RELATION OF THE PROSTATE TO THE SPINAL CORD.

What is the relation of the prostate to the spinal cord? It has a direct relation and influence as follows: The center of erection and ejaculation is in the lumbar region of the cord and the cerebral genital center, which is largely inhibitory, presides over the prostate, genitally speaking.

Some of the nerve fibres passing between the spinal cord and the genital center of the cerebrum transmit exciting and other inhibitory influences. The prostate has erectile as well as muscular and glandular tissue and participates in the venous as well as the arterial engorgement in sexual excitement. A tendency to frequent or constant erection and impending orgasm, as is found in many of the degrees of prostatitis, has a devitalizing influence on the spinal cord. Ultzman and Winternitz both recognized this influence on the cord: the one experimenting with electrotherapeutics and the other with hydrotherapy in spinal derangements following this prostatic condition.

Friend (Jour. Amer. Asso., 1904) describes a prostatic crisis as a symptom of incipient tabes dorsalis. He claims pain is particularly localized in the perineum in periodic attacks of three to five minutes. Asthenia of the spinal cord, in its different parts, occurs secondarily to prostatic disease.

Asthenia of the dorsal cord is indicated by pain in the occipital region, the nape of the neck and shoulders. Pain in the lumbar region and over the kidneys, is due to lumbar asthenia. Cerebral exhaustion thru the influence of the genital center, is indicated by asthenopia. Pain in the cervical and occipital regions when complained of seldom leads the physician to think of prostatic disease as the primary cause. The following case illustrates this condition: Mr. L., age 27, traveling salesman, contemplated matrimony, was much worried with paroxysmal pains. in the cervical and occipital regions; a heavy dull feeling in the nape of the neck and a sensation of weight in the center of the perineum. Patient stated that he thought there was some relation between these pains, being very observant and intelligent.

Urethra was examined with the urethroscope and the prostate, palpated per rectum, showed a marked congestion of the prostatic urethra, a hypersensitiveness of the prostate, which was firm, hard and somewhat large. No gonorrheal history, but a frank confession of prolonged sexual excitation with only temperate amount of intercourse. A three-months treatment of local applications to the urethra, rectal treatment of the prostate, completely relieved his pains in neck and occiput and he discontinued wearing his glasses that had been prescribed by an oculist for his so-called weak eyes.

NEURALGIA OF THE PROSTATE.

Neuralgia of the prostate is very often caused by a nonvenereal inflammatory hyperesthesia of the prostatic urethra.

Keyes makes a distinction between the two classes of cases, one a pure neurosis, the other cases of sexual excess in the young.

This is one of the most distressing and harrassing of all prostatic diseases to the patient and our effort at rapid and effective treatment is often very slowly responded to, much to the chagrin and disgust of our patients. It may be reflex to some disease of the testes or epididymi, and vice versa neuralgia of the testes and spermatic cord may be merely a reflex condition due to a chronic inflammation of the prostate. At present I have a case of this latter class under my observation, which is due to chronic gonorrheal prostatitis, in a dentist, who has suffered so severely in the last three years that he now desires a prostatectomy with the hope of getting his aching testicles relieved.

I have a very interesting case of chronic-prostatitis under observation, with a severe sacral pain reflexly for some months, who suddenly developed a dull pain over his upper pubic region, and symptoms suspicious of renal colic. An X-ray picture shows a small calculus in the lower end of the right ureter. In this case undoubtedly his prostatic disease long preceded the stone in the

ureter..

Very commonly we hear of sciatica, sacroiliac disease and disease of the psoas muscles being diagnosed because of some vague pain as a symptom in the upper or middle of thigh, when a thoro and well directed examination of the prostate, and the proper treatment may bring a speedy relief to the patient.

A patient, 22 years of age, left the insane asylum one year ago, where he was incarcerated for acute mania. He admits excessive masturbation for months, and presents all the appearances of dementia, while he is very rational at times. He said he often told the physicians of pains in his sacrum and hips, and he was dismissed without any attention for same. I examined his prostate and found same as large as a good size lemon and abnormally sensitive. Urethra extremely hypersensitive. Prostatic treatments have made a different individual of him, and done much to quiet a very neurotic patient.

