Excessive Salivary Secretion.—Bumm considers that the excess of secretion of saliva which is so often noticed in pregnancy is of the same nature and should be treated rather by suggestion than by any particular remedy, though remedies should be tried because of certain helpful physical effects, and then the psychic element that goes with them. The less importance given to the symptom, the less attention it attracts, the more its passing trivial character is emphasized, the sooner it will subside. Solicitude causes it to persist and even increase.
LABOR
Suggestion in Labor.—When the subjects are normal, expectancy has much to do with the severity of labor pains. In recent years so much fuss has been made and so much said and written about woman's burden and travail in the pains of childbirth, that preliminary dread and anxious attention have wrought young women up to such a poignancy of expectation as to make these pains worse than they really are. In the old days child-bearing was as much a matter of course as the husband going out to his daily work, and the taking of the dangers and fatigues of it was a simple matter of duty. Labor was then {458} comparatively easy and, while never pleasant, was also never an over-uncomfortable process. The effect of unfortunate suggestion has been to make it seem ever so much worse than it really is. Multiparae furnish the best proof of this. A healthy woman who has already had more than one child does not dread labor pains very much, or only to a slight degree, because the previous maternities have lessened the physical pain to be experienced, though a healthy woman's tissues are so thoroughly resilient that nature is able to bring about a return to normal conditions so complete that it is not always easy to decide whether a woman has given birth to a child or not. Of course, there are many cases in which tears reveal the former labor, but there are others in which it is not so, and the renewal of the birth process must, therefore, be nearly if not quite as painful as before, especially if it is recalled that succeeding children are usually larger. In spite of this in multiparae, labor has lost most of its terrors because real knowledge of its comparative ease has replaced the previous unfavorable suggestion, and instead there has come a proper appreciation of what will have to be borne, and of the positive pleasure of the relief when it has been borne successfully.
Healthy women of the lower classes have so little difficulty in labor that they are quite frank to confess that it means scarcely more than a few severe muscular pains during an hour or so. Some of them mind it so little that up to within half an hour of the birth of the baby they occupy themselves with other things and succeed effectually in distracting their pains away.
In their article on "Hypnotism and Suggestion in Obstetrics" Drs. Auvard and Secheron [Footnote 37] suggest that hypnotism can be employed with advantage during labor, but it is more difficult to produce it then than in the normal condition. Its only advantage is anesthesia, and this can be obtained during the preliminary pains in many cases. It is frequently impossible to produce complete anesthesia, however. To replace hypnotism they advise that suggestion in the waking state be used and they even suggest the employment of pseudo-choloroform or other like means. This method they consider more advisable than hypnotism, for there are no inconveniences and many real advantages. The nervous condition of the patient after hypnotism during labor is sometimes far from satisfactory.
[Footnote 37: "L'Hypnotisme et la Suggestion en Obstétrique," Paris, 1888.]
Nature's Methods.—In obstetrics and labor we have been finding in recent years that we have not trusted nature enough, have not looked sufficiently to the woman herself for assistance in its difficulties, and have made her too much a passive rather than an active factor. Practically all of the dangers that have accrued to the woman in childbirth, certainly many times more than have come from any other factor, have been due to well-meant but unfortunate attempts to help her while preventing her from helping herself. Before the middle of the nineteenth century most of the puerperal fever was due to infection from over-zealous but unclean attendants. Now men are proudly reporting hundreds of cases of delivery without even a vaginal examination. Above all, we have failed to take advantage of the occupation of mind that could be used to save women much of the anxiety and suffering of labor. If the parturient woman were allowed to change her position, as she does so naturally and frequently in a state of unsophistication, and to help actively, as she can {459} in many postures, in the delivery of her child, it would mean much in diverting her mind from pain which is emphasized by inactivity. The rule of having the woman lie on her back has been unfortunate in many ways and has required much more external interference than if other positions were adopted, while the pains have been more unbearable because that is actually the position in which the woman suffers most and in which she can do least to lessen them.
I was once told by an Irish grandmother the story of nearly one hundred deliveries without accident of any kind, in which the only rule had been not to touch the woman, but to allow her to change her position and, above all, to facilitate her in getting on her knees in a stooping bent-over posture so as to help herself. The upper mattress was doubled over completely and the woman was encouraged to kneel on the lower straw mattress, which was so arranged that it could be changed completely, or destroyed immediately after labor. This seemed old-fashioned and unscientific twenty years ago, when I heard the story, but I have been interested recently in reading Professor King's address on "The Significance of Posture in Obstetrics." [Footnote 38]
[Footnote 38: Bulletin of the Lying-in Hospital, Vol. V, No. IV.]
