 
 
 Stone in bladder 86, 111, 120 
 
 Sterility 166, et seq. 
 
 Stomach — Nervous relation to prostate 16, 117 
 
 Stricture 39, 40, 49, 64, 66 
 
 Treatment of 67 
 
 Suppositories, rectal 22, 73, 96, 105, 110 
 
 Surgical treatment of hypertrophy 121 et seq. 
 
 Sympexia 85, 86, 87, 112, 145 
 
 Syphilis, as cause of prostatitis 143 
 
 Tenesmus 21, 64, 141, 142 
 
 Testicle 24 
 
 Theories on metastasis 26, 281, 29 
 
 Thiry's theory on rheumatism 26 
 
 Toxins of gonococci 29, 30, 31, 32, 81 
 
 Treatment— Author's 126, 127, 128 
 
 Congested enlargement 92 to 99 
 
INDEX. ix 
 
 Treatment — Author's — Frequency of 61 
 
 Of acute prostatitis 22 
 
 Of acute urethritis 22 
 
 Of gonorrheal prostatitis 57 
 
 Of sub-acute prostatitis 32, 33, 44, 45 
 
 Of stricture 67 
 
 Per rectum ....73, 96, 97, 103, 105, 102, 110, 127, 137, 141 
 
 Senile hypertrophy 120 et seq. 
 
 Surgical 120 to 125 
 
 Technique of electric 59 
 
 Tuberculosis of prostate 144 
 
 U. 
 
 Ulcerations 55, 57, 65, 74 
 
 As cause of gleet 24 
 
 Of rectum 11, 78, 104, 143 
 
 Uremic toxemia 102 
 
 Ureters 16, 67 
 
 Urethra— Prostatic 12, 27, 31, 51 
 
 Elongation of 89 
 
 Localized lesions within the 43 
 
 Membranous 16, 49 
 
 Urethroscope, use of 44 
 
 Description of 44 
 
 Urethritis — Caused by diplococci 30 
 
 Chronic 39, 40, 41 
 
 Prostatic ....19, 38, 49, 52, 64, 71, 82, 105, 106, 108, 112 
 
 Treatment of acute 22 
 
 Urine — Acrid condition of 
 
 43, 51, 80, 81, 99, 100, 104, 107, 110, 137, 140 
 
 Asepsis of 38, 74 
 
 Blood in 85, 110, 113 
 
 Conditions of 83, 84, 85, 91, 100 
 
 Dribbling of 117 
 
 Pus in 84, 85, 137, 140 
 
 Shreds in 50, 61, 65, 85, 168 
 
 V. 
 
 Varicocele 24 
 
 Vaso-motor contraction — Result of current 55, 61 
 
 Veins of bladder 16 
 
 Of prostate 16 
 
 Of rectum , 16 
 
X INDEX. 
 
 Verhoogen on chronic urethritis 40 
 
 On gonococci 28 
 
 Vesiculitis 22, 44, 50, 71, 72, 82, 104, 112, 113 
 
 Treatment of 97 
 
 W. 
 
 Wet feet— Effect upon prostatic disease 36, 109 
 
 Wines — Cause of prostatitis 38, 77 
 
 Prohibited 94 
 
 Y. 
 
 Young's theory on gonococci metastasis 29 
 
 Z. 
 
 Zinc sulpho carbolate — In acute urethritis 23 
 
 In prostatic urethritis 53, 65, 135 
 
NOV 30 1903 
 
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