Reprinted from Columbus Mkdical Journal for Sept., 1884. 
Irritation of the Prostate, 
BY K. HARVEY REED, MANSFIELD, O.] 
From a paper read before the Ohio State Medical Society June 14, 1884. 
Definition.—Irritation of the prostate may consist of a true or sympa- 
thetic congestion of all or a part of the prostate gland; or a catarrahal 
condition of all or a part of the follicles and ducts of the racemose glands, 
or even involve the ejaculatory ducts; or it may consist of a hyperes- 
thesia of the nerve filaments supplying the gland, anyone, or all of which, 
will keep up an irritated condition of the gland, unattended with a chill, 
or acute inflammation, and the graver symptoms of the more serious and 
destructive diseases of the gland. 
Causes.—The causes which lead to an irritation of the prostate are 
masturbation, inordinate sexual excitement of any kind, cold and expos- 
ure, traumatic causes, gonorrhea, sympathetic irritation from surrounding 
structures, such as constipation, diarrhea, and hemorrhoids ; or cystitis, 
acute or chronic, morbid change in the urine, vesical calculus, etc. 
Symptoms.—In the milder forms of congestion the symptoms will not 
be more than a slight weight or fulness in the perineum, with, perhaps, a 
slightly increased desire to micturate, which is generally followed with an 
uneasy feeling in the region of the prostate, and in the glans penis. This 
morbid desire to void the urine is seldom observed in the early part of 
the day, but gradually increases toward the close of the day, and, unless 
rest is sought, will be the worst just before retiring. 
When the recumbent position, with quiet, is resorted to, relief is gen- 
erally obtained; hence we find this class of patients troubled but little at 
night, and nearly always feeling the best in the morning. 
They seldom complain of having had a chill, or being troubled with 
febrile disturbance, loss of appetite, or of marked constitutional disturb- 
ance, other than that of having taken a slight cold, from which they can 
probably date their trouble. 
A full-sized sound can be passed with little or no difficulty, other than 
tenderness along the prostatic urethra. 2 
A digital examination through the rectum will not reveal any percep- 
tible enlargement but a general tenderness over the entire gland. 
An examination with a bulbous bougie will not reveal any secretion ex- 
tending from the gland of more than ordinary consequence, in the purely 
congestive form of this irritation. 
Very frequently, when this difficulty has been allowed to go on with- 
out relief, whether the congestion causing the irritation is the consequent 
of a cold or the sequel of an attack of gonorrhea, or the result of con- 
tinued sexual abuses, it will often cause a “ catarrhal ” irritation of the 
ducts and even the follicles of the gland, which may go on until it involves 
all or a greater part of these, and even extends to the ejaculatory ducts. 
We have used the word “catarrhal” for the want of a better expres- 
sion, although we do not believe this to be strictly a “catarrh” of these 
ducts or their follicles, for we have not a profuse discharge, in fact, 
scarcely any discharge or “ flow ” at all, but a blocking up of these ducts, 
with a thick gummy, gelatinous, semi-solid material, of a greyish color, 
which, I am satisfied, in many instances, forms the nucleus for a prostatic 
or even a vesical calculus, or may degenerate into a calcareous mass, and 
remain in the ducts of the gland for years, a constant source of irritation 
and annoyance. 
Under these circumstances the patient will come to you complaining of a 
fulness, accompanied with tenderness in the perineum, a frequent desire 
to urinate, and sharp pain ifiifc-contraction of the acceleratores urinae 
muscles in the attempt to eject the last few drops of urine, but little or no 
pain is complained of except just at this time, other than previously 
mentioned. 
When there is hyperesthesia of the prostatic nerves the most prominent 
symptom is the occurrence of nocturnal emissions, ranging from every 
few nights to as often as twice in a single night. The patient generally 
suffers but little or no pain, although an examination with a sound or 
bougie, combined with a digital examination in the rectum, will reveal 
considerable tenderness of the gland, while the muscles will, in many of 
these cases, be found more or less flabby, and the patient generally pale, 
anemic and exceedingly nervous. 
Not unfrequently patients will come to the surgeon complaining of 
being impotent, which a careful examination will prove to be caused by 
an irritated condition of the prostate gland. 
Out of twenty cases reported by Prof. Gross, in the late edition of his 
little work on “ Impotence and Sterility,” he mentioned thirteen as hav 3 
ing hyper-sensitive or irritable prostates in his chapter on impotence. The 
same author says, in his recent work just, referred to, “I long ago reached 
the conclusion that impotence was generally induced by subacute or 
chronic inflammation and morbid sensibility of the prostatic urethra,” 
The same writer, in speaking of “atonic impotency,” says the exciting 
causes were chronic hyperesthesia and inflammation of the prostatic 
urethra. 
In this disease we have a multiplicity of symptoms arising from a va- 
riety of causes, yet all producing an irritable condition of this gland, and 
seriously affecting the health of the patient. 
