Guyon and the French School generally maintained that the enlargement of the prostate is not merely a purely local diseases, but a local manifestation of a constitutional disorder which commences with general arteriosclerosis and ends in fibroid degeneration; that the genito-urinary organ-prostate, bladder, ureters and kidneys-re liable to undergo this changes in a pronounced form, the muscular and glandular structures being replaced by dense fibrous tissue; these latter changes never being independent of general arteriosclerosis. The enlargement of the prostate and changes already described s taking place in the urinary tract behind, are held to be coincident and not related to each other as cause and effect. It is pointed out that all the symptoms commonly regarded as the result of the hypertrophy of the prostate, may occur when there is no enlargement of that organ, merely as a result of sclerosis of the bladder.
Against the theory, though it may be very instructive from the homoeopathic point of view it is urged that though arteriosclerosis and enlargement of the prostate do occur together, it is no proof that the latter is the result of the former-as well might cancer and other diseases which are liable to occur during the arteriosclerosis age, be attributed to this degeneration; that enlargement of the prostate occurs, when there is no such general arteriosclerosis, that arteriosclerosis induces atrophy rather than hypertrophy, that enlargement of the prostate frequently starts before the arteriosclerosis period and that this enlargement always commerces as adenomatous overgrowth and not as fibroid degeneration.
One of the most important effects, from a surgical point of view, of the acceptance of Guyon’s theory, if carried to its logical conclusion, would be to prohibit the employment of any form of operative interference aimed at the radical cure of the disease, to limit the treatment, i n fact, to the palliative kind.
Another theory is that propounded by Velpeau, that enlargement of the prostate is analogous to fibroid disease of the uterus. In support of this view, it is pointed out that a special part of the prostate, the so-called utricle-is the equivalent of the uterus (and vagina), that the structure of the prostate and uterus are somewhat similar, that there is a great resemblance in structure, position and mode of growth between the tumours of the uterus and the overgrowths that constitute enlarged prostate, and that the disease in both instances sets in, when sexual activity is on the wane and does not originate when the activity has completely ceased.
The third theory that enlargement of the prostate is of inflammatory origin dates back to the days of John Hunter, Virchow and Ciechanowski.
The advocates of this theory hold that the disease s confined mainly to persons who have suffered from inflammation of the prostatic urethra previously, whether due to a gonorrhoea, masturbation or sexual excesses (whether natural or unphysiological). But they entirely fail to explain now it happens that the enlargement of the prostate does not occur during that period of life, viz, early manhood, when these diseases and conditions, held to be the cause, prevail; except that the process latent for years, till even the existences of the provoking conditions has in many instances faded from memory.
My own experiences prove that as a rule patients who have been suffering from prostatic urethritis never get an enlargement of the prostate, whereas patients suffering from an enlargement of the prostate never have been suffering from a gonorrhoea. Anyway, the previous mode of life of the patient has nothing to do whatever with the advent of this disease. All we know of the disease is, that the enlargement of the gland is mainly, if not wholly, of an adenomatous character and that it occurs only during the decline of life, when the sexual functions are on the wane. Having fulfilled its purpose as an accessory sexual organ in early and mature manhood, as its function diminished, the gland has a tendency in disease to “run to seed” as it were in assuming this unhealthy adenomatous overgrowth. Why it does, so, has yet to be explained.
