GONOKEHCEA. 435 



the meatus is the narrowest part, the opening should be enlarged 

 in a direction upwards into the glans, and that the penis should 

 be seized on the proximal side of the stone, so that the calculus 

 may not slip into the higher and wider part of the urethra during 

 its removal. 



If the urine cannot be withdrawn per urethram, the bladder 

 may be