Diagnosis.—The diagnosis of this morbid condition is not always 
easy, although a careful consideration of the foregoing symptoms will aid 
very much in guiding us in the proper direction. In the congestive form 
there is danger of mistaking it for cystitis, especially when the cystic 
inflammation is confined to the neck of the bladder. 
CYSTITIS. 
A constant desire to void the urine. 
Great straining and tenesmus during mictu- 
rition. 
Urine ammoniacal, high colored, and often 
loaded with mucus and pus. 
I.ittle or no tenderness of the prostate. 
Pain and uneasiness over the pubes. 
Epithelial casts of the bladder. 
No casts of the prostatic ducts. 
No pain in passiug the catheter except after 
reaching the bladder. 
Desire for copulation not increased, but usu- 
ally diminished. 
Generally marked constitutional disturb- 
ances. 
IRRITATION OF THE PROSTATE. 
Micturition more frequent but not a constant 
desire, which is increased toward the after- 
noon and evening. 
Weight and bearing down in the perineum, a 
slight smarting or tingling as the urine passes 
the prostate, accompanied with a prickling or 
burning sensation in the glans penis. 
Urine not much changed excepting it is ab- 
normally acid, and more highly colored. 
Marked tenderness over the prostate. 
Pain and uneasiness in the perineum. 
No epithelial casts of the bladder. 
Casts of the prostatic ducts in the catarrhal 
form of irritation. 
Pain in passing the catheter marked along 
the prostatic urethra. 
Desire for copulation increased rather than 
diminished. 
Seldom any marked constitutional disturb- 
ances. 4 
In the catarrhal form an examination with the bulbous bougie usually 
aid in the diagnosis. This may be done by swabbing out the urethra 
carefully several times with a bulbous bougie, after which by gently pass- 
ing a clean one past the gland and leaving it there until you pass the 
finger well into the rectum and keep up a process of kneading the gland 
gently, interchanging it for continued pressure ; after keeping that up for a 
few minutes, gradually remove the bougie while the finger is still in the 
rectum, and making firm pressure on the gland. 
An examination of the bulb of the bougie will generally reveal more or 
less exudation from the ducts of the gland; not unfrequently a partial 
mould of them. 
A microscopical examination of this exudation will reveal mucus, min- 
gled with epithelium cells, and in cases of long standing, occasional pus 
cells, mingled with crystals of magnesium phosphates or the triple phos- 
phates, all combining to form one heterogeneous mass, which seldom 
contains any spermatozoids, and when it does they are usually inactive. 
There is usually no marked, bloody or purulent discharge, or enlarge- 
ment of the fibrous structure of the gland, or the usual clear, trausparenj 
“white of egg” discharge, so common, in prostatorrhea or interruption 
in the flow of the urine, which is usually not subjected to marked chemi- 
cal changes in the same, as is so commonly seen in acute or chronic pros- 
tatitis and cystitis. 
In hyperesthesia of the nerves supplying the prostate, we may have all 
or part of the symptoms above described, but the most prominent symp- 
tom is the constant annoyance with nocturnal emissions, or almost unre- 
sistible desire for sexual intercourse under the least provocation, which 
often induces them to resort to masturbation or unrestrained sexual 
abuses, which only increases their difficulty. 
Prognosis.—In giving a prognosis in this disease, too much discretion 
cannot be used by the surgeon ; every part of the field must be diligently 
surveyed and carefully considered. Their habits, general health, mental 
and moral surroundings, will power, are all important factors, as well as 
the particular form of the disease; and unless the surgeon has taken all 
these into consideration, as well as that of having secured the entire con- 
fidence of the patient, he will be sadly disappointed if he relies on a 
favorable prognosis; otherwise, he can generally feel safe in giving his 
patient a fair amount of encouragement. 
Duration.—This difficulty may last for months, and even years, fluc- 
tuating up and down according to the surrounding circumstances of the 
patient. 5 
If allowed to go on without proper care, the patient is in constant dan- 
ger of violent outbreaks in the gland structure itself, from the develop- 
ment of acute inflammation, or suppuration, calcareous degeneration, 
chronic enlargement, or the complications arising from the involvement 
of surrounding structures, which may not only hazard the patient’s health 
entirely, but sacrifice his life. 
On the other hand, I have known it to yield in a few weeks to treat- 
ment, although I have seen it continue months and months before recov- 
ery would take take place. 
Treatment.—The first thing to do in the treatment of this disease is 
to gain the entire confidence of the patient, and then to ascertain the 
cause or causes producing the irritation. If it is the result of masturba- 
tion, endeavor, by all the means at your control, to prevent its continu' 
ance. I haves een patients who had this abominable and filthy habit so 
fixed on them that they would resort to it in their sleep, night after night, 
until I found it necessary to put tight drawers on them to prevent them 
from getting a hold of their penis while asleep, and committing the act 
automatically, as it were. Others, again, would knowingly and willingly 
yield to the temptation in the lace of all my admonitions, and deliber- 
ately masturbate day in and day out, notwithstanding all my warning 
against it, until I was obliged to paint the glans penis with some irritant 
or vesicant, and thus destroy thetr pleasure in the act, until other reme- 
dies could be administered. 
The remedies which have served me the best under these circum- 
stances have been bromides combined with ext. of viburnum prunifo- 
lium, or ext. viburnum opulus, tr. belladonna, ergot or camphor, to 
soothe the sexual excitement. Generally such tonics as strychnia, iron, 
quinine, arsenic, or the hypo-phosphites of sodium or calcium, are indi- 
cated, and prove highly beneficial in building up the general system, 
with which should be associated sufficient alterative to insure an active 
condition of the secretions. Whilst locally, if I cannot quiet the irrita- 
tion by the use of injections of tepid water into the bowel, just before or 
immediately after retiring, to which may be added hydrate of chloral, 
I give a suppository of hyoscyamus combined with iodoform and 
camphor. 
In the inflammatory or congestive form, especially when associated 
with scanty or high colored urine, I have found the following to be very 
beneficial: 6 
R. Pot. brom £ij; 
Aquae dest gj ; 
Ext. ergotae 5j; 
Ext. digitalis 3j; 
Ext. gelsemii 3j; 
Elix. glycyrrhizae, q s. ad 3iv. 
M. S.—Teaspoonful between meals and before retiring. 
The catarrhal form is more difficult to control than the congestive, 
owing to involvement of the ducts and follicles, which are exceedingly 
difficult to reach with remedies, and the danger of calcareous degenera 
tion of their secretions. 
In addition to the general tonic treatment above suggested, we will find 
in this form beneficial results from the use of iodide of potassium inter- 
nally, combined with the external use of tr. of iodine along the perineum. 
But it must be remembered that, owing to the preponderance of fibro- 
muscular tissue in comparison with the purely glandular structure, we do 
not get as decided advantages from the use of oidine and its compounds 
as we do in the enlargement and inflammation of the purely glandular 
structures. 
In addition to general constitutional treatment, a line of local treat- 
ment should be promptly instituted in this form of the disease, which 
would secure as nearly as possible the discharge of all the semi-solid 
secretions which block up the ducts and thus interrupt the healthy action 
of their follicles, and which will, at the seme time, stimulate them to 
healthy action. 
This can be aided very much by the use of a solution of bi-borate of 
soda, used with a prostatic syringe, which aids in dissolving this thick- 
ened mucoid discharge, and thus facilitates its more rapid escape. Finely 
powdered borax, or the impalpable powder of boracic acid, applied along 
the prostatic urethra, will not only favor the discharge of this thick secre- 
tion, but act as a gentle stimulant to the diseased ducts and their follicles. 
If a more decided stimulant is desired, a mild solution of argenti nitras 
of five or ten grains to the ounce, may be applied, with the porte caus- 
tique, or the parts dusted with iodoform or covered with the balsam of 
Peru ; but none of these should be applied unless there is pretty positive 
evidence that the mucoid discharge has been pretty thoroughly removed 
first in order to permit direct contact to the diseased parts of these latter 
remedies. 
Occasional kneading of the gland through the rectum will not only 7 
aid in emptying the engorged ducts, but act as a gentle stimulant to the 
gland itself. 
Where there is hyperesthesia of the nerves supplying the gland, and 
thus keeping up, through sympathetic irritation, a constant desire to 
copulate, or inducing frequent nocturnal emissions, I have never found 
anything which gave me such prompt relief as the use of carbolic acid 
applied with the porte caustique along the prostatic urethra. 
Sometimes a single application, combined with tonics, sedatives or 
alteratives, as the case may demand, will be sufficient, but if not, a few 
at the most will serve to control the difficulty. 
The use of suppositories containing suitable remedies applied with 
Harrison's porte-remide, will be found very beneficial, especially if intro- 
duced shortly before the patient retires. 
The use of cold, in the form of pounded ice, filled into an eyeless 
catheter (gum preferred) and introduced into the bladder, and allowed to 
remain for a few minutes, is often serviceable in relieving the irritation. 
The use of electricity may be of some service, although it is question- 
able whether it has any advantages over the remedies above mentioned, 
and it is a remedy we must use with care, lest we induce other troubles, 
such as neuralgia of the testicles, or even suppuration of the same, or 
induce inflammation and cause it to extend along the urethra, and thus 
complicate our trouble rather than relieve it. 
In addition to all these remedies, the hygienic surroundings of the 
patient demand the careful attention of the surgeon in every particular, 
but especially should the skin be kept healthy, the diet judiciously 
guarded, in order to avoid if possible any bowel complication, and last, 
but not least, the general habits of the patient directed in a line of mode- 
ration in all things.