Professor King is sure that there are many advantages in following certain natural inclinations of the mother to change her position and that this helps her in many ways. Above all, as the psychotherapist sees at once, it will occupy her mind, keep down anxiety and lessen pain in many natural ways, besides encouraging concentration of attention on muscular effort instead of on painful sensation. The whole article is well worth reading, for in it he suggests that certain obstetrical operations, even version, would not be so often necessary, if the woman were sometimes allowed to assume the squatting position in the course of birth. His illustrations make very clear the help that changes of position are in the mechanics of many difficulties of labor. The pressure of the patient's thigh on the abdomen, when she was allowed to assume a squatting position, enabled him, in a case in which the woman had been in labor twenty-eight hours, in which ergot had been given by the midwife, in which the waters had been discharged and the uterus was tetanically contracted around its contents, to deliver the child without instrumentation and without further delay. In five minutes the arm (for it was an arm presentation) began to recede, and in twenty minutes the child was delivered, head first, and mother and infant both did well. Other cases with similar results have been reported by obstetricians quite as distinguished as Professor King. Many other experienced obstetrical teachers have expressed themselves to the same purpose in recent years.
Postures after Labor.—Allowing changes of position after labor also has its advantages. There is often retention of urine and this can be relieved by allowing the woman to assume the usual position. It may be impossible owing to the swelling and hyperemia in the neighborhood of her urethra for the woman to pass water, and yet if she is allowed to sit in the usual position upon a commode, she will in most cases pass her water in a few minutes without difficulty and the risks attending catheterization will be obviated. The power to urinate is due in these cases partly to the pressure of the thighs upon the abdomen which helps the bladder to contract and undoubtedly also to the suggestive influence that the position has.
NURSING
The attitude of mind of a woman toward her milk supply is important, as the flow of milk is closely subject to mental influence. The presence of the child and the consequent exercise of maternal instinct does more to bring about the prompt, healthy flow of milk than anything else. Sometimes women in the later months of their first pregnancy upon seeing a mother nursing her child have felt the flow of milk to their breasts not rarely with such painful overdistention of the milk ducts as to require artificial relief. On the other hand, a fright may stop the flow of milk or make it scanty and a mother's aversion to a child may prevent her being able to nurse it. The sight of the father of the child in a state of intoxication may have a similar result.
How much milk supply may be dependent on the state of mind, or at least the state of the nervous system, can be realized from the animals from which we obtain milk. Any serious disturbance is likely to interfere with the milk supply. When a cow's calf is taken away the animal will often refuse for a time to give milk. If a cow is scared, as by the attack of a wild animal, or by being hit though only slightly injured by an engine, it will often not have milk for several days or even longer. There is an impression prevalent among farmers that if a cow takes a dislike to a particular person they are not likely to "give down" as much milk as would otherwise be the case. This may be only a curious farmer tradition, that has no basis in fact, although it is supported by so many observations reported from many different countries that it is apparently to be taken as of scientific value.
In modern times many fashionable women do not nurse their children because they have not the proper supply of milk. It is easy to see how this can be brought about through suggestion from many sources and the sight of others neglecting their duty in this matter. Most fashionable women would rather not nurse their children, and yet many of them feel a bounden duty in the matter. Some of these, however, having heard that many mothers of the better class are not capable of nursing their children, easily persuade themselves that they come in this category, and so their whole attitude of mind toward nursing is one of extreme doubt. Knowing as we do how the mental state influences nursing we are not surprised when these women prove not to have sufficient milk in the early days of the nursing. If they are to have it they must look forward with confidence to nursing their children and they must be ready and willing to take such food and secure such fresh air as will put them in the best possible condition for this function, always with the thought that nothing can be better for a child than to be nursed by its own mother. Nature has made exactly the form of food suited for the particular child, and it matters not how healthy a wet nurse may be, her milk is not likely to be so suitable. Much depends on the nutrition of the child during this early susceptible period of its life and there is more that passes over with the milk than merely the food elements. It is well recognized now that the reason why nurslings are protected from most of the so-called children's diseases and the contagious diseases generally, is that, as a rule, their mothers {461} have had these diseases, have acquired an immunity to them and this immunity is transferred to the child so long as the nursing process is continued. This has been shown to be true over and over again in animals and holds good for human beings.
