OBSERVATIONS ON THE FUNCTIONS OF THE PROSTATE GLAND IN MAN AND IN THE LOWER ANIMALS.

This paper (by Joseph Griffiths, M. B, C. M., University of Cambridge) contains an account of some very interesting observations by the author on the relation of the prostate gland to the sexual function. His most striking observations are those made on hedgehogs, moles, and other such animals, which have a strongly developed sexual passion, that gradually increases up to a certain season, and then as gradually decreases, until it finally disappears. He divides the state of animal sexual development into three stages, the quiescent, the intermediate and the active. He finds that in the quiescent stage, the prostate is small, and the gland-cells proper form a comparatively small part of the whole; the greater part being long spindle cells, which the author believes to be connective tissue, rather than unstriped muscle.

In the intermediate stage, the gland is much larger; the gland-cells, which in the previous stage were small and cubical, have now become much larger and of columnar form. A scant secretion of mucus is found in lumina of the alveoli, and well defined non-striated muscle cells are formed in the outer alveolar sheath.

In the active stage, the prostate is many times larger than in the quiescent stage. The gland-cells proper are columnar, large and swollen. The lumen is filled with mucus and "corpuscles resembling leucocytes." Between the columnar cells, close to the basement membrane, are found scattered small round granular cells, which the author thinks have the same function as the demilune cells in the salivary glands and pancreas, viz., to replace the columnar secreting cells when these are used up The outer coats of the alveoli have now a strong, well developed coat of unstriped muscle, capable of squeezing out the secretions which had collected in the lumina, In other words, the prostate at this time is an actively secreting gland.

The author has also studied the effect of castration on the prostate, and finds that after removal of the testicles, the gland-cells of the prostate atrophy and the connective tissue closes in on the aveoli of the gland, so that only narrow streaks of shrunken gland tissue remain to mark the once actively secreting lobules, The author has made no observations on man, but quotes several authorities who have found that the prostates of eunuchs very much diminished in size. All these observations tend to show that there is some relation between the secretion of the prostate and the sexual function. Its secretion is said to resemble that of the seminal vesicles, and, it may be, plays a more prominent part than has heretofore been ascribed to it. The enlarged prostate of old age is no exception to this, for it is the connective tissue, not the-gland cells, which proliferates.

THE

BROOKLYN MEDICAL JOURNAL

PUBLISHED MONTHLY BY THE MEDICAL SOCIETY OF THE COUNTY OF KINGS.

EDITORIAL COMMITTEE:

JOSEPH H. RAYMOND, M. D.,

ALEX. HUTCHINS, M. D.,

JOSEPH H. HUNT, M. D.,

GLENTWORTH R. BUTLER, M. D., FRED. D. BAILEY, M. D.

Presented by George R. Westbrook, M.D., at a meeting of the Brooklyn Surgical Society, November 7, 1889.

J. D. M., aged thirty-four, an engraver of watch-cases, had, in the early part of August, 1887, an abscess form on his back, between his shoulders, which I opened in two places, establishing good drainage. Repair of the abscess went on satisfactorily. About the middle of September he complained of pain and swelling about the right elbow. I suspected inflammation of the joint. Exploring with a hypodermic syringe, I found pus a little above the external condyle of the humerus. A free opening was made, the pus cavity washed out with an antiseptic solution, and a drainage tube introduced; shortly after pus was found below the joint over the olecranon; this was treated in the same way. I could not find any communication with the joint from either of these cavities.

The arm was kept in a splint and the pus cavities washed out every other day with an antiseptic wash, the patient all the time taking a tonic of iron and quinia; his temperature all the time keeping one and a half to two degrees above normal. Two or three weeks after the last abscess was opened, denuded bone could be detected with a probe in both openings.

Prof. J. S. Wight saw him with me, and advised a continuation of the treatment a while longer. Soon crepitus could be detected on manipulating the joint. Prof. Wight saw him with me again, when it was decided to remove the diseased bone, which I did, December 27, 1887, assisted by Prof. Wight and Drs. Buckmaster and Brewster.

A longitudinal incision was made on the posterior aspect of the arm, from about two inches above the olecranon to about two inches below; the tissues were drawn apart, the ulnar nerve exposed and drawn to one side, when about an inch from the lower end of the humerus, about an inch from the upper end of the ulnar and the head of the radius were removed. The wound was washed out with a bichloride solution, the parts drawn together, an antiseptic dressing applied, and the arm placed in a right angle splint. Convalescence went on slowly, giving the man a good and useful arm.

The bones of the forearm are drawn up in front of the humerus, the radius seems to articulate with it, but I do not think the ulna does. Rotation and flexion of the forearm are good. As the attachment of the triceps to the olecranon is lost, extension is considerably impaired. Flexion and extension of the hand and finger are good; the grasp of the hand is firm. The arm from the shoulder to the tip of the middle finger is two inches shorter than its mate; and there is some atrophy of the hand.

