Diseases of Prostate 4 1 5 



times he finds that he can more completely empty it by getting on to 

 his hands and knees. The pressure of the tumour against the lower 

 bowel gives rise to the sensation that defaecation is not complete, and 

 may cause the patient to go to the closet to void the urine. On account 

 of the straining at micturition and at stool, the enlargement is apt to 

 cause piles. Pressure against the rectum may even obstruct defaeca- 

 tion, and render the sphincter flaccid and the anus patulous. The 

 subject of enlarged prostate usually avoids a soft-seated chair, because 

 the yielding cushion, forced up against the perineum, presses on the 

 hypertrophied masses. Pieces of enlarged prostate have often been 

 removed through a median perineal incision, and McGill has suc- 

 cessfully excised with scissors and forceps, by a suprapubic opera- 

 tion, portions of enlarged prostates which prevented micturition. 

 Probably in most cases in which a vesical calculus is associated with 

 enlarged prostate, suprapubic lithotomy should be resorted to in order 

 that, at the same time, the projecting middle lobe may be nipped 

 off, as advised by McGill. 



Acute prostatitis is caused by extension of gonorrhceal inflam- 

 mation. The gland rapidly enlarges, and, blocking up the urethra, 

 causes retention. The patient is in dire distress, and neither hot bath 

 nor opium may afford relief. Examination by the rectum proves the 

 gland to be swollen and tender. With the utmost gentleness a soft 

 catheter should be passed and the water drawn off. Leeches may be 

 applied in front of the anus. Should suppuration follow, the prostatic 

 abscess will be likely to find its discharge into the urethra, bladder, 

 or rectum, or even through the perineum. The strong fascial covering 

 of the upper aspect of the prostate usually prevents the matter escap- 

 ing into the pelvis. Should the abscess break into the urethra, reco- 

 very is apt to be tedious, pus escaping during micturition, especially 

 towards the end of the act, when the gland is brought under the in- 

 fluence of the levatores ani. At other times by firm pressure in the 

 perineum and by appropriate manipulation, pus may be made to escape 

 from the meatus urinarius. 



In chronic prostatitis enlargement may be detected per rectum; 

 there may be irritability of the bladder, and a feeling of weight in the 

 perineum. From the follicular glands of the prostate filamentous 

 casts are shed, which float in the urine like vermicelli. 



THE MALE URETHRA 



From the neck of the adult male bladder to the meatus urinarius is 

 about nine inches. The prostate contains the first inch and a-half ; the 

 next half-inch is between the two layers of the triangular ligament 

 (membranous portion, p. 413), and the remainder is surrounded by 

 the erectile tissue of the corpus spongiosum (p. 385). That piece of 

 the urethra which is inclosed in the enlarged portion of the corpus 



