TREATMENT - ACUTE PROSTATITIS.
The treatment of acute prostatitis should be very active. A brisk mercurial purge should be ordered at once, and be followed by a full dose of some saline in the course of three or four hours. Ten to fifteen grains of calomel followed by hall an ounce of epsom salts is as good as it is old-fashioned, and will unload the portal circulation, as well as produce general depletion. An excellent way to use the mercurial and saline treatment is to put the patient on small doses of calomel, giving one-fifth of a grain in tablet triturate form every three hours until four or five doses have been taken. Coincidentally with the administration of the calomel, four-ounce doses of a saturated solution of sulphate of magnesia, containing glycerin in the propor tion of about 1-3, should be given by enema. This may be repeated till the patient has had a number of watery evacuations. This is the ideal method of producing pelvic depletion, and is quite as valuable in prostatic disease as in pelvic and abdominal inflammation in the female. Having fulfilled this indication, there are several special measures which are essential. The febrile symptoms call for aconite or veratrum virile, remedies which are far more reliable than anti mony, as recommended by Thompson. Ergot and the fluid extract of hamamelis are probably beneficial. In my hands, at least, they have seemed to be efficacious. They are certainly philosophical remedies from a theoretical standpoint. These remedies may advan tageously be combined with gelsemium and the bromide of potas sium; anaphrodisiac remedies having an especially sedative effect upon the inflamed organ. Hypodermic injections of pilocarpine have proved serviceable in several of my own cases, this remedy being a powerful derivative.
After the bowels have been evacuated as already suggested, opium is the remedy upon which the most reliance is to be placed. As in all inflammations, opium is directly antagonistic to inflammation of the prostate. It relieves pain and strangury, lessens the frequency of micturitiou, and counteracts nervous depression. Opium and other anodynes act best in acute prostatitis when given by suppository. If the rectum be particularly irritable, the anodyne may be adminis tered in the form of a thin ointment to be injected into the rectum.
Iodoform may be combined with morphine and belladonna or hyos cyamus, and administered in the form of a suppository. Care should be taken to avoid large doses of anodynes per rectum, as most pa tients are much more susceptible to their toxic influence when given in this manner than is usually supposed. If the. administration of anodynes per os be considered preferable to rectal medication, codeine will be found to be quite as reliable and much less disagreeble than the other preparations of opium.
The diet should be restricted to milk or other unstimulating fluid aliment, and the patient should lie quietly upon his back with the hips slightly elevated. Above all things, the patient should be im pressed with the absolute necessity of perfect rest for some weeks, for in no disease is movement more likely to aggravate the morbid condition than in prostatitis. In many cases in which acute prosta titis assumes a subacute or chronic form and persists indefinitely, movement, sexual excitement, alcoholic and dietetic indulgence, one or all, are likely to be in great measure responsible. Too much stress cannot be put upon the necessity of perseverance in the rules of genito-urinary hygiene.
Local depletion should be resorted to early in the case and re peated from time to time as circumstances may require. This is best accomplished by means of leeches, cups being rather unhandy of application. Five to eight leeches should be applied to the peri neum and about the anus, and the bleeding encouraged by warm fomentations. The rationale of this treatment is obvious, if the inti mate association of the prostatic and inferior hemorrhoidal plexuses be taken into consideration. After the hemorrhage has ceased, hot poultices or fomentations may be applied to the perineum. So great is the relief to be obtained by judicious leeching of the ano perineal region in acute inflammation of the prostate, that the san guinary enthusiasm of our medical forefathers is hardly to be won dered at. It is perhaps unfortunate that this old-fashioned method of treatment is not more frequently adopted, not only in acute pros tatitis but in other diseases in which local depletion is a desider atum.