NEUROSES OF PROSTATIC ORIGIN TREATMENT.
The neuroses of prostatic origin constitute a most emphatic indication for attention to genito-urinary hygiene. Careful regula tion of diet, attention to the various emunctories of the body, and most careful supervision of the sexual habits of the patient are the keynote of treatment. Remedies calculated to correct lithmmia are essential in appropriate cases. Regulation of the diet, however, is of prime importance in such cases. Tobacco and liquor are espe cially to be interdicted. Certain sedative remedies are often of great value. The bromides, camphor—or a combination in the form of the monobromide of camphor—and gelsemium are of especial value, the latter remedy perhaps being the most reliable of any at our com mand. Ergot is often of great service. Cold sitz-baths and enemata often give great relief. Careful attention should be paid to the con dition of the bowels. Strong cathartics should be avoided and mild laxatives given. The local measures of relief are as numerous as they are unsatisfactory. In some cases in which there is a strong psychic element, a cold sound or the psychrophore is of great value. Should a certain degree of actual organic disease of the prostatic urethra exist, however, these measures may produce more harm than good. In some cases the nervous make-up of the patient is such that local treatment simply serves to direct his attention to the part with resulting exaggeration of his symptoms. In cases where there is actual disease of the mucous membrane of the prostatic urethra, the judicious application of nitrate of silver by means of the deep ure thral syringe or the endoscope is of value. The author, however, takes this opportunity of stating that deep urethral injections have probably been productive of more damage in this class of cases than in any other which could be mentioned. Many cases of neuralgia and hypermsthesia of the prostate, in which there primarily existed no pathological change whatever in the deep urethral mucous mem brane, are treated so assiduously by deep urethral injections that the erroneous diagnosis of actual disease of the prostatic urethra is made good by the development of genuine pathological conditions under the irritating influence of the local applications. It appears very
illogical in cases in which careful local examination and conscientious urinalysis fail to show the existence of organic disease of the urinary organs, to treat the prostatic urethra by frequent deep in jections of nitrate of silver solution in the attempt to cure a poste rior urethritis, which exists only in the mind of the practitioner until it has been developed by the treatment itself. The readiness with which the diagnosis of posterior urethritis—which happens to be the prevailing fad—may be made, and the ease with which one may sup ply himself with the necessary instruments for deep urethral injec tions, constitute a constant menace to many patients who have genitourinary disease, real or imaginary. In cases in which actual organic disease exists, the first duty of the surgeon is to institute appropriate measures for its removal. While it is best from a psychical standpoint to impress the patient with the radical result expected to accrue from the treatment, the surgeon should remember that even after the original organic difficulty has been cured the neu rosis may remain. The experience derived from the removal of the original cause in reflex neuralgias in other situations has been that the neuralgia frequently persists in spite of a radical operation for the removal of the offending part. The same argument applies to neuralgia and hyperaesthesia of the prostate.