Prostatic gout is a term coined by Harrison and is not generally referred to as a distinct entity. In this condition we have a typical picture of systemic gort with the corresponding involvement of the urinary tract, and the prostate involved merely as a coincident.

SEXUAL NEURASTHENIA..

Sexual neurasthenia is a vague, misunderstood term, well worthy of consideration and is so commonly used to cover much professional ignorance and omission. It is a secondary condition only too common as a sequel of a diseased prostate as a primary factor. Abrams in a recent monograph, says: "Nervousness while expressive of an enfeebled nervous system is an expression evoked by some irritant, resident somewhere in the system, other

wise than the nervous system." If this definition be correct then we may assert that sexual neurasthenia is dependent on some irritant in the genito-urinary tract, not in the nervous apparatus.

This irritant is only too commonly a chronically diseased prostate. Beard, a pioneer neurologist, claims, "next to the stomach the prostatic urethra is the most important center of reflex irritation in the body. There is every reason physiologically and anatomically why this should be so, and a close study of the symptoms of nervous debility proves it to be so. A morbid state of the prostate is both an effect and a cause of nervous exhaustion; for it is impossible to have an irritable prostate and yet be in good health in other respects."

Sexual neurasthenia is an impoverishment of nerve force, and without doubt it is proven that prostatic disease produces it. In this condition we may find a prolonged phosphaturia and oxaluria, which does not as a rule respond to a change in dietary or to mineral acids.

Therefore in a neurosis, where there exists a continued phosphaturia or oxaluria, and a condition of irritation in the genital tract, after eliminating the possibility of calculus, we must remember the prostate as being the factor to receive attention.

Psychoses from chronic disease of the male genital organs are only too frequent. Lydston says: "Care must be taken to carefully discriminate between cases that are psychoses ab initio and those in which the psychic element is simply an ingraft upon the symptoms produced by the organic disturbances."

The following illustrates a case of psychosis from prostatic disease in which there was no evidence of organic nervous trouble.

Mr. X., age 35 years, merchant; married for two years. He suddenly became worried over his inability to perfectly fulfil his marital relations. He complained of physical weakness and inability to concentrate his mind on business matters for any length of time, with occasional cardiac pains and palpitation, black spots before his eyes, occasional vertigo while walking on the street. While at work at his desk at intervals of two months he had attacks of syncope. His case was diagnosed by an ophthalmologist, who used the ophthalmoscope, as anemia of the brain; by an able internist as an incipient myocarditis, who sent him to a sanitarium for several weeks to take a course in mineral baths, etc.

Finding that hydrotherapy failed to relieve his spinal weakness, he consulted another clinician, who told him he had enteroptosis with autointoxication and was advised to wear an abdominal belt and was given intestinal antiseptics. He finally came under my observation, and as I had known this patient very well socially for several years, I knew that his prematrimonial habits were those of sexual excesses and dissipation. I attributed his spinal asthenia to his past habits and life, and thought the cerebral exhaustion, enteric and cardiac symptoms were merely secondary conditions. The patient agreed that his past sexual

career had some bearing on his present condition, causing his apparent impotence, etc. Urethroscopic examination of his prostatic urethra showed an edematous verumontanum, and merely swabbing his urethra with a cotton applicator set up a hemorrhage showing a high degree of congestion. Prostate was extremely hypersensitive, so that on rectal palpation patient fainted. in the office. Prostate was soft and large, causing, as I believed, to a degree his constipation.

Local applications and treatment made rapid improvement so that the patient's confidence in the diagnosis was obtained. Chronic prostatitis existed in this case, with an absolute denial of any previous gonorrhea. According to his statement, he consulted six different clinicians and not once was any hint made of any possible prostatic involvement. He has been constantly under observation for the past three years, and he has successfully impregnated his wife and is now living a happy and comfortable life.