Professor Von Leyden, the distinguished professor of medicine at the University of Berlin, points out that we are not quite sure as yet just what may happen to the human race from the very general refusal of mothers to nurse their children and the almost universal substitution of the bovine mother; whether in times to come certain bovine traits, at least as regards susceptibility to disease, may not be stamped upon the human race, cannot be determined until this experiment in ethnology, now being conducted on so large a scale, has been carried to some definite conclusion.
Perhaps this view is groundless, but there is no doubt that milk is more than merely a food and that during the period after birth when the child's nervous system is being formed, the perfectly adapted mother's milk is more likely to be the proper food than anything that human ingenuity can elaborate. We have heard much in recent years of the tendency of education and civilization to lower the birth-rate and to make women less fitted for maternity and for such maternal duties as nursing, but stronger than any deterioration of the physical constitution by the mental development is the unfortunate unfavorable effect of mental suggestion upon such functions, by which the preparation of the organism for their fulfillment is greatly influenced. It is in this respect that the women of to-day differ from the woman of the past much more than in mere physical development.
CHAPTER II
MATERNAL IMPRESSIONS
"Maternal impression" is accepted as a specific designation to signify the real or supposed influence of emotion and especially serious trouble, which may affect the mother's mind during pregnancy and be transferred to the child in utero, with the production of deformities or mother's marks. There used to be an almost superstitious belief in the power of the maternal impressions to influence unfavorably the child in utero. With the newer developments as to the influence of the subconscious and subliminal there might well occur in some minds an exaggeration of these ideas with the production of much mental suffering at least, if not of more serious results.
Maternal Impressions in Old Literature.—The belief in the influence of maternal impression on the child in utero is so strongly fixed that to most people it will seem paradoxical to question the whole subject. The evidence for it, however, is quite trivial, and none of it rises above the grade of what may be explained by coincidence. But there are many apparently insuperable difficulties, from the standpoint of our modern scientific knowledge, with regard to the whole subject. If we take up the medical books and the popular science, or rather pseudo-science, and the folk stories of a century ago we find overwhelming evidence for the belief in maternal impressions. More recent {462} literature has but few examples, and the more the details are studied the less is the evidence of any kind that the mother's mind influences her unborn child. There is really no more reason why a child should he marked within its mother's womb than that it should be marked while nursing at the breast if something should happen to the mother at that time. This latter effect strikes one at once as absurd; the former, as we shall see, is exactly of the same nature.
Many of the older stories of maternal impressions are reported on no better grounds than the vomiting of snakes and the like, even live mice, which used to be found in old-time medical literature. It is true that there was usually no such morbidity about the stories of maternal impressions, but men wanted to find some explanation for the problem of the occurrence of deformities and markings and the maternal impression idea seemed satisfactory and inviting by its very mystery. The belief that animals could live for some time in human stomachs is now relegated to the limbo of old-time credulous traditions. Maternal impressions are on the same path and in twenty-five years they will be as great curiosities in serious medical literature as the gastric fauna of two generations ago. Under these circumstances prospective mothers who are anxious over possibilities and who have dreads of all kinds about their unborn children should be reassured and informed as to the scientific status of this important question.
Mother and Child Distinct Beings.—There is no direct connection between the mother and her unborn babe. No nerves run in the cord and none pass from the uterine tissues to the placenta. It is easy to understand the influence of mind on body under ordinary circumstances, at least the mystery has a rational explanation. The central nervous system rules the nutrition of the body. To cut off the nerve supply has as serious an effect as to cut off the blood supply. Owing to the existence of a chain of neurons, that is, a succession of nervous elements, instead of one continuous nerve fiber from center to periphery, it is possible for one of the neurons of the chain to be so disturbed that the conducting apparatus is interrupted and impulses do not flow. Hence, if a strong impression is produced on the mind with regard to a particular part of the body the neurons leading to it may be so disturbed that trophic nerve impulses do not flow down, the blood supply of the part may be disturbed through the vaso-motor system and consequent changes may take place.
