Reprinted from the Boston Medical and Surgical Journal 
of June 18, 1896.] 
GENITO-URINARY CASES.1 
BY GARDNER W. ALLEN, M.D., 
Surgeon, Genito-Urinary Department, Boston Dispensary. 
The following cases seem to me to present some 
points of interest, and are therefore briefly reported: 
J. B. has had vesiculitis a long time, the result of 
gonorrhea. During the first three months of 1895 he 
was treated by stripping the vesicles, with marked 
improvement. Early in June he had a mild exacerba- 
tion of urethritis, but this had practically disappeared 
by the 27th. On that day, while urinating, the stream 
stopped for an instant, and he then expelled from the 
meatus a mass of membranous-looking substance. On 
inspection it was seen to have numerous branches, 
some very long and slender, some finger-like, some 
clubbed. Under the microscope it appeared structure- 
less and transparent. It was examined by Dr. Coun- 
cilman, who said it was inspissated mucus and might be 
a cast of a seminal vesicle. In view of the history and 
the difficulty of imagining any other origin for it, this 
would seem the most probable source. During the 
next two weeks be passed a few similar but smaller 
masses; since then nothing of the kind has occurred. 
SEMINAL VESICULITIS. 
TUBERCULOSIS. 
Case I. A. H., age thirty-eight, without previous 
venereal history, on August 29, 1894, had a urethral 
* Bead before the Boston Society fpr Febru- 2 
discharge of six weeks' duration which, although ap- 
parently the result of coitus, had been very>slight from 
the beginning; no gonococci could be found. He also 
complained of partial loss of sexual power. His gen- 
eral health had always been good and he never had 
any pulmonary trouble. Rectal examination showed 
both seminal vesicles somewhat enlarged, soft and 
slightly sensitive. 
Three weeks later the right vesicle was about the 
same, while the left (or, perhaps, rather the ampulla 
of the vas deferens) had become very much indurated, 
forming a long, sharply defined, nodular tube, perfectly 
hard and unyielding. The prostate was normal. 
The urine was turbid and alkaline. 
Micturition gradually became frequent and painful, 
and the urine grew worse until, on November 5th, it 
was very turbid with a large trace of albumin and a 
heavy sediment containing pus, granular detritus and 
bacteria. By this time the induration of the left vesi- 
cle had diminished, but the left epididymis had become 
swollen, the globus minor being the size of a walnut, 
hard and nodular, but not sensitive. A week later an 
indurated nodule appeared in the right epididymis. 
Tubercle bacilli were found by Dr. Balch in the urin- 
ary sediment and in the fluid squeezed from the 
vesicles. 
From this time improvement set in. The urine 
gradually cleared up until in January it was practically 
normal. The induration of the vesicle and epididymes 
had then almost entirely disappeared. His general 
condition had also so far improved that he felt per- 
fectly well. He was seen in September and, although 
under treatment for iritis, had continued well in other 
respects, complaining only of sexual weakness. 
This patient was seen only at infrequent intervals, 
and what little treatment it was possible to give him 3 
seems to me to have been entirely insufficient to ac- 
count for his marked improvement, or rather apparent 
recovery, which, I believe, was due to hygienic influ- 
ences. He was a carpenter and worked out of doors 
all winter. 
Case II. April 14, 1895. G. R., age twenty-nine, 
has had gonorrhea two or three times, the last time 
three years ago; he never had any complications. 
Five months ago a painful swelling of the globus 
major of the right epididymis appeared, and gradually 
spread to the rest of the organ. The whole epididy- 
mis is now greatly swollen, hard and comparatively 
smooth, except at the upper part which is nodular and 
shows at one point a soft, fluctuating area just under 
the skin, apparently a small abscess nearly ready to 
break. The epididymis is not especially sensitive and 
the cord does not seem to be implicated. In the upper 
posterior part of the left epididymis there is a very 
small, sensitive, indurated nodule. The patient thinks 
the left testicle is growing smaller; right testicle not 
affected. Prostate apparently normal; right vesicle 
indurated and very sensitive. No trace of urethral 
discharge. No urinary symptoms; urine examined by 
Dr. C. M. Smith and found practically normal; no 
tubercle bacilli. Sexual function normal. General 
health good; never had any pulmonary trouble. 
Two weeks later the abscess had broken and was 
discharging slightly. The swelling of the epididymis 
had somewhat diminished, and it looked less inflamed. 
The nodule in the left epididymis had disappeared. 
Pus from the sinus in the epididymis at this time, and 
also another specimen taken a month later, were ex- 
amined for tubercle bacilli by Dr. Smith, with nega- 
tive result. 
Three months after the first visit the left epididymis 
swelled suddenly without apparent cause, and in a few 4 
days was greatly enlarged and extremely painful, red 
and tender, looking exactly like an ordinary acute 
epididymitis. There was no urethral discharge, nor 
even any shreds in the urine. This inflammation sub- 
sided somewhat, but then grew worse again and ex- 
tended up the cord, forming a very painful swelling 
in the groin. 
On August 9th, when last seen, this acute inflamma- 
tion had subsided again, leaving the epididymis indu- 
rated and nodular with a soft, red, fluctuating area 
over the globus major. Meanwhile an unsuccessful 
attempt had been made to heal the sinus in the right 
epididymis by laying it open and curetting. The pa- 
tient would not allow any more radical operation. 
A change of climate and an out-door life were ad- 
vised. 
In this case the diagnosis of tuberculosis was made 
by exclusion and based on the clinical history and 
course of the disease, and seems to me justified, al- 
though not confirmed by the microscope. 
I believe opinion is at present divided as to the ex- 
pediency of radical operation in cases of this kind. 
Dr. Alexander of New York has recently reported 
two successful cases of removal of both epididymes for 
tuberculosis. 
AZOOSPERMIA. 
A man, twenty-nine years old, was referred to me in 
December, 1894, by Dr. D. E. Baker of Newtonville. 
He has always been in good health and never had 
gonorrhea or any affection of the scrotal contents. 
No history of excess. He was married six years ago ; 
coitus has always been perfectly normal. Testicles 
small; otherwise normal. Seminal vesicles apparently 
normal. 
Dr. Baker writes: "This young man and one 5 
brother have small testes that can be pushed back into 
the abdomen. He is not impotent, but I am afraid he 
was born sterile ; brother also. I can find no sperma- 
tozoa in the somewhat thin and translucent fluid 
which he brought me." 
Dr. Baker writes again (February 21, 1896): "I 
have yesterday examined again the semen of Mr. , 
and find it has the appearance of thickened serum, 
somewhat turbid and without spermatozoa. He has 
never been excessive in the matter of coitus, and had 
been away three weeks on a business trip, this being 
the first connection subsequent thereto. I have exam- 
ined the semen three times, and the urine directly 
after coitus twice, without finding spermatozoa in 
either semen or urinary sediment. His brother re- 
mains sterile; two out of a family of five sons." 
This is apparently a case of congenital azoospermia, 
which is rare, and on this account, I think should be 
put on record. 
ACCIDENTAL CAUTERIZATION OF PENIS. 
A. man recently came to the dispensary with a penis 
much swollen and inflamed, and gave the following 
history. The previous night his wife, acting on the 
advice of friends and with the purpose of preventing 
conception, had injected pure carbolic acid into her 
vagina shortly before coitus. The husband, ignorant 
of this fact, experienced an unwonted burning and 
smarting during and after the act, but thought little of 
it, and soon fell asleep. In the morning he found 
large blisters on the glans, but no longer had pain. 
When seen the prepuce was retracted and very edema- 
tous, the whole penis was much swollen, and there 
was a large, perfectly raw surface on either side of 
the glans, most marked underneath. 6 
MASSAGE OF THE PROSTATE. 
September 21, 1895. C. S., age fifty-two, never 
had any veneral disease ; no history of excess. Dur- 
ing the last year on a few occasions he has had dis- 
agreeable nervous symptoms - dizziness and fulness 
of the head - after coitus, especially two or three 
times last spring. Three months ago he began to 
have a dull, burning pain at the end of the penis com- 
ing on toward the end of micturition, sometimes last- 
ing several hours, sometimes severe enough to interfere 
with work and sleep. The same pain is caused by 
jolting. Coitus sometimes seems to relieve it. There 
are also occasional disagreeable local sensations, cold- 
ness of perineum and nates, etc. 
Rectal examination showed the prostate slightly and 
asymmetrically enlarged, the left lobe being consider- 
ably larger than the right and very hard and smooth; 
not sensitive. Left seminal vesicle slightly enlarged 
and sensitive; pressure causes a strong desire to urin- 
ate rather than pain. Small amount of viscid substance 
squeezed out and passed with the urine. 
The next week there was marked improvement in 
the symptoms, and stripping of the vesicle was re- 
peated and continued weekly until it was apparently 
restored to a healthy condition. In the process the 
prostate was necessarily massaged more or less, and 
after a time I began to notice a marked change in this 
organ, the left lobe having become much softer and 
diminished in size. 
Attention was then directed especially to massage of 
the prostate, which has been given weekly ever since. 
It is now difficult to detect any difference in size of 
the two lobes which, although slightly enlarged, are 
of normal consistency. The symptoms have nearly 
disappeared.