ETIOLOGY - CHRONIC PROSTATITIS.
The causes of chronic prostatitis may be conveniently grouped in the following table: It is hardly necessary to expatiate upon the role of h.yperfumia in the etiology of chronic prostates. It is not likely that any of the factors enumerated as predisposing causes can whela acting alone pro duce chronic prostatitis. Several of them taken together may, how ever, act as exciting causes. Thus sexual excess and alcoholism in combination with the gouty or rheumatic diathesis, particularly if associated with exposure to cold, may produce chronic prostatitis. It must be remembered, however, that in by far the majority of cases in which these factors are apparently responsible for the chronic in flammation, some source of infection or of direct irritation of the, prostate exists. The more carefully these cases are studied, the more essential infection appears to be in the causation of chronic prostatitis, this being especially true of the follicular form. It is not denied that cases of chronic diffuse prostatitis are met with, espe cially in middle-aged men, where no history of gonorrhoeal or instru mental infection can be elicited. Careful inquiry, however, determines some source of infection in by far the majority of cases. The possi bility of auto-infection from deep urethral catarrh, brought on by the numerous predisposing factors which have been outlined, is here to be taken into consideration. Middle-aged patients who present them selves with symptoms of prostatic disease, and in whom upon exami nation an enlarged, moderately soft, tender, and obviously inflamed prostate is found, are usually gouty or rheumatic, are high livers, and as a rule acknowledge sexual excesses. That such a condition may be the foundation for senile hypertrophy of the prostate is highly probable. In some instances the development of chronic inflamma tion, particularly of the interstitial variety, is so insidious that the patient's attention is not directed to his condition until mafly years after the inception of the disease. He may or may not recall a gon orrhoea occurring during his years of indiscretion. If he does recall it, it is generally with the idea that he was perfectly restored to health after the gonorrhoea, when, as a matter of fact, the foundation for his present trouble was laid at that time. Cases are occasionally met with, on the other hand, in which a history of continuous vesical irritation is related and referred by the patient to his old-time gonorrhoea.
The injudicious passage of instruments into the bladder is often times responsible for chronic prostatitis. The instrumentation acts in two ways : (1) By producing mechanical irritation and hyperemia; (2) by carrying infection from the anterior urethra to the deeper parts of the canal. The hyperaemia excited by the frequent instru thenta,tion supplies the necessary susceptibility to germ infection. The microbes and their products conveyed by the instruments thus have an excellent culture-bed prepared for them. Irritation of the lower bowel and the bruising incidental to chronic constipation or frequent defsecation in bowel diseases are very potent factors in the production of chronic prostatitis. The slightest infection or expo sure superadded to the condition of irritation and hyperaemia already existing is likely to set up a low grade of inflammation which usually becomes chronic. The same may be stated regarding the effects of excessive indulgence in bicycling and horseback riding. The excit ing causes of chronic prostatitis which have been enumerated are with few exceptions effective only through the medium of infection. Even in the case of repeated overstimulation of the prostatic urethra by irritant drugs infection may play a very important role, secon dary, it is true, but none the less important. Infection, however, in such cases is probably not absolutely necessary to the production of inflammation. In the case of chronic suppurative prostatitis it is obvious that pus microbes play the most important part. The pyo genic germs may enter the organ by way of its ducts and glands or by ]ymphatic absorption. Lymphatic absorption is generally precipi tated by traumatic abrasion of some portion of the urethral tract most generally the prostatic portion. It may, however, in all proba bility occur through the unbroken mucous membrane. That it may occur by way of the general circulation is shown in certain cases of variola and parotiditis. In such cases the suppurative process is generally an acute one, yet it may be of a chronic character and is very likely to be unrecognized until serious damage has resulted. A fatal issue without special symptoms referable to the prostate is possible.