PROSTATITIS.
Acute inflammation of the prostate gland is generally the result of gonorrhoeal infection or of traumatic causes, as after catheterisation. It is not rare as a sequel to prolonged sexual excesses, especially when the congestion of the prostate has been fanned into activity by jolting exer cises as horse or bicycle riding, or driving in springless vehicles over rough roads.
Absolute rest in bed unless when the patient is sitting in a hip or sitz bath is essential, and the lower extremities should be elevated above the level of the trunk by raising the foot of the bedstead. The bowel should be cleared out by a large warm water enema, and towards the end of the operation a stream of very warm or of very cold water may be employed to irrigate the lower end of the rectum. Hot fomentations or poultices applied to the perineum give relief; when these fail ice may be tried, and a large smooth piece inserted occasionally within the sphincter.
Leeches applied to the perineum and bleeding encouraged from the bites by the application of a hot poultice or small cupping-glass are a very reliable means of subduing pain, tenesmus and painful micturition.
A full dose (2 gr.) Morphia as a suppository may be inserted into the rectum or a small Starch and Laudanum enema may be administered. By combining io to 15 grs. Ichthyol with the morphia and gr. Ext. Belladonna a very soothing suppository or small medicated pessary may be devised.
Retention of urine commonly results; this should be met by prolonged immersion in the hot hip bath, during which the patient attempts to relieve the bladder without making violent expulsive efforts. If the retention resists this, a smart saline purge may he tried. If it becomes necessary to draw off the urine, a few drops of Cocaine solution having been injected into the urethra and massaged backwards through the compressor urethan muscle a soft rubber catheter may be gently coaxed through the narrowed prostatic urethra,.but when the pain is intense this may not be possible, and a general anesthetic may be needed, and the instrument should be left in situ. Sometimes it will be found necessary to aspirate the bladder above the pubes.
Should an abscess forni in the inflamed prostate, the finger being inserted into the rectum, a free and deep incision should he made in the perineum over a hougie or staff introduced through the urethra, and drainage must he provided. Though a prostatic abscess may sometimes spontaneously
burst into the rectum it is not now opened from the bowel by the surgeon.
Chronic Prustatilis.—This is often a sequel to the acute attack caused by ;gonorrhoea, and it is sometimes most rebellious to treatment; it is sometimes due entirely to sexual excesses. The glairy fluid or muco purulent secretion which escapes from the meatus, especially during or after defecation, leads the patient to believe that he is suffering from discharge of seminal fluid—so-called " spermatorrlicea "—and as this is usually accompanied by profound mental depression or hypochondriasis moral treatment is also indicated, and will be found discussed under the latter heading.
Sexual excitement must be avoided, and though there is nothing but harm to be got from sending the patient to bed, as thereby his melancholy and introspection will he increased, he must be warned to confine his physical exercises to quiet walking, cycle and horse riding and driving being forbidden. An open-air life or a sea voyage is very beneficial, and alcohol should be strictly avoided. Though some surgeons condemn all local treatment it is generally necessary when a history of gonorrhoea is present to pass a full-sized solid sound in order to dilate the urethra to its fullest extent, after which the application of Nitrate of Silver to the prostatic urethra should be made as described in the articles on Gonor rhc2a. and Gleet. The acute symptoms which may follow should be treated by rest in bed and the agents suitable for the relief of acute prostatitis.
In very chronic cases nothing is so successful as massage of the prostate through the rectum, which should be repeated at intervals of every 4 or 5 days. When the discharge is indicative of the presence of an abscess in the prostate or of a suppurative condition of the seminal vesicles, the best procedure is to evacuate the pus by a free and deep incision into the perineum, curette the cavity and pack with gauze. Search should be made for the presence of prostatic calculi in all acute or chronic cases, and these should be removed through the incision for abscess. Alexander of New York strongly advocates the removal of the lateral lobe containing the pus, as the abscesses are generally multiple; he operates by the median perineal route.