Abscesses of the prostate open in various directions. Not unfrequently they burst into the bladder on the introduction of the ca theter. Sometimes they open into the urethra on the side of the veru montanum ; or they make their way forward to the perinwum, and opening externally terminate in the formation of perinwal fistulw. Occasionally they open at once into the rectunt ; or they may burst into the adjacent cellular membrane, and even extend to the penis and scrotum.
Ulceration.—This mode of termination of an inflamed prostate is rare. It is one of the most distressing consequences of inflammation, and is only found in cases of hypertrophy of the prostate in old age. It may arise spon taneously, or it may be the consequence of the rude introduction of the catheter. It is invariably attended with most severe sy mp toms, and is generally indicated during life by the mixture of blood With the urine. The mucous membrane of the bladder adjacent is in a state of high inflammation. Ulceration may exist in various degrees, from simple erosion, as after passing a catheter, to a deep ulcer with indurated edges. In one case, re lated by Sir Benjamin Brodie, the prostate was found ten or twelve times its natural size, making a large circular projection into the bladder, round the internal, orifice of the ure thra. Nearly the whole of this portion was superficially ulcerated, and in some places the ulcerated surface was incrusted with a thin la3er of coagulated lymph.
Simple enlargement of the prostate is an other consequence of common inflammation. It is one of the not unfrequent sequelm of repeated and neglected attacks of gonorrheea. It is generally accompanied with induration, and is confined to the lateral lobes, rarely im plicating the middle lobe. This condition is occasionally dependent on the irritation or stricture ot the urethra, and subsides on the cure of the latter disease.
Tubercles.—The deposit of scrofulous tu bercles in the prostate is rare. When this happens it is generally found to co-exist with similar deposition in the testicles, vesiculm seminales, and the adjacent lymphatic glands, and is associated with tubercles in the lungs. It occurs occasionally in the form of one large mass, occupying a large portion of the gland, and causing an increase in its size, or many small distinct depositions are found in various situations. Scrofulous tubercles of the pros tate undergo the same progressive disintegra tion as in other parts, and terminate in ab scesses, which take a similar course and direction as common abscesses. I have seen
the whole tissue of the gland broken down by the gradual softening of scrofulous tubercles. Mr. Cross, of Cincinnati, met with one in stance of this disease ; it was in a y oung man vvho died in the Cincinnati Hospital of psoas abscess. There were six or eight small masses of a pale yellowish colour, and of a soft curdy consistence, scattered through different parts of the gland, which was considerably reduced in size ; he thinks they are originally formed in the follicles of the gland. Lallemand also mentions a case in which thirty small abscesses, and the same number of crude tubercles were found in the prostate. There were similar deposits in the kidney's.
Cancer.— Cancer in any form is extremely rare in the prostate. Carswell regards it as a not uncommon cause of hmmorrhage from the urethra, whilst Cruveilhier says that he has never seen an instance of it.—(Walshe on Cancer.) The encephaloid form is that which most commonly attacks this gland ; and, ac cording to VITalshe, in M. Tanchon's tables, out of 8289 fatal cases of cancer, in five death occurred from the disease in the prostate. Rokitanski regards the affection as very rare, and makes allusion only to the encephaloid variety. When the disease attacks the pros tate, the gland becomes increased in size. It has been found by Mercier of the size of an ostrich's egg, " and was attended with effusion of blood into both lobes, communicating with each other and with the urethra by means of false passages." In a boy, five years old, Mr. Stafford found the prostate of a globular form, and as bulky as the largest walnut ; the mid dle lobe was nearly as large as a small hazel nut. — (Walshe.) By the same author, a case is recorded from Langstaff of an encephaloid growth as big as an orange, vvhich sprang principally from the middle lobe. Cancer of the prostate, as it advances, generally rnakes its way towards the bladder, and thus forms a bleeding mass in the cavity of that viscus, oc casionally filling it up completely, and giving rise to a distinct hypogastric tumour, whichI have known mistaken for a bladder over-dis tended with urine, the true nature of which was not suspected until after the introduction of the catheter. The cancerous mass at its base was surrounded with a distinct border of ulcer ation, so characteristic of cancerous tumours, when they have made their way into cavities lined with mucous membrane.