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The Medical Society of City Hospital Alumni
President, LOUIS H. BEHRENS, 3742 Olive Street Secretary, FRED. J. TAUSSIG, 2318 Lafayette Ave.
CHAIRMEN OF STANDING COMMITTEES :
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Müllerst part onts of", sopar
CHAS. E, BARNETT, M. D.
FORT WAYNE, IND. FROM the hypothesis that the prostate in the male arises as two separate glands, which are developments of the lining membrane of the first part of the urethra, instead of the Müllerian duct coalescence embryologic idea gives the female the opportunity for a like glandular development. So in order to call a closer attention to the subject of the deep urethral glands of the female, I bave dubbed them, in the title of this paper, the Female Prostate.
In substantiation of the claim “that the male prostate has an entirely distinct and different origin from that of the utriculus masculinus,” and thus allowing, in the writer's opinion, the analogy between the male prostate and the female deep urethral (Skene's) glands, the following points in em. bryology are offered as evidence:
"In the male the utriculus masculinus (the coalesced Müllerian duots) enters the back of the first part of the uret bra (the urogenital sinus) in the middle of the line, and the vasa deferentia (the Wolffian ducts) terminate, in the edge of the orifice of the utricle, on either side.
In the female the vagina (the coalesced Müllerian duots) enters the back of the vesti. bule (the urogenital sinus) in the middle line, and the ducts of Gärtner (the Wolffian ducts) terminate in the lower part of the vagina on either side.
The homology between the male prostatic utricle and the female uterus and vagina is a demonstrable fact.
The male prostatic utricle and the female uterus and vagina have an origin distinct and different from that of the urogenital sinus.
The prostate glands are developed in the wall of the genito-urinary sinus, at a poiut farther from the bladder than the opening of the utricle. They are apparently mucous gland of the urogenital sinus, and they consist, in the fourth month, of a few
branching columps of cells which cluster togetber at the back of the urethra, where they are seen in two separate masses, one on each side of the middle line. At this stage they are entirely within the layer of volun. tary muscle of the urethral wall, and do not form any visible projection. In the ninth month they are larger, more fully developed, and form visible projections; they are two separate and distinct glands and have grown beyond the limits of the external wall of the urethra."'-Richardson.
It would seem from a study in comparative anatomy, that the prostate gland, Cowper's glands, and the vesiculae seminales (glands)1 Furnish the anl furnish the culture media for the sperm cell in the male.
Would it be straining a point too far to consider the female accessory glands, viz., the deep urethral, Bartholin(2) and Nabothian as secreting a still further culture media for the spermatozoa, (3) active if the male is passive and performing a greater function than a mere lubricant during coitis.
It is claimed as an undoubted fact that we have “the orgasm with discharge of semen in tbe male and the orgasm and reception of semen in the female." -Lydston.
The smaller mucous glands in the male are pouring out their fluid during tbe exciting stage of passion, we will say for the purpose of l'ubrication, but not so with the larger ones until the orgasm occurs. From the limited investigation that the writer bas been able to make there a like functuation condition present in the female, with the difference that the simple mucous primary flow is greater than in the male and the secondary special How with orgasm is not so profuse.
Observations on the chemistry of semen have been so few and fragmentary in charac.
(1) Piersal finds glandular tissue in the vesiculae seminales. (2) The comparison between Cowper's glands and the glands of Bartholin is good They both lie just below the bulb, within the triangular ligament; upon the levator ani or constrictor urethra muscle, as it is called, in this region. Their size and lengths of ducts are practically the same.
(3) Stohr's Histology, fifth edition, says, “In this mixture of fluids (i, e., spermatozoa plus vesicular, prostatic and Cowper's gland fiuid) the motions may continue for from twentyfour to forty-eight hours after death, and for still longer period in the secretion of the female genitalia. . • Acids suspend motion while animal fluids of alkaline reaction restore motion." This would tend to show that there was a secondary fiow in the female that was sufficiently alkaline to neutralize the ordinary acid vaginal mucous membrane.
ter that the writer was not surprised not to The usual case comes late to the surgeon. be able, after considerable search to gain Should' there be sufficient time to abort sup. any information relative to the cliemistry, puration, the best procedure, in the writer's or physiology of the female accessory-gland opinion, is to slit the ducts to the glands and ular fluid.
cauterize the field with silver nitrate. The study of the anatomy of the bladder If suppuration is present, the absoess and bladder appendages has never been should be opened from the vaginal side and more active than today, and it is not im. properly drained. After resolution has taken possible tbat some things bave been over. place if any glandular remparts remain, they looked by our older anatomists, on account should be taken away during the interval be. of their non-importance heretofore.
tween the inflammatory crises, thus giving The new anatomies are giving the deep the operator a chance to avoid urethro-va. urethral glands of the female a passing no. giual fistula. In case of uretbro-glandular tice, wbile the older ones are silent on tbat fistula, cauterization of the fistulous traot an subjeot. Our recent works on the surgery abscess cavity should be done, followed by of the urogenital tract of the female are further advanced even than the more recent anatomies in their anatomic description. This shows that the subject courts farther investigation.
The writer has found, after having made a number of female bladder dissections—the last ones being made in Weichselbaum's pathologic laboratory in Vienna-that the deep urethral glands of the female were located midway between the neck of the blad. der and the meatus urinarus externus; placed latterly to the urethra, above tbe ves. ico-vaginal fascia and having ducts which empty just internal to the external meatus. When hypertrophic, the gland encroached upon the bladder neck. The cbanges in shape during hypertrophy being similar to the male prostate during its outcroppings of lobules. (See out).
In the majority of gonorrheas of the female, the uretbra is invaded. During this urethritis the deep urethral glands are con. stantly in danger. Should they become infected the pathology present is much similar to gonorrheal prostatitis in the male. Should
Weer. 24. December 1905 pus form and the abscess break the solution of continuity will either be toward the urethra or toward the vagina. Should the vaginal route be taken, there is a great danger of an
an interval operation, if possible, after the uretbro-vaginal fistula which is practically
urethra bas healed. In vesico-vaginal fistula a vesico-vaginal fistula.
a plastic operation with the removal of all
glandular remnants is indicated. The vesico-vaginal fascia is so thin and so
In all of these cases the bladder neck will lacking in tone quality that an abscess pene.
be found inflamed and will need attention. tration of it is affected with no great effort.
The writer sees no reason why hypertrophy Should the urethra remain competent the
should need surgical attention unless it would drainage opening will close and the abscess
happen to be like the case illustrated. Even will reform ad libitum until surgical help is
with that condition present, the Fenwick
vi called. Should this infection be not suffi.
operation with the large urethral specula for ciently virulent to produce a breaking down
the removal of papalomatous growths in the of the tissues, there will remain a passive in
bladder, could be utilized for the removal of flammation that by the stimulating effeot,
the glandular lobule. within the ascinus, will produce an hyper.
The report of three cases will give an idea trophy of the glands. *
of tbe kind of cases encountered by the sur. *See writer's article on Pathological Changes Resulting geon that are due to inflammation of these 1905.
