Few authorities at the present day attribute as much importance to prolonged irritation and habitual engorgement of the prostate from various causes as did the elder Gross, but it is the author's opinion that the etiological factors outlined by this distinguished surgeon were based upon sound reasoning and accurate clinical observation. Any condition of the urethra which gives rise to prostatic irritation and hyperaemia or to actual inflammation, may lead to permanent irri tability of the vesical neck, with a resulting increase in the frequency of urination which may become a permanent condition. - It seems reasonable that such a condition may produce, later in life, hyper trophy of the overworked prostate when, as is likely to be the case, undue sexual excitement or indulgence coexists with the urinary irri tation. The gouty and rheumatic diatheses probably bear a subordi nate relation to the etiology of hypertrophy of the prostate in certain cases.
In a general way, it may be said that the various etiological fac tors outlined are productive of prostatic overstrain, which bears the same relation to prostatic hypertrophy that a long-forgotten strain, experienced during early life, sometimes does to a stiffened and thickened joint in the aged. It is a matter of common experience that when an individual well along in years begins to lose that elas ticity which characterized his tissues in youth, when his joints begin to grow less mobile and he is inclined to rheumatoid and other senile difficulties, special complaint is likely to be made of so-called rheu matism or rheumatoid arthritis limited to some joint which has expe rienced an injury at some remote period. Many injuries experienced in youth, and long forgotten, are called to mind by some pathological change supposed to be incident to senility. It is hardly conceivable that so large a proportion of mankind should be affected with pros tatic hypertrophy- if there were no special causes for the condition such as those above-mentioned. Prostatic hypertrophy is certainly not a natural concomitant of advanced life, and it is probable that the various causes which have been mentioned bear the same relation to it that frequent child-bearing does to certain pathological condi tions of the uterus. It is a noteworthy fact that the majority of
authorities who do not frankly acknowledge that they are unable to assign the disease to any particular cause, dwell with greater or less emphasis on the dependence of the disease upon conditions which produce irritation and hyperaemia of the organ. It is also worthy of note that the operation of castration recently advocated for enlarged prostate, has in several cases been beneficial. This has a direct bearing upon the etiological views above outlined.
Prostatic enlargement, as shown in the résumé of opinions upon its etiology, has been attributed to stricture. Stricture of the ure thra is undoubtedly capable of producing chronic congestion and hyperplasia of the prostate—i.e., overstrain with resulting circula tory disturbance. Paradoxical as it may seem, however, the danger of resulting prostatic hypertrophy is inversely to the degree of ob struction. Strictures of large calibre in the penile portion of the canal produce proportionately greater reflex disturbance of the prostate than deep strictures of small calibre. A man who at the age of from thirty to forty develops a tight stricture in the deep urethra is likely to be perfectly protected from enlarged prostate in after-life. Irritation and congestion of the prostate occur, it is true, but hyper plasia of that portion of the organ which is most likely to produce urinary obstruction is prevented by the of the urine in the prostatic urethra during micturition. The author's experience in the performance of perineal section upon tight strictures in the musculo membranous region is that the prostatic urethra is often dilated, ap parently at the expense of the prostate itself, or at least that portion immediately contiguous to the mucous membrane lining the prostatic Urethra. The effects of pressure in producing relative prostatic atrophy are well shown in cases of calculi which become lodged in the prostatic urethra. There may be, it is true, compensatory hyper trophy of the remaining fibres of the prostate, but we must not forget what seems to be a logical analogy, viz., the hypertrophy of the heart followed by extreme dilatation which results from obstructive valvular lesions.