Columbian Leprosy and Photographs of Three Pre-Columbian Skulls with Ten Huacos Potteries," I said: "In the first photograph, the one ccntaining the figure ly. ing on its belly, there is shown both feet amputated. The other four figuers have also amputated feet which is not seen in the photographs, for the figures are represented faced front and kneeling. By turning the real images front facing backwards, the amputations could be seen. The surgical flaps are shown in the clay, and even the two bones of the leg near the ankle at the seat of amputation. Whatever disease is here represented on the faces must have been accompanied by dis

off, as by a knife. In many figures we find there is partial or total loss of upper lip, eaten or cut away. Not drawn away by cicatrization as would be the case in lepers. One of the figures in the American Museum, has retracted head, this is accompanied by loss of nose and partial loss of upper lip. The same disease which here destroyed the nose and upper lip, it is reasonable to suppose afflicted the spine. Only Uta (skin-tuberculosis) could have worked thus-never leprosy."

One thing more. There is but a single pottery in the whole museum world that shows conclusively amputation of a single foot. The next nearest to such is the one I

eased feet. And amputation was frequently required for some reason, but not only of one foot, but of both. One of the figures is shown in the act of dressing the stump with medicine, the other extremity cannot be seen, as he is sitting on it. At least it does not protrude behind as he sits down. In many of the faces these images, the nose has been eaten away, irregularly. The fleshy and cartilaginous parts, up to the bridge is gone. In not a single instance does this eating away show any resemblance to leprosy. The bones are never melted away as in lepers, fallen in at the bridge. In every case the bony structure remains; only the soft part is absent, either gnawed away, or clean cut

have represented as dressing a foot with a cup of medicine, while the other's condition is hidden as he sits on it. Everywhere else where amputation is shown it is double. But the fact, that there is known even one foot showing unmistakably single amputation, makes us believe that many, if not most of the double amputations were performed one foot at a time. As the disease progressed, the other foot was probably later on amputated. In that single amputation, moreover, there is represented not so certainly that the nose and upper lip of the image are not intended to be shown diseased. The wings of the nose are represented widely spread out, and the mouth-angles of the upper lip are swollen

and overhang. It is possible that they are diseased, although no eating away can be observed as represented. There is another probability to consider, namely, that a disease usually of nose and upper lip might have involved the foot in this case.

In every vase of double amputation examined and published thus far, there was always represented at work an eating disease of nose and upper lip, and far advanced. Perhaps when the first foot only was amputated, the facial disease had not yet had time to show its eating stage, like when the second foot had been amputated. But this is problematical. In all my observations, there is never shown, on any Huacos pottery of Peru, a representation of amputated upper extremity or extremities. The hands of all the images, even where is shown the most horrible mutilations of face and feet are represented as perfect. Now if these amputations of feet were intended by the artist to represent punishment for crime, would they not also sometimes have shown amputation of hands? And what is most strange is that there is never shown a diseased hand? Surely if the feet were diseased by Uta, the hands too, exposed as they are just as much, to the ravages of insects, as the bare feet are, should as often, or more often, be the seat of the same disease, and to the same extent be damaged.

As clearly as I can see it, the explanation of this strange absence of evidence is as follows: Those ancient Peruvians had the belief that the soul after burial took a four days journey from the grave before it reached Paradise. Hence food and drink were buried with the corpse, to supply its needs while on this journey. That there is no hand ever represented amputated on a vase, is because the hand was needed to reach out for its food and drink. If the hands were mutilated on the vase, like the real hand of the corpse or amputated and represented amputated, the soul in its grave could not take up its drinking vessel, while journeying to Paradise.

Therefore, if the corpse had lost its hands, before burial, the potter would give it some artificial hands to use, otherwise the double or spirit of the departed one might die of thirst or hunger on its four days journey.

BIBLIOGRAPHY.

Albert S. Ashmead: Vorkommen von Aussatz in pracolumbischer Zeit in America. Verhandlungen der Berliner Gesellschaft fur Anthropologie, Ethnologie und Urgeschichte, 1895, p. 305–306. Ad hoc.

Virchow: ibidem.

Bastian: Vorkommen von Aussatz in America in pracolumbischer Zeit Verhandlungen etc. 1895, p. 165-366. Ad hoc. Virchow- ibidem.

