PRACTICAL OBSERVATIONS 
UPON THK 
NATURE AND TREATMENT 
OF 
PROSTATORRHCEA 
Read before the Medical Society of the State of Pennsylvania, in June, 1860, 
by 
SAMUEL D. GROSS, M.D., 
PROFESSOR OF SURGERY IN THE JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA. 
[Reprinted from the North American Medico-Chirnrgical Review.] 
PHILADELPHIA; 
J. B. LIPPINCOTT & CO 
186 0. PRACTICAL OBSERVATIONS 
UPON THE 
NATURE AND TREATMENT 
OF 
PROSTATORRHOEA. 
The disease which I am about to describe has not, so far as is known 
to me, received any attention either from specialists or from the authors 
of general treatises on surgery. The term by which it is here designated 
appears, it is true, in M. Nelaton’s “Elemens de Pathologic Chirur- 
gicale,” but altogether in an incidental manner, and evidently without any 
definite idea on the part of that distinguished writer as to the true nature 
of the affection in question. 
Prostatorrhoea is, as the term implies, a discharge from the prostate 
gland, generally of a thin mucous character, dependent upon irritation, if 
not actual inflammation, of the component tissues of that organ. The 
reason why the disease has not hitherto received any specific name or 
place in surgical nomenclature, is simply because it has always been con- 
founded with other lesions, as gleet, or chronic urethritis, seminal losses, 
and cystorrhoea, or chronic inflammation of the mucous membrane of the 
bladder; from which, in fact, it is often difficult to distinguish it. As for 
myself, I have long been familiar with the affection, and latterly have 
described it in my lectures at the College. 
I have not met with prostatorrhoea in children or very young subjects, 
probably because all kinds of diseases of the prostate are so very rare at that 
period of life. That it may occur, however, even at a very tender age, is 
altogether likely, especially in children laboring under stone in the bladder, 
prolapse of the bowel, or worms in the rectum, causing the organ to suffer 
from reflected irritation. After the twentieth year the disease is suf- 
ficiently common, and instances are occasionally met with even in very old 4 
Observations upon Prostatorrhcea. 
persons. As long as the prostate gland remains small and inactive, or is 
not brought fully under the influence of the sexual organs, with which it is 
so intimately associated, it is comparatively infrequent. 
I am not able to say, from my experience, what classes of persons are 
most liable to sulfer from this affection ; but it has seemed to me that it is 
most frequent in those of a sanguineo-nervous temperament, with strong 
sexual propensities, leading to the frequent indulgence of the venereal ap- 
petite, if not to positive venereal excesses, either in the natural manner 
or by masturbation. An irritation would thus seem to be established in 
the prostate gland, attended with more or less discharge of its peculiar 
secretion, either in a normal or abnormal state. Single and married men 
are, apparently, equally prone to it. Once established, it is probable that 
certain occupations may serve to keep it up; and it is also likely that 
there are certain employments which may predispose to it, although it would 
require a much longer experience than what is possessed by any one in- 
dividual to point them out in a definite or satisfactory manner. Intem- 
perance in eating and drinking, frequent horseback exercise, sexual abuse, 
and disease of the bladder, anus, and rectum, may all be regarded as con- 
tributing to such a result. 
The exciting causes of prostatorrhcea are not always very evident. In 
most of the cases that have fallen under my observation, the affection was 
traceable, either directly or indirectly, to venereal excesses, chronic in- 
flammation of the neck of the bladder, stricture of the urethra, or disease 
of some kind or other of this canal. In some cases it has its origin in 
disorder of the lower bowel, as hemorrhoids, prolapse, fissure, fistule, 
ascarides, or the lodgment of some foreign body. It is easy to conceive 
how reflected irritation might induce this disease. The connection 
between the prostate gland and ano-rectal region is very close and 
intimate, and, hence, whatever affects the one will almost be sure, in time, 
to implicate the other, either in consequence of proximity of structure, or 
as an effect of the laws of sympathy. However this may be, no judicious 
surgeon ever omits to examine these parts most thoroughly in the event 
of any serious disease of any of them before he attempts a course of treat- 
ment. Temporary prostatorrhcea is occasionally excited by the exhibition 
of internal remedies, as drastic cathartics, cantharides, and spirits of tur- 
pentine; or, in short, whatever has a tendency to invite a preternatural 
afflux of blood to the prostate gland and neck of the bladder, or to the 
posterior portion of the urethra. Another cause of the disease, and, ac- 
cording to my experience, a very common one, especially in young men, is 
masturbation or self-pollution. Many of the most obstinate and perplexing 
cases of it that have come under my notice were the direct result of this 
detestable practice. Observations upon Frostatorrhcea. 
