Etiology and Pathology.—After a large number of post-mortem dissections Sir Henry Thompson claimed that 1 man in every 3 over fifty-four years of age showed some enlargement of the prostate. In about 1 case in 7 the en largement was sufficient to cause some degree of obstruction, and in 1 case in 15 the degree of enlargement was suffi cient to demand some form of treatment. The enlargement of the prostate is so common at and after the sixtieth year of life that some writers have described it as physiological. This view does not seem justified, however, inasmuch as in perhaps two-thirds of the population there is no increase in size whatever.
Much has been written upon the eti ology of this affection, but without add ing anything to our knowledge of the subject. It seems to occur with about equal frequency in the various classes of society; nor do the habits of the indi vidual, so far as can be learned by in quiring, seem to bear any relation to the condition.
The general term hypertrophy or en largement is applied to the different con ditions of the prostate occurring after the fiftieth year of life which result in an increase in its size. It is not intended, of course, in this statement to include the inflammatory affections of the pros tate. In some cases the increase in size appears to include all of the structures of the gland in about an equal degree: a true hypertrophy. In other cases there is a circumscribed overgrowth involving only one portion or one lobe, which, strictly speaking, should be termed hyperplasia. Besides these two forms, true tumor formations are occasionally met with.
The normal prostate consists chiefly of two lateral lobes with a small inter mediate portion sometimes called the middle lobe. These may all be equally enlarged or the overgrowth may involve but one or two of the three portions. If the overgrowth is composed chiefly of the glandular elements of the prostate the tumor is, comparatively speaking. a soft one. While if it be composed chiefly of the fibrous and muscular stroma it will he very hard to the touch.
From microscopical examinations of SO eases of prostatic hypertrophy the following conclusions are reached: That the essential alterations in senile hyper trophy consist in increase of the fibro muscular stroma, the latter usually being unimportant and secondary. In a few cases alterations in the stroma prevail, and may induce complete disappearance of the glandular elements. The hyper
trophied prostate presents in most eases the characteristics of a large adenoma. In some eases a latent transformation into a malignant epithelial new growth occurs, which finally causes all the symp toms of carcinoma. --Marron and N. Hall6 (Ann. des Mal. des Org. Gen.-urin., viii, '93).
Treatment.—As we do not know any prophylactic treatment for hypertrophy of the prostate, and inasmuch as the symptoms of which the patient plains are not those referable to the pros tate, but to the function of urination, no particular treatment is to be advised until the abnormal conditions are suffi ciently marked to cause some annoyance. In the earlier stages, with slightly-in creased frequency of urination only, the patient's comfort may be very much in creased by careful attention to hygiene. As the prostate, the seat of hypertrophy, is in a condition of chronic congestion, everything which tends to increase this should be avoided. The body should be well protected by proper clothing in order to avoid catching cold. The food should be plain, easily digested, and non stimulating; a diet consisting largely of milk is to be recommended. The func tion of the bowels should also be at tended to. Regular, moderate exercise is desirable rather than the reverse. If the amount of residual urine present be three or four ounces, a soft catheter should be passed once daily, preferably at bed-time so as to give a longer period of rest at night. If the quantity be five or six ounces, it should be withdrawn morning and evening, and, if half a pint Or more, it is desirable to pass the cath eter every eight hours. After withdraw ing the urine it is desirable to irrigate the bladder with warm, boric-acid solu tion, 10 or 15 grains to the ounce. If there be pronounced cystitis present it may he necessary to pass a catheter more frequently, and the irrigations of the bladder then become especially impor tant. No drugs have any direct influ ence upon the prostatic overgrowth un less it he ergot, and opinion as to the value of this remedy is divided. If it be decided to employ it, half a teaspoonful may he administered three times a day for a considerable period. Strychnine and other tonics will frequently be indi cated for the general conditions.