NEUROSES OF THE PROSTATE AND REFLEX NEUROSES OF PROSTATIC ORIGIN.
When we consider the abundant nervous supply of the prostate and its environs, and especially its liberal endowment with sympa thetic nerve filaments, with its resulting intimate association with the rectum, bladder, and other viscera, it is by no means surprising that nervous phenomena of various kinds, referable directly or indirectly to disturbance of the prostate, should occur. It is true that many neurotic disturbances which the author believes should come prop erly under the head of neuroses of the prostate have their origin pri marily in demonstrable organic disease. The clinical fact, however, remains, that pronounced nervous disturbance, such as direct or reflex pain, and in some instances considerable psychical disturbance may persist and constitute the principal source of disquiet long after the primary organic cause has completely or in great measure sub sided. In either case the primary condition is of so little moment that there would be little or nothing to attract the attention of the physician were it not for the disproportionate nervous disturbance which results.
In using the term neurosis, the author is well aware that a certain element of ambiguity must necessarily enter into the consideration of the subject, but in the present state of our knowledge of disease, in the light of practical clinical experience, and more especially to subserve the purposes of an intelligent therapy, it would seem that the term neurosis is sufficiently clear and comprehensive.
In considering neuroses of the prostate, there are four points to be borne in mind : First, the physiological and anatomical analogy between the prostate taken as a whole and the uterus. Second, the relation of the prostate to the function of urination. Third, the sex ual function of the prostate. Fourth, the intimate association of the prostate with the rectum, anus, seminal vesicles, urethra, and bladder.
Neuralcria and ITypercesthesia.—Neuralgia of prostatic origin, un attended with evidences of organic disease or associated with very slight organic changes, is by no means rare. It is probable that a certain degree of hyperemia exists in by far the majority of cases of prostatic neuralgia, yet a disturbance of the circulation does not seem to be absolutely necessary in such cases. Hypermsthesia of the prostate is usually limited to its urethral portion and is very frequently met with. Hypermsthesia and neuralgia are often asso ciated, the former being the more likely to exist alone.
The causes of neuralgia and hypersthesia of the prostate are : (1) Sexual excesses and masturbation. (2) A gouty or rheumatic diathesis; this constitutes a very potent predisposing factor.
(3) Traumatism of the prostate, surgical and accidental. (4) Acute or chronic congestion from various causes. (5) Acute or chronic in flammation of infectious origin. (6) Urethral disease, notably stric ture. (7) Foreign bodies or tumors in the bladder. (8) Psychical disturbance with an attendant element of mental suggestion inciden tal to, (a) ignorance of sexual physiology and the influence of quack literature; (b) injudicious and perhaps unnecessary treatment of the sexual organ under suspicion; or, (c) the prolonged duration of mental disturbance produced by actual organic disease. These cases are especially liable to be associated with hyperaemia. Prostatic catarrh is also a frequent concomitant.
It would be difficult to disassociate the local irritation produced by highly acid urine in gouty and rheumatic patients from the exag gerated nervous sensibility produced by the constitutional effects of lithmmia. Many cases are found, however, in which neuralgic pain, referable to the perineum, anus, neck of the bladder and urethra, is experienced by lithmiaic patients in whom the correction of the acid and irritating properties of the urine is not followed by appreciable benefit until alkaline and anti-lithic remedies have had sufficient time to appreciably modify the diathesis present. The author has under observation at the present time the case of a gentleman forty-five years of age, who has been for some years annoyed by neuralgic pain of the kind described, associated with intense hypersthesia of the pros tatic urethra. He is particularly annoyed by persistent erections at night, and irrespective of the reaction of the urine the act of urina tion gives him considerable pain. Careful examination of the bladder and the urethra by means of the endoscope, cystoscope, and mechani cal exploration fails to reveal any organic condition which will explain his symptoms. There is apparently no disturbance of the kidneys which might by reflex irritation constitute the etiological factor in the case. As far as can be determined, the origin of the difficulty in this patient was a gouty constitution associated with strictures of large calibre. The latter were operated upon by the author some years ago with perfect success in every respect, save in the failure to ameliorate what to him appeared to be the most annoying condition. Similar symptoms are often produced by rectal or anal irritation, but this was not present in this case. Pain of a neuralgic character, ref erable to the perineum and neck of the bladder, and perhaps radiat ing into the testes, is by no means an unusual feature of disease of the lower bowel. This is a point worthy of remembrance.