5 
The symptoms of prostatorrhoea are sufficiently characteristic. The 
most prominent, as already stated, is a discharge of mucus, generally per- 
fectly clear and transparent, more or less ropy, and of varying quantity, 
from a few drops to a drachm and upwai’ds, in the twenty-four hours. It 
is seldom that it is puriform, and still more rare that it is purulent. 
When considerable, the flow keeps up almost a constant moisture at the 
orifice of the urethra, and may even make a decided impression upon the 
patient’s linen, leaving it wet and stained, somewhat in the same manner 
as in gleet or gonorrhoea, though in a much less marked degree. The 
most copious evacuations of this kind generally occur while the patient is 
at the water-closet, engaged in straining, especially if the bowels are con- 
stipated, or the faecal matter is uncommonly hard, or greatly distends the 
rectum, so as to exert an unusual amount of pressure upon the prostate 
gland. 
The discharge, whether small or large, is often attended with a peculiar 
tickling sensation, referred by the patient to the prostate gland, from 
which it frequently extends along the whole length of the urethra, and 
even to the head of the penis. In some cases, indeed in many, the feeling 
is of a lascivious, voluptuous, or pleasurable nature, not unlike that which 
accompanies the earlier stages of sexual intercourse. Not a few patients 
experience what they call a “dropping sensation,” as if the fluid fell from 
the prostate gland into the urethra. Other anomalous symptoms often 
present themselves, such as a feeling of weight and fatigue in the region 
of the prostate, the anus and rectum, or along the perineum, with, per- 
haps, more or less uneasiness in voiding urine, and a frequent desire to 
empty the bladder; some patients are troubled with morbid erections, 
and their sleep is interrupted with lascivious dreams. 
It is astonishing how much the patient’s mind often suffers in this affec- 
tion. The discharge, even if ever so insignificant, occasions him the 
greatest possible disquietude; for at one time he imagines that it is a 
source of much bodily debility, or that it is productive of weakness and 
soreness in the dorso-lurabar region, especially if these symptoms happen 
to coexist; at another, that he is about to become impotent, under the 
delusive idea that the flow is one of a seminal character; an idea which 
not unfrequently haunts him day and night, and from which hardly any- 
thing can, perhaps, even temporarily divert his attention. His mind, in 
short, is poisoned, and the consequence is that he is incessantly engaged 
in trying to obtain relief, running from one practitioner to another, dis- 
trusting all, and affording none an opportunity of doing him any good. 
In the worst forms of the affection, his business habits are destroyed, he 
becomes morose and dyspeptic, and he literally spends his time in watch- 6 
Observations upon Prostatorrikea. 
mg for the discharge which is the source and cause of his terrible suf- 
fering. 
The affections with which prostatorrhcea may be confounded are the 
various forms of urethritis, especially gleet or chronic gonorrhoea, dis- 
charges of semen, and chronic inflammation of the bladder. 
From urethritis, whether common or specific, it is generally easily distin- 
guished by the history of the case, the nature of the discharge, and the 
attendant local phenomena. In most cases, the affection comes on grad- 
ually, not suddenly, as in gonorrhoea or simple inflammation, and without 
impure connection; the discharge is white or grayish, translucent, and 
ropy, not purulent, opake, and yellowish; and there is ordinarily no 
burning or scalding in micturition. Moreover, there is seldom any evi- 
dence of inflammation in the urethra or penis. In gleet or chronic 
urethritis the signs of distinction are sometimes more difficult; but even 
here a satisfactory conclusion may generally be reached by a careful con- 
sideration of the history of the case, and a proper examination of the 
discharge, which is nearly always more or less puriform, as well as more 
abundant than in prostatorrhcea. When the discharge of the urethra is 
kept up by the presence of a stricture, the diagnosis can be determined 
only by a thorough exploration with the bougie. 
