CASTRATION FOR PROSTATIC HYPERTROPHY. 
It is not two years since J. William White communicated to the 
American Surgical Association the results of his experiments for 
inducing atrophy of the prostate in dogs by removing their testicles, 
and pointed to the marked and speedy diminution of the prostate 
thus uniformly induced as suggesting the probability that in the hyper- 
trophied prostates of men an equally marked shrinking would follow 
the same procedure. 
Search in literature had enabled him to marshal in addition a 
very limited number of observations in comparative anatomy, recorded 
by Hunter, Owen, and Griffiths, that lent additional weight to his 
own investigations. To these could be added certain observations 
upon the atrophied condition of the prostate in eunuchs and in one 
case where the growth of the external genitals had been arrested in 
boyhood. This was the sum total of recorded knowledge of the influ- 
ence exerted upon the prostate gland by the testicles that at the time 
of the publication of White's memoir was in the possession of the 
medical profession. 
The effects of the removal of the ovaries upon the uterus and 
upon uterine myofibromata were well known generally, and it is doubt- 
less the fact that the similarity in structure between these uterine 
growths and the prostatic growths awakened in the mind of White 
the idea that it might be possible to affect the latter through the testi- 
cles as favorably as the former were affected through the ovaries that 
prompted him to his experiments. The final suggestion of the ther- 
apeutic application of castration for the relief of prostatic hypertro- 
phy, with which his memoir was concluded, was, evidently, not a 
haphazard idea, but was a logical deduction from an adequate and 
well-considered series of already established facts. The novelty of the proposition made its proposer show proper caution in recom- 
mending it to the attention of the profession, even after he had 
worked it out, and he forestalled unfavorable criticism by stating that 
he himself had not then formed definite and final convictions on the 
subject, but advanced the suggestion for the purpose of provoking 
discussion and trial. 
It is quite evident that the Philadelphia surgeon, previous to the 
inauguration of his personal experiments early in 1893, had knowl- 
edge only of facts that were the common property of surgeons gen- 
erally. Possibly the existence of a relation between the testicles and 
the prostate gland, similar to that known to exist between the ovaries 
and the uterus, had independently occurred to the minds of some 
surgeons before the publication of White's memoir. Mansell-Moullin 
has since stated, in his little book on " Enlargement of the Prostate," 
that in November, 1892, he had discussed with a patient the advisa- 
bility of trying such an operation, but that the patient declined to 
have the experiment made upon himself. Even this date was six 
months after the beginning of White's investigation of the subject, 
and at any rate Mr. Moullin seems to have himself considered the 
proposition as a passing caprice, and to have dismissed it from 
serious consideration, for, notwithstanding the large number of cases 
of prostatic overgrowth that are continually demanding surgical relief 
for the most urgent suffering, he does not claim to have considered 
the subject again until after the publication of White's memoir, nearly 
a year later, since which time he has unreservedly advocated the oper- 
ation. 
Perhaps no surgeon ever received a greater compliment from 
another than Mr. Moullin has given Dr. White in the opening sen- 
tence of the chapter (XI) in the boQk referred to, p. 154, which is 
as follows : " Removal of the testes is followed in a large proportion of cases, 
if not in all, by complete and rapid absorption of the enlarged prostate. 
This has now been proved conclusively. The gland entirely disap- 
pears ; nothing is left but a little fibrous mass." 
It is true that in the later paragraphs of this chapter the author 
does not specifically state that White had first demonstrated this fact 
by an elaborate series of experiments upon the lower animals under- 
taken for the express purpose of determining whether or not such an 
influence could be exerted upon the prostate by removal of the testi- 
cles, and whether, if so, it was sufficiently certain to justify the adop- 
tion of the procedure as a therapeutic resource in the prostatic over- 
growths of men. It is to be presumed that Mr. Moullin did not 
think it necessary to restate in so many words what he knew that all 
the surgical world already knew. An implied compliment is always 
greater than a baldly stated one, and, although it would have been 
a much more graceful thing for the London surgeon to have fully 
and specifically stated the real character of the work that had been 
done by his Philadelphia colleague, it was not necessary, for its omis- 
sion could not detract from the well-earned credit which is universally 
ascribed to the latter for his masterly work. An undue sensitiveness 
has been displayed by some of the American medical journals as to 
the way in which Mr. Moullin has chosen to speak of White's work, 
as if in some way the credit of the latter had been assailed, and an 
important question as to priority had been raised. There is certainly 
no ground for any of this feeling. 
As to actual priority of performance, three months after the pub- 
lication of Dr. White's memoir a Norwegian surgeon, Ramm, of 
Christiania, published (September, 1893) the statement that in April 
of that year, before the reading of White's paper, he had removed 
the testicles from an old man as an experiment for the purpose of producing atrophy of an enlarged prostate. 
In some English and American journals there has been of late 
quite a number of communications upon various phases of this sub- 
ject. Not the least interesting is the statement by Harrison, of Lon- 
don, that years ago a patient had requested of him that he would 
remove his testicles in the hope that it might benefit his prostatic 
disease ! This the surgeon refused to do, and contented himself with 
subcutaneously dividing the vasa deferentia of his patient, and then 
" thought nothing further of it" until the fact was recalled by read- 
ing White's paper. Here, as far as information goes up to date, 
would seem to be the real father of the operation. For this man not 
only conceived the idea, but offered his own body for the performance 
of the experiment. It is to be regretted that Mr. Harrison did not 
take advantage of the offer, for, with the light of after events, it is 
quite apparent that he missed a great opportunity. 
These questions of priority of mental conception, of suggestion, 
or even of actual performance are of little importance. As far as the 
surgical world is concerned, the fact is undeniable that the general 
serious consideration of the possible value of the removal of the tes- 
ticles as a therapeutic measure in the treatment of prostatic hyper- 
trophy dates from June i, 1893, when J. William White read his 
paper upon " The Present Position of the Surgery of the Hypertro- 
phied Prostate" before the 4merican Surgical Association. Without 
this work of White, the subsequently-published cases of Ramm would 
have attracted but little attention ; the operations of Haynes and 
of many other surgeons which have since been reported would not 
have been made, and Chapter XI of Mansell-Moullin's book on 
" Enlargement of the Prostate" would never have been written. 
L. S. Pilcher.