Report of Seven Cases of Double 
Castration for Relief of 
Enlarged Prostate 
Gland. 
BY 
H. O. WALKER, M. D., 
DETROIT, MICH. 
REPRINTED FROM THE 
Neto Yorft iHeMcal journal 
for April 20, 1895. Reprinted from the New York Medical Journal 
for April 20, 1895. 
REPORT OF 
SEVEN CASES OF DOUBLE CASTRATION 
FOR RELIEF OF ENLARGED PROSTATE GLAND.* 
By H. O. WALKER, M. D., 
DETROIT, MICH. 
The operation of removing both testicles for the relief 
of symptoms consequent to an hypertrophied prostate gland 
is in its infancy, and is therefore claiming the critical at- 
tention of surgeons generally. Yet before it becomes an 
accepted or rejected procedure we must have cumulative 
evidence as to results, and this is my apology for offering a 
report of seven cases of double castration that have not 
heretofore been published. 
Case I.-G. B., aged sixty-five years, came into my care 
January 21st by advice of his physician, Dr. Campbell, of Lan- 
sing, Mich., with a history of enlarged prostate dating back over 
a period of nearly eight years. Has had to use a catheter for 
over a year past and has all the symptoms of an aggravated 
cystitis which I verified by vesical and rectal examinations, to- 
gether with a urinary analysis. He had lost flesh in consid- 
erable quantity, and the night before I saw him had slept but 
little on account of the frequent desire to urinate, and, as he ex- 
* Read before the Tri-State Medical Society, April 4, 1895, at St. 
Louis. 
Copyright, 1895, by D. Appleton and Company. 2 
DOUBLE CASTRATION FOR ENLARGED PROSTATE. 
pressed himself, was ready to submit to any operation however 
hazardous. Even death was preferable to his present condition. 
He readily assented to the removal of his testicles, which 1 did 
January 23, 1895, and, with the exception of a small haemato- 
cele, there were no untoward symptoms and he was able to be 
about in eight days. On the third day he could retain his urine 
for from three to five hours. On the eighth day the use of the 
catheter was discarded and the urine, nearly clear in character, 
was retained from six to nine hours. He left for his home on 
the twenty-first day following the operation, when I examined 
per rectum the prostate and found an appreciable diminution in 
its size. I received a letter from him two weeks ago in which 
he was not cognizant of having any difficulty whatever in pass- 
ing his urine. 
Case II.-P. B., aged seventy-one years, has had increasing 
difficulty in voiding urine for nearly fifteen years. Uses a cathe- 
ter and desires to urinate at intervals of from five minutes to 
an hour and a half. Examination revealed a very much en- 
larged prostate with a centric median bar holding behind it 
from two to three ounces of residual urine with the usual cystic 
symptoms. I removed both testicles February 6, 1895. Im- 
provement was appreciable within a week, holding the urine at 
one time nine hours and a half. Since getting up, however, 
the improvement has not been so marked, and at times he has 
to use a catheter. Yet the cystitis has nearly disappeared, as I 
found by examining the urine a few days ago, and there is a 
manifest relief in his condition. 
Case III.-A man, aged sixty-three years, has a history of 
prostatic enlargement of seven years' duration. Four years ago 
I removed from him by perineal section a median pedunculated 
growth of considerable size which was followed by a fair amount 
of relief for nearly three years, when the old symptoms gradu- 
ally returned to their former intensity with an almost constant 
reminder that he had to void his urine. After several consulta- 
tions with me he decided to have double castration done, which 
I did February 26, 1895. He left for his home two weeks after 
the operation with a decided abatement of his bladder symp- 
toms. A letter from him, dated March 29, 1895, states that DOUBLE CASTRATION FOR ENLARGED PROSTATE. 
3 
" there is but little pus in the urine, entire subsidence of pain, 
urinates but about once in four hours, and does not have to use 
a catheter." 
The cases just reported, although in one there is ap- 
parent cure and in the others evident improvement, are 
of such recent date that I should hardly feel warranted in 
offering dogmatic conclusions as to permanent results. I 
have, however, older and more reliable testimony as to the 
efficacy of this operation furnished by my old friend Dr. 
Horace Tupper, of Bay City, Mich., who writes me as 
follows : 
My dear Doctor: According to promise I made you while 
here, I have been looking up notes of the history of cases in 
which I did double castration, and here briefly transmit them 
to you : 
Case I was in a French Canadian, aged fifty-six years, who 
consulted me in 1877 for an enlarged and painful right testicle. 
Also frequent and painful micturition, necessitating the use of 
a catheter almost daily, and at times much oftener. I found by 
examination that he also had a very large prostate as well as 
the absence of the left testicle, which he informed me had been 
removed more than a year previous for supposed malignancy. 
Its removal had improved his micturition materially for several 
months, but the previous symptoms gradually returned with 
greater intensity than before, when he decided to have the 
other removed, which I did, although no cancer cells were 
found. By the time the wound had healed all the bl dder 
symptoms had disappeared. I saw him some years afterward, 
when he said he had had no further trouble with micturition. 
