146 



PROSTATE GLAND. 



suddenly in a state of syncope, after having 

 been repeatedly bled, and in whom the cere- 

 bral veins and choroid plexus were found full 

 of air. M. Rerolle* has published several 

 cases of the kind, where profuse haemorrhage 

 had existed ; in one of fatal epistaxis, the 

 heart, arteries, and veins, contained large 

 quantities of air. Another of these is ren- 

 dered particularly remarkable by the fact that 

 the gas (subcutaneous) took fire with slight 

 detonation (as in M. Bally's case), and burned 

 with a bluish flame ; here the patient had 

 died of haemorrhage after removal of a tumour 

 from the back, and was examined six hours 

 after death, the thermometer (Reaum.) mark- 

 ing only + 2. Similarly Dr. Graves has 

 noticed emphysema of the abdominal parietes 

 in a sufferer from frequent epistaxis. 



In all this there is much mystery. M. 

 Rerolle conjectures that, in such cases, air is 

 absorbed by the radicles of the pulmonary 

 veins, the air would then have no claim to 

 be considered adventitious, and the hypo- 

 thesis is, perhaps, not to be rudelv rejected. 

 (Walter Hayle Walshe.) 



PROSTATE GLAND. (Corpus glandu- 

 losum ; TIpo(TTciTr]c, Gr. ; die Vorsteherdruse, 

 Germ. ; La Prostate, Fr.). The prostate is a 

 glandular body surrounding the neck of the 

 bladder and beginning of the urethra of the 

 male, deriving its name from its position in 

 front of the vesiculae seminales. It is situated 

 in the anterior part of the pelvis, behind and 

 below the level of the sy mphysis pubis, posterior 

 to the triangular ligament of the urethra, with 

 which it is connected by a continuation of the 

 latter with its capsule. It has the mem- 

 branous part of the urethra in front of it, and 

 somewhat below its level, and it rests upon 

 the anterior surface of the middle of the rec- 

 tum. The prostate is perforated by the ure- 

 thra, two thirds of the gland are below this 

 canal ; it inclines obliquely downwards and 

 forwards from behind, its apex being situated 

 rather below the base. 



In shape the prostate resembles a Spanish 

 chesnut, or the ace of hearts on playing cards, 

 and presents a base behind and an apex in 

 front ; it is compressed from before back- 

 wards ; its sides are convex, and its base is 

 notched. From base to apex the prostate 

 measures from an inch to an inch and a quar- 

 ter; from side to side, from an inch" and a half 

 to two inches ; and from half an inch to an 

 inch in depth from before backwards : a 

 healthy prostate weighs five or six drachms. 

 This measurement nearly accords with that 

 given by Dupuytren, who devoted much at- 

 tention to this subject, as having a most im- 

 portant bearing upon the bilateral operation 

 of lithotomy. 



A correct knowledge of the relations of this 

 body to the adjacent viscera is of the highest 

 practical importance. If, after the introduc- 

 tion of a catheter through the urethra into the 

 bladder, the finger be passed into the rectum, 

 * Theses de Paris, No. 129. 1832. 



and carried forward, the bulb of the urethra 

 is first indistinctly felt, behind which is the 

 membranous portion; whilst beyond this, and 

 still within reach of the finger, the prostate 

 is perceived. In the empty state of the blad- 

 der the outline of this body is usually distinct 

 enough ; but when the bladder is over dis- 

 tended with urine it becomes in a great mea- 

 sure confounded with the posterior surface of 

 this viscus, and cannot be easily distinguished. 

 To obtain a good view of the connections of 

 the prostate, a side view of the pelvis should 



Fig. 100. 



a, os pubis ; b, ischium ; c, bladder ; d, ligaments 

 of the prostate ; e, prostate gland ; /, posterior 

 false ligaments of the bladder ; g, ureter ; h, vas 

 deferens ; i, left vesicula seminalis ; j, rectum ; 

 k, a small portion of levatorani. 



be prepared in the ordinary manner, by the 

 removal of the left os innominatum, with the 

 soft structures in immediate connection with 

 it, leaving a small portion of the sym- 

 physis and ramus of the os pubis, together 

 with the spine and a part of the ramus of the 

 ischium. In this manner the levator ani is 

 first brought into view, at the upper edge of 

 which is seen the point of division of the 

 pelvic fascia into the vesical and obturator. 

 The levator ani has no immediate connection 

 with the prostate, for, although it gives it a 

 general lateral support, it is separated from 

 it bv the vesical fascia. Internal to the leva- 

 tor *ani lie the vesical fascia and the levator 

 prostatae muscle. The vesical fascia is con- 

 tinuous with the pelvic, it passes inwards over 

 the prostate, rectum, and bladder, inclosing 

 these structures in separate sheaths. Thus 

 the prostate gets a complete investment from 

 it ; this covering is above continuous with the 

 anterior true ligaments of the bladder, in front 

 it is connected with the posterior layer of the 

 deep perinaeal fascia, and beneath, the fascia 

 passes between the gland and the rectum ; 

 thus the gland is completely invested by a 

 fibrous capsule. This envelope incloses within, 

 it the prostatic plexus of veins, and the 

 blood-vessels and nerves of the prostate ; the 

 veins are continuous in front with the dorsal 



