Prostatorrhma must be clearly distin guished from chronic prostatitis. The se cretion from the prostatic gland is a thin fluid, which is cloudy, sometimes milky white, never sticky, and characterized usually by a seminal odor. Prostator rhcea is never a catarrhal affection; it is a hypersccretion of the prostate, unattended by inflammation acute or chronic, and should be classed under the head of a neurosis. The secretion may contain amyloid bodies which, upon the addition of a 1-per-cent. solution of am monia, produce the peculiar crystals known after Boettcher, which are never found in the secretion from any other por tion of the genital organs except from the prostate. Sturgis (Jour. of Cut. and Gen.-Urin. Dis., June, '98).
Etiology. — Chronic inflammation of the prostate develops insidiously as such, or it remains as a sequel of an acute flammation. Among the causes which are responsible for chronic prostatitis are irritating injections; injuries from im proper use of urethral instruments; foreign bodies, such as prostatic calculi; and conditions which cause a chronic congestion, like constipation, haemor rhoids, etc. There is also probably a chronic pyogenic infection in which either the dose of the germs is so small or the virulence so mild that but a mild reactionary inflammation results. Such cases may complicate chronic gonorrhoea and urethral strictures.
Although sexual excess, masturbation, gout, etc., may be etiological factors in chronic prostatitis, gonorrhoea is the principal cause. H. R. Wossidlo (Jour. Amer. Med. Assoc., Aug. 27, 'OS).
Treatment.—Every factor which tends to cause congestion of the prostate should be taken away as far as possible. Therefore a contracted meatus, a strict ure of the urethra, constipation, etc., should receive appropriate treatment.
Sexual excitement should be avoided. Tonics are frequently indicated on count of the rather depressed condition of the health. The diet and digestion should receive attention as well as the matters of exercise, bathing, etc. tating articles of diet—such as Cayenne pepper, mustard, sauces, vinegar, pickles, tomatoes, and other acid vegetables and fruits—are to be avoided. Counter-irri tation to the perineum—obtained by the daily application of equal parts of tinct ure of belladonna and tincture of iodine or by the occasional application of blistering collodion—will be beneficial.
The daily use of a jet of cold water on the perineum from a bidet is of value in most cases. The low temperature of the water and the force of the stream both tend to cause reflex contraction of the blood-vessels and relief to the congested organ. In some cases the hot hip-baths for a few moments each day will be bene ficial. In the rebellious cases silver nitrate may be introduced into the pro static urethra with advantage. The ap plication is made by means of a specially designed syringe with a long, hard-rub ber nozzle. In beginning the treatment, 3 to 5 drops of a 1-per-cent. solution should be introduced. This may be re peated at the end of from three to five days. The strength of the solution may be very gradually increased; but, if this be done too rapidly or if the primary application be unduly strong, it will re sult in considerable inflammatory reac tion and distress to the patient.
Nearly 40 cases of prostatitis, some of gonorrhoeal origin and a11 chronic or in the later stages of an acute attack, treated with icbthyol with remarkably good results. From 5 to 10 grains of the ichthyol was made into a suppository with from 30 to 3S grains of cocoa-butter. One such suppository was used in the morning after defecation and another on retiring at night. Hollow suppositories are not to be used. A. Freudenberg (Merck's Arch., Mar,, '90).
Feleki and others believe that massage is the ideal and the rational therapy for chronic inflammation of the prostate. It empties the ducts, improves the circu lation, and tends to cause absorption of the inflammatory products. For this procedure the patient may lie on the back with the thighs flexed and sepa rated. The massage may be performed either with the finger or with an instru ment devised for the purpose. The seances may last from three to ten min utes, and may be repeated two or three times weekly. The gland should be rubbed from the periphery toward the urethra, and from right to left and left to right alternately.
In using tubes for rectal douching in chronic prostatitis, in order to apply moist heat directly to the gland it is necessary to have concavity near the end of the instrument to fit over the con vexity of the prostate, so that when the inflow is taking place the hot fluid as it comes out of the tube flows right against the gland which one is desirous of treat ing.