Absence of Circulatory Connection.—Since no nerves pass, as we have said, from mother to babe, disturbances acting on the mother's mind can at most only influence the blood supply to the baby. Most people think that there is a direct blood supply from mother to child and that the mother's blood literally flows in the baby's veins. This is not true. The baby's blood is an entirely independent structure, originating in the child's own body, and always maintaining a distinct and quite different composition from that of the mother. The baby's blood has a higher specific gravity, and it has, in normal condition, nearly double as many red corpuscles to the cubic millimeter as the mother's blood. If the blood supply is disturbed by mental influences, then it is not the baby's blood nor its circulation that is disturbed, but only the circulation through the maternal part of the placenta where an exchange of gases and nutrient elements between mother's and baby's blood takes place. It is {463} impossible to conceive that during this passage through a membrane of nutrient elements, soluble proteids, gases, etc., mental influences should also pass over.
Supposed Examples of Maternal Impression.—The stories that are told would lead us to believe that somehow definite changes in the mother are reproduced in the babe. One case, which in a circle of friends that I knew very well made many a convert to the idea of maternal impressions, was that of a young woman at whom, during an early stage of her first pregnancy, her husband playfully threw a tiny frog. He did not know that she had a mortal dread of frogs. She was seriously frightened and put up her hand to ward off the animal, and as the clammy thing struck her palm she felt a shiver go through her. When her baby was born a curious growth that had some pigment in it and that, by a stretch of the imagination, might be considered to resemble a frog was in the baby's hand—the same hand, by the way, as that which the mother used to ward off the animal. The lack of any nervous connection and of any direct blood connection between mother and child makes the story simply absurd as an illustration of maternal impression.
In recent years such stories have come from more and more distant parts of the country. Kansas was the principal source of them until a generation of great editors arose there. Texas was then their favorite location, but Texas has in recent years become so progressive and so closely connected with the rest of the world that, in spite of its size, it does not produce so many of these wonders. A generation ago the announcement of the birth of six children at once in Austria, or somewhere else in Central Europe, would usually be followed by a report from Texas announcing seven at a birth. Maternal impression stories grew luxuriantly for the benefit of the news-gatherer in dull seasons. A standing type of them is that of the farmer cutting hay on his farm who puts his fingers too far into the hay cutter and has them taken off. His wife binds up the bleeding stump. She is pregnant at the time. When her baby is born—usually two or three months later—just the same fingers are missing on the same hand of the child. Now the mechanism by which such maternal impression could be transferred to the child is incomprehensible. There is no connection between the two, and the old metaphysical axiom (actio in distans repugnat) that all action between bodies at a distance from one another, that is without some connecting link between them, is absurd, holds as good in modern times as it did in the Middle Ages. Surely a tendency-to-amputation is not carried over from mother's blood to baby's blood through the membrane in the placenta just as are the gases for respiration and the nutrient elements for food. If it is, we have a greater mystery than ever to solve.
Period of Occurrence.—The infant in the uterus is fully formed before the tenth week of pregnancy and at a time when women are usually almost unconscious of the fact that they are pregnant. Such impressional changes as we have referred to, if produced after this, must be in the nature of backward growth or an inversion of trophic influences or a great perversion of embryonic life. They have nothing to do with the formation of the child, since that is completed. They are as much accidents as if the child should fall after it was born. We know how fetal limbs are amputated through the formation of amniotic bands, but that maternal impressions should influence the formation of these bands is of itself ridiculously absurd. That it should {464} influence them in a directive and selective way so that certain limbs may be amputated at a certain point reaches a climax of absurdity. A distinguished physician of our generation once said that one might as well hope to absorb a pencil case in one's vest pocket by medicine as to try to bring about absorption of fully formed connective tissue by drugs. We cannot think of any mental influence bringing about such absorption, yet to credit maternal impressions with the production of fetal amputations not only supposes the directive formation of connective tissue within the uterus, quite beyond the domain of the influence of the mother's nervous system, but also assumes the direction of the anomalous action of that connective tissue in its mutilating procedures in a very exact and definite way.
