Acute prostatitis occasionally develops in the course of the infectious fevers, and it has been noted in a number of in stances of pymmia. Almost all of the cases met with, however, are due to in fection from the gonococcus either alone or in combination with other micro organisms.
Treatment.—The first requisite is rest. The patient should be confined to bed. The diet should be liquid and chiefly milk. Water may be given freely. In the more severe cases it is desirable to have the bed so arranged that the pa tient's hips shall be on a higher level than the shoulders. If the inflamma tion is of a high grade, considerable re lief will be afforded by the application of a number of leeches to the perineum and around the margin of the anus.
Sitz-baths at a temperature of 100° to and frequently repeated give re lief by drawing the blood to the surface of the body. If there is marked vesical irritation great relief will be afforded by administering a mixture containing boric acid, sodium bromide, and tincture of belladonna. If there is much fever, a diaphoretic mixture containing potas sium citrate, sweet spirit of nitre, and aconite will be very useful. If the pain is excessive, a small quantity of mor phine may be added to the latter pre scription. If this fails to relieve the pains sufficiently, suppositories of mor phine or opium may be given in addi tion. If there is retention, the urine should be drawn at regular intervals with a soft-rubber catheter. If the in flammation has gone on to suppuration, it is desirable to evacuate the abscess as soon as softening or fluctuation is de tected by rectal examination. The ab scess should be opened in the middle line of the perineum and the urethra and rectum carefully avoided. In the case of small, circumscribed abscesses their presence will probably not be detected, and they usually evacuate themselves by spontaneous rupture into the urethra.
Chronic Prostatitis.
The most prominent symptom is the occasional discharge of a clear, viscid fluid: the secretion from the glands of the prostate. It varies in amount from a few drops to half a tea spoonful. Occasionally the discharge is accompanied by spasm of the perineal muscles. It may be observed at inter vals throughout the day, but it is espe cially noted during or after an action of the bowels, especially if the movement be constipated. In addition to this, the patient will have at least some of the fol lowing symptoms: Frequency of urina tion, dull pains in the perineum and loins, a tickling sensation in the ure thra, pain at the end of urination, some perinea] tenderness which may make sitting uncomfortable, and moderately increased sensitiveness of the prostate on rectal examination. There is usually some enlargement of the gland. The introduction of a catheter may reveal hypersensitiveness of the prostatic ure thra. The urine usually shows some cloudiness, especially the first portion, which is due to shreds of muco-purulent matter and masses of epithelium from the prostatic urethra. Those suffering
from chronic prostatitis very constantly exhibit an extreme degree of anxiety and mental depression. The various symp thins are magnified by the patient, who believes himself the subject of sonic seri ous malady. This is particularly true of the discharge, which is erroneously sup posed by the laity to be semen.
Diagnosis.—Chronic prostatitis must be differentiated from chronic cystitis, vesical calculus, hypertrophy of the prostate, and seminal vesiculitis. In the first of these the characteristic discharge, the mental depression, and the prostatic tenderness will be absent. If the urine be passed in two portions in the case of prostatitis the cloudiness will be in the first portion only, while the second por tion will be clear. In inflammation of the bladder the two portions would be alike. Vesical calculus would be ex cluded if the characteristic symptoms are not present, and finally by demon strating its absence by the careful use of the sound. Hypertrophy of the pros tate usually begins after the fiftieth year of life, and is much more common after the sixtieth year. The distinction will sometimes be difficult to make, be cause patients with hypertrophy not in frequently have some degree of chronic inflammation associated. The cardinal symptoms of chronic inflammation,—the discharge of prostatic fluid and the cloudy condition of the first portion of urine as determined by the two-glass test,—together with the mental condi tion would point to inflammation of the prostate, and their absence would argue against it. Inflammation of the seminal vesicles, when chronic, gives rise to symp toms more closely simulating chronic prostatitis than any of the other condi tions mentioned. There is apt to be per sistent urethral discharge. Pain may be complained of in the back, over the pubes, or in the bladder, and occasionally the rectum or perineum. Digital exam ination through the rectum will, how ever, show an absence of changes in the prostate, and will probably reveal a dis tended seminal vesicle. As a means of reaching a conclusion in doubtful cases Posner, of Berlin, has proposed the fol lowing method: An ounce or two of urine is passed in one glass and a similar portion in a second glass, a quantity still being retained in the bladder. The pros tate is then to be thoroughly expressed by massage either by means of the finger introduced into the rectum or by an in strument devised for the purpose. The patient is then requested to pass the last portion of urine. If chronic prostatitis be present this portion of urine will be found to be cloudy and the microscope will show pus-corpuscles, shreds, epi thelium, and probably micro-organisms. Gonococci have been found in many cases. In making this test care must be taken not to confound the fluid from a distended vesicle, if one exist.