CASTRATION is indicated in cases in which the bladder symptoms are such as to demand a more prompt result than is apt to follow vasectomy. If the patient he between the ages of sixty-five and eighty years, with marked obstruction and cystitis, and if the vitality be fair, castration offers a better prospect of re lief with a smaller mortality than the other operations mentioned. Of course, it is necessary to fully explain to the pa tient in advance the nature of the opera tion and to secure his consent. An analysis of the cases subjected to castra tion shows that in rather more than SO per cent. of the cases there was marked improvement. The figures are as follow: Rapid atrophy of the prostate, 87 per cent.; disappearance of long-standing cystitis, 52 per cent.; return of vesical contractility, 66 per cent.; amelioration of the most troublesome symptoms, 83 per cent.; and a return of local condi tions not very far removed from nor mal, 46 per cent. (For a full discussion of this subject see article by J. William White in the Annals of Surgery, Aug., '95.) In 93 cases of which accurate notes were kept the prostate underwent atrophy in 83 per cent. (P. Bruns). Of 99 carefully analyzed cases there were 9.8 per cent. of failures; 6.6 per cent. was followed by moderate improvement, and substantial or very great improve ment was noted in 83.6 per cent. (Cabot). The mortality from this operation has been 7 per cent., omitting the cases that died from causes having no connection with the operation. It would be much lower had not many cases already in extremis been castrated. It will be less in the future, as we learn better how to select cases for this and for the other procedures recommended for prostatic hypertrophy.
Castration diminishes hypertrophy of the prostate, especially when the enlarge ment is of the glandular form. This
atrophy may not begin for six months or even more after operation, and may progress for more than two years. How ever, in certain cases, it is probable that there may be no atrophy. Out of 124 cases operated upon by castration the mortality was 14.5 per cent., due, in the main, to antecedent infection of the kid neys. Contrasting this mortality with that of the prostatics received in the Hos pital Necker and not submitted to opera tion, the figures stand at 14 per cent.: i.e., 31 deaths in 220 cases. This opera tion should be rejected in cases of renal infection, in eases where the patient is extremely ill, and in cases which can be cured by simpler means. Albarran and Motz (Ann. des Mal. des Org. Gen.-urin., Jan., '95).
Relations which the prostate glands bear to the feeundative power of the spermatic fluid. Series of experiments instituted in which the gland in white rats was excised in part and in whole, and its effects on fecundity noted. They showed that a removal of the anterior lobes of the prostate gland in rats has no effect on breeding; but in a certain number it diminishes the fecundating power; and in a few it is destroyed entirely. Complete excision had a very marked effect on fecundity, reducing it to almost nil when the gland was en tirely removed.
Partial or complete removal of the prostate had no effect, however, upon the sexual desire and capacity.
Complete removal of the gland in the adult animal had no effect on the histo logical structure of the testicles. In the young animal it had no effect upon the subsequent development of the testes. George Walker (Johns Hopkins Hosp. Bull., Mar., 1901).