DISCUSSION.

Dr. BURGE. It speaks for itself as an exceedingly interesting case, and I think its present condition testifies to the excellence of the operation. It does not occur to me to say anything very special upon the subject beyond this, that the use of the fingers seems to be good and the nerve connections well preserved.

Dr. WIGHT.-I only wish to say very briefly that the facts of the clinical history, from what the doctor has said and from what I remember of it, and tracing along the line of the facts all the way up to the present, as they come to my judgment, without going into detail, I arrive at this conclusion: that it is an example, an important example, of conservative surgery, the conservatism that ought to be put in force nowadays from time to time, while we are inclined to amputation. That is one of the greatest triumphs of conservative surgery that I have known, saving a limb that had just a chance to be saved, a useful limb, and saving a man's life and putting a fairly useful limb in the place of no limb at all, with a very good movable joint, so that it can be used to help support his family. It seems to me that such a case as that should be presented to every practical surgeon, to give him at least a strong suggestion in the direction of conservative surgery, especially in the upper limb.

Dr. PILCHER.-One thing that is particularly remarkable about this is the freedom from atrophy which the muscles of the forearm present. Dr. WESTBROOK.-The muscles of the forearm measure more in circumference here than the sound arm; there is some atrophy of the hand.

Dr. PILCHER.—I think that is very unusual. Is there any reason you can give for the preservation?

Dr. WESTBROOK.-The flexor muscles seem to be used almost altogether, and that is the only way I can account for it.

ing?

Dr. WIGHT.-Wouldn't it also be due to some extent to the shrink

Dr. PILCHER.—It is now, I believe, nearly two years since the operation. The excellent range of motion which he has at the elbow and the strength which he has in it are remarkable. And there is no apparent threatening of any recurrence of trouble about it, it seems to be thoroughly healed.

Some of the gentlemen may remember the case of a young girl whom I presented here more than a year ago, showing the result after an excision of the elbow, in which at the time I presented her there was almost a flail-like condition, from the considerable separation of the bones of the forearm from the humerus with only the soft tissues between. At that time I suggested the propriety in that case of operating again, refreshing the ends of the bone and bringing them up together and endeavoring to secure ankylosis. In course of time I did such an operation. I refreshed the bone ends and brought them up together and sutured them, and succeeded in getting the parts united again, with the bones in close relation to each other, but still without ankylosis; I had a good movable elbow joint. In that case also there was recurrence of tuberculosis in the parts, so that two or three secondary operations had to be done by me before it was entirely overcome. It is now soundly healed, however, and the patient has a useful arm, though by no means as strong and well developed as this. She plays the piano with her hand. In that case, however, there had been disease of very much longer standing; she had had disease of the elbow joint for twelve years or more, and there was much atrophy to begin with. As Prof. Wight has remarked, these cases show the possibilities of conservatism in connection with extremely threatening conditions, and would encourage us to make an attempt at conservatism before condemning a limb to amputation.

THE LEGAL RELATIONS OF IMBECILITY AND OF

SUICIDAL AND HOMICIDAL MANIA.

BY EDWARD C. MANN, M.D., F. S. S., BROOKLYN, N. Y.,

President New York Academy of Anthropology; Member Medical Society of the County of New York, etc.

Read before the American International Congress of Medical Jurisprudence, held in New York, June 4, 5, 6 and 7, 1889.

LEGAL RELATIONS OF IMBECILES.

In determining the civil and criminal responsibilities of the imbecile, several points must be borne in mind by the lawyer. With regard to their moral sense this class have no clear definite idea of rights, justice or law. They cannot feel for the sufferings of others. They see only in the most imperfect manner the consequences of their acts. They gratify every appetite or desire regardless of consequences. Their appetites and passions are not restrained by the higher faculties of the mind, which are deprived by disease or bad development of their power to restrain or guide. Theft is very common with them. They have not the mental competence necessary to make them legally criminal, and it does no good to punish them in this way, as they recommence their offences the moment they are released from confinement, and thus are thought to be simply wicked. Those who have strong sexual propensities, if men, soon become guilty of outrages on women and are imprisoned, as they are judicially decided to be rational beings. There are many imbeciles who daily engage in occupations that require no great extent of mind and who perhaps are merely thought singular by their friends. With respect to their civil responsibilities, if there exists an inability of comprehending the value of numbers, the person is evidently not capable of managing property. Ray very properly says, that the real capacity of an imbecile's mind is to be estimated not from any single trait, but by a careful appreciation of all its powers, and especially in their relation to the particular act in question. Relative to marriage, the person should be proved to have had a rational idea of the marriage contract and of the duties and relations incident to the marriage life. Respecting a business contract, the question would be, had the person an adequate idea of the money involved in the transaction? Was he independent and executive, or was he credulous and submissive to his friends regardless of what happened? It is no test of capacity that a person of either sex has behaved fairly well in company, especially when they have moved in cultured circles. This, by constant repetition, has become