When a prostatic abscess is suspected the patient should be anesthetized, the sphincter dilated, the exploring needle used if necessary, and any collection of pus, no matter how detected, should be either completely emptied with the aspirator or by free incision.

CHRONIC PROSTATITIS.

Chronic prostatitis may be the residue of an acute lesion or the gradual production of a mild but more or less constant septic infection. It leads always to more or less enlargement, is often the basis for the classic prostatic hypertrophy, and causes dull pain, referred in various directions, often to the sacrum and the back, with frequency of urination and escape of a viscid mucus, the natural prostatic mucus in excess, which the patient will usually consider semen, but which is really the product of the overworked prostatic glands.

This last phenomenon is spoken of as prostatorrhea, and deserves consideration not alone from the alarm with which patients often regard it, but because it indicates a significant condition. A prostate whose glandular structures have been unduly active will, in consequence, enlarge; such a prostate is compressed with the passage of every hard stool, the consequence being the expulsion of some of this fluid with each act of defecation, a feature interpreted by too many patients as spermatorrhea. The two conditions are to be differentiated in clinical study, the former being common, the latter quite rare. Acute prostatorrhea is also frequently the consequence of more or less prolonged sexual excitement. It corresponds essentially to a chronic nasal catarrh, which is accentuated by exposure to cold or to irritation of any kind, and is only the overflow of a natural fluid under morbid conditions. With chronic prostatitis, furthermore, the sexual appetite is often decreased, while sensations are more or less disturbed, ejaculation being perhaps premature; the patient is often made thereby despondent, and the case regarded by himself, or by the quack whom he is led to consult, as at least incipient, perhaps hopeless, impotence.

The physical evidences of chronic prostatitis are enlargement, with tenderness not only of the prostate itself, but of the seminal vesicles above it, and often the appearance of a few drops of prostatic mucus at the meatus after pressure or stroking of the prostate itself has expelled them.

Treatment.

—Removal of the cause is the secret of success; if this be a stricture it may be divided and dilated; if cystitis, it must be combated; if chronic constipation, it should be overcome; while excesses, either alcoholic or sexual, should be controlled. Some one or nearly all of these conditions will be seen in nearly every case of this character. To other manipulative features may be advantageously added a certain massage or “milking” of the prostate, at intervals of five or six days, by which it is emptied of its accumulated secretion. Equally beneficial is the occasional passage of a large sound through the prostatic urethra and into the bladder. Its effect also is to make pressure, while at the same time it stimulates and does good in a way perhaps difficult of explanation. Irritation in the prostatic urethra should also be controlled by occasional injections, with a deep urethral syringe, of a drop or two of a ¹⁄₂ per cent. solution of silver nitrate. Improvement in other respects may be expected from constitutional, dietetic, and hygienic measures.

PROSTATIC HYPERTROPHY.

Many theories have been advanced as to the etiology of prostatic enlargement. Those worthy of any consideration may be summarized as follows: