CHRONIC FOLLICULAR OR PARENCHYMATOUS PROSTATITIS. —The nomen clature of this variety is based upon the same proposition which was laid down in the consideration of acute follicular prostatitis, namely, that the secreting glandular structures of the prostate and their ducts constitute the essential anatomical elements of the organ and should therefore be regarded as the true parenchyma. Chronic parenchy matous prostatitis necessarily involves the glandular structures of the organ and usually the prostatic urethra, the latter being the point of departure of the inflammation in nearly, if not quite, all cases. The mucous membrane of the prostatic urethra- may regain an approxi mately normal condition, while the glandular inflammation remains for an indefinite period. Chronic follicular or parenchymatous pros tatitis embraces a variety of erroneously diagnosed affections. Cysti tis, urethral stricture, neuralgia of the vesical neck, posterior urethritis, prostatorrhcea, spermatorrheea, and catarrh of the bladder constitute some of the diagnoses under which chronic follicular prostatitis is likely to masquerade. The disease may be associated with a certain amount of chronic diffuse inflammation; indeed, the two conditions are quite frequently combined. Many cases are met with in which the glandular inflammation is the essential condition, the interstitial involvement being a subordinate feature and apparently secondary to the glandular disturbance. In some instances chronic parenchyma tous prostatitis has been preceded by well-marked acute parenchyma tous inflammation associated with diffuse involvement of the pros tatic tissue, yet the interstitial inflammation has practically subsided without any appreciable improvement in the glandular inflammation. As has already been remarked in connection with acute follicular prostatitis, this form of inflammation of the prostate has a greater tendency toward chronicity than the interstitial variety.
Chronic follicular prostatitis is usually due to infection and fol lows as a rule the acute form of inflammation. In by far the larger proportion of cases the patient gives a history of gonorrhoea with some complication which has been referred to the deep urethra, bladder, or prostate. Broadly speaking, a patient who does not give
a history of some acute disturbance of the function of micturition during the course of a gonorrhoea is not very likely to be suffering from this form of prostatic inflammation. If, however, such a his tory be given it is safe to infer that some morbid condition of the prostate is still present. The exceptions to this rule the author be lieves to be very few. In some few instances, perhaps, the deep urethra becomes infected and the inflammatory process limits itself to the membranous portion of the canal. Such cases, however, must certainly be the exception. In by far the larger proportion of in stances the prostatic urethra and almost inevitably the glandular structures of the prostate become involved sooner or later in cases in which deep infection occurs. Once the prostate is infected, whether or not a diffuse inflammation develops, it is the author's firm con viction that a perfect restoration to health never thereafter occurs. The frequency of chronic inflammation of the prostate is much greater than is generally believed, as may be demonstrated by a careful dissection of a number of prostates taken at random, espe cially among hospital patients. When we consider the multitudinous glands and ramifications of ducts which constitute the most import ant part of the prostate and the poor facilities for drainage afforded these tissues, the prolonged duration of infectious processes is by no means remarkable.
The subjective signs of the inflammation depend largely upon the degree and duration of the inflammation of the prostatic urethra. The objective signs depend mainly on the degree of involvement ot the interstitial tissue. Careful examination may fail to detect any alter ation in the size, consistency, form and sensibility of the prostate even when well-marked chronic follicular inflammation exists. The uri nary symptoms having subsided and the prostate having apparently returned to its normal condition, as far as rectal examination enables us to determine, it will still be found that upon the slightest indis cretion or exposure the patient is likely to have attacks of vesical irri tation and tenesmus which usually pass as exacerbations of cystitis.