Case II, M. C., aged fifty-nine years, called on me in 1882 
suffering from painful testicles and persistent desire to urinate 
of several years' standing. I found a greatly enlarged prostate, 
lie had used a catheter for a considerable period, and had had 
the bladder aspirated for retention. His principal reason for 
visiting me was for the purpose of having his testicles removed, 
as he had been advised by several physicians to have the opera-  DOUBLE CASTRATION FOR ENLARGED PROSTATE. 
4 
tion done, since all other efforts to relieve the neuralgia of the 
testicles had been futile. On the second day after castration 
he was surprised to find that he could make water without his 
catheter, and in about two weeks there was but little bladder 
irritation remaining. Six months afterward he informed me 
that he could urinate as well as he ever did, and to my surprise 
he stated that he could enjoy intercourse more satisfactorily 
than he had for six years past, and, to use his own language, 
said: "I am sorry that I did not have the damned stones out 
before." 
Case III, B., aged fifty-eight years, consulted me in 1886 
concerning the advisability of having bis testicles removed for 
persistent and exquisite pain in them of ten years' duration 
He also gave a history of irritable bladder and a frequent use of 
the catheter. I found, on examination, both testicles enlarged 
and exquisitely sensitive, and a very large prostate. As it was 
the opinion of a number of physicians that castration should be 
done, I accordingly did the operation. He made a good recov- 
ery, entire relief from pain and freedom from all bladder trouble 
in three weeks following the operation. He left the city shortly 
afterward and I have not seen him since. 
Case IV was that of an old man that came to my knowledge 
through a consultation with the late Dr. Thomas, of Bay City, 
over ten years ago. The fellow was an inmate of the County 
House, confined there principally for exposing his person on im- 
proper occasions. Dr. Thomas was treating him at the time, 
not only for his mental condition, but for the distressing blad- 
der irritation due to an enlarged prostate gland. He was after- 
ward removed to his home, when another physician assumed 
charge of the case, and removed both testicles with a view of 
relieving his mania. The castration cured both the brain and 
bladder troubles. I have seen him frequently since, and he is 
perfectly well. 
Dr. Tupper's report is valuable evidence in relation to 
the operation of double castration. The operations were 
not done with a view of relieving the urinary symptoms, 
but were evidently done in the first three cases for the pur- DOUBLE CASTRATION FOR ENLARGED PROSTATE. 
5 
pose of relieving the neuralgia of the testicles, in the last 
one for the correction of the mental difficulty. 
Tt is not my purpose at the present time to burden you 
with an account of the development, anatomy, function, 
pathology, and surgery of the prostate. That is familiar 
to you all. Suffice it to say that the majority of enlarged 
prostates, when necessary, can be cared for by proper asep- 
tic catheterism, for I firmly believe that " dirty old cathe- 
ters " have been the source of the great majority of the cases 
of cystitis that we meet with in connection with hyper- 
trophied prostates than from any other cause. Aseptic 
catheterism is much better than antiseptic irrigation. 
Operative procedures for the relief of distressing symp- 
toms accompanying hypertrophied prostate are not always 
attended with any great " haven of rest," except wherein 
death follows in the wake of the operation. Prostatecto- 
mies are questionable in their results. Suprapubic or peri- 
neal drainage are simply palliative measures, the best of 
which is perineal, and do not materially diminish the size 
of the prostate, the great impediment to urination. 
Sir Henry Thompson aptly describes the condition of 
the patient after making a suprapubic section : " Now mark 
his condition. He was able to walk three or four miles a 
day, was free from pain, and his general health was on the 
whole good. But he had constantly to wear his silver can- 
nula, and supplemented his own faulty anatomy with the 
ordinary urinal worn by persons requiring such a conven- 
ience. Instead of the simple method of relief which nor- 
mally precedes sleep, this man had to wash out a large part 
of his urinary tract. First, he removed and washed his can- 
nula, then, I suppose, he cleaned out his rubber bag, and, 
lastly, the relics of his bladder." 
The restoration of the normal function of micturition 
has only been realized to a limited extent by the various 6 
DOUBLE CASTRATION EOR ENLARGED PROSTATE. 
operations done upon the prostate. We are therefore 
in a position to welcome any operation that promises a 
safer and more radical cure. The reports of castration so 
far are certainly promising. It unquestionably gives rest 
to the genital function of the prostate, lessens its size, first, 
by arrest of inflammation and oedema, and afterward grad- 
ual atrophy, as has been proved by castration of many 
of the lower animals. Indiscriminate emasculation will do 
much toward bringing this operation into disrepute. Sim- 
plicity of execution and limited danger will be a great 
temptation to the neophyte to do this operation. I fully 
agree with Dr. Belfield in his warnings against castration. 
Yet I am willing to trust to the experience of genito urinary 
surgeons to make out a diagnosis of the many conditions 
which may occur in connection with an hypertrophied pros- 
tate, and the " mistaken diagnosis " is no more likely to 
take place than it would with any of the operations upon 
the prostate. Time, however, and experience of operators 
will, at all events, settle the merits of double castration for 
the relief of the hypertrophy of the prostate gland. 
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