1266 



URETHRA. 



calculi or foreign bodies from the bladder, 

 and thus becomes paralysed, and never after- 

 wards recovers its normal tone. This is an 

 unfortunate condition, as it admits of no 

 remedy. 



The female urethra is occasionally the seat 

 of inflammation : this is almost invariably of 

 the catarrhal form, and may arise spontane- 

 ously or as the consequence of gonorrhoea. 

 The follicles at the meatus are especially liable 

 to inflammation, in conjunction with the fol- 

 licles of the vulva and margins of the nymphae. 

 The disease is described by Dr. Oldham under 

 the head of the "Follicular Inflammation of 

 the Vulva." It consists of a number of slightly 

 raised vascular points, clustering around the 

 elevated border of the orifice of the urethra, 

 ami skirting the margins of the nymphae. The 

 points are isolated and small ; but, as the 

 disease progresses, several of them coalesce, 

 and here and there a minute speck of ulcera- 

 tion may be seen in their centre ; but little or 

 no swelling accompanies it. 



Dr. Ashwell has recognised the same dis- 

 ease, and concludes that the same is alluded 

 to by Dr. Churchill, where he speaks of " a 

 more circumscribed inflammation which may 

 attack any portion of the vulva, and is often 

 seen merely surrounding the orifice of the 

 urethra, and occasionally confined to the 

 clitoris." * 



Specific inflammation of the urethra is 

 usually the consequence of gonorrhoea. The 

 disease seldom attacks the female urethra until 

 after the vagina has been some time affected. 

 It is easily recognised by a swelling or pouting 

 of the meatus ; and on pressing upwards 

 against the pubis the true gonorrhoeal dis- 

 charge appears. It is accompanied with a 

 sense of scalding on micturition and pain ; but 

 the symptoms, for obvious reasons, are much 

 milder than in gonorrhoea of the male. It is 

 amenable to the same treatment. 



Tumours of various kinds are occasionally 

 found connected with the meatus and the 

 urethra itself ; the former have their seat 

 especially in the inferior labium of the ure- 

 thral orifice. The most common is the simple 

 vascular tumour, first described by Morgagni 

 as " a red fungous excrescence, the size of a 

 bean, sometimes to be observed [attached to 

 the orifice of the urethra." It has since been 

 recognised by others ; and has been well de- 

 scribed by Sir Charles M. Clarke. Sir C. 

 Clarke describes it as a vascular tumour, arising 

 from the meatus urinarius. " Its texture is 

 seldom firm ; it is of a florid scarlet colour, 

 resembling arterial blood, and if violence is 

 offered to it, blood of the same colour is ef- 

 fused. It is exquisitely tender to the touch, 

 and if an accurate examination of it be made, 

 it appears to shoot from the inside of the 

 urethra. Its attachment is so slight that it 

 appears like a detached bod}' lying upon the 

 parts." It is sometimes connected higher 

 up with the urethra, and can then only be 

 brought into view by introducing a catheter or 



* Ashwell, on the Diseases of AVouien. 



probe, and separating forcibly the walls of the 

 urethra, when it will be found attached to the 

 mucous membrane. 



Mr. Hughes, of Stroudwater, described a 

 tumour " of a red colour, and of a soft, spongy 

 texture, with an irregular, jagged surface, 

 connected with the meatus." He removed 

 the meatus, which completely included the 

 disease. 



Carcinomatous tumours are also met with 

 in connection with this part. They have been 

 described by Boivin and Dujes. They are 

 frequently associated with similar diseases of 

 the uterus. They are generally of the ence- 

 phaloid character, present a lobulated ap- 

 pearance, and are exceedingly painful. If un- 

 accompanied by disease of other organs, they 

 can be successfully removed. 



Fungoid tumours of the malignant class 

 spring occasionally from the mucous membrane 

 of the urethra. After excision they have a 

 great tendency to recur. They are occasion- 

 ally associated with a similar disease of the 

 bladder. 



The urethra sometimes becomes thickened 

 along its whole extent. According to Clarke, 

 this thickening exists principally in the cellu- 

 lar membrane surrounding the urethra, and is 

 accompanied by a varicose state of the cir- 

 cumjacent veins. On examination, a bulbous 

 tumour will be found behind the pubis, and if 

 much pressure is made upon it, pain will be 

 produced, but not of a severe kind."* It is 

 accompanied with a mucous discharge from 

 the urethra and vagina. The vessels on the 

 surface of the tumour become so large as to 

 admit of being opened with a lancet. When 

 the patient is erect the size of the vessels 

 increases, and they diminish in the recumbent 

 position. Sometimes a pouch forms in the 

 urethra, in which a few drops of urine are 

 lodged : this can be emptied by pressure with 

 the finger. The mucous membrane covering 

 the tumour is sometimes thick, occasionally 

 thin and shining. The disease occurs princi- 

 pally in married women who have had child- 

 ren ; and, according to Clarke, in those with 

 red or auburn hair and fair complexions. The 

 disease seems to consist of an enlargement 

 of the veins of the part, with hypertrophy of 

 the cellular membrane. 



The female urethra is rarely the seat of 

 stricture. I have made inquiries of some of 

 the most experienced accoucheurs in London, 

 and they agree that stricture of the female 

 urethra is very rare. The circumstance clearly 

 depends on two causes ; the first is the ex- 

 treme natural dilatability of the urethra in 

 women ; and the second is, that, although it 

 is liable to gonorrhoeal inflammation, the dis- 

 ease does not persist long in the canal, and 

 consequently its tissues are not involved in 

 protracted chronic inflammation, as is so com- 

 mon in the male. 



Sir Benjamin Brodie, however, met with a 

 case of stricture in the female urethra : it 

 commenced at the extremity of the canal, 



* C. M. CLirkc, on some of the Diseases of Fe- 

 males. 