Some curious things have been explained on the score of maternal impressions and it is this very exaggeration that is perhaps the best proof of how coincidence, imitation, and other factors play a role that has exaggerated the idea of maternal impressions into a causative factor. A typical illustration is the case cited years ago, half in joke, perhaps, half in earnest, by a distinguished professor of obstetrics. It occurred in the days when the elder Sothern was playing Lord Dundreary to crowded houses and when Dundrearyisms were the current witticisms and Dundreary ties and Dundreary clothes and Dundreary whiskers were all the rage. A young woman who was recently married became much taken with the actor and went to see him over and over again, secured an introduction to him, and showed the liveliest interest in him and the performance. Their acquaintance, however, remained merely that of chance friends. Some months after it began, not more than five or six at the most, a boy was born to her. According to the story this boy, when he began to walk some years later, developed that little skip in his gait which proved so taking to those who crowded the theaters to see Sothern as Lord Dundreary.
By this time the play had lost something of its vogue and most people did not recognize the curious halt in the gait, but it was very clear to the mother and her friends. It was set down as due to a maternal mental impression. Mental transfer seems ludicrous in this case. It is much more likely that the mother was hysterical, and, wishing in a morbid way to attract attention to herself and her child, taught the boy the little skip, or perhaps some curious little skip once taken by the child attracted the mother's attention because of her memory of Sothern, and her surprise at the act impressed the peculiar action upon the boy's mind, who proceeded to attract further attention by repeating it. It is cases like this with their reductio ad absurdum of the whole process that have quite discredited the belief in maternal impressions.
Some Figures and Coincidences.—The occurrence of mothers' marks in connection with various external incidents of pregnancy are only coincidences. Most young mothers dread lest something should happen to their children. About once in a thousand times an infant is marked in some way. Nine hundred mothers rejoice over the fact that their baby is not marked in spite of the fact that they feared it might be, ninety-nine of them never gave the matter any thought and one of them finds to her sorrow that her foreboding has come true. Occasionally a mother who has not dreaded such a result finds that her offspring is marked. Then she recalls all the happenings of her pregnancy and picks out something to which she thinks she may attribute the accident. {465} There must be some reason for it and she finds it. Sometimes she begins by saying that it must be because she was frightened at such a time, or fell down at such a place, or saw such a thing, and then a week later she tells the story with circumstantial additions which make it very clear to her friends that she knows exactly the reason and that she had thought about it before and feared it might be so, though the whole matter was hazy until it had been talked over a number of times.
Coincidences have been the most serious detriment in drawing scientific conclusions in every department of medicine. Most of our diseases are self-limited and any medicine that was given being followed by recovery seemed to be the cause of that recovery and the more strictly self-limited a disease the greater the number of remedies. When stories of maternal impressions are analyzed it is found that a great many mothers have had forebodings as to their children being marked and their dreads have not come true. A few have feared and have realized their worst fears. Many women whose children are marked can recall no event in the course of their pregnancy which could have marked their child and they ask the doctor what he thinks must have been the reason. But unintelligent mothers can always find some cause by searching out unpleasant details of their experience during pregnancy.
Intrauterine Nutrition and Nursing.—To explain the occurrence of a frog-like appearance or a mousey patch on a baby as due to its mother having been frightened by one of these little animals while nursing would be the height of absurdity. But it is no more absurd than the supposition that mental impressions in the late months of pregnancy can have the effects that are popularly ascribed to them. If a mother suffers from severe fright, or even if she has a fit of intense anger or other profound mental disturbance, her milk may disagree with her infant. Every physician has seen nursing infants made sick by the change in the milk superinduced by strong mental emotions in the mother. This, however, could have nothing to do with the production of a special lasting physical mark on the outside of the body.
Maternal Solicitude and Superstition.—The wonderful stories that are told are nearly all in the older literature and are much more reasonably explained on the score of coincidence than on that of any possible direct connection of cause and effect. Mothers, then, may be reassured and made to understand that the better their own health, the less they worry about their condition, the more likely is their pregnancy to terminate favorably with a perfectly healthy offspring. This is the source of so much concern in the little world of child-bearing that it is worth while taking it seriously and making mothers understand that the old notions in this matter are but superstitions. Superstitions are not always nor exclusively religious, they are survivals from a previous state of knowledge, the reasons for which are now known to be false. Maternal impression, that is, the belief in the power of the mother's mind over the unborn child, is a superstition that we must now dismiss.
