TREATMENT - HYPERAEMIA OR HEPEREMIA OF THE PROSTATE.
The first principles of treatment of prostatic hyperemia involve all of the rules of genito-urinary hygiene, a subject which can not here be exhaustively discussed. Briefly, the urine should be rendered unirritating by the administration of bland fluids, of which distilled water or the various saline mineral waters may be taken as the type. Alkaline remedies may be administered where simpler measures are not sufficient to neutralize urinary acidity. The diet should be unstimulating, milk being the ideal form of ali ment for reasons too thoroughly understood to require expatiation. All sources of sexual excitation, both mental and physical, should be removed. Exercise should be restricted and, if necessary, prohibited altogether. Athletic feats, bicycling, horseback riding, and climbing are particularly to be forbidden. Climbing exercises, as practised by young lads and some athletes, are especially injurious. The danger of the supervention of acute inflammation or of a chronic condition of disease should be impressed upon the patient. Instru mentation of the urethra is in a general way to be avoided in acute hyperemia. There are numerous internal remedies which are ser viceable in prostatic congestion. Mercurial and saline cathartics and laxatives are especially beneficial as tending to relieve hepatic congestion, and thus indirectly to remove obstruction to the pelvic cir culation. Ergot and the fluid extract of gossypium are of undoubted value as directly tending to correct the circulatory disturbance. The element of sexual excitation is best combated by the administration of the bromides in combination with gelsemium. Monobromide of camphor, hyoscyamus, and some other anaphrodisiacs are likely to be of service. Suppositories of ice and enemata of cold water are often valuable. Cold sitz-baths constitute an excellent adjuvant. In pro static hypermmia dependent upon ano-rectal or vesical disease, the treatment should necessarily be directed to the relief of the primary condition.
In cases of chronic prostatic hyperdemia associated with so-called prostatorrhcea, special attention should be paid to the psychological disturbances present. It is rarely indeed that such cases come
under the observation of the reputable practitioner before a number of quacks have been consulted. The patient is thoroughly imbued with the notion that he has spermatorrhcea with an allied train of serious nervous disturbances, and last, but not least, he believes him self to be impotent. Instruction in sexual physiology and hygiene is absolutely necessary for this class of patients. Particularly must they be impressed with the fact that they are not losimi semen in the urine, else all of our efforts will be set at naught by the morbid con dition of the patient's mind. By far the larger proportion of cases will be found to be suffering from constipation. The relief of this condition in most instances causes the prostatorrhcea, which is the most prominent symptom in the mind of the patient, to disappear. Ergot and the bromides are exceedingly useful internal remedies. Hamamelis and hydrastis are likely to be serviceable from their known influence over unstriated muscular fibre and incidentally by controlling vascular supply. Tonics are very likely to be useful in this class of cases. Various preparations of strychnine, iron, and arsenic and the mineral acids are of service. The occasional passage of the cold steel sound constitutes a most valuable local measure of treatment. The effect of instrumentation is to a certain extent moral, but the resulting benefit is none the less marked. The phy sical effect is probably the restoration of local vascular tone and a relief of nervous irritability. Cold sitz-baths and injections of cold water into the rectum constitute a valuable adjuvant. Counter-irri tation of the perineum is likely to be beneficial. The local applica tion of astringents directly to the prostatic sinus may be alternated with the insertion of the steel sound. Nitrate of silver in mild solutions, tannic acid, and the muriate of hydrastine are all service able drags. Soluble bougies containing astringents are sometimes of service. The local treatment in prostatic associated with so-called prostatorrhoea is very similar to that of chronic folli cular prostatitis, in which escape of prostatic secretion is also a symptom.