from Prostatic Enlargement, American Medicine, April 8,
CASE 1.-Mrs. “X.” Operated by the cystotomy in two sittings. After cleaning writer several years ago for kidney stone, the bladder thoroughly, to freshen the edges with recovery. About a year following oper. of the fistula, close same tightly with chromation she was infected by her husband with icised catgut, then cover over the whole fis. gonorrhea. On account of her innocence and tulus region with a flap composed princi. unsuspecting disposition the writer was called pally of the bulb of the vagina (patient being late, and consequently got the sequela of the put to bed, lying on her belly, in order to disease, which in this case was an acute aden- drain the urine away from the wound). Should itis of the deep urethral glands. Under treut. the closure be complete a urethral canal will ment the inflammation subsided to a marked be tunneled at another sitting, degree, leaving a passive inflammation with tenderness and some enlargement in that re. gion. An operation for the removal of the THE TUBERCULOSIS CAMPAIGN IN CHICAGO. glands was suggested, which was declined by
- A campaign to secure funds for the treatthe patient. The fact is that the patient is
ment of tuberculosis in Chicago was planned not aware of the cause of her trouble and, un- recently at the bi-monthly meeting of the fortunately for the writer, considers that it is
Executive Committee of the Chicago Tuber. a remnant of her old kidney trouble. "
culosis Institute. Although efforts are being CASE 2-In consultation with a doctor of
made to secure donations for summer camps our city, Miss “Y.” was examined. She
and other means of treatment, the physicians gave a history of acute inflammation at the
and societies interested in the work pin most neok of the bladder. Emphatically denied
of their hopes for adequate funds on the gonorrheal infection. She was ordered to
charter legislation. A committee, consisting the hospital where a vaginal examination was
of Dr. Henry B. Favill, Dr. Frank Billings made, at which time a slide was smeared
and Mis. Lenora Hamlin, of the Institute, with pus milked from the deep urethral
was appointed to confer with the charter con. glands. The pus contained Niserian diplo.
vention with regard to additional revenue for cocoi; a cystoscopy was done the next day; the Departinent of Health. The Institute neck of the bladder found bighly congested; bas raised, through the auxiliary committee. bladder washed and neok painted with silver $1,000 for a summer camp, but has been nitrate; duots of glands silt and cauterized
obliged to abandon its plan of having tents with silver nitrate. Two weeks after leaving
in une of the parks, the South Park Board tbe hospital there was a reourrence of the
having very properly deolined to listen to a adenitis, with suppuration. A cutting oper.
proposition to that effect. ation for drainage followed by the removal of the glands during the interval, was sug. THE NATIONAL FORMULARY.-- The Na. gested; said suggestion caused the discharge tional Formulary bids fair to become, in a of both the attending pbysicians and the way, an actual rival of the United States writer. From our hands she landed in the Pharmacopoeia. It caters to the require. hands of a thorougbly competent practitioner, ments of the average retail druggist in place wbo called in a surgeon, who was also thor- of being ambitious to occupy a position as oughly competent, but they failed to find the an authority for expert chemists and ethical true cause of the trouble, "more's the pity," professors. If the American Pbarmaceutical and from these men the patient bas drifted Association recognizes its opportunities, the until finally, on account of their Auwery prom next revision of the National Formulary will ises, she has been attracted to the osteopath contain a statement of the therapeutic action and the Christian Scientists. As this dis. of each preparation, as well as the maximum ease is entirely out of their sphere, the writer and minimum doses. It will give, in so would not be surprised at no distant date to many words, the amount of eachi potent inhave the patient return for the surgical relief gredient in an average dose of the beroio that was advised in the beginning.
preparations. These are some of the practiCASE 3.- Was called to Detroit to see Mrs. cal improvements wbich will find their way Z. Gave history of infection of deep urethral into the every day hand-book of the dispensglands seven years ago wbich was followed ing pharmacist. The medical profession is with abscess formation. Vesico-vaginal fis. crossing the border line between medicine tula followed the breaking of the abscess, and pharmacy in its effort to find standard leaving an opening larger than would admit drug store remedies to prescribe. If the Na. one finger. She had been operated for the tional Formulary titles are reduced to a man. closure of the fistula five or six times by com. ageable form, the preparations will meet with petent surgeons with negative results.
favor at the hands of the prescribers and inThe writer proposes, in endeavoring to close crease the prescription trade of competent the fistula, in this case, to do a suprapubic pharmacists.-Meyer Bros. Druggist.
