An Address on UNUSUAL SYMPTOMS DUE TO ENLARGEMENT OF THE PROSTATE
Authors: G. G. Turner
Journal: BMJ (1929)

THJs address is not intended for genito-urinary specialists, or even for operating surgeolas, but for those among you who ar-c genieiral practitioners, whlose duty it is to sce patieilts at the outset of their troubles and assume respon-siLility for their diagnosis.Further, wlhat I have to say i3 entirely from the point of view of the general surgeon, for, thoughli I have alivays been interested in genito-urinary disease, 1 have liot devoted especial attention to this brancl of practice.I lhave alw-ays beeni alive to the importance of the probl&ms of disease as they are presented by the " patielnts' complain-ts," and my responsibility as a teacher of medical students, who are miiost of them to become the practitioners of the future, has miiade me pay particular attention to this asPect of our work.Most of us must have recognized the difficulty of getting clinical knowledge from books, for the descriptions of diseases, as we read them, have been pieced together from many cases.Quite a limited expe- rience of practice of any kind soon teaches how much actual " patienits " differ from "ecases."Similarly, emxpe- rience lhas taught me that a wlole variety of symptoms nlot obviously colnected witli the urinary system may depend on enilargemilent of the prostate, and it is to this aspect that I p)articularly wish to refer.USUATAL SYMPTOMS OF ENLARGED PROSTATE.As I was 1)utting together my niotes it seemiied to me that perhliaps it would avoid misunderstanding if I enu-lmerated quite briefly thle " usual " sort of symptonms which bring patienits suffering from enlargement of the prostate unider the care of tlle surgeon.Of coulse, I fully realize hoow easy it may be fur aniyone, like mnyself, working pr-incipally in large hospitals to get ideas on disease whichl are different from those obtainied in genieral lpractice.At the same time, practically all the cases are sent into hospital by the practitioners of the district-in which I live, so that they represenit the problems with -which they haave to deal.At tlhe outset I w-ould like to emiiphasize the truth of the dictum laid dpwn by Sir Henry Thompson, to the cffect that cenlargement of the prostate of such a degree as to give rise to sys) ptois demalnding treatment does not occur before 50 years of age.It has been quite surprising to me, but it is rnoine the less true, that in an experience of over thirty years T lhave niever yet seen a case of ordinary clnlargemenit of the prostate, that is, non-malignant, exce-pt in those over this age.Now the usual prostatic symptoms can be arrang,ed under one or other of the following heads:Hesitation in starting and finishing the act of micturition.Irritability and frequency, with dribbling.Mostly nocturnal frequency. Attacks of retention.A culminating attack of complete retention.Retention with overflow, and any combination of the above.I do not doubt that there are other symptoms wllich will at once stamp the patient as suffering from urinary trouble, probably of prostatic origin, anld those whose reputation particularly attracts uriniary cases will often be consulted by people complaining of very early symptoms associated with prostatic enlargenlent, but these are less definite anld are not alwvays easy to assign to their proper cause.UNTUSUAL SYMPTOM3S OF ENLARGED PROSTATE.And niow I want to draw attention to the unustual sym- ptoms w-h0ich I hlave promised to discuss.Early in my career my attention was attracted to this matter by the case of a miian whom I saw in consultation * Given before the Medical Society at Nottingham, December 5th, 1928.with his -fanlily doctor, because lie was supposed to be suffering from gastiric car-'cinioa.