Yery many patients confound this discharge with a flow of semen; an 
idea in which they are often encouraged by their attendants, in consequence 
of their ignorance of the nature of the affection. Much has been said 
and written respecting diurnal spermatic emissions; but, according to 
my experience, these evacuations are among the rarest occurrences met 
with in practice. We are often told that they take place at the water- 
closet, during efforts at straining, and this is, no doubt, occasionally the 
case; but more commonly it will be found that these discharges are of a 
strictly prostatic character, the fluid being forced out of its appropriate 
receptacles into the urethra, along which it is presently discharged. This 
delusion will be more likely to take hold of the mind if the escape of the 
fluid be accompanied by a sort of pleasurable sensation, somewhat similar 
to that which follows a feeble emission. Persons affected with prosta- 
torrhoea will often tell us that they have quite a number of such evacua- 
tions—perhaps as many as six or eight—during the twenty-four hours, 
especially if they are troubled with disease of the ano-rectal region, lead- 
ing to frequent visits to the water-closet, or if they are much in female 
society, engaged in exciting reading, or addicted to the pleasures of the 
table or to inordinate sexual intercourse, eventuating in general and local 
debility. Should the history of the case fail to afford the requisite light, 
it may be promptly supplied by a miscroscopic examination of the sus- 
pected fluid, semen always revealing distinct spermatozoa, whereas the Observations upon Prostatorrhcea. 
7 
prostatic and urethral secretions never afford any such indications. This 
will be the case whether the discharge be taken fresh from the orifice of 
the urethra or from the stiffened spots left upon the patient’s linen. 
The characteristic symptom of cystorrhoea, or chronic inflammation of 
the bladder, is an inordinate secretion of mucus, associated, in nearly all 
cases, with an altered condition of the urine, frequent and difficult mictu- 
rition, pain in the region of the affected organ, as well as in the surrounding 
parts, and more or less constitutional disturbance. In prostatorrhcea 
there may also be more or less uneasiness low down in the pelvis, with 
trouble in voiding urine, especially where the prostate is much enlarged, 
so as to cause constant vesical irritation; but the two disorders are so 
widely different as to render it impossible to confound them. 
The pathology of this affection consists in some disorder of the prostate 
gland, especially of its follicular apparatus, leading to an inordinate secre- 
tion of its peculiar fluid, and to a discharge of this fluid along the urethra, 
at longer or shorter intervals, and in greater or less quantity. That this 
disorder is, at times, of a real inflammatory nature, would seem extremely 
probable from the character of the concomitant phenomena, and also from 
the fact that this organ is frequently, if indeed not generally, found to be 
more or less enlarged .and indurated. Nevertheless, there are cases, and 
these are by no means uncommon, in which it is, to all appearance, either 
entirely healthy, or so nearly so as to render it impracticable, by the most 
careful exploration, to discover any departure from the normal standard. 
The discharge under such circumstances seems to be the result solely of a 
heightened functional activity, probably connected with, if not directly 
dependent upon, disorder of the seminal vesicles, the urethra, neck of the 
bladder, or recto-anal structures; in other words, upon reflected irritation, 
or, as our professional forefathers would have denominated it, sympathetic 
disturbance. 
The prognosis of prostatorrhcea is generally favorable; for it does not, 
in itself, present anything grave, being, as just stated, not a disease, but 
merely a symptom of a disease, usually slight, and therefore easily remov- 
able. Its obstinacy, however, is often very great, and hence the surgeon 
should always be guarded in the expression of his opinion respecting a 
rapid cure. When the mind deeply sympathizes with the local affection, 
as is so frequently the case, especially in young men of a nervous, irritable 
temperament, there is no disease which, according to my experience, is 
more difficult of management, or more likely to result in vexation and 
disappointment. 
In the treatment of this affection, one of the first and most important 
objects is to inquire into the nature of the exciting cause, and, if possible, 
to remove it. To set about it in any other way would be the climax of 8 
Observations upon Prostatorrikea. 
absurdity; for here, as everywhere else, our therapeutic measures must be 
based upon a rational pathology, or a full appreciation of the nature and 
seat of the disease. The points which should more especially claim at- 
tention are, first, the condition of the prostate and its associate organs, 
and, secondly, the habits and state of health of the patient. 