THE MEDICAL FORTNIGHTLY
has been maintained, as it was established, by the municipal councils of Victoria and
Vancouver and the provincial government. Issued Tenth and Twenty-Fifth of Every Month. Their policy in dealing with the lepers has THOMAS A. HOPKINS,
heen virtually the same as that prevailing Managing Editor.
in oriental countries during countless ages. Editorial Staff :
Any one suspected of leprosy, and there 0. E. LADEMANN, Internal Medicine.
have been about tbirty sent to the island, OHN MCHALE DEAN, Surgery.
bas been bunted down by the police, and R. B. H. GRADWOHL. Pathology and Bacteriology. W. H. VOGT, Obstetrics and Gynecology.
after conviction by the oity medical bealth WALDEMAR FISCHER, Ophthalmology. A. LEVY, Pediatrics.
officers, condemned to life exile. There W. T. HIRSCHI, Therapeutics.
was no appeal. Houses and food supplies A. F. KOETTER, Otology. HERMAN STOLTE, Laryngology and Rhinology. were provided and isolated from all human F. P. NORBURY, Nervous and Mental Diseases.
intercourse, tbe poor creatures were aban. T. A. HOPKINS, Genito-Urinary Diseases. ROBERT H. DAVIS, Dermatology.
doned to inexorable and inevitable fate. This barbarous and obsolete polioy the do
minion refuses to pursue now that the lazar. EDITORIAL
etto bas become a Canadian institution.
In the past treatment has been a neglected COMPANIES for the exploitation of denaturized feature of the work at this institution, here. alcohol for use in various places where other after the unfortunates are to have the best agents are now em.
that modern therapy affords, and oures are ployed are multiplying expeoted where hopelessness has heretofore Denaturized
since the passage of the reigned. Alcohol.
bill removing the tax
LAY diagnoses are characterized by amusing terial. It appears that it is to revolutionize
qualities, even those made by the more learned domestic arrangements. If we are to believe
in matters wutside of various promoters, it is to give us ligbt and
medicine, and members heat, and that in the safest, cheapest and most “ Trouble.”
of our profession bave desirable form. It has been our privilege to
been known to care. investigate the generation of light with the
lessly drup into some of these lay inacoura; German burner adapted to the common Amer
cies, at least in conversation. The number ican kerosene lamp, and beat with a burner
of kinds of "trouble" to which the human adapted to attachment to the ordinary gaso.
body is heir to is illimitable, but in a gross line or gas stove, and in both the alcohol is
way the limit, exclusive of subdivisions and a suocess. The light is an intense wbite
doubles, is that of the number of organs comlight, steady and clear, the heat of the stove
posing the body. We have heart trouble, lung was equal to any emergenoy. Whether its
trouble, womb trouble, kidney trouble, etc. great economy is to be proved, as bas been
Kidney trouble is a fair example of the range claimed, remains to be demonstrated, but the
of possible ipacouracy, this disorder may new fuel is certainly clean, safe and effective.
mean lumbar or dorsal myalgia, reotal ulcer, It will be largely used under any circum
cystitis, prostatitis, some forms of intestinal stances, but if as cheap as claimed it will
disease, etc., and may mean genuine kidney largely supercede the products of the Stand
involvement, though this is fortunately the ard Oil Co.
least frequent. The unfortunate side of this
is that wbile patients have a very erroneous PRESS reports tell us that the Canadian gov. diagnostic ability they have a real conception ernment bas assumed cbarge of the Victoria of tbe seriousness of a nephritis, and they
Vancouver lazaretto and read all the symptoms of their “kidney trou.
has decided upon ma. ble'' to point to that disease. The conseCanada's
terial changes in the quent mental distress and anxiety are de. Lepers.
care of lepers on the plorable and in a vast majority of cases need.
