Desault held that enlarged prostate was very common in elderly men and those who have had numerous attacks of gonorrhoea. He also believed that the disease might bear a certain relation to scrofula and other cachexia3.
Civiale, in discussing the etiology of prostatic hypertrophy, placed vesical calculus first in the order of prominence. Second only to vesical calculus, he considered organic stricture of the urethra. He denied the relation of venereal excesses to chronic prostatic disease.
Coulson contents himself with the presentation of the views of others and has no definite opinion of his own.
Thompson expresses himself in the most unequivocal fashion as believing that prostatic enlargement is seen in young patients ; the organ in such cases becoming enlarged by interstitial plastic effu sion, the result of inflammatory action, while in old age there is unnatural development of the prostatic tissue proper, i.e., true hyper trophy. According to him the action of inflammation and its pro ducts does not favor growth, but is directly antagonistic to such a process. A prostate, therefore, which has been enlarged by inflam matory effusion is, according to Thompson, probably less likely sub sequently to exhibit an hypertrophic tendency. Nutrition is thus impeded, not encouraged. In brief, Thompson feels warranted in excluding inflammation from the list of causes. Urethral stricture and calculus are not considered by him to be of great importance in the etiology of prostatic hypertrophy. He does not believe that habitual engorgement of the prostatic and hemorrhoidal plexuses has much to do with the etiology of the disease. "True hypertrophy," according to him, " in any situation never has venous congestion for a cause; venous congestion impairs structure and predisposes to ulceration of the tissues affected by it, but it never augments vital force or stimulates growth." Upon this ground Thompson denies congestion as a possible ground of hypertrophy of the prostate. He further disputes the possibility of rheumatism, gout, or syphilis play ing any part in the pathological process. Regarding the effect of sexual excesses, he says : "Much influence has been attributed to the effect of habitual indulgence of this kind; but from the fact that the affection has been observed to occur in individuals known to have been remarkable for chastity, the opposite extreme of continence has been regarded as exercising a similar influence. In regard to the first, it appears reasonable to believe that repeated use might induce hypertrophy here as elsewhere. Without entering upon the ques tion of the prostatic function, it is impossible not to associate the organ with the sexual act, and admitting this it appears not to be easy to escape the inference that hypertrophy is likely to result from sexual excess ; yet facts do not favor this view. Hypertrophy does
not exist when the function is in greatest vigor and is not called into immediate existence by the most licentious excesses indulged in dur ing the prime of life, and it must be admitted that in any part of the body hypertrophy develops itself coincidentally with, or at all events immediately follows, the increased action which induces it." Although Thompson disputes the view that the prostate is truly a secreting gland, he admits it for the sake of argument, and claims that no other gland offers a pathological parallelism with hyper trophy of the prostate; all of its component issues not being in creased in their relative proportions. An enlargement of the gland may be due to an increase of glandular elements; or, on the other hand, to a change in the structure and an increase in the bulk of the "prostatic tissue proper." Thompson does not believe, furthermore, that an enlargement of the prostate is a simple muscular hypertrophy induced by increased action. He called attention to the close simi larity between the uterus and the prostate, and seems to think that " just as during the latter part of the period of reproductive activity the uterus is prone to develop new growths identical in structure with its own, a similar tendency will be found to develop new growths in the prostate at a corresponding period in life of the male." Thompson's tables apparently support the view which he promulgates by showing that hypertrophy of the prostate is a disease incidental to old age, but he fails to make clear the precise connection between advancing age and the development of prostatic hypertrophy. Even granting that old age is the chief factor in the production of the disease, there is yet much to be accounted for. Why should so large a proportion of elderly men present a condition so distinctly pathological, affecting an organ which in old age at least should. be practically of no impor tance from a physiological or functional standpoint? Thompson himself admits that hypertrophy of the prostate is not necessarily or even usually present in old age, but is rather an exceptional condi tion. According to him, a slight tendency to hypertrophy of the prostate undetermined during life may exist in about one in three individuals after sixty years, and that a marked enlargement may be met with in any one out of seven or eight after that age. Among forty prostates of elderly men dissected by Thompson only 32 per cent were appreciably enlarged, and but 2 per cent sufficiently so to have produced symptoms during life.