Albert S. Ashmead: Photographs of two ancient Peruvian vases. with some particularities presented by them, and some observatione about them. "Journal of cutaneous and genito-urinary diseases," for November, 1905. Albert S. Ashmead: Pre-columbian leprosy. "Journal of the American Medical Association," 1895. Ext., 66 pages. Albert S. Ashmead: Prof. Bandeliers views on Huacos Pot

tery deformations and pre-columbian syphilis. "Journal of cutaneous and genito-urinary diseases," for February, 1896. Albert S. Ashmead: Pre-columbian leprosy. "Journal of the American Medical Association," April 10, 1897. Albert S. Ashmead: The question of pre-columbian leprosy: photographs of three pre-columbian skulls, and some Huacos pottery. Mitteilungen nnd Verhandlungen der internationalen wissenschaftlichen Lepra-Conferenz, im October 1897. Berlin 1897; Band I. Abt. 4. p. 71-75.

Virchow: Die von Dr. Ashmead (New York) aufgefundenen krankhaften Darstellungen an alt-peruanischen Thonfiguren, ibidem, Band II, 3. Sitzung vom 13. October 1897, p. 798. Ad hoc. Polakowsky: ibidem, Band II, p. 82.

Virchow: Die internationale Lepra-Conferenz in Berlin und die verstummelten peruanischen Figuren. Verhandlungen etc. 1897, p. 4.4-276. Ad hoc. Polakowsky: ibidem, p 470-477

Lehmann-Nitsche:; Ha exist do la lepra en la epoca precolombiana? Actas del primer Congreso Cientifico LatinoAmericano (en prensa). Vease el resumen en "La Semana Medica," Buenos Aires, Ano V, numero 228, Mayo 26 de 180s, paginas 182-183 Lehmann-Nitsche: Ha existido la lepra en la epoca precolombiana? Reproduccion del anterior (sin la discusion y sin la bibliografia) en los "Anales del Circulo Medico Argentino," tomo XXI, ano XXI, numero 7 y 8, paginas 196-198. Virchow, W. von den Steinen, Polakowsky (Bastian, Reiss, Stubel, Middendorf, Jimenez de la Espada): Discussion uber Die verstummelten Thonfiguren aus Peru." Verhandlungen etc. 1897, paginas 558.561. Seler: Nachrichten uber den Aussatz in alten mexikanischen Quellen. Verhandlungen etc., 897, paginas 609-611. Polakowsky Jimenez de la Espada), W. von den Steinen, Virchow: Discussion uber "Pracolumbischen Aussatz und verstummelten peruanischen Thonfiguren." Verhandlun

gen etc. 1897, p. 612-621.

Lemann-Nitsche: Lepra precolumbiana? de La Plata", tomh IX, p. 337-370.

"Revista del Museo

Una traduccion alemana de la mayor parte de este trabajo

08:

-: Pracolumbianische Lepra und die verstummelten peruanischen Thon Figuren des La Plata Museums vor dem ersten wissenschaftlichen lateinisch-amerikanischrn Con, resse zu Buenos Aires; die angebliche Krankheit Llaga und briefliche Nachrichten von Hrn. Carrasquilla. "Verhandlungen der

Barliner Gesellscha6t fur Authropologie, Ethnologin und Urgeschichte", 1899, p. 81-99.-Ad hoc. Virchow: ibidem, p. 99.

Polakowski: [Besprechung der Lepra precolombina?] "Zeitsch ift fur Ethnologie, 1898, p. 417-418.-"Petermanns Mitteilungen", 1899, Litteraturbericht, No. 518. p. 127; -: Ueber prakolumbianische Lepra. "Dermatologisches Centralblatt", 3. Jahrg. No. 2, 7 pp.

Fritsch: Zwei Aufnahmen von Lepra-Kranken. gen etc.", 1898, p. 41-142.

"Verhandlun

Polakowsky: Gab es eine prakolumbianische Lepra in Amerika? Petermanns Mitteilungen", 1898, No. 8, p. 188. Ashmead: Was leprosy Pre-Columbian in America? "Verhandlungen etc.," 1898, p. 448-492.-Ad hoc.

Virchow: ibidem, p. 493-494.

Bloch: Zur Vorges chichte des Aussatzes.

etc.," 1899, p. 205-215.-Ad hoc.

v. Luschan: ibidem, p 214;

Virchow: ibidem, p. 214–216.

"Verhandlungen

Ashmead: No evidence in America of Pre-Columbian leprosy. The Canadian Journal of Medicine and Surgery," March, 1899, 19. pp.

Richter: Zur Erklarung der altperuanischen Vasen, welche verstum melte menschliche Figuren darstellen. "Verhandlungen etc ', 1900, p. 44-237.

