URETHRA. 



1259 



similar kind. The prostatic part of the ure- 

 thra evinces signs of disease in severe attacks 

 of clap. 



The glands of Cowper are sometimes in- 

 flamed, independent of gonorrhoea, and be- 

 come indurated ; or they occasionally suppu- 

 rate. 



Ulceration of the urethra may arise from 

 common and specific causes. In the latter 

 category, chancres take the first rank ; these 

 can only occur in the anterior part of the 

 canal, and are generally found at the urethral 

 orifice. 



Ulceration, independent of specific cause, 

 is sufficiently common : thus, it may arise 

 spontaneously, or as the consequence of stric- 

 ture, or foreign bodies in the canal, as calculi, 

 pieces of bone, bougies, &c. Spontaneous 

 ulceration of the urethra is exceedingly rare ; 

 it is not mentioned, usually, by writers on the 

 diseases of the urethra. 1 have met with one 

 instance of it myself: in this case three suc- 

 cessive attacks of ulceration had occurred, 

 which terminated in urinary fistulae, one an- 

 terior to the scrotum, one in the perinaeum, 

 and one in the vicinity of the tuber ischii. 

 They were each preceded by rigors, and other 

 signs of fever, and were accompanied by much 

 constitutional disturbance ; no stricture, or 

 other appreciable disease of the urethra what- 

 ever, had preceded the ulcerative process. 



Ulceration behind a stricture is very com- 

 mon ; it depends on inflammation attacking the 

 part as the result of long continued irritation. 



A stricture itself sometimes becomes the 

 seat of ulceration, when bougies and catheters 

 are used with violence for its cure. It also 

 happens, though rarely, that spontaneous ulcer- 

 ation of the stricture occurs, by which the 

 stricture is cured. Sir Benjamin Brodie re- 

 lates an instance of this. 



Ulceration consequent on tubercular deposit 

 now and then occurs in the urethra, but only 

 in cases where tuberculosis prevails over the 

 entire urinary apparatus.* An instance of 

 this description occurred to Mr. Robinson of 

 Peckham, in a man who had been the subject 

 of extensive tuberculosis in the urinary and 

 genital organs. The disease appears to attack 

 the follicles. 



Cancerous ulceration attacks the male 

 urethra in carcinoma of the glans penis and 

 other parts of the organ. 



Sloughing of the urethra, as a consequence 

 of stricture and violent catheterisation, often 

 leads to the destruction of a considerable por- 

 tion of the canal. 



In severe cases of small pox, pustules are 

 not unfrequently found in the urethral mem- 

 brane. 



Abscesses. As a consequence of inflam- 

 mation, abscesses form in connection with 

 the urethra: they may be acute or chronic : 

 sometimes they communicate with the urethra, 

 but frequently they have no such commu- 

 nication. Abscesses may take place in any 

 part adjacent to the canal: thus, in severe 



gonorrhoeas, suppuration in the spongy body 

 from inflammation of contiguous parts is not 

 very uncommon ; the same also is occasion- 

 ally met with in the perinaeum, in Cowper's 

 glands, and even in the prostate. Abscesses 

 are not unfrequently met with as the conse- 

 quence of injury to the urethra from blows or 

 falls upon the part. In all such cases the 

 abscess communicates with the canal, and 

 frequently, if not generally, is attended with 

 extravasation of urine. 



The most common forms are those depend- 

 ing on stricture ; they are preceded by ulcer- 

 ation or sloughing, which generally takes 

 place behind the seat of stricture. Syme 

 thinks that ulceration of the urethra is se- 

 condary to the formation of matter, which is 

 external to the urethra, and precedes the ul- 

 ceration. Abscesses now and then form in 

 the vicinity of the urethra without any direct, 

 or indirect communication with the canal ; 

 this happens occasionally in cachectic states of 

 the constitution, in which abscesses are not 

 unfrequentin thevicinity of other mucous out- 

 lets, as the rectum. When these are opened, 

 the matter is disgustingly foetid, and is strongly 

 impregnated with an urinary odour, although 

 no urine has become mixed with it, no breach 

 having occurred in the urethral membrane. 



One of the most common forms of abscesses 

 connected with the urethra arises from in- 

 flammation of the lacunae during a severe 

 attack of gonorrhoea. Under these circum- 

 stances the orifice of the lacuna, the subject 

 of the disease, probably becomes closed by 

 adhesive inflammation, a small, round, indo- 

 lent tumour is formed in the direction of the 

 spongy body, or in the perinaann. Ulcera- 

 tion or bursting into the urethral canal often 

 occurs, and the urine escapes into the sac, 

 causing increase of inflammation ; and now 

 distinct suppuration having taken place, 

 fluctuation becomes evident, and either the 

 matter escapes externally by ulceration, or 

 the surgeon is induced to puncture it with a 

 lancet. 



Tubercles. Louis states that he has rarely 

 examined the urethra of tuberculous subjects. 

 Rayer, however, quotes two cases, one of 

 which he witnessed himself, and the other 

 was communicated to him by Vernois. The 

 former occurred in a man thirty-six years of 

 age, who had tubercles in his kidneys, testicles, 

 and prostate ; the latter in a boy, aged twelve, 

 with tubercles in the kidneys and on the sur- 

 face of the peritoneum ; in this case the 

 whole urethra was apparently affected ; in the 

 other, only two inches and four lines of the 

 vesical end were diseased. 



Ricord presented to the Academy of Me- 

 dicine* a curious specimen of an urethra 

 completely studded with miliary tubercles. It 

 was removed from a man who had undergone 

 the operation of castration for tubercular 

 deposit in the testicle some years previously. 

 The prostate contained a tubercular excava- 

 tion. 



* Sec Eokitausky. 



* Seance <lu 2 Avril. 



