PROSTATE GLAND. 



159 



gated by Mr. Qnekctt, who, on submitting sec- 

 tions of the gland either in a healthy or dis- 

 eased condition, to microscopical examination, 

 has met with them so frequently, that they 

 would seem to be a part of the natural consti- 

 tuents of the gland or its secretion. He de- 

 scribes them as commencing by a deposit of 

 earthy matterinthesecretingcells of the gland ; 

 they increase in size either by aggregation, or 

 by deposition in the form of concentric layers ; 

 in the former case they mould themselves to 

 the follicles, in the latter they present the ap- 

 pearance of an ordinary lithic acid calculus 

 on section. Where many cells were together, 

 the parietes of the cells in contact are de- 

 stroyed ; so that by adding dilute muriatic 

 acid, and thus dissolving the earthy matter, a 

 multilocular cavity remains. In consequence 

 of the manner in which they mould themselves 

 to the follicles, they frequently present an 

 appearance externally like mulberry calculi.* 



The opinion of Prout that the deposition 

 of earthy salts is the result of a deranged ac- 

 tion in a mucous membrane appears thus fully 

 borne out. In a case which I recently ex- 

 amined with Mr. Qnekett the concretions were 

 exceedingly numerous ; and this was especially 

 remarkable in the middle lobe of the prostate. 

 The gland had been removed from a young 

 man who had died of phthisis, and was of the 

 natural size. The middle lobe was much 

 firmer than either lateral lobe They are so- 

 luble in acetic acid by the aid of heat. 



Prostatic Calculi. It is most probable that 

 these concretions undergo an early solution ; 

 thus yielding up their granular or amorphous 

 contents to form apart of the secretion of the 

 gland. Tins is the opinion of Dr. Jones. But 

 if they are not removed in this manner they 

 become the nuclei of prostatic calculi. 



Prostatic calculi are thus formed in the 

 gland, occasionally in immense numbers ; they 

 are generally rounded in form, and from 

 their pearly semi-transparent appearance, Dr. 

 Wollaston compared them to grains of pearl 

 barley. They become covered with a brownish 

 coating from a deposit from the natural secre- 

 tion of the gland. Continuing to increase in 

 size, they come in contact with one another, 

 and at the points of contact are as it were 

 articulated together. They are smooth upon 

 the surface, and often resemble porcelain from 

 the high polish they obtain. As they increase 

 still further in size they cause absorption of 

 the surrounding glandular substance, and thus 

 convert the gland into a multilocnlar bag, in 

 which as many as fifty or sixty calculi have 

 been seen. In this condition, if the finger is 

 passed per anum, the prostate gives the feel 

 of a bail of marbles. Sometimes there is only 

 a single large cavity in one lobe filled with a 

 single calculus. The smaller stones often 

 escape into the bladder through the dilated 

 ducts, and are readily extracted by theurethral 

 forceps. When divided they exhibit a radiated 

 and laminated structure; or they are com- 

 pact. 



* See Guy on Cause and Treatment of Stricture 

 of the Urethra, and Diseases of the Prostate Gland, 

 1845. 



From the analysis which has been made of 

 the prostatic calculi in the College of Surgeons, 

 it appears that the relative proportion of 

 phosphoric acid and lime in all the varieties 

 of these calculi appears to vary considerabty, 

 although they may, in all probability, be re- 

 duced to two salts, the neutral phosphate 

 of lime, or the diphosphate, which exists in 

 those varieties that are partially fusible hefore 

 the blowpipe, and which generally exhibit a 

 crystalline structure; and the basic phosphate 

 of lime which is completely infusible by the 

 mouth of the blowpipe. In estimating the fusi- 

 bility of these compounds, care must be taken 

 that none of the triple phosphate is present.* 

 When they pass into the bladder, they excite 

 irritation of its mucous surface, and become 

 coated with the triple phosphate; or if a large 

 stone remains in the prostatic portion of the 

 urethra, it may cause a deposit of lithic acid 

 on its surface from the urine which is conti- 

 nually passing over it. A single calculus 

 sometimes extends from the prostate into the 

 membranous part of the urethra, which be- 

 comes much dilated. In these cases the cal- 

 culus has usually an elongated, somewhat 

 conical figure, and consists of two or three 

 separate portions, which are closely adapted 

 to each other, and have polished articulating 

 surfaces at the point of contact. The rounded 

 extremity of one calculus is often received into 

 a corresponding concavity of another. These 

 calculi almost always contain a larger portion 

 of phosphate and carbonate of lime, than 

 those found in any other situation. When 

 the prostate is completely disorganised and 

 converted into a mere cyst, the calculi found 

 in its cavity are of the fusible character, or 

 contain more or less of the triple phosphates. 



It sometimes happens that the phosphates 

 are secreted by the prostate in immense quan- 

 tities, and are excreted with the urine, giving 

 it a milky aspect. This may be confounded 

 with a similar deposit from the urine itself, 

 but it is generally accompanied by symptoms 

 of irritation of the prostate gland and neck of 

 the bladder as discharge from the urethra ; 

 hence the diagnosis is not difficult. 



" Vogel, in his pathological anatomy of 

 the human body, has given an account of 

 these prostatic calculi : he described them 

 of small size, not larger than a pin's head, 

 and usually of a brownish, reddish-brown, 

 or yellowish-brown colour, presenting a 

 crystalline or laminated arrangement, with a 

 polyhedric or facetted surface. He says that 

 they are formed by a precipitate of phosphate 

 of lime. 



" Lassaigne has given an analysis of the 

 quantitative composition of these concretions. 

 Thus in 100 parts there are contained 



Basic phosphate of lime . . 84V5 



Carbonate of lime . . . 0*5 



Animal matter (mucus, &c.) . 15'0 

 It is presumed that they are formed by a de- 

 position of these salts when existing in excess 

 in the prostatic secretion. Similar concrc- 



* Catalogue of Calculi contained in the Museum 

 of the Royal College of Surgeons hi London, 1842. 