Favorable Maternal Influences.—Every now and then a sensational newspaper has an article on how mothers will tend to make their children physically handsomer by gazing at beautiful works of art, beautiful scenes in nature, and seeing only handsome (one feels like inserting well-dressed in the category, also) people during pregnancy. The reading of good books {466} containing moral lessons of the highest quality are supposed to have something of the same influence on the child's character. There is no doubt at all that the more carefully and simply and beautifully and healthily the mother lives, and the more her mind possesses itself in peace and happiness, the better will be her own nutrition and consequently that of her offspring, and, all things considered, this will contribute to the perfection of the infant's body and so give the best instrument for the expression of its soul. That these supposed favorable influences have any more direct power than this over the state of the infant that is to be is doubtful. It is worth trying for, but if the indefinite influence for good emphasizes, as it apparently does in many minds, the presumed direct and definite influence for evil, then it is not worth dwelling on.
Etiology of Deformities.—But if these curious deformities and markings are not due to maternal impressions, what, then, is their cause? To the question for many of the minor marks and slight deformities—naevi vascular and pigmentary, extra fingers, slight overgrowths, special peculiarities of bone and soft tissues—no satisfactory answer can be given. We must simply say that as yet we do not know. It is a good thing to say we do not know. Long ago Roger Bacon declared that the principal reason why man did not advance in knowledge more in spite of the amount of their work was that they were afraid to say "I do not know," and accepted inadequate reasons and insufficient authority in order to avoid this humiliating expression. On the other hand, there are many deformities and markings, the reasons for which have been found, and the more important they are the more we know about them, as a rule. Besides, with the advance of our knowledge of embryology we are getting to know more and more about these difficult problems and many things that were mysteries before are now clear. In addition to observation we have experiment and this is making observation more thoroughly scientific.
The more we know of the intricacies of the development of animals and human beings, the greater is our surprise that deformities do not occur even more commonly than they do. All the openings of the human as of the animal body gradually close in with the production of the finished form. The slightest interference with growth in the neighborhood of these openings, which involve nearly all of the front of the body, leaves various deformities. Nature has surrounded the developing embryo with fluid so that it is saved from jars of all kinds and from contact with other tissues that would disturb growth. Cell is laid on cell as brick is laid on brick in the building of a house, and the predetermined plan in the immense majority of cases is followed without accident to the minutest detail. That more mishaps do not occur, considering the delicacy of the process and the perfection of the finished structure, is hard to understand.
There are many factors likely to intrude in every pregnancy that may lead to the production of unfortunate results. Literally millions of cells are growing with apparent freedom from constraint in many portions of the fetus, yet all are directed with definite purpose corresponding to other cells and are destined to meet in due course of time. Each one of them or at least each group seems to be independent in its growth. Each growing cell doubles by dividing every few hours, yet all are co-ordinated to a definite end. We admire the men who begin at the two ends of a tunnel far distant from one another and work without any communication except through the engineer's plans {467} made long before, and yet make two bores that can be depended on to meet with but a few inches of divergence. The bridges of tissue that are built across the openings of the body jut out to meet one another in this way and in more than ninety-nine out of every one hundred cases there is not the slightest divergence. Many things may occur to disturb conditions—not connected with mental influences, but with distinctly physical factors—missteps, trips, jars on stairs or getting off and on cars, on the sidewalk, etc. These, and not the mythical factors that make up so-called maternal impressions, are the causes of deformities and mothers' marks.
SECTION XII
GENITO-URINARY DISEASES
CHAPTER I
PROSTATISM
It may seem impossible to include prostatic hypertrophy, or the train of symptoms connected with it, among those affections likely to be benefited by mental treatment. The history of this affection, however, and especially of its treatment in recent years since it has come to be the subject of special study, has furnished many examples of the value of suggestion in the relief of many of its symptoms. Many forms of treatment have been exploited for a time, attracting attention because of the cures attributed to them, and have then been relegated to the limbo of unsuccessful remedial measures. A striking example of the place of suggestion came with the development of organo-therapy some fifteen years ago. The succession of events illustrated well how much persuasion and a favorable attitude of mind might mean even in so purely physical an affection as interference with urination by enlargement of the prostate.
It was at a time when thyroid medication for myxedema having proved successful the medical journals were full of reports of other successful phases of organo-therapy. The spleen and the bone marrow were being used in the anemias, the ductless glands in various nutritional diseases and even extract of heart for heart disease. Just on what general principle it was assumed by some German investigator that possibly extract of prostate from animals might be of benefit in the treatment of prostatic hypertrophy is hard to understand. The German physician, however, gave an order to the butcher to send him prostates and as furnished they were administered to the patients. A number of patients began at once to improve on the treatment. They were able to empty their bladders much better than before, the residual urine was decreased, the tendency to fermentation was diminished and, above all, the patients' general symptoms were much improved.
