SYMPTOMS - HYPERAEMIA OR HEPEREMIA OF THE PROSTATE.
One of the most characteristic symptoms is a sense of fulness in the perineum and a sensation of a voluptuous character as of im pending orgasm. There is likely to be a sensation of fulness in the rectum with possibly erotic sensations and more or less tenderness .during the evacuation of the bowel. An urgent desire to urinate is almost invariably excited by the act of defecation. There may be considerable engorgement of the prostate without much, if any, ' increase in the frequency of micturition. If, however, the point of departure be direct or reflex irritation or inflammation of the pos terior urethra, frequent and painful micturition is an inevitable re sult. Even in cases in which micturition is not increased in fre quency, the patient will very likely complain of some pain and a bruised sensation in the perineum following the act of micturition. If the hyper2emia be long continued, " prostatorrhcea" is likely to super vene as a consequence of hypersecretory activity of the prostatic glands. In some cases the floor of the prostatic urethra becomes so hypersensitive that seminal emissions are frequent. Rusty or bloody semen is occasionally observed, but as a rule this symptom is indicative of seminal vesiculitis.
Pain during the paroxysmal spasm incidental to seminal ejacula tion is a quite frequent symptom. Many patients, however, will state that coitus is beneficial. In such cases it is very safe to con clude that the condition of the prostate is one of simple But even here it is not unusual for the patient to experience only temporary relief from coitus. Often repeated indulgence results in aggravation of the symptoms. Rectal examination may elicit some fulness and tenderness of the prostate. This is not always present, as there may be quite a degree of passive hyperaemia without any particular increase in the size of the prostate. This symptom is quite apt to be unreliable, because of the variability of the size of the prostate as felt per rectum and the varying degrees of digital expertness in rectal examinations. Passive hypermia of the pros tate associated with circulatory disturbance in the lower bowel, or dependent upon a gouty or rheumatic diathesis, is occasionally as sociated with hpamaturia. The author has observed a number of cases of hmnaturia with the expulsion of the characteristic fusiform clot found in prostatic hemorrhage, in which he was unable to de termine any other cause than a condition of passive prostatic con gestion, which attention to the assumed etiological factors very speedily relieved, measures to relieve portal congestion having been especially efficacious. This point is worthy of consideration in cases of hmmaturia of obscure origin.
A very frequent symptom of chronic hypermmia of the prostate is a discharge of the characteristic secretion of the affected organ from the urethra. This is favored by sexual excitement, erotic ideas be ing sufficient in some cases to produce it. Under such circumstances it is associated with a greater or less amount of secretion from the urethral glands, the secretion of the latter escaping during the excite ment, while the prostatic secretion afterward comes away with the escaping urine. It is most frequently observed during straining at
stool, and sufficient secretion may escape with the outflowing urine to produce an appreciable deposit in this fluid when allowed to stand. Very often no discharge of the prostatic fluid is observed excepting at the termination of the act of micturition, when, according to the patient's story, the urine appears to be decidedly milky. These patients are of all others the most likely to become the victims of the quack, and they constitute by far the larger proportion of cases of alleged spermatorrhcea. Associated with the local difficulty is more or less hypochondria, perhaps verging upon melancholia. The pa tient occupies himself very industriously in magnifying every symp tom, real or imaginary, of which he may chance to be the victim. The unstable condition of the patient's mind is a sufficient explana tion of the profound influence which quacks and quack literature are likely to have upon him. Associated with the so-called prostator rhcea may be more or less vesical irritation, largely neurotic in char acter, and perhaps neuralgic pains in the urethra, perineum, groins, and thighs. The majority of patients complain of pain in the back as the most prominent symptom aside from the urethral dis charge.
Whenever fluid escapes from the meatus during the intervals of micturition, excepting during the act of defmcation, some morbid condition of the anterior urethra is superadded to the prostatic hyperaemia. The prostatic fluid cannot escape unless the true sphincter vesicw—i.e., the membraneous urethra and its muscular in vestments—be physiologically relaxed, or the prostate be mechani cally squeezed by the perineal muscles and the passage of hardened faeces.
The fluid which escapes during sexual excitement consists of the secretion from the urethral glands. The term prostatorrhcea has about the same significance, as far as its relation to the affected part is concerned, that gleet does to diseases of the urethra. It is a term which it might be well to dispense with altogether, excepting with the understanding that it is merely a symptom. In cases of simple chronic hyperaemia of the prostate, the resulting discharge of pros tatic secretion does not contain inflammatory elements, being made up almost entirely of prostatic secretion, mucus, and some effete epithelial cells. There may be present, especially after sexual excite ment, a certain number of seminal elements which have escaped from the over-distended vesiculEe seminales. The escape of semen into the prostatic urethra is favored by a relaxation or patulousness of the mouths of the ejaculatory ducts, and is often immediately induced by straining at stool. The seminal elements are few in number and their presence is by no means a necessary symptom. Rarely indeed, are they sufficiently abundant to warrant the use of the term sperma torrhcea. No matter how few in number they may be, however, they are hailed with delight by the spermatorrhosa-seeking quack, and undue importance is often attached to their presence even by honest practitioners.