CHRONIC DIFFUSE PROSTATITIS.—As has already been asserted, the parenchymatous form of the disease is apt to be associated with a greater or less degree of diffuse inflammation. The severity of the symptoms is in direct proportion to the degree of diffuse inflamma tion present in cases in which the two conditions are associated. The symptoms of the diffuse form are obviously essentially the same as those already outlined, with, however, certain exceptions, due to a difference in the etiology of the case. In cases in which the glandu lar inflammation follows acute infection, which usually occurs in comparatively young subjects, the principal condition present is one of chronic inflammation of the glands and ducts of the prostate, and the symptoms referable to the urinary and sexual functions are more marked than in those cases occurring in middle-aged men in whom the gouty or rheumatic diathesis, high living, excesses, and a com paratively mild degree of infection are responsible for the condition present. In such patients the urinary symptoms may be compara tively mild until such time as mechanical disturbance of the function of micturition supervenes. In these cases, too, the discharge may not be present, although the urine may give evidence of a chronic inflam mation of the prostatic urethra of low grade. In some instances there is not only no discharge but the urine is absolutely normal. While in the parenchymatous form of the disease there may be little or no enlargement of the prostate, in the variety at present under considera tion the prostate is distinctly and sometimes considerably enlarged.
In both forms of the disease there is more or less tenderness upon pressure in the perineum, and decided tenderness with an urgent desire to micturate on digital pressure through the rectum. The psychic disturbance in middle-aged subjects with diffuse chronic inflamma tion of the prostate is either subordinate or entirely absent. Aberra tions of the sexual function, however, are frequently met with, although they are not likely to be regarded by the patient with the degree of solicitude characteristic of younger men. Digital examination is likely to show in these cases thickening and perhaps tenderness of the seminal vesicles and vasa deferenlia. This state of diffuse hy perplasia may be mistaken for the condition of arterio-sclerosis so strenuously insisted upon by Guyon and his school as the essential feature of prostatic hypertrophy; indeed, it may perhaps lead to arterio-sclerosis with its attendant interstitial fibrosis. The author is firmly convinced that chronic diffuse inflammation is the founda tion for many cases diagnosed as hypertrophy of the prostate, and that such chronic inflammation may be the result of abuse of the organ, not only by high living, but by sexual over-indulgence during the patient's earlier life.