1262 



URETHRA. 



wards the pubis, and gives rise to inflamma- 

 tion and caries of the bone ; nay, it may take 

 its course even to the groin and lower part 

 of the abdomen. 



For obv'ous reasons, stricture seldom 

 happens prior to puberty; nevertheless some 

 rare instances are recorded of the disease 

 in young children. I do not here allude to 

 such as result from mechanical injury, for 

 these may happen at any age. Hunter 

 mentions a case of stricture accompanied 

 with fistula in perina3O in a boy four years 

 old, but he does not speak of the cause.* 

 He also mentions one in a boy eleven years 

 old. In the Museum of the College of Sur- 

 geons there is a preparation (No. 2535.) of 

 the bladder and penis of a boy seven years of 

 age, laid open to show a stricture at the mem- 

 branous part of the urethra, and behind the 

 stricture a small stone is lodged. The case 

 occurred to Sir E. Home, who also mentions a 

 case of stricture occurring at ten years of age. 



What is the true nature of a stricture ? I 

 believe that a stricture (1 speak of the per- 

 manent class) may result from the organisa- 

 tion of lymph effused upon the surface of the 

 mucous membrane, as in the formation of 

 bridle strictures. Secondly, that it may arise 

 from the healing or cicatrisation of an ulcer, 

 in which case a fibrous puckering is produced. 

 Thirdly, that it may arise from hypertrophy 

 of the elastic layer beneath the mucous mem- 

 brane. Fourthly, from deposition of lymph 

 between the urethra and spongy body ; and, 

 lastly, from deposit and organisation of lymph 

 in the cells of the spongy body ; and that these 

 conditions may all co-exist. 



When the strictured part is laid open, it 

 will be found that at the exact seat of stricture 

 the mucous surface is raised; and beneath this 

 the submucous elastic lamina is observed dis- 

 tinctly thickened, of a firm texture, and de- 

 prived more or less of its natural elasticity, 

 this thickening passing off gradually and in- 

 sensibly in a longitudinal direction until it 

 altogether disappears and the canal resumes 

 its natural diameter, or is dilated or contracted 

 according to circumstances. The thickening 

 usually extends equally around the urethra, 

 so that the opening of the canal is in the 

 middle of the stricture, but in some instances 

 it is confined to one side. On attempting to 

 dissect the urethra from the subjacent spongy 

 body, it will be found that its adhesion at the 

 seat of stricture is so complete, that it cannot 

 be raised without much difficulty, and in 

 many cases the separation of the two struc- 

 tures cannot be accomplished at all. The 

 spongy body itself is frequently thickened, and 

 the delicate tissue forming the septa of its 

 cells is much hypertrophied. 



Causes of stricture. Most strictures are the 

 result of inflammation of the urethra. Long 

 persistent and neglected claps constitute by far 

 the most common of the causes of the disease. 



I have no hesitation in admitting that the 

 indiscriminate use of stimulating injections 



* Hunter, On the Venereal Disease, p. 115. 



may be fairly set down as the occasional cause 

 of stricture. Masturbation, and the too frequent 

 indulgence in the venereal act, may be enu- 

 merated amongst the occasional causes of the 

 disease. 



Co-existence of stone ivith stricture. It often 

 happens that calculus in the bladder co-exists 

 with stricture in the urethra, and the con- 

 nection between the two diseases appears 

 easily accounted for. But some curious cir- 

 cumstances occasionally occurring in these 

 cases, render it very doubtful whether we are 

 justified in indiscriminately attributing the 

 formation of stone to the impediment to the 

 discharge of water from the stricture ; nay, 

 the circumstances to which I allude rather 

 tend to prove the converse of the proposition, 

 namely, that the stricture depends on the ir- 

 ritation in the urethra, maintained by the pre- 

 sence of stone in the bladder. The inference 

 appears legitimately deducible from the fact, 

 that cases of severe stricture have been entirely 

 cured by the removal of the stone from the 

 bladder by lithotomy.* 



Diseased lacunce. Sometimes one of the 

 lacunae becomes the seat of chronic inflamma- 

 tion, and is converted into a small indurated 

 tumour, varying from the size of a hemp-seed 

 to a horse-bean. It becomes imbedded in the 

 spongy body.f According to Sir B. Brodie, 

 the usual situation is about two or three 

 inches from the orifice, but it is sometimes 

 perceptible close to the fraenum, at others 

 within the scrotum. 



Rokitansky mentions a curious form of 

 disease occurring after repeated attacks of go- 

 norrhcea. " The urethra presented numerous 

 cartilaginous protuberances, from the size of a 

 millet-seed to that of a pea, in part coalescing, 

 and scattered over the inner surface as far 

 back as the bulb, leaving the passage, however, 

 of adequate dimensions." \ 



Obstruction from other causes. The urethra 

 is sometimes occupied by verrucous vegeta- 

 tions, the result of gonorrhoea. Numerous 

 instances of this are given by Ricord ; they 

 are usually found near the meatus, and are 

 remarkably vascular ; but sometimes they 

 exist in the membranous, or even the pro- 

 static, portion. They are distinguishable by 

 their greater vascularity from another form 

 of excrescence or caruncle, which co-exists 

 occasionally with stricture. Both, however, 

 are formed in consequence of irritation of the 

 urethra! membrane, and represent simple or- 

 ganised structures connected with the urethra 

 by a base or stem. 



Hunter met with two, and these were in 

 cases of very old stricture, where the urethra 

 had suffered considerably. Home says, that 

 with all his opportunity in inspecting these 

 diseases in the dead body, he never met with 

 them. Rokitansky}) also affirms their extreme 



* See Edinburgh Monthly Journal for April, 

 1850, p. 367. 



f Home, On Strictures. 



\ Kokitansky's Pathology; Sydeuham Society's 

 edition, vol. ii. 



Loc. cit. 



