ETIOLOGY - TUBERCULOSIS OF THE PROSTATE.
In the primary cases it is possible that an hereditary or acquired tubercular predisposition may exist. But the most important and determining factor is usually chronic follicular inflammation. That the general health of the patient is usually below par, is a matter of almost universal clinical experience. In such cases the point of les sened resistance to bacillary infection is afforded by the long-contin ued chronic inflammation. In some cases the patient has either had no antecedent inflammation or he has been subject to acute deep seated inflammation involving the prostate and posterior urethra which has so long subsided that it seems unwarrantable to attri bute the symptoms of tubercular infection to the almost forgotten gonorrhoeal infection. In such cases it is possible that the tubercu lar infection is not preceded by chronic inflammation. It is probable, however, that hyperemia from sexual excesses, ungratified desire, or alcoholism, or any cause of pelvic or prostatic congestion associated with constitutional debility, may prepare the soil for infection. More
often the prostatic tuberculosis is secondary to tuberculosis of asso ciated organs, such as the penis, testes, bladder, kidneys. Secondary infection from testicular tuberculosis is the most frequent of all. In volvement of the prostate as a secondary feature of renal tuberculosis may occur in one of two ways : (1) By the lodgment of the bacilli carried downward by the urine; (2) In the same manner as in tu berculosis of the lungs, by infection through the general circulation. Prostatic tuberculosis secondary to infection of distant and unas sociatecl organs is obviously not of so great clinical importance as the preceding varieties, inasmuch as the primary infection, es pecially of the lungs and peritoneum, is usually intrinsically fatal, the prostatic tuberculosis being therefore chiefly of pathological impor tance, aside from attempts at palliation of the local urinary difficulty.