The first of these indications is best fulfilled by a thorough exploration 
of the genito-urinary apparatus and of the anus and rectum. For this 
purpose, a catheter is employed with a view of ascertaining the condition 
of the urethra, the prostate, and the bladder, aided by the finger in the 
bowel, previously emptied by an enema. In this manner, the surgeon be- 
comes at once apprised of the existence or non-existence of stricture of 
the urethra, and of the presence or absence of morbid sensibility of its 
mucous membrane; the size and consistence of the prostate, and the 
state of the urinary reservoir, particularly, as to whether there is inflam- 
mation, stone, hypertrophy, or other lesion. The finger in the rectum 
will be of great service, not only in detecting disease in the prostate and 
bladder, but also in this tube itself and in the anus. Indeed, without its 
aid no exploration of these organs could be at all satisfactory. If disease 
of the seminal vesicles exist, it will usually be evinced by tenderness on 
pressure through the wall of the bowel, provided the finger is sufficiently 
long or the prostate is not too voluminous. 
The habits of the patient should be particularly inquired into. In 
many of this class of persons they are decidedly lascivious, or marked by 
excessive sexual indulgence, either naturally or in the form of masturba- 
tion, the prostate gland, seminal vesicles and adjoining structures being thus 
kept in a state of continual excitement, highly favorable to the production 
of prostatorrhcea. The nature of the patient’s diet, his temperament, the 
state of his health, and his mode of life as it regards sleep and exercise, 
both of mind and body, also deserve special consideration. 
Having ascertained the above facts, or, in other words, having made 
himself perfectly familiar with the local and general condition of the 
patient, the surgeon will be able, in most cases, to institute something 
like a rational mode of treatment. This should be directed, as a general 
rule, partly to the system at large, partly to the suffering structures. 
In many of the cases the patient is weak, or deficient in muscular and 
digestive power, indicating a necessity for tonics, as iron and quinine, a 
nutritious diet, with a glass of generous wine, and gentle exercise in the 
open air, either on foot or in an easy carriage; riding on horseback being 
scrupulously avoided as likely to keep up undue excitement in the parts. 
One of the best preparations of iron is the tincture of the chloride, in 
union with tincture of nux vomica, in the proportion of twenty drops of 
the former to ten of the latter, four times a day. If the patient be Observations upon Frost atorrikea. 
9 
plethoric, he may use with great advantage small doses of tartar emetic 
in the form of the antimonial and saline mixture, care being taken not to 
nauseate. In either case, it is of paramount importance to correct the 
secretions and to maintain a soluble condition of the bowels. Drastic 
purgatives are of course avoided, as they would only tend to perpetuate 
the mischief. Unless the patient is actually debilitated, he should rigor- 
ously abstain from condiments and high-seasoned dishes. 
Among the more important topical remedies are, first, moderate sexual 
indulgence, as a means of allaying undue excitement of the prostate 
and its associate organs; secondly, cooling and anodyne injections, or 
weak solutions of nitrate of silver and laudanum, or, what I generally 
prefer, Goulard’s extract with wine of opium, in the proportion of from one 
to two drachms of each to ten ounces of water, thrown up forcibly with 
a large syringe three times a day, and retained three or four minutes in 
the passage. In obstinate cases, cauterization of the prostatic portion of 
the urethra, or even of the entire length of this tube, may be necessary, 
the operation being repeated once a week. The cold hip-bath should be 
used twice in the twenty-four hours; the lower bowel should be kept 
cool and empty; and, if the disease do not gradually yield, leeches should 
be applied to the perineum and around the anus. 
Such, in a few words, is a brief outline of the treatment which I have 
found most efficacious in this affection. Whatever plan may be employed, 
perseverance and an occasional change of prescription are indispensable 
to success. When there is deep mental involvement, hardly anything 
will effect a cure; or, more correctly speaking, it is almost impossible to 
induce the patient to believe that he is well, or that nothing serious is the 
matter with him. Under such circumstances our chief dependence must 
be upon travelling and an entire change of scene and occupation. If the 
patient be single, matrimony should be enjoined.