HYPERAEMIA OR HEPEREMIA OF THE PROSTATE.
The line of demarcation between prostatic hyperaemia, active or passive, and true inflammation is often rather indefinite. From a pathological, and more especially from a clinical, standpoint, there are, nevertheless, many cases of prostatic disease which fall rather under the head of active or passive hyperaemia than of actual inflam mation. That conditions of hyperaemia predispose to, and are likely to terminate in, true inflammation, is well understood even by the tyro in medicine. Especially is this true of prostatic diseases involv ing local disturbances of circulation. This proposition is, therefore, taken for granted as a preliminary to the discussion of prostatic In perhaps the majority of cases of acute prostatic dis ease which fall under the observation of the practitioner, the diag nosis of prostatitis, acute or chronic, is made and allowed to pass without question. That no harm results therefrom in the majority of cases is simply due to the fact that the principles of treatment are essentially the same in both conditions. In some cases, however, there is little doubt that a true appreciation of the conditions pres ent would be of direct benefit to the patient, as in certain cases of passive congestion from venous obstruction. Measures calculated to relieve passive hyperemia are likely to prevent the development of true inflammation.
Active prostatic has its point of departure, as a rule, in disturbance either of the sexual function, or of the physiological act of micturition. The prostate is, from time to time, the seat of physi ological hyperaemia, as is true of all glandular organs. This attends sexual excitement, however such excitement may be produced. Under normal conditions the circulation resumes its normal status as soon as the source of excitement has been removed. The return to its nor mal circulatory condition is still more rapid when the sexual function has been performed in a normal manner. Prolonged excitement with out gratification is perhaps the most prolific source of prostatic hyperaemia. Frequent masturbation and sexual excess will also pro duce marked circulatory excitement of a more or less permanent character. The periods of rest between the acts of ejaculation are so
short that the circulation has no time to regain its normal equilibrium. Sexual excess and masturbation are still more potent factors in the production of pathological hyperaemia when associated with erotic mentality, alcohol and other elements of high living, or the gouty and rheumatic diathesis. If the causes of hyperemia be long continued, subacute or chronic inflammation will probably supervene.
The relation of sexual excitement to the production of morbid con ditions of the prostate should receive the greatest consideration. It should be understood that physical continence may be associated, so to speak, with mental incontinence, with resulting prostatic hyperaemia which may give rise to both functional and organic changes in the affected part. As will be seen in a subsequent chap ter, it is the author's conviction that prostatic from fre quently repeated and prolonged sexual excitement is an important factor in the etiology of prostatic hypertrophy. The importance of avoiding all sources of sexual excitation, both mental and physical, cannot be too strongly insisted upon in the management of all dis eases affecting the prostate and neck of the bladder.
A greater or less degree of prostatic hyperemia is probably an almost constant concomitant of urethral and bladder disease, whether acute or chronic, and is due in these cases not only to an inflamma tion of vesico-urethral mucous membrane rer se, but also to the frequent acts of micturition necessitated by irritation of the vesical neck. The termination of the act of micturition is characterized by reflex spasm of the cut-off muscle which is greatly exaggerated in the presence of hypeiwstbesia of the posterior urethra incidental to in flammation or reflex irritation of this structure. So vigorous is the 'spasmodic contraction of the muscles constituting the physiological cut-off that actual traumatism of the prostate results. There is a marked disturbance of the circulation and not only an active_hyperm mia, but a lessened power of resistance of both glandular and mus cular structure to sources of infection.