Ashmead: No relation between the leprosy and syphilis of Japan and Pre-Columbian America. Verhandlungen etc.", 1900, p 536.

- Pre-Columbian lupus (uta) and its surgical treatment by amputation of nose and upper lip, as represented on the Huacos pottery of Peru. The St. Louis Medical and Surgical Journal", Nov, 1900, 14 pp.

- Deformations on American (Incan) pottery not evidence of Pre-Columbian leprosy. "The St. Louis Medical and Surgical Journal", whole No. 724, Volume LXXX, April, 1901, No. 4, p. 177-19.

Uhle: Die Deformierten Kopfe von peruanischen Mumien und die Uta. Krankheit. "Verhandlungen etc.", 1901, p. 404-408. Ashmead: Pathological evidence of the Huacos Potteries of Peru Trans American Philosophical Society, Phil., Pa. 1904.

CHIGGERS.-Rubbing exposed parts with salt bacon before going where exposure is possible is said to insure immunity. As a remedy touch the spots with liquid camphophenique at intervals until healing is complete. Mercuric ointment is also used to this end.

President, LOUIS H. BEHRENS, 374? Olive Street Vice-Pres., WALTER C. G. KIRCHNER, City Hospital

Executive. A. Ravold, Century Building Entertainment, Frank Hinchey, 4041 Delmar Ave.

OFFICIAL

Publication, W. E. Sauer, Humboldt Building
Public Health, R. B. H. Gradwohl, 522 Washington Ave

FEMALE PROSTATE-ANATOMICO-SURGICAL STUDY.

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 have 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 embryology are offered as evidence:

"In the male the utriculus masculinus (the coalesced Müllerian ducts) enters the back of the first part of the urethra (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 ducts) enters the back of the vestibule (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 point 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 columns of cells which cluster together 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 voluntary 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 glands, and the vesiculae seminales (glands)1 anatomy, that the prostate gland, Cowper's 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 the 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 the exciting stage of passion, we will say for the purpose of lubrication, but not so with the larger ones until the orgasm occurs. From the limited investigation that the writer has 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 flow 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 fluid) 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 flow in the female that was sufficiently alkaline to neutralize the ordinary acid vaginal mucous membrane.

ter that the writer was not surprised not to be able, after considerable search to gain any information relative to the chemistry, or physiology of the female accessory-glandular fluid.

The study of the anatomy of the bladder and bladder appendages has never been more active than today, and it is not impossible that some things have been overlooked by our older anatomists, on account of their non-importance heretofore.

The new anatomies are giving the deep urethral glands of the female a passing notice, while the older ones are silent on that subject. Our recent works on the surgery 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 bladder and the meatus urinarus externus; placed latterly to the urethra, above the vesico-vaginal fascia and having ducts which empty just internal to the external meatus. When hypertrophic, the gland encroached upon the bladder neck. The changes 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 urethra is invaded. During this urethritis the deep urethral glands are constantly in danger. Should they become infected the pathology present is much similar to gonorrheal prostatitis in the male. Should 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 urethro-vaginal fistula which is practically a vesico-vaginal fistula.

The vesico-vaginal fascia is so thin and so lacking in tone quality that an abscess penetration of it is affected with no great effort. Should the urethra remain competent the drainage opening will close and the abscess will reform ad libitum until surgical help is called. Should this infection be not sufficiently virulent to produce a breaking down of the tissues, there will remain a passive inflammation that by the stimulating effect, within the ascinus, will produce an hypertrophy of the glands.*

See writer's article on Pathological Changes Resulting from Prostatic Enlargement, American Medicine, April 8, 1905.

The usual case comes late to the surgeon. Should' there be sufficient time to abort suppuration, the best procedure, in the writer's opinion, is to slit the ducts to the glands and cauterize the field with silver nitrate.

If suppuration is present, the abscess should be opened from the vaginal side and properly drained. After resolution has taken place if any glandular remnants remain, they should be taken away during the interval between the inflammatory crises, thus giving the operator a chance to avoid urethro-vagiual fistula. In case of urethro-glandular fistula, cauterization of the fistulous tract an abscess cavity should be done, followed by

an interval operation, if possible, after the urethra has healed. In vesico-vaginal fistula a plastic operation with the removal of all glandular remnants is indicated.

