The secretion of urine is frequently, under this condition, in a great measure suspended. I have known one case where the bladder was tapped above the pubis, under the idea that it was filled with urine ; but little or no urine escaped, and after death the bladder was found filled with a cancerous tumour originating in the prostate ; and no doubt many such in stances have happened. It is a mistake of no very serious consequence, but might be avoided if a careful examination of symptoms were instituted. If an elastic catheter were gently introduced into the bladder, it would be found to give the impression as if it entered a spongy substance, little urine would escape, and that tinged with blood and mixed with shreds of ceiebriform matter : if doubt still existed, a microscopical examination of the substance voided would, I apprehend, set the matter at rest. The introduction of the finger per rectum wiU assist the diagnosis.
True scirrhus of the prostate is extremely rare. Mr. Travers and Sir Benjamin Brodie both allude to supposed cases of' this disease, and from the narration there can be little doubt of their genuineness. The former sur geon examined one case after death, and described the gland as occupied by a tumour, having all the character of scirrhus ; and the latter mentions an instance " where the prostate was found much enlarged, and of a stony hardness."—(Walshe.) Fibrous tumours, according to Rokitanski, are frequently found in the prostate. They are of a size varying from that of a pea to that of a hazel nut, are round or oval, causing, when seated at the peripheral portion of the gland, knotty protuberances on its surface. They are always attended with distinct hyper trophy of the gland. This eminent patho logist attaches great interest to them, on account of their similarity to fibrous tumours of the uterus. They are of very frequent oc currence ; and in many cases of the enlarged prostate of old men that I have had an op portunity of examining, I found them readily distinguishable on section. This subject has been alluded to before, in the account of the morbid anatomy of the enlarged prostate.
Cystic Prostate.—The prostate, like the kidney, is occasionally the seat of cystic disease. It is characterised by the formation of cysts in various parts of the gland. It is extremely rare. There is an excellent exam ple of it in the Museum of the College of Surgeons. The gland was hypertrophied, and on section was found studded here and there with cysts containing fluid. These are, in all probability, dilated and closed follicles ; and in this respect they bear a strong analogy to the cysts of the kidney, which are found to be dilated uriniferous tubes.
In the situation of the uvula vesicw, the fold of mucous membrane is occasionally thrown up, so as to form a remarkable pro jection or bar at the neck of the bladder. Mr. Guthrie especially directed the attention of surgeons to this, but it has been met with often by others, and there is a good repre sentation of it in Baillie's Morbid Anatomy. No doubt it has often been confounded with supposed enlargement of the middle lobe of the prostate, with which it is often combined, but of which, in many cases, it is wholly in dependent. In a surgical point of view it is of very great interest. The bar in question, in its most simple form, consists simply of a double fold of mucous membrane, raised at right angles from the bladder ; in other cases, there is found between the layers of mucous membrane a quantity of a substance of an in termixture of elastic and organic muscular tissue, similar to what is found in the neck of the bladder in the normal condition ; whilst in other instances, apparently in the more ad vanced stages of the disease, the middle lobe of the prostate, considerably hypertrophied, is found as if it had forced its way between the mucous layers, and thus carried the fold with it ; in the latter condition, it will be found in the form of two wing-like processes, one on either side, connecting the middle lobe to the side of the bladder.
The disease is necessarily attended with difficult micturition, and leads to retention of urine. The diagnosis between retention from this cause and frona enlarged third lobe is difficult, but practically it is not unimportant, as Mr. Guthrie thinks it may be cured. In the rough introduction of the catheter or bougie, the bar is sometimes perforated. This sur geon found in one case as many as fifty cal culi behind this projection. It leads, if neg
lected, to similar changes in the bladder, as are found in cases of enlarged prostate. Prostatic Concretions. — The formation of calculous concretions in the minute follicles of the gland are not by any means of unfre quent occurrence. They are not to be con founded with calculi of laraer size, which have been long recognised by pathologists, and have been especially alluded to and described by Baillie,Woollaston, Cruveilhier, and Prout. They have very recently been examined by Mr. John Quekett and Dr. C. H. Jones, the latter of whom has published a paper on the subject in the first number of the Transac tions of the Pathological Society, and in the Medical Gazette of August 20th, 1847. The following is the result of the microscopical observations on this subject :—The calculi are found in great numbers in the follicles of the gland, presenting sometimes a deep yellow or red colour ; occasionally they are pale and colourless, remarkably small, and scarcely to be distinguished from the tissue in which they are imbedded. Dr. Jones describes their mode of formation thus : " They arise in a large oval vesicle, of a single wall of homo geneous membrane. This is occupied by a colourless finely-mottled substance, in the centre of which a nuclear corpuscle some times occurs. Their mean diameter is about =--)jo-s th of an inch. In those of larger size, the envelope is still seen, but the contained amorphous matter is beginning to be arranged in layers concentric to the envelope. In the further stage, the vesicles measure ,hth of an inch or more, showing concentric layers, which are more developed on one side than on an other, like so many repetitions of the original envelope, the intervals between the layers being occupied by a finely-mottled deep-yellow or red substance. There is a central cavity corresponding with the external contour in its form, which is triangular, with rounded angles or quadrilateral. From this normal appear ance, these bodies present numerous variations in form and internal arrangement, and appear to occupy an intermediate position between organic growths and inorganic concretions : to the former, by their vesicular origin and by their growth, which chiefly appears to take place by the dilatation of the vesicle and suc cessive depositions in its interior ; to the latter, by their shape, their tendency to become infiltrated with earthy matter, and to pass into the condition of a dead amorphous mass of a deep yellow red, even almost black. The chemical composition varies probably with their different stages of development, at first consisting of little else but animal matter, then acquiring, especially when in a state of de generation, calcareous salts, stated by Dr, Prout to be phosphate, with a little carbonate of lime. The colouring matter is unaffected by ether, liquor potassw, and muriatic acid." These minute concretions in the follicles and tubes of the prostate have been investi gated by Mr. Quekett, who, on submitting sec tions of the gland either in a healthy or dis eased condition, to microscopical examination, has met with them so frequently, that they would seem to be a part of the natural consti tuents of the gland or its secretion. He de scribes them as commencing by a deposit of earthy matter in the secreting cells of the gland ; they increase in size either by aggregation, or by deposition in the form of concentric layers; in the former case they mould themselves to the follicles, in the latter they present the ap pearance of an ordinary lithic acid calculus oti section. Where many cells vrere together, the parietes of the cells in contact are de stroyed ; so that by adding dilute muriatie acid, and thus dissolving the earthy matter, a multilocular cavity remains. In consequence of the manner in which they mould themselves to the follicles, they frequently present an appearance externally like mulberry calculi.* The opinion of Prout that the deposition of earthy salts is the result of a deranged ac tion in a mucous membrane appears thus fully borne out. In a case which I recently ex amined with Mr. Quekett the concretions were exceedingly numerous ; and this was especially remarkable in the middle lobe of the prostate. The gland had been removed from a young man who had died of phthisis, and was of the natural size. The middle lobe was much firmer than either lateral lobe They are so luble in acetic acid by the aid of heat.