In regard to the fluids to use in giving these douches or irrigations: Hot. saline solution is one of the best, and in some cases where perhaps it is not as effica cious as one would like to have it, espe cially in the acute cases, hot flaxseed-tea, strained, is very grateful to the patient.
Patients should take it just as hot as they can stand it. Certain men say that rectal douches for the relief of prostatitis and seminal vesieulitis ought not to be given at over a temperature of 105 de grees, but often patients can stand it as high as 120 degrees, and it appears to do more good the hotter it is. Ramon GuitCras (Jou•. Cutaneous and Genito Frin. Ms., Feb., 1900).
Abscess of the Prostate.
—The cases which go on to suppuration will present all the symp toms of acute inflammation in a marked degree. The temperature will be high, the pain severe and of a throbbing char acter, and chills are apt to occur. The diagnosis will be confirmed if an area of softening or fluctuation can be detected by digital examination.
El-101,0(1v.— Acute inflammation of the prostate may undergo resolution, it may result in chronic inflammation, nr, finally, in the formation of an abscess. Abscess will be more apt to occur in the cases in which the treatment has been neglected or the health of the tient particularly depressed. Suppura tion may occur early or late in the course of the disease. There may be a single abscess or a number.
Prostatie suppuration is most fre quently due to the gonococcus. This is prone to affect the follicles of the gland rather than the substance of the pros tate. As the result of the lowered re sistive vitality consequent upon chronic gonorrhoea of the posterior urethra, sec ondary infection of the prostate is liable to take place. The microbes most fre quently concerned are staphylococci, streptococci, and the bacillus con cony Innis. Recently an anailrobie bacillus has been described as occurring in very acute prostatie conditions; this form of prostatie abscess, however, is specific and is apt to be followed by gangrene and the production of very fcetid pus. Pseudo-abscess of the prostate, due to infection of the follicles of the gland from the urethra, is apt to be multiple. This condition does not, as a rule. give many symptoms, nor does it require operative interference. True prostatic abscess should be opened at the earliest possible moment in order to avoid com plications, and Dr. Alexander's sugges tion as to early diagnosis and treatment will undoubtedly prove to be of the greatest valve in this matter. .John an der Poe] (Medical News, May 31, 1902).
—As a rule, the abscesses open spontaneously into the urethra, and complete recovery occurs. As soon as distinct fluctuation is detected, how ever, it is desirable not to wait for this event, but to evacuate the abscess by an incision in the perineum, avoiding both the urethra and the rectum. The cases in which this will be necessary are, how ever, comparatively few. The wound should be packed with gauze and re dressed daily.
Prostatic abscess may burst of its own accord into the rectum, perineum, or ure thra. But the latter event is usually brought about by efforts to relieve reten tion. They not infrequently refill and burst only to refill again. Incision and drainage will effect the necessary cure, should they fail to heal naturally. Camp bell Williams (Clip. Jour., June 9, '97).
Prostatorrhcea.
This term refers to the periodical dis charge from the urethra of a colorless or slightly turbid, whitish, viscid fluid, most frequently observed after a pated stool, but, in pronounced cases, also at other times.
Prostatorrhcea is perhaps invariably a symptom of chronic prostatitis or of flammation of the seminal vesicles; the subject has therefore been treated under the former heading.
Hypertrophy of the Prostate.
Symptoms.—There may be a consider able enlargement in the size of the pros tate without any subjective symptoms whatever. On the other hand, a very moderate or slight enlargement in other cases may give rise to considerable an noyance. The first symptom which at tracts the patient's attention almost without exception is increased frequency of urination. This is especially noticed at night. Patients observe that they are obliged to rise once or twice during the night to pass water. No change is noticed usually at this during the day. The nocturnal frequency ally becomes greater, and finally the diurnal frequency is also increased. If the patient be particularly observ ing, he will note that the natural force of the stream is lacking; that it tends to fall vertically downward, in stead of being directed outward away from the body. There is also apt to be some hesitation of the stream in starting, and the stoppage is frequently incom plete. The subsequent course of the case depends, to some extent, upon whether the urine remains sterile or whether it. becomes infected. In the former as the overgrowth of the prostate be comes more and more pronounced, there is a corresponding obstruction offered to emptying the bladder. The result is that at the conclusion of each act of urina tion a certain portion of the urine re mains. The normal capacity of the blad der is therefore reached much earlier than would be the case if the viscus had been completely emptied. This is the cause of the more frequent passage of urine. When the amount of residual urine reaches several ounces to a pint or more, it naturally requires but a short time for the bladder to become fully dis tended and to call for relief. In some cases the obstruction is so great that nor mal urination is impossible; the bladder becomes distended to its utmost limit, when the urine escapes voluntarily from the urethra as fast as it enters the blad der from the kidneys. This dribbling is a most significant symptom, and one which constantly deceives the patient and not infrequently the physician, the argument being that, owing to the fre quent or almost constant passage of urine, the bladder must be empty.