158 



PROSTATE GLAND. 



on section was found studded here and there 

 with cysts containing fluid. These are, in all 

 probability, dilated and closed follicles ; and 

 in this respect they bear a strong analogy to 

 the cysts of the kidney, which are found to be 

 dilated uriniferous tubes. 



In the situation of the uvula vesicae, the 

 fold of mucous membrane is occasionally 

 thrown up, so as to form a remarkable pro- 

 jection or bar at the neck of the bladder. Mr. 

 Guthrie especially directed the attention of 

 surgeons to this, but it has been met with 

 often by others, and there is a good repre- 

 sentation of it in Baillie's Morbid Anatomy. 

 No doubt it has often been confounded with 

 supposed enlargement of the middle lobe of 

 the prostate, with which it is often combined, 

 but of which, in many cases, it is wholly in- 

 dependent. In a surgical point of view it is 

 of very great interest. The bar in question, 

 in its most simple form, consists simply of a 

 double fold of mucous membrane, raised at 

 right angles from the bladder ; in other cases, 

 there is found between the layers of mucous 

 membrane a quantity of a substance of an in- 

 termixture of elastic and organic muscular 

 tissue, similar to what is found in the neck of 

 the bladder in the normal condition ; whilst 

 in other instances, apparently in the more ad- 

 vanced stages of the disease, the middle lobe 

 of the prostate, considerably hypertrophied, 

 is found as if it had forced its way between 

 the mucous layers, and thus carried the fold 

 with it ; in the latter condition, it will be 

 found in the form of two wing-like processes, 

 one on either side, connecting the middle lobe 

 to the side of the bladder. 



The disease is necessarily attended with 

 difficult micturition, and leads to retention of 

 urine. The diagnosis between retention from 

 this cause and from enlarged third lobe is 

 difficult, but practically it is not unimportant, 

 as Mr. Guthrie thinks it may be cured. In the 

 rough introduction of the catheter or bougie, 

 the bar is sometimes perforated. This sur- 

 geon found in one case as many as fifty cal- 

 culi behind this projection. It leads, if neg- 

 lected, to similar changes in the bladder, as 

 are found in cases of enlarged prostate. 



Prostatic Concretions. The formation of 

 calculous concretions in the minute follicles 

 of the gland are not by any means of unfre- 

 quent occurrence. They are not to be con- 

 founded with calculi of larger size, which have 

 been long recognised by pathologists, and 

 have been especially alluded to and described 

 by Baillie,Woollaston, Cruveilhier, and Prout. 

 They have very recently been examined by 

 Mr. John Quekett and Dr. C. H. Jones, the 

 latter of whom has published a paper on the 

 subject in the first number of the Transac- 

 tions of the Pathological Society, and in the 

 Medical Gazette of August 20th, 1847. The 

 following is the result of the microscopical 

 observations on this subject : The calculi are 

 found in great numbers in the follicles of the 

 gland, presenting sometimes a deep yellow or 

 red colour; occasionally they are pale and 

 colourless, remarkably small, and scarcely to 



be distinguished from the tissue in which they 

 are imbedded. Dr. Jones describes their 

 mode of formation thus : " They arise in a 

 large oval vesicle, of a single wall of homo- 

 geneous membrane. This is occupied by a 

 colourless finely-mottled substance, in the 

 centre of which a nuclear corpuscle some- 

 times occurs. Their mean diameter is about 

 _..i-_th of an inch. In those of larger size, 

 the envelope is still seen, but the contained 

 amorphous matter is beginning to be arranged 

 in layers concentric to the envelope. In the 

 further stage, the vesicles measure r^th of an 

 inch or more, showing concentric layers, which 

 are more developed on one side than on an- 

 other, like so many repetitions of the original 

 envelope, the intervals between the layers 

 being occupied by a finely-mottled deep-yellow 

 or red substance. There is a central cavity 

 corresponding with the external contour in its 

 form, which is triangular, with rounded angles 

 or quadrilateral. From this normal appear- 

 ance, these bodies present numerous variations 

 in form and internal arrangement, and appear 

 to occupy an intermediate position between 

 organic growths and inorganic concretions : 

 to the former, by their vesicular origin and by 

 their growth, which chiefly appears to take 

 place by the dilatation of the vesicle and suc- 

 cessive depositions in its interior ; to the 

 latter, by their shape, their tendency to become 

 infiltrated with earthy matter, and to pass into 

 the condition of a dead amorphous mass of a 

 deep yellow red, even almost black. The 

 chemical composition varies probably with 

 their different stages of development, at first 

 consisting of little else but animal matter, then 

 acquiring, especially when in a state of de- 

 generation, calcareous salts, stated by Dr. 

 Prout to be phosphate, with a little carbonate 

 of lime. The colouring matter is unaffected 

 by ether, liquor potassae, and muriatic acid." 



Fig. 107. 



Prostatic concretions. 



These minute concretions in the follicles 

 and tubes of the prostate have been investi- 



