The prostate gland is very liable to be affected with inflammation in gonorrhoea, and in stricture, and to lay the foundation for more serious disease. In these affections, the symptoms indicative of the prostate gland being inflamed, are an irritable state of the uri nary bladder, pain and straining at stool, with tenes mus. An examination per rectum confirms it. Some times retention of urine ensues with a throbbing pain in the region of the neck of the bladder, and when the catheter is inserted, great pain is experi enced when the instrument arrives at the gland, and is with difficulty passed beyond it into the bladder. The treatment consists in the applica tion of leeches to the perineum or in the anus, ene mata of warm water followed by one of laudanum, warm fomentations externally, gentle laxatives, low diet, and rest. General bloodletting is sometimes requisite, and even puncturing the bladder. Ab scesses occasionally succeed this inflammatory at tack, and the matter is sometimes situated on the exterior aspect of the gland: in general their formation is indicated by rigors, which, however, are not always present, particularly when it takes place in advanced life, from irritability of the blad der. Sometimes the matter is discharged into the urinary bladder, sometimes into the urethra, rec tum, and occasionally at the perinxum. Whenever it is ascertained that matter is formed, it should be freely evacuated by an incision; and in those cases where there is not too much irritation it is advisible to insert an elastic gum catheter and re tain it in the bladder. Calculi are sometimes se creted in its substance, and require to be removed by an operation similar to the lateral one of litho tomy. Varicose enlargement of its blood-vessels oc casionally take place, and are relieved by leeches applied through the medium of the rectum. Medul lary sarcoma, fleshy excrescences and scrofulous enlargement, with suppuration, occur; but the chro nic scirrhous state is the most common affection of this gland, attacking the male about forty years of age, like that disease in the female mamma about the same period of life. It has been seen in a few rare cases of early life.
The symptoms are, a frequent inclination to make water, which is voided very slowly, in small quan tities and with difficulty, and has a strong flavour of ammonia; a dull heavy pain in the region of the gland, which, however, is occasionally sharp and lancinating along the urethra even to the glans, the latter of which, as well as the prepuce, sometimes feels benumbed. He has a difficulty in expelling his feces, which become small, wiry, or flattened; is affected with hemorrhoids and prolapsus ani. When riding in a carriage or on horseback, he passes blood per urethram, and as the disease ad vances, the urinary bladder becomes affected, and also the urethra and kidneys. On dissection, the gland is indurated, and resembles that described under scirrhus of the mamma; and when much en larged there projects towards the bladder a portion which resembles a third lobe; sometimes, however, this projection takes place laterally; and in rare instances fungous polypi are attached to its base. The mucous tunic of the urinary bladder, immedi ately behind the prostate gland, is occasionally forced through the muscular, forming herniary sacs, an event that sometimes occurs in stricture of the ure thra, in consequence of the violent straining efforts in expelling the urine. The treatment hitherto has
been only considered palliative, which consists in local bloodletting, semicupium, domestic and opiate enemata, and teaching the patient to draw off the urine with the catheter whenever he has a desire to void it, or by his wearing a flexible gum or pew ter catheter, which must be changed every ten or fourteen days. The radical treatment consists in removing the gland by an operation, for which the reader is referred to the late Dr. Bruce's Thesis De Illorbis Glandulx Prostatz 1827. In the fungoid condition of the gland, the blood flows into the urinary bladder, and requires to be removed by a silver catheter having a brass syringe adapted to it.
Calculus in the urinary bladder has been already described under lithiasis in the article McnielsE, so that it remains only for us to detail the resources of surgery, which are the extraction of the stone along the urethra by means of a pair of forceps, with or without dilatation of the urethra; secondly, the breaking down of the calculus in the bladder by means of a lithontripter; and thirdly, by an opera tion to cut into the bladder and remove the stone. When the calculus is small, it may be extracted by the forceps represented in Fig. 14 or 15 of Plate DXV., or by dilating the urethra by means of flex ible gum catheters or metallic bougies, for small calculi are often voided with the urine; but if large, attempts may be made to seize and break it down with the lithontripter represented in Fig. 16 of Plate DXV. which was invented either by Meirieu, Leroy, or Civiale; but the pain attendant on this method is so harassing, and occasionally so severe, that a patient affected with calculus vesicx will rather submit to the lateral operation. Besides the lateral, there are several other operations of litho tomy; the apparatus minor or cutting on the gripe; the apparatus major; the high or hypogastric; the recto-vesical; the bilateral or Celsian; and lastly, the quadrilateral method. The apparatus major, and the recto-vesical operations may be said to be now abandoned; and the high operation only per formed when the calculus is so large that the outlet of the pelvis will not permit its exit. The bilateral is a revival of Celsus or rather Ammonius of Alex andria's method by Bedard and Dupuytren, and differs from the lateral in this, that a Inflated incis ion is made from the tuberosity of the one os ischii to that of the other; and Beclard's differs from Cel sus's that he keeps the sound in the urethra until the bladder is freely incised. This is evidently an ad visable operation when the calculus is large, and is decidedly to be preferred to the hypogastric. We are confident that this mode, together with Le Cat's teeth forceps or Mr. Earle's stone breaking or screw forceps, will extract the largest calculus that was ever removed in life. This bilateral appears to an swer every purpose that the quadrilateral operation, invented the other day by Vidal, can possibly do, and is unquestionably safer and simpler.