Chapter XXX: Section IV: The Seminal Vesicles and Prostate

[=Notice=: 1. _Seminal vesicles_—present or absent; size; distended or
empty; contents. Condition of mucous lining; inflamed, thickened,
ulcerated, perforated; tubercular deposits, etc. 2. _Prostate
gland_—abnormalities; size; density; enlargement of middle or lateral
lobes; color of section; appearance of inflammation; abscess; tumors;
cancer; tubercle. _Contents of ducts_—calculi: their position, size,
etc.]

=Congenital Anomalies.= The vesiculæ seminales participate in the defective development of the testes, being absent or imperfect when their related glands are so.

=Inflammation.= It is not uncommon for these bodies to be attacked with chronic catarrhal inflammation, which causes a swelling of their mucous membrane, the secretion of unhealthy mucus, dilatation of the cavity, and thickening of its walls. Ulceration, perforation, and the formation of abscess in adjacent parts, may result.

=Tubercular Deposits= are occasionally met with, chiefly in cases of extensive tuberculosis. “It appears as a thick, yellow, cheesy, lardaceous, fissured, purulent layer, replacing the mucous membrane.” It never occurs before puberty.

The Prostate Gland.

=Congenital Anomalies.= When the organs of generation are imperfectly developed, the prostate gland is generally found to be so too.

=Hypertrophy and Atrophy.= _Hypertrophy_ is of frequent occurrence, especially in connection with old age. All the lobes may be enlarged equally, or nearly so, or one or the other of the lateral lobes alone, or the middle lobe, without any corresponding hypertrophy of the lateral. Hypertrophy of the middle lobe, when considerable, throws the neck of the bladder forward, and increases the depth of its lower region, so that calculi may lodge behind and below the prostate in its cavity. The canal of the urethra becomes lengthened in its prostatic portion, and may be narrowed by compression, or considerably dilated, so that the prostatic sinus may contain two or three ounces of urine. The retained urine decomposing, may cause irritation and inflammation of the bladder.

The texture of the enlarged gland is generally indurated, though sometimes it is found to be looser and softer than natural. On section, the cut surface bulges above the level, and the shades of color are more strongly marked than in health. Frequently single gland-lobules are found hypertrophied. Small cavities, dilatations of the gland-follicles, are occasionally met with, sometimes empty and sometimes containing a yellow, pus-like fluid, the prostatic secretion in a thickened state.

_Atrophy_, with consolidated texture, is found with atrophy of the testes.

“_Eccentric atrophy_ is occasionally met with; the cavities are dilated and the walls thinned, in consequence of the increase in size of calculous concretions in its follicles. Cases sometimes occur, in which the whole of one lobe, or even the entire organ, is converted into a thin fibrous capsule, the proper substance of the gland being almost wasted.”

=Inflammation.= As a result of suppressed gonorrhœal discharge, the prostate may be attacked with acute inflammation, followed by suppuration, or chronic enlargement, or an irritable state of the gland, with increased secretion.

_Abscesses_, single or multiple, may occur, and open into the bladder, into the prostatic sinus of the urethra, into the rectum, or, externally through the perineum.

Ulceration rarely occurs.

Morbid Growths.

_Cancer_ of the prostate is rare; encephaloid is almost the only form that occurs. The gland is enlarged and the growth may perforate the mucous membrane of the bladder, and vegetate in its cavity.

_Tubercles_ occasionally occur. Their softening and disintegration give rise to abscesses, which pursue the same course as inflammatory abscesses.

_Fibrous tumors_, varying in size from that of a pea to a nut, are of frequent occurrence; sometimes but loosely attached to the hypertrophied gland.

_Cysts_ are of extremely rare occurrence, commonly resulting from closure and dilatation of the gland-follicles.

_Concretions._ “In greater or less numbers, they are of almost constant occurrence in the prostatic cavities; they may often be seen on making a section of the gland, as reddish-yellow grains. Their form varies very much; in the smaller it approaches the oval or circular; in the larger it is more polygonal or triangular. They are not unfrequently pale or colorless. The contents of these semiorganized formations appear to be earthy matter (phosphate, with a little carbonate of lime), tinged by the ordinary yellow pigment which is so often derived from the blood.

It is most probable that, in ordinary healthy states, these concretions undergo solution at an early period of their existence, yielding up their contents to form part of the secretion of the gland. But, if this does not occur, and they go on increasing in size, they become the nuclei, or are developed into _prostatic calculi_. These are not unfrequently very numerous; as many as fifty or sixty have been found in an atrophied, dilated prostate. The calculi sometimes cohere, and form a large mass, projecting into the membranous portion of the urethra, which becomes in consequence much dilated. The smaller calculi often escape into the bladder through the dilated prostatic ducts; if they remain there, they excite irritation of the mucous membrane and deposition of phosphates upon their own surface.”

CHAPTER IV.
THE FEMALE GENERATIVE ORGANS.