DISEASES OF THE PROSTATE.
An exhaustive anatomical description of the prostate would not be in keeping with the character of this work, but it is almost impos sible to give a practical outline of the various diseases affecting this organ without a preliminary discussion of some of the main points of its anatomy and physiology. Especially is this necessary in view of the fact that our text-books upon anatomy are notably defec tive in their descriptions of this particular structure. Slight atten tion is usually given to the prostate in the dissecting-room, compara tively few students acquiring even a superficial knowledge of its structure and functions. Without entering into an elaborate discus sion of the views of those who believe the prostate to be essentially a muscle, or of their opponents who claim that it is essentially a gland, it will suffice to say that the prostate is a musculo-glandular organ, situated at the outlet of the bladder and surrounding the neck of that viscus. It lies behind the triangular ligament or deep perineal fascia and impinges upon the rectum, through the thin walls of which it may readily be palpated by the finger. The relation of the organ to the rectum is one of the most important of its gross anatomical re lations, having a very important bearing upon both the symptomatol ogy and diagnosis of prostatic disease. The close anatomical associ ation of the prostate and rectum very often results in coincidental disturbance in both organs, through the medium of the associated nerve supply, as a consequence of disease in one or the other.
In a general way, the old description of the prostate as resembling a horse-chestnut is quite accurate, as regards both shape and size. The organ measures on the average about an inch and a half in breadth, three-quarters of an inch antero-posteriorly, and somewhat less than an inch in thickness. The prostate is supported by the pubo-pro static ligaments, derived from the anterior vesical ligaments, the posterior layer of the triangular ligament, and the levator ani muscle. The organ presents the appearance of two moderately distinct lateral halves or lobes. The so-called median lobe is a misnomer, this structure being a pathological formation. It is not sur prising that such a mistake should be quite general when authorities state, as does one excellent anatomist, that the median lobe is a cause of obstruction in fully twenty per cent of prostates after the age of sixty. The prostate is tunnelled by the urethra and by the prostatic and ejaculatory ducts. On its floor is a longitudinal, highly sensitive, erectile structure, known as the veru montanum. This is supposed to be the principal seat of sexual sensibility. Upon either side of the veru montanum is a longitudinal depression, the prostatic sinus, into which open the prostatic ducts, some fifteen or twenty in number. At the anterior extremity of the veru montanum are situated the mouths of the ejaculatory ducts one upon each side. Just in front of the vent montanum is a depression known as the uterus masculinus or prostatic utricle, from its supposed homology to the uterus. The prostatic urethra does not traverse the prostate in the same manner in all individuals, the roof of the canal being barely covered in by prostatic tissue in some cases. It does not al
ways begin anteriorly in the centre of the prostatic apex, being occa sionally deflected to one or the other side, as shown by specimens in the possession of the author.
The length of the prostatic urethra and the direction of its curve vary greatly. In the average adult it measures about an inch and a quarter in length. Its curve is quite sharp and short in the child, is longer and more gradual in the adult. A knowledge of the normal curve of the prostatic urethra is of great importance in diagnostic explorations of the canal, inasmuch as pathological conditions of the organ or the tissues about the vesical neck produce alteration in the conformation or length of_ the prostatic urethra. The structure of the prostate differs somewhat in children and adults. The assertion has been made, and accepted, in certain quarters that children have no prostate. This, however, is incorrect. The difference between the child and the adult is mainly in the direction of the relative propor tion of glandular and fibro-muscular elements. Even in very young children the muscular elements of the prostate are sufficiently abun dant to give a sharply defined and prominent character to the organ. The glandular and fibro-connective-tissue elements, however, are not so abundant and well marked as in the adult. The veru montanum, ejaculatory ducts, and mouths of the prostatic follicles and the semi nal vesicles—which are so closely associated with the prostate and its functions—are capable of definite demonstration even in young in fants. The argument has been advanced that children really have no prostate, because, its function being purely sexual, there is no occasion for its development until such time as the sexual power manifests itself. This argument is not particularly logical, in view of the fact that the seminal vesicles and veru montauum, which are perhaps of more importance from a sexual standpoint than the glan dulo-muscular elements of the prostate, are disproportionately devel oped in infants. A superficial dissection shows that in spite of all argument very young children have well-developed prostates, a spar sity of the prostatic glandular tissue to the contrary notwithstanding. In a general way, however, it may be asserted that the prostate is of no great functional importance until the period of puberty arrives. Whether its muscular tissue is of importance in the function of mic turition, thus rendering the organ to a certain extent a urinary one, is a question which has excited much controversy. In the author's opinion, while urination might be carried on in the absence of the muscular tissue of the prostate, the organ nevertheless appears to have a distinct part in the physiology of micturition. While admit ting, then, that the prostate is to all intents and purposes a procreative organ, it would seem that it is a participant in the function of mic turition and should, therefore, receive consideration as a urinary organ as well.