ETIOLOGY - HYPERTROPHY OF THE PROSTATE.
Few pathological conditions indeed have been the subject of a greater variance of opinion as to their etiology, than enlargement of the prostate. The opinions of authorities have varied from the ag nostic assertion that in the present state of our knowledge we are unable to determine positively the cause of the condition, to opinions as dogmatic as could be imagined. It is a noteworthy fact that most of the modern theories are fully as open to criticism as some of the more ancient views. Thus there is much of logic in the opinion of Home, who some seventy-five years ago promulgated the theory that the principal cause of prostatic disease was slow return of blood from the neck of the bladder, arising from the disadvantageous situ ation of the veins as regards their relation to the heart, which favors habitual congestion of these vessels. He held the opinion that this tendency to congestion was enhanced by high living, or any other circumstance which increased the circulation of the blood in this region. • Home believed that traumatism, such as is incidental to horseback riding, sometimes produced in deeper parts of the prostate a rupture of blood-vessels which was subsequently followed by hypertrophy. This rupture of vessels he believed to be in some measure analogous to apoplexy. He also assigned to old age a prominent role in the production of hypertrophy of the prostate.
Wilson, in 1821, indorsed the opinion of Home so far as the ten dency to the disease on the part of high livers was concerned. He seemed to think that strict celibacy on the one hand, and venereal excess ou the other, were alike potent in the production of the dis ease, although he admitted that exceptional cases occurred in which enlargement of the prostate developed in people who lived abstemi ous and temperate lives.
Sir Charles Bell asserted the existence of a predisposition to pros tatic enlargement, but did not state what constituted or caused this predisposition. Admitting that such predisposition existed, he be lieved that the exciting causes were associated with irritation of the bladder and the resulting frequent contractions of that viscus. As a
consequence of these contractions of the bladder, he believed that the urethral muscles were the seat of over-action, the result of which was to draw back the so-called median lobe in such a manner as to elevate it and constitute obstruction to the escape of urine.
Samuel Cooper frankly confessed that the causes of prostatic hypertrophy were unknown. He seemed to think from his experi ence, however, that people who led sedentary lives were more liable to the affection than others.
Astley Cooper arbitrarily stated that hypertrophy of the prostate was the consequence of old age alone, and not of disease.
Brodie seemed to think that enlarged prostate was a matter of course in old men. He believed that prostatic hypertrophy never becomes manifest until plainly marked evidences of senility have de veloped.
The late Dr. Gross expressed himself to the effect that prostatic hypertrophy might result from habitual engorgement of the organ incidental to protracted and repeated sexual intercourse, irritation from a vesical calculus, the free use of stimulating diuretics and alco holic or malt liquors, exposure to cold, the suppression of cutaneous diseases, gout and rheumatism, or traumatism, to the frequent in troduction of the catheter, and to habitual straining at stool, as in chronic diarrhoea and other affections of the bowels.
Mercier classed as predisposing causes all conditions and influ ences which favored sluggishness of the circulation. According to him, men of lymphatic habit, with plenty of cellular and adipose tis sue, have generally a lax and unresisting venous system. Such sub jects, he claimed, are most frequently the victims of prostatic enlarge ment. He believed that sedentary habits favor the disease.
Amussat stated that syphilis, a foreign body in the bladder, and stricture of the urethra were the most common causes of prostatic enlargement. It is observed, he claimed, chiefly in elderly persons who have for a long time used sounds or bougies upon themselves.