ment. Finally, it goes almost without saying that all operations for strangulation should also be operations for radical cure, unless the patient is so reduced as to render the least prolongation of the operation impossible.

The Prostate: Some of Its Acute and Chronic Conditions and Their

Treatment.

,,

By L. Bolton Bangs, M. D., New York City, Consulting Surgeon to "St. Luke's, the "City" and " Methodist Episcopal" Hospitals; formerly Professor of Genito-Urinary Diseases in the New York Post Graduate Medical School and Hospital, Etc., Etc.

Al

A man with prostatic disease is in a plight. though the prostate is a sexual organ, its relation to the urinary bladder is such that it is more or less acted upon by the act of urination. There is no back-door for the escape of urine. This must come through the prostatic portion of the urethra, and the more the latter functionates, the more the diseased prostate suffers.

Moreover, congestion of this organ stimulates the sexual nerve centres, which in turn react upon the prostate, and sexual activity becomes an additional aggravation. Also, in some individuals a certain irritability of temper is produced, which no amount of good sense or philosophy can fully control. Brain and prostate reciprocate in their effect upon each other. Therefore, the prostate has no rest, and is heavily handicapped when nature undertakes

its repair. From the age of puberty onward it is liable to lesion, and the man who escapes without some damage may well rejoice. Consider how simply and easily it may be injured, and for illustration, take a common case. A lad, either from the teaching of companions, or from natural tendency and without the restraint of sensible and proper instruction, becomes a masturbator. He repeats the act frequently or infrequently, according to his temperament or opportunity; but no matter, even infrequence is too often and before long he is in a state of chronic sexual erythism. Remember the anatomy, function and situation of the prostate and the subsequent effects of chronic congestion are readily understood. The prostate, then, participates in each erection, it becomes congested in response to each erotic thought, and sooner or later its vessels remain dilated. Even at this stage evidences of disturbance of function and of tissue change are present. The act of urination, although not increased in frequency, becomes lame or hesitating "(stammering," Sir James Paget long ago called it) and in the urine, if examined carefully, may be found flocculi or shreds of epithelium from the prostatic urethra. The whole urethra is hypersensitive, the prostatic portion especially so, and were an instrument now passed into the lad his suffering would be severe and possibly produce syncope. At this time his attention is arrested, his conscience aroused, his innate manhood asserts itself, he stops the unnatural habit, and some of his local hyperaemia disappears. But his mind is not at rest sexually. He is alive to every erotic suggestion, a partial erection is excited by trifling things; his prostate remains in a state of erythism, and his lame urination persists. Involuntary emissions now disturb him. Each one is like a

prick of conscience to him. He would rather walk the floor all night long than have one, and he readily falls a victim to the "remedial institutions" and quacks of all kinds. In the meantime, he has fallen in with a young person of the opppsite sex who is responsive to him and a sort of virtuous calf-love begins. He seeks her society constantly and remains with her by the huor, all the time in a state of partial or complete erection. They go on from step to step, and ignorant of the results, excite each other most wofully. He caresses and fondles her. She permits everything but the sexual act, and to him the effects are disastrous. From some of them he never recovers. His symptoms are now aggravated and increased. Besides the lame or hesitating urination and the flocculi of epithelium, which have multiplied, he has a shorter interval between the acts of urination, and in some individuals even at this period of life, I have seen a few drops of blood follow the urine. He has an aching or sense of heaviness in the perineum, which is irrespective of an associated ache in the testicles, etc., and in regard to which I prefer to say noth

ing in this paper. His garments are frequently moistened

by urethral fluid or thin mucous, and this is especially and copiously so when in the company of young women. Mentally, he is irascible, morbid, and at times in a state bordering on sexual frenzy. Sexual intercourse now seenis to him the only relief and to be the cure-all of his miseries. If the prostate be now examined by the rectum a distinct increase in volume will be appreciated. The organ

has lost the sense of firmness and vigor which are characteristic of its normal state, and which are distinctly appreciated by the skilled finger. Even soft pressure upon the lateral lobes will provoke a peculiar sensation, as if the

glans penis were being hammered or pounded, and in some cases an outcry of pain will be caused by the gentlest manipulation.

Here let me remark, that in presenting this subject to you, I am not drawing upon my fancy. The facts presented are the results of many confidences drawn out by careful questioning, and minutely recorded at the moment. I have adopted this narrative style not only to lay before you causes and symptoms, but to emphasize more strongly, if possible, the relation which I believe exists between the prostatic disease of mid-life and of old age and ignorance and errors of youth. You, as scientific men, will readily make the practical and clinical application.

From this point onward there is a divergence in the course of these cases, according to the moral status of the individual.

Let us take the case of a boy, who, restrained either from good morals, timidity, or for want of opportunity, does not fornicate. He is among those who in after life come to you with prostatic disease, and says, "Doctor, I don't understand it. I never had any venereal disease. I never even had intercourse till I was married, and now look at me." The doctor himself does not understand the etiology, unless he has been able to follow such cases as I am now describing to you. But when, by your questioning you remind him of his youth, of that period in his development when by repeated excitation (whether he had previously been a masturbator or not) over activity of his prostate had been caused and finally certain symptoms had resulted, he does come to understand, with you, the relation of cause and effect. To proceed, the indulgences