PROSTATE GLAND. 



157 



superficially ulcerated, and in some places the 

 ulcerated surface was incrusted with a thin 

 layer of coagulated lymph. 



Simple enlargement of the prostate is an- 

 other consequence of common inflammation. 

 It is one of the not unfrequent sequelae of 

 repeated and neglected attacks of gonorrhoea. 

 It is generally accompanied with induration, 

 and is confined to the lateral lobes, rarely im- 

 plicating the middle lobe. This condition is 

 occasionally dependent on the irritation or 

 stricture of the urethra, and subsides on the 

 cure of the latter disease. 



Tubercles. The deposit of scrofulous tu- 

 bercles in the prostate is rare. When this 

 happens it is generally found to co-exist with 

 similar deposition in the testicles, vesiculae 

 seminales, and the adjacent lymphatic glands, 

 and is associated with tubercles in the lungs. 

 It occurs occasionally in the form of one large 

 mass, occupying a large portion of the gland, 

 and causing an increase in its size, or many 

 small distinct depositions are found in various 

 situations. Scrofulous tubercles of the pros- 

 tate undergo the same progressive disintegra- 

 tion as in other parts, and terminate in ab- 

 scesses, which take a similar course and 

 direction as common abscesses. I have seen 

 the whole tissue of the gland broken down by 

 the gradual softening of scrofulous tubercles. 

 Mr, Cross, of Cincinnati, met with one in- 

 stance of this disease ; it was in a young man 

 who died in the Cincinnati Hospital of psoas 

 abscess. There were six or eight small masses 

 of a pale yellowish colour, and of a soft curdy 

 consistence, scattered through different parts 

 of the gland, which was considerably reduced 

 in size ; he thinks they are originally formed 

 in the follicles of the gland. Lallemand also 

 mentions a case in which thirty small abscesses, 

 and the same number of crude tubercles were 

 found in the prostate. There were similar 

 deposits in the kidneys. 



Cancer. Cancer in any form is extremely 

 rare in the prostate. Carswell regards it as a 

 not uncommon cause of haemorrhage from 

 the urethra, whilst Cruveilhier says that he 

 has never seen an instance of it. (Walshe on 

 Cancer.) The encephaloid form is that which 

 most commonly attacks this gland ; and, ac- 

 cording to Walshe, in M. Tanchon's tables, 

 out of 8289 fatal cases of cancer, in five death 

 occurred from the disease in the prostate. 

 Rokitanski regards the affection as very rare, 

 and makes allusion only to the encephaloid 

 variety. When the disease attacks the pros- 

 tate, the gland becomes increased in size. It 

 has been found by Mercier of the size of an 

 ostrich's egg, " and was attended with effusion 

 of blood into both lobes, communicating with 

 each other and with the urethra by means of 

 false passages." In a boy, five years old, Mr. 

 Stafford found the prostate of a globular form, 

 and as bulky as the largest walnut ; the mid- 

 dle lobe was nearly as large as a small hazel 

 nut. (Walshe.) 'By the same author, a case 

 is recorded from Langstaff of an encephaloid 

 growth as big as an orange, which sprang 

 principally from the middle lobe. Cancer of 



the prostate, as it advances, generally makes 

 its way towards the bladder, and thus forms a 

 bleeding mass in the cavity of that viscus, oc- 

 casionally filling it up completely, and giving 

 rise to a distinct hypogastric tumour, which! 

 have known mistaken for a bladder over-dis- 

 tended with urine, the true nature of which 

 was not suspected until after the introduction 

 of the catheter. The cancerous mass at its base 

 was surrounded with a distinct border of ulcer- 

 ation, so characteristic of cancerous tumours, 

 when they have made their way into cavities 

 lined with mucous membrane. 



The secretion of urine is frequently, under 

 this condition, in a great measure suspended. 

 I have known one case where the bladder was 

 tapped above the pubis, under the idea that it 

 was filled with urine ; but little or no urine 

 escaped, and after death the bladder was found 

 filled with a cancerous tumour originating in 

 the prostate; and no doubt many such in- 

 stances have happened. It is a mistake of 

 no very serious consequence, but might be 

 avoided if a careful examination of symptoms 

 were instituted. If an elastic catheter were 

 gently introduced into the bladder, it would 

 be found to give the impression as if it entered 

 a spongy substance, h'ttle urine would escape, 

 and that tinged with blood and mixed with 

 shreds of cei ebriform matter : if doubt still 

 existed, a microscopical examination of the 

 substance voided would, I apprehend, set the 

 matter at rest. The introduction of the finger 

 per rectum will assist the diagnosis. 



True scirrhus of the prostate is extremely 

 rare. Mr. Travers and Sir Benjamin Brodie 

 both allude to supposed cases of this disease, 

 and from the narration there can be little 

 doubt of their genuineness. The former sur- 

 geon examined one case after death, and 

 described the gland as occupied by a tumour, 

 having all the character of scirrhus ; and 

 the latter mentions an instance " where the 

 prostate was found much enlarged, and of a 

 stony hardness." (Walshe.) 



Fibrous tumours, according to Rokitanski, 

 are frequently found in the prostate. They 

 are of a size varying from that of a pea to 

 that of a hazel nut, are round or oval, causing, 

 when seated at the peripheral portion of the 

 gland, knotty protuberances on its surface. 

 They are always attended with distinct hyper- 

 trophy of the gland. This eminent patho- 

 logist attaches great interest to them, on 

 account of their similarity to fibrous tumours 

 of the uterus. They are of very frequent oc- 

 currence ; and in many cases of the enlarged 

 prostate of old men that I have had an op- 

 portunity of examining, I found them readily 

 distinguishable on section. This subject has 

 been alluded to before, in the account of the 

 morbid anatomy of the enlarged prostate. 



Cystic Prostate. The prostate, like the 

 kidney, is occasionally the seat of cystic 

 disease. It is characterised by the formation 

 of cysts in various parts of the gland. It is 

 extremely rare. There is an excellent exam- 

 ple of it in the Museum of the College of 

 Surgeons. The gland was hypertrophied, and 