In all of these cases the bladder neck will be found inflamed and will need attention. The writer sees no reason why hypertrophy should need surgical attention unless it would happen to be like the case illustrated. Even with that condition present, the Fenwick operation with the large urethral specula for the removal of papalomatous growths in the bladder, could be utilized for the removal of the glandular lobule.

The report of three cases will give an idea of the kind of cases encountered by the surgeon that are due to inflammation of these glands.

CASE 1.-Mrs. "X." Operated by the writer several years ago for kidney stone, with recovery. About a year following operation she was infected by her husband with gonorrhea. On account of her innocence and unsuspecting disposition the writer was called late, and consequently got the sequela of the disease, which in this case was an acute adenitis of the deep urethral glands. Under treatment the inflammation subsided to a marked degree, leaving a passive inflammation with tenderness and some enlargement in that region. An operation for the removal of the glands was suggested, which was declined by the patient. The fact is that the patient is not aware of the cause of her trouble and, unfortunately for the writer, considers that it is a remnant of her old kidney trouble.

CASE 2-In consultation with a doctor of our city, Miss "Y." was examined. She gave a history of acute inflammation at the neck of the bladder. Emphatically denied gonorrheal infection. She was ordered to the hospital where a vaginal examination was made, at which time a slide was smeared with pus milked from the deep urethral glands. The pus contained Niserian diplococci; a cystoscopy was done the next day; neck of the bladder found highly congested; bladder washed and neck painted with silver nitrate; ducts of glands silt and cauterized with silver nitrate. Two weeks after leaving the hospital there was a recurrence of the adenitis, with suppuration. A cutting operation for drainage followed by the removal of the glands during the interval, was suggested; said suggestion caused the discharge of both the attending physicians and the writer. From our hands she landed in the hands of a thoroughly competent practitioner, who called in a surgeon, who was also thoroughly competent, but they failed to find the true cause of the trouble, "more's the pity,' and from these men the patient has drifted until finally, on account of their flowery promises, she has been attracted to the osteopath and the Christian Scientists. As this disease is entirely out of their sphere, the writer would not be surprised at no distant date to have the patient return for the surgical relief that was advised in the beginning.

CASE 3.-Was called to Detroit to see Mrs. Z. Gave history of infection of deep urethral glands seven years ago which was followed with abscess formation. Vesico-vaginal fistula followed the breaking of the abscess, leaving an opening larger than would admit one finger. She had been operated for the closure of the fistula five or six times by competent surgeons with negative results.

The writer proposes, in endeavoring to close the fistula, in this case, to do a suprapubic

cystotomy in two sittings. After cleaning the bladder thoroughly, to freshen the edges of the fistula, close same tightly with chromicised catgut, then cover over the whole fistulus region with a flap composed principally of the bulb of the vagina (patient being put to bed, lying on her belly, in order to drain the urine away from the wound). Should the closure be complete a urethral canal will be tunneled at another sitting.

THE TUBERCULOSIS CAMPAIGN IN CHICAGO. -A campaign to secure funds for the treatment of tuberculosis in Chicago was planned recently at the bi-monthly meeting of the Executive Committee of the Chicago Tuberculosis Institute. Although efforts are being made to secure donations for summer camps and other means of treatment, the physicians and societies interested in the work pin most of their hopes for adequate funds on the charter legislation. A committee, consisting of Dr. Henry B. Favill, Dr. Frank Billings and Mrs. Lenora Hamlin, of the Institute, was appointed to confer with the charter convention with regard to additional revenue for the Department of Health. The Institute has raised, through the auxiliary committee, $1,000 for a summer camp, but has been obliged to abandon its plan of having tents in one of the parks, the South Park Board having very properly declined to listen to a proposition to that effect.

THE NATIONAL FORMULARY.- The National Formulary bids fair to become, in a way, an actual rival of the United States Pharmacopoeia. It caters to the requirements of the average retail druggist in place of being ambitious to occupy a position as an authority for expert chemists and ethical professors. If the American Pharmaceutical Association recognizes its opportunities, the next revision of the National Formulary will contain a statement of the therapeutic action of each preparation, as well as the maximum and minimum doses. It will give, in so many words, the amount of each potent ingredient in an average dose of the heroic preparations. These are some of the practical improvements which will find their way into the every day hand-book of the dispensing pharmacist. The medical profession is crossing the border line between medicine. and pharmacy in its effort to find standard drug store remedies to prescribe. If the National Formulary titles are reduced to a manageable form, the preparations will meet with favor at the hands of the prescribers and increase the prescription trade of competent pharmacists.-Meyer Bros. Druggist.