Pacific seaboard of the less. dominion, the obsolete and inbuman polioy To what extent a physician should in. hitherto pursued while the lazaretto has been struct his patient in the details of his illunder joint municipal and provincial control, ness is a much debated question, but there being succeeded by the most advanced and can be no question of the propriety of giving scientific treatment for the unfortunate pa sufficient information to allay anxiety, and tients, now that their care is vested in the the patient usually has a right to an exnational authority. Heretofore the institution pressed diagnosis; to leave a case of lumba
go with the idea that a nephritis exists is THE second annual report of the Henry quackish and cruel. Those who maintain that Phipps Institute for the treatment, study and the patient needs to know nothing of his
prevention of tuberou. ailment, beyond what is necessary to the
losis (1906) gives an acapplication of the line of therapy adopted,
count of the work of
Report of the leave bebind them anxieties wbicb cannot be
the second year, a re
Henry Phipps expressed; such a course is more frequently
view of the subject of
Institute. an error than that of those who take the op.
immunization in tuber. posite course and elaborate details beyond
oulosis, a preliminary the grasp of the lay mind. There is a happy report on the Maragliano serum treatment, medium which spells success; it knows pa. and a report of some of the scientific work tients, and will go into details wbere details done by members of tbe staff of the Institute are needed and will with bold judiciously. during tbe year. This report is an admirable There is no calling where that admirable exposition of the possibilities and impossi. quality known as oommon sense, and its exer- bilities in the practical sanatorium treatment oise is more demanded than in medicine. The of tuberculosis on this continent. The insti. physician who is happily possessed of this, is tution is located in Philadelphia, and its fortunate for it is a tremendous necessity in medical director is Lawrence Fliok, a gentle. handling patients, and except by birth rigbt man whose reputation as a tuberculosis exit is alnjost impossible to acquire.
pert is well known. In his account of the work of the year, he states that while the work has been carried on in temporary quar.
ters, with great difficulties, these very diffi. In common with other sections of the coun culties an impediments increase the value of try St. Louis has been financially embar- said work from a sociological point of view,
rassed in her individual inasmuch as they have enabled the Institute
households and in ber to give an object-lesson of what can be done The Price
obaritable endeavors by under unfavorable conditions. It was of Ice.
the fact that ice, wbich shown at this institute that tuberculosis is
they have taught us is quite amenable to treatment. Nearly all a necessity and not a luxury, could be had cases can be benefited for a time at least, only at an unaccountably increased price. and many cau be oured. The curability deThe why of the increase is not apparent for pends upon the stage somewhat upon the we have not, for years, depended on natural chronicity. Even advanced cases can be ice, and the cost of manufacture is as small benefited. Most of the cases treated at the as ever. Trust tactics were so manifest that hospital were advanced cases. Nearly balf an investigation was started early in the sum of those admitted were discharged as immer, and at the present rate of progress we proved and one case was discharged as bay. may hope for some definite results by the ing bad the disease “arrested.” Less than middle of next winter.
one-third of those admitted died. Ice is a necessity, especially so in a cli. The most advanced cases improve for a mate like ours, where the heat comes so time when put at rest in the open air and steadily and is so trying. The addition of properly fed. Death is brought about by an ten cents to the price of a hundred weight intercurrent disease as a rule, cold, influenza and the reduction of the size of the five cent or pneumonia. piece to proportions mythical is little short Patients treated in the dispensary were less of a crime, unless there is a very demonstrable advanced, but the results obtained were only reason in the cost of manufacture, which a little better than those obtained in certainly cannot be shown. What St. Louis the hospital, because of the difficulty of needs is a man at the helm, a whole souled, bringing dispensary patients under control. publio spirited man, one full of initiative On account of home conditions and great who can rise to the situation, who will poverty it is next to impossible to maintain make his authority, if need be, and get action. discipline with such patients in their homes. The poor and the sink are waiting to call such Fliok says that the story of tuberculosis an one blessed.
work among the poor can be read out of the last table which he gives, sbowing that
out of 477 patients treated this year, 156 had THE INTERNATIONAL SURGEONS CLUB is improved the year before, 119 had not imthe name of a new organization at Rochester, proved the year before, and in 202 no result Minn., composed of visiting surgeons at the was recorded the year before. Restoration to Mayo Brothers hospital in that city. The so. health and preservation of health depend ciety starts with a membership of fifty. upon assistance. To restore these poor peo