156 



PROSTATE GLAND. 



the calculus from coming in contact with the 

 sensitive neck of the bladder. But an obvious 

 inconvenience arises in other cases from the 

 difficulty of seizing calculi under such cir- 

 cumstances, in the operation of lithotrity ; and 

 after a calculus is broken up, it prevents the 

 escape of the fragments, and thus favours the 

 recurrence of the disease. 



Its influence on the rectum is felt in the 

 flattening of its cavity from before backwards, 

 and by its projection it causes the rectum to 

 rise up on either side of it. Haemorrhoids 

 and prolapsus ani are by no means unfrequent 

 attendants on enlargement of the prostate. 



On examining with the microscope sections 

 of an hypertrophied prostate with Mr. Quekett, 

 I found numerous crystals in its ducts, which 

 disappeared on adding dilute muriatic acid. 



Atrophy. The prostate is liable to atro- 

 phy, but the disease is rare. I have met with 

 it myself occasionally in very old persons. 

 When the gland is altogether diminished in 

 size it is usually more consolidated in its tex- 

 ture. It is, however, liable to another form 

 of atrophy (eccentric atrophy), by which I 

 mean a thinning of its tissue generally, and its 

 conversion into one or more cysts, in conse- 

 quence of continued pressure exerted by the 

 increase in size of calculous concretions in its 

 follicles. " Cases sometimes occur, in which 

 the whole of one lobe, or even the entire organ, 

 is converted into a thin fibrous capsule, the 

 proper substance of the gland being almost 

 wasted." (Crosse's Pathology.) In those cases 

 the ducts of the prostate are usually increased 

 in size, so as to arrest the progress of the 

 catheter. It generally occurs in connection 

 with urinary calculi, or long-standing stricture. 

 Dr. Baillie met with one instance of atrophied 

 prostate ; it occurred in a case of ectropium 

 of the urinary bladder, and malformation of 

 the organs of generation ; the utriculus pros- 

 taticus was larger than natural. 



Inflammation. Inflammation, acute or 

 chronic, not unfrequently attacks the prostate, 

 leading to increase of size, and suppuration of 

 the gland. It is very commonly the result of 

 suppressed gonorrhceal discharge, and follows 

 the employment of copaiba, cubebs, and power- 

 fully stimulating injections. The signs of this 

 condition are easily understood. With care- 

 ful and somewhat active treatment by leeches, 

 cupping in the perinaeum, warm fomentations, 

 &c., the disease terminates in resolution ; but 

 permanent enlargement or suppuration are the 

 too frequent consequences of inflamed pros- 

 tate. An irritable state, characterised by an 

 uneasy sensation referred usually to the end 

 of the penis, and attended by an increase in 

 the secretion of the gland, which can be drawn 

 out in threads, with a frequent desire ofmaking 

 water, indicates an inflamed condition of the 

 prostatic ducts. The discharge is occasionally 

 puriform in appearance. 



Abscess. If the inflammation be unsub- 

 dued, suppuration often occurs. The whole 

 tissue of the gland is, in some instances, in- 

 filtrated with pus ; in others a single abscess, 

 of large size, or numerous small abscesses 



occupy one or both lobes of the prostate. Sir 

 Benjamin Brodie relates an instance of an old 

 man, the subject of abscess of the prostate, 

 containing at least half a pint of pus, which 

 escaped through the catheter, after the urine 

 had been drawn off. Many similar instances 

 are recorded. These large collections are 

 generally the result of an attack of acute in- 

 flammation on an already enlarged prostate. 

 Smaller purulent deposits are met with in 

 various parts of the gland ; so that when after 

 death the pus is washed away, the prostate is 

 found riddled with holes. Such deposits are not 

 uncommonly associated with suppuration of the 

 vesiculae and the adjacent structures ; and are 

 frequently consequent on intense sexual ex- 

 citement and onanism. Lallemand gives many 

 instances of this, and relates one in particular, 

 where the urethral membrane was perforated 

 by numerous apertures, through which the pus 

 escaped, so as to present a sieve-like appear- 

 ance, which he compares to the cribriform 

 lamella of the ethmoid bone. Mr. Curling* 

 mentions a similar case of a young man ex- 

 cessively addicted to onanism, and who died 

 with symptoms of cerebral congestion. The 

 prostate was converted into -a multilocular 

 cavity, and the urethra was perforated by 

 numerous large apertures. These openings 

 are the orifices of the prostatic ducts preter- 

 naturally enlarged, suppuration most probably 

 commencing in the minute follicles of the 

 gland. A secretion -of a puriform fluid often 

 takes place from the prostatic ducts in cases of 

 severe attacks of gonorrhoea, and small ab- 

 scesses give way one by one. 



Abscesses of the prostate open in various 

 directions. Not unfrequently they burst into 

 the bladder on the introduction of the ca- 

 theter. Sometimes they open into the urethra 

 on the side of the veru montanum ; or they 

 make their way forward to the perinaeum, and 

 opening externally terminate in the for-mation 

 of perinaeal fistulas. Occasionally they open 

 at once into the rectum ; or they may burst 

 into the adjacent cellular membrane, and even 

 extend to the penis and scrotum. 



Ulceration. This mode of termination of 

 an inflamed prostate is rare. It is one of the 

 most distressing consequences of inflammation, 

 and is only found in cases of hypertrophy of 

 the prostate in old age. It may arise spon- 

 taneously, or it may be the consequence of 

 the rude introduction of the catheter. It is 

 invariably attended with most severe symp- 

 toms, and is generally indicated during life by 

 the mixture of blood with the urine. The 

 mucous membrane of the bladder adjacent is 

 in a state of high inflammation. Ulceration 

 may exist in various degrees, from simple 

 erosion, as after passing a catheter, to a deep 

 ulcer with indurated edges. In one case, re- 

 lated by Sir Benjamin Brodie, the prostate 

 was found ten or twelve times its natural size, 

 making a large circular projection into the 

 bladder, round the internal orifice of the ure- 

 thra. Nearly the whole of this portion was 



* Curling, on Diseases of the Testicle. 