THE MEDICAL ASPECT OF RAPE AND CRIMINAL ASSAULT.

Almost daily we read in our press of cases of rape and criminal assault. The recent riots in some of our municipalities had their initiative because of an assault on a white woman by some colored fiend. It has been interesting to me to ascribe some cause for these frequent cases both in the North and in the South, due, as I believe, to condition of sexual mania. In a recent number of Collier's Weekly, it is stated as follows: "Is it plain now the secret of many and many a lynching in the South? The primitive negro field hand, a web of strong, sudden impulses, good and bad comes to town on a Saturday and pays fifty cents for a pint of gin. He absorbs not only its toxic heat, but absorbs also the suggestion, subtly conveyed (due to some obscene label) that it contains aphrodisiacs. He sits in the road or in the alley at the height of his debauch, looking at the picture of an obscene white woman on the label, drinking in the invitation which it carries. And hence comes-opportunity. There follows the hideous episode of the rope or the stake."

We find in this dramatic recital an inference that most cases of rape committed by the negro are due to liquor, i. e., alcohol and aphrodisiacs. I have taken the pains to inquire from the St. Louis manufacturer of this brand of gin, whom Colliers attack and obtained the statement that they do not use any aphrodisiac drugs in same, but merely flavor it with some aromatics. I therefore suggest this periodical prove the correctness of its logic that sexual mania, causing its victim to rape, is due to alcohol. I will proceed to show it is due to uncured venereal diseases more than to alcohol.

From records of my clinics, I can absolutely prove that very few of the average negroes allow themselves to get cured of gonorrhea; seldom if ever returning when the urethral discharge diminishes, and as is so common when a posterior infection sets

in, the urethral discharge temporarily ceases, they often think they are well. Therefore they go on indefinitely with a posterior gonorrhea, and as we presume only too frequently the prostate gland becomes involved. Many of these kind of patients have told me in the clinic that they have had some kind of a urethral discharge for years. In a recent magazine article, entitled "The Future of the Southern Negro," the writer, a physician, stated that the large percentage of chronic venereal diseases amongst them is appalling. It is almost second nature for the roustabout or plantation hand to have his so-called "running-rings," the vulgar name for a urethral discharge. In his hip pocket only too commonly does he carry his bottle of Haarlem oil, or a mixture of copaiba and nitre, which is the prophylactic and specific he prescribes for himself.

Such a negro, low in the scale of intellectual development with a diseased prostate and prostatic urethra, is in a condition of constant erotic excitation. At times he is so excited that he borders on a state of orgasm, and like a vulture seizing its prey on the field, he assaults some innocent woman he passes on the highways.

There is a popular fallacy amongst some ignorant persons, that to cure a clap, intercourse should be had with a virgin. This also may have some influence on his ignorant superstitious mind. How many white men of intelligence boast of their morning drop, urethral tears of years' standing?

May I assert without fear of contradiction that some forms of sexual perversion may a priori be due not to a pyschosis, but to an originally diseased prostatic urethra, affecting the nervous system. Irritable prostate is frequently referred to.

merely symptom of some organic prostatic disease, possibly an old gonorrheal condition, causing all varieties of reflex neuroses. We have shown the relation of the prostate to the sympathetic nervous system. Therefore it is proper to believe that erotic delirium is superinduced by some chronic inflammation of the prostate or exudate in its sheath.

"Do something for me, or I will attack a woman on the streets," is the statement I have heard from these sufferers who have often been men of culture and standing. The poor negro, however, does not realize that his excitation is due to some previous venereal infection. In 1899, at the St. Louis Hospital, I made a careful study of the prostates of negroes and found a large number of diseased conditions, where the patients never placed any relation to some previous urethral infection. Tuberculous involvement of prostate and epididymis was very common.

In a medico-legal contest on a criminal pervert is it not logical to examine his genital organs and the condition intrapelvically, in ascertaining his mental and civil responsibility? Is not chronic disease of the prostate as much of a specific condition as thickening and inflammation of the covering membranes of the cerebrum for which many a criminal is sent to an asylum?