which accompany it. The presence of pus in the urine, of occa sional hæmaturia, of pains in the loins, perineum, and penis, give rise to suspicion of calculus, to be resolved sometimes only by careful sounding. The state of nutrition of the patient, his history, and the condition of the lungs, are among the main points to be considered in connection with the urinary derangements, which have probably more especially attracted his attention.

TREATMENT. Nothing need be said of the constitutional treatment of tubercular disease, and little in relation to the local manifestation in the prostate. Mechanical interference is to be avoided, and every kind of irritating application. If suppuration takes the form of external abscess, it must be treated as other perineal or ischiorectal abscesses. But more commonly the dis charge of purulent and tubercular matter takes place into the urethra. The improvement of the health, by all those numerous means which regulation of the diet, regimen, exercise, climate, and medicine enable us commonly to achieve in tubercular patients, constitutes almost the whole of the treatment to be employed in the affection, when involving the urinary or genital organs. The diagnosis once established, it is of great importance that the patient should be kept free from all instrumental treat ment, which, in such cases, provokes irritation, and aggravates the disease, without conferring upon him any benefit whatever.

Tubercle of the prostate is a very rare affection. It is extremely uncommon to meet with it in the deadhouse. The preserved examples are few. There is no preparation of it in the Royal College of Surgeons, London, although there are one or two specimens of abscesses in the prostate, which are supposed to be of a scrofulous character or origin. There are two examples in the Museum of St. Bartholomew's Hospital, one in Guy's, one in St. George's, one in that of the College of Surgeons, Edinburgh, and one in a small collection at the Royal Naval Hospital, Greenwich.

The following cases, eighteen in number, have been condensed into a tabular form. They constitute the greater portion of the

EIGHTEEN CASES OF INTERCULAR PROSTATE.

287

data on which our knowledge of this disease is founded. The age of the patient, the condition of the prostate itself, and that of other organs of the body also tuberculous are presented. The sources from which they are obtained are also added in a note.

18

right,

Mr. Simon mentions a case in which the entire genito-urinary tract was more or less affected with tubercular deposit, from the testicle to the prostate, and from the kidney to the same point.

1. Lloyd on Scrofula. p. 110. 1821.

2. Adams on the Prostate. 2nd ed. p. 127.

3. Trans. Path. Soc. Vol. i. p. 120.

4. Lancet, 1855. Vol. ii. p. 542.

5. Urinary Organs. 2nd ed. p. 721.

6. Annales de Chirurgie. 1845.

7. L'Union Médicale. 1850.

8. Des Pertes Séminales. 1836. Vol. i.

9. L'Union Médicale. 1849.

10. Guy's Hospital Museum. No. 2393, 75.

11. & 12. Barth. Museum. Series xxix. 19 and 20.

13. St. George's Hosp. Museum. Series x.

14. Catalogue. p. 260.

15. Med.-Chir. Trans. Vol. xliii. p. 157.

16. Recueil de Mém. de Méd. de Chir. &c. 1860.

17. Bull. de la Soc. Anat. 1860. p. 183.

CHAPTER XVI.

CYSTS, OR CAVITIES IN THE PROSTATE.

True Cysts unknown.-Cavities are of three kinds--Dilated Follicles; Purulent Depôts; and containing Concretions.-Hydatid Cysts between the Prostate and the Rectum.

SMALL cavities, which have received from many authors the name of cysts, are frequently to be seen in the prostate, especially in those of aged subjects.

If by the term "cyst" it is designed to describe a thin-walled, cell-like body or closed sac, spheroidal, or nearly so, in form, containing fluid, a structure of new formation apparently, not a mere dilatation of some already existing cavity, then I know of no such affection of the prostate, either from personal examination or on the report of others. Such cysts are found in many parts of the body, containing hydatids, jelly-like material, serous fluid, &c. But in the prostate we find no such isolated cysts, as for example, in the kidney, nor any formation indeed which can be regarded as analogous to that, which may be considered as the type of simple fluid cysts. Although I have, in conformity with the practice of other authors, referred to "cystic disease" of the prostate, it does not appear that the use of the term is warranted by the phenomena presented; and if retained, it must be held to signify a formation of a wholly different kind from that which is indicated by it in the breast or kidney; neither is any species of proliferous cyst ever met with.

Cavities are frequently found in the prostate, but these manifestly belong to one of the three following orders :

(a.) Mere dilatation of gland-follicles.

(b.) Cavities containing pus; abscess.

(c.) Cavities containing concretions or calculi, the walls of which become denser and firmer in proportion to their magnitude, which corresponds with that of the contained body.

Of the first kind, viz. dilated gland-follicles, examples may be found in most prostates from elderly subjects; as has been before seen, some of the gland-follicles generally exhibit a tendency to enlarge or dilate as age increases. The cavity is often filled with yellowish, semi-fluid material, or with yellow, semitransparent concretions, of so small a size as only to be discernible with the microscope. And it appears that the increase in size of the contained and of the containing parts, takes place pari passu.

The second kind, viz. cavities containing pus, offers no subject for remark here. These have been fully examined and described in Chapter IV. on the results of inflammation, under the heads of Acute and Chronic Abscess.

The third kind of cavities consists of those which contain solid formations, whether concretions or calculi. It is common, when making sections of the prostate from an elderly subject, whether it is hypertrophied or not, to find cavities, of a somewhat irregular form, in its substance, having all the appearance of being dilated follicles of the glandular structure, which contain numerous little dark-coloured concretions. I have seen from thirty to fifty of these bodies occupying a cavity about the size of a grain of wheat or of a small pea.

But larger concretions, that is, of the size of pearl barley, may occupy each a separate recess of its own; and on removing the foreign body, a spherical, thin, and smooth-walled cavity is displayed. Sometimes hundreds of such small cavities may be found in one prostate,—but this is a very rare circumstance. A good example may be found in the museum of the College of Surgeons, Prep. No. 2519. See Chap. XIII. for numerous others.

The cavities referred to do not attain a sufficient size, nor, as far as I know, do they give rise to any symptom whatever, to render a knowledge of their presence possible during life. Gene