The success was so marked that the German investigator published his cases and, with the public mind interested in organotherapy, they attracted wide-spread attention. He was asked how to obtain the material and only then did he take the trouble to investigate just what the butcher had been sending him. The description furnished the butcher by the doctor was that he wanted an organ lying below and somewhat in front of the bladder of the bull. It was found on careful inquiry that the abattoir attendants following these directions had supplied not prostates but seminal vesicles. As soon as this was found out some of the therapeutic suggestions failed. A number of cases, {469} however, continued to improve. German medical journals made fun of the whole proceeding and most people will consider the ridicule deserved.
Shortly before this time, however, we had had a very similar experience with another pair of organs. In spite of the fact that whatever we know about Graves' disease would seem to indicate that that affection is due to an increased thyroid secretion in the system, at the time of the organo-therapeutic fads, thyroid extract was reported as having been used successfully in the treatment of this affection. The name signed to the report was that of a trustworthy English clinical observer. A few practitioners of medicine got similar results, but most of them failed entirely to get his successes and some of them were sure that their patients were rather harmed than helped by the new medication. An investigation of just what material was being employed in the English cases showed that the butcher was supplying thymus and not thyroid glands. Suggestion did the rest, for thymus has proved to be quite ineffective, and the treatment was entirely expectant but acted on a favorable state of mind. Anyone who has had much experience with Graves' disease knows how amenable to suggestion the patients are. It would seem evident from the foregoing story of organo-therapy for prostatic hypertrophy that sufferers from prostatism are probably as prone to suggestion as patients with Graves' disease. This is all the more surprising as the two affections are so different in their etiology. Graves' disease being undoubtedly a ductless gland disease, while prostatism is due entirely to mechanical obstruction.
We have abundant additional evidence of the role of psychotherapy in prostatism. Some years ago a well-known American surgeon suggested that removal of the testicles would reduce the enlarged prostates. And much improvement was seen after castration in those who previously suffered from prostatism. The subject was carefully studied. Experiments were made on animals and the results seemed to prove that castration in them constantly produced prostatic atrophy. The fallacy probably came from the fact that at the time so little was known about the prostate in comparative anatomy and, above all, with regard to the prostate in dogs, that it was impossible to come to any sure conclusion as to reduction in weight and size after removal of the testicles. A number of prostatic cases were treated by different surgeons and with excellent results. Then after a time the number of supposed successes dwindled or proved to be failures and now no one does the operation. The only explanation that is at all satisfactory in these cases, is that the rest in the hospital, the favorable suggestion of reported cures and of an experimental demonstration on animals led many patients, some of them even physicians, to secure a better control over their bladders.
It took a good deal of persuasion as a rule to bring men, even men well beyond seventy, to consent to the sacrifice of their testicles, but once they did, the sacrifice brought a favorable suggestion to work and so it was not long before they were able to make their bladder act much more efficiently against the obstacles presented to its contraction. Some could be persuaded more easily to sacrifice a single testicle, but in these cases the mental influence was less and the reported cures fewer. After a time the operation of vasectomy was suggested as a substitute for the removal of the testicles. For a time even this in the hands of certain operators gave excellent results. Almost any other operation in the genito-urinary tract performed with the definite persuasion {470} on the part of the patient that he would be better after it would probably have acted just as favorably. The whole story of these series of incidents in the surgery of the last decade of the nineteenth century ought to be a clear demonstration of how valuable for therapeutic purposes is mental influence oven in prostatism, and how much we should try to secure its favorable effects.
Unfavorable Suggestion.—Since enlargement of the prostate has become a familiar subject of discussion and men know and hear much about it every now and then, one has to reassure a man but little beyond fifty that he is not suffering from this affection. Just as soon as a man begins to urinate frequently during the day and to have to got up once at night he begins to wonder how soon he will be likely to suffer from further symptoms of enlarged prostate. If he is of the nervous kind his worrying will soon give him additional symptoms that will confirm his suspicions. Probably one of the most familiar of phenomena, even to the non-medical man, is the ease with which worry and excitement causes frequent urination. Probably no system of organs in the body is so likely to be disturbed by the mind as the urinary system with the exception, of course, of the allied tract, the genital system, but the two are so one in union and sympathy that they cannot be separated in practice. The prostate is rather a genital than a urinary organ.
Urinary Worries.—When a man begins to worry about the possibility of bother from enlarged prostate and recalls that frequent urination is one of the symptoms of it, it will not be long before this symptom develops. Occasionally his first wakings to urinate at night or in the early morning are only due to passing conditions, either he drank freely shortly before bedtime or perhaps he did not drink enough. In the one case the bladder is rather full; in the other a concentrated urine, especially with the patient lying on his back, makes itself felt over the sensitive area at the base of the bladder, waking him up. The rest of the symptoms may develop as a consequence of solicitude over a few such incidents.
Practically all men who reach sixty have some tendency to more frequent urination than before. Their bladder does not hold as much fluid with comfort and they are likely to have to get up in the early morning. This does not necessarily mean any enlargement of the prostate nor any pathological change. The physiological change that takes place seems to be rather conservative than otherwise. Old muscles are less capable of extension and thorough reaction than they were earlier in life and in order that the bladder may not be over-distended nature makes it more sensitive than before.
Emptying the Bladder.—In the study of these cases individual peculiarities in the emptying of the bladder must be remembered. There are some men who cannot urinate if anyone is near them, and who even have to step into a closed toilet if they are to succeed in emptying their bladders when others are in the room. Some who find no difficulty in the presence of others in open urinals find it difficult or impossible to urinate when it is expected of them. Under worry and excitement urination may become urgent or imperative, but on the other hand some men find it very difficult to empty their bladders under an emotional strain. Now that much more is written publicly with regard to symptoms from enlarged prostate and much more is heard of the affection, many old men got worried and lose some of the power that they had over their bladder before, not so much because of their enlarged prostate as from the {471} psychic loss of control over their bladder. The viscus consists of a series of muscles, the fibres of which must be rather nicely coordinated and controlled in order to secure that complete contraction necessary for thorough emptying. A certain amount of residual urine occurs occasionally at least in many other persons besides those who have prostatic obstruction.
The Question of Operation.—In recent years there has been a tendency to suggest operation even on comparatively small prostates when symptoms referable to them are noted. Operations on the prostate have become much more easy and successful, and there has been the same sort of feeling about them among surgeons as there was when operations for affections, real or supposed, of the ovaries came into general vogue twenty years ago. I have seen patients in whom an operation for the removal of the prostate had been suggested, though the only symptoms were somewhat increased frequency of urination during the day and the necessity for rising two or three times at night. Such a suggestion, by calling the patient's attention strongly to his condition, emphasizes the irritability of the vesical tissues and is almost sure to bring about a considerable increase in the symptoms. The first principle of any treatment of irritability of the bladder should be the setting of the patient's mind as free as possible from solicitude. Any over-attention is sure to lead to reflexes and often to what seems to be even imperative urination, though with a little care and discipline much can be done for the relief of such symptoms.
The necessity for operation must be judged entirely from the symptoms of the individual patient and not from any hard and fast rule with regard to the size of the prostate. Prostates are eminently individual organs, at least as individual as the human nose, and their projection into the rectum is dependent on the relations of other tissues in the neighborhood as well as on mere size. Men have been known to live with comparatively few or no symptoms for many years, though at autopsy they proved to have what would ordinarily be considered a pathologically enlarged prostate.
Operations upon the prostate are valuable and indeed often afford the only avenue of relief from an intolerable condition. The results are not so encouraging in all cases, however, as to make recourse to operation advisable until a thorough trial of palliative measures has been made. It is surprising how often the confident suggestion of assured relief when accompanied by the same amount of rest in bed and the special care that is required for an operation, brings about a disappearance of symptoms that seemed inevitably to demand surgical intervention. There may be much residual urine, there may even be, as a consequence of this, some fermentation with cystitis, and yet a course of rather simple remedial measures may serve to bring about a period of prolonged freedom from vesical symptoms. If these patients, however, have heard much of the trials and sufferings of a catheter life, the solicitude aroused with regard to their condition is sufficient of itself to disturb their urination to a marked degree. Unfavorable suggestion is particularly serious in its effects in these cases, while favorable suggestion frequently repeated will enable the patient very often to regain bladder control when the developments present might seem to put that almost out of the question.