TWO CASES OF APPENDICITIS ASSOCIATED WITH RHEUMATISM
American Journal of the Medical Sciences
SURGERY. 353 kidneys have become disorganized by the two factors rarely absent in advanced cases-backward pressure and infection. This would leave a mortality of 7.1 per cent., which will probably be decreased as advancing knowledge permits of a better selection of cases. It is important to note that even in the desperate cases which make up this series of deaths, 15 (75 per cent.) showed improvement of symptoms or shrinkage of the prostate before they died. 4. Comparison with other operative
... h other operative procedures seems to justify the state¬ ment that, apart from the sentimental objections of aged persons on the one hand, and the real, entirely natural, and very strong repugnance to the operation felt by younger patients, castration offers a better prospect of per¬ manent return to nearly normal conditions than does any other method of treatment. The relatively greater degree of improvement in successful cases should be considered, as well as the mortality, in comparing the operation with the various forms of prostatotomy and prostatectomy. So, too, should the absence of any risk of permanent fistulse, peritoneal or supra pubic, the ease and quickness with which the operation can be performed, and the pos¬ sibility of avoiding altogether the use of anaesthetics, which, in these cases, are in themselves dangerous. 5. The evidence as to unilateral castration is at present contradictory, but there can be no doubt that in some cases it is followed by unilateral atrophy of the prostate, and in two cases, at least, it has resulted in a very marked improvement of symptoms. It is worthy of further investigation. 6. My experiments on dogs have shown in nearly every case in which the vas deferens was tied or divided on both sides, that, without much change in the testicles, there were beginning atrophy and considerable loss of weight of the prostate. These experiments need repetition and confirmation, as the absence of corresponding testicular change seems to make the results some¬ what anomalous. It is possible that the inclusion or severance of small but important nerves may account for the effect on the prostate. 7. Ligation of the vascular constituents of the cord, or of the whole cord, produces atrophy of the prostate, but in my experiments only after first causing disorganization of the testis.