The prostate is generally found to be small when the organs of generation are in an imperfect condition. Its most important anomalies consist in:

1. Abnormities Of Size

And of these the most common is enlargement, resulting from hypertrophy. It is one of the most frequent causes of the urinary obstructions occurring in advanced life. The substance of the gland in these cases appears normal, occasionally a little softened, of a spongy elastic consistency, and succulent, i. e. its ducts contain much secretion; in other cases it appears tough and coriaceous, without visible alteration of structure. The formation of fibroid tumors (vide p. 198) is often complicated with this benignant variety of enlargement.

The enlargement varies much in degree; occasionally it is so considerable that the gland attains the size of a fist. The lateral lobes are the chief seat of the enlargement, which affects both uniformly, or predominates on one side; but the development of a so-called middle lobe (Home) is of greater importance, in reference to the impediment it offers to the discharge of the urine; it not unfrequently predominates in a most remarkable manner, even when the hypertrophy affects the entire gland. It rises from the posterior section of the prostatic ring, between the two lateral lobes, and, according to its size, projects more or less into the cavity of the bladder. It presents the appearance of a rounded tumor, of the size of a bean, or hazel-nut, which projects into the neck of the bladder; it may increase to the size of a walnut, hen's or duck's egg, or more, and then protrudes into the cavity of the bladder in the shape of a smooth or rough, nodulated, slightly lobular, rounded or cordiform, pyramidal or cylindrical tumor.

All enlargements of the prostate impose an obstacle to the passage of the urine, both by narrowing the neck of the bladder and the prostatic portion of the urethra, as well as by inducing a change in the direction of the channel, by diminishing its calibre, and by dividing it. The last two malformations are more particularly the result of unilateral development of the gland, and of increase of its middle lobe. The former not only produces a lateral contraction and deformity of the canal in the vertical direction, so as to produce a sickle-shaped fissure, but forces it out of the mesial line to the opposite side; the middle lobe not only obstructs the internal orifice of the urethra, but often narrows the neck of the bladder by pushing it on one side, or divides it into two diverging passages, which reunite in the prostatic portion of the urethra.

The results of this enlargement are hypertrophy of the bladder, dilatation of the urinary passages, etc.

A diminution of the prostate, with relaxation of the glandular tissue, is observed in rare cases, as accompanying atrophy of the testicles.

2. Diseases Of Tissue

1. Inflammation

An opportunity is scarcely ever presented of studying inflammation of the prostate in the dead subject, except in its results, suppuration and abscess, or induration. The former occurs not unfre-quently as the issue of chronic inflammation, which exacerbates from time to time. The abscesses, which vary in size and number, generally discharge themselves into the bladder, into the prostatic portion of the urethra, in which case the ejaculatory ducts are destroyed, into the vesi-culae seminales, the surrounding cellular tissue, or the rectum; or they force their way along the urethra to the penis, or into the scrotum.

2. Morbid Growths

a. We have never observed the formation of cysts in the prostate.

b. Fibroid tumors occur frequently, and generally induce considerable hypertrophy of the gland. They are commonly of the size of a pea, a bean, or a hazel-nut, round or oval, and when deposited in the peripheral layer of the gland, give rise to nodulated protuberances. Although they do not attain an extraordinary magnitude, they are of interest, on account of the relation they bear to analogous growths in the uterus.

C. Tubercle

Tubercle of the prostate is always complicated with tubercle of the testis, of the vesiculae seminales, and of the allied lymphatic glands. The softening process gives rise to tubercular abscesses, which are enlarged by the fusion of secondary tubercular deposits and thus extend beyond the gland, causing the devastations spoken of under the head of abscess.

D. Cancer

Cancer in any shape rarely occurs in the prostate, which is curious as contrasted with the frequency of its occurrence in the uterus. Medullary carcinoma is occasionally found to attack the prostate, and to give rise to considerable enlargement of the gland; it may sometimes perforate the fundus vesicae, and sprout into its cavity, causing a cancerous ulcer with raised edges, and of varying size.

3. Anomalous Contents Of The Prostatic Ducts

The prostatic ducts, in advanced age, very often contain calculous concretions; they are generally very minute, resembling fine sand or poppy-seeds, rarely attain the size of millet-seeds, and still less frequently form conglomerations of the size of hemp-seeds or peas. They present a black, blackish-brown, or yellowish-brown color, are very hard, and generally glossy. Their number varies, but is often considerable, and a section of the gland shows them more or less uniformly scattered through its tissue. The gland at the same time appears very juicy, and the ducts are more or less dilated.