DISEASES PECULIAR TO MEN 647 



of the acute form of the disease. Enlargement of the 

 prostate is considered by some to be a necessary accom- 

 paniment of old age; bnt this is certainly not the case, 

 though it is probable that fully one-third of all men 

 who have attained the age of fifty years have more or 

 less enlargement of the part. 



Many persons have a considerable degree of en- 

 largement of the prostate without being aware of the 

 fact, the increase in size being so gradual that it is not 

 observed until so great a degree of obstruction to the 

 passage of urine is produced as to require a consider- 

 able degree of voluntary expulsive force. The size of the 

 stream is not usually lessened, but the force is greatly 

 diminished. The patient urinates with much greater 

 frequency than usual, and as the disease advances, 

 considerable irritability and discomfort in the rectum 

 is occasioned by the frequent and violent straining 

 efforts required to evacuate the bladder. After a time, 

 the obstruction becomes so great that the bladder can- 

 not be fully evacuated by any effort on the part of the 

 patient. When it becomes greatly distended, a small 

 quantity of urine may be forced out by violent efforts, 

 and during sleep a sort of overflow occurs, which may 

 be the first symptom to which the patient's attention 

 is seriously directed. The retained urine decomposes, 

 becoming alkaline, irritating the mucous membrane and 

 causing catarrh or inflammation of the bladder, and a 

 great variety of attendant disorders and inconven- 

 iences, which, if neglected, may lead to fatal results. 

 "We have frequently met cases of this kind in which 

 the bladder contained almost incredible quantities of 

 urine which had probably been retained for weeks. In 

 some cases, possibly the bladder had not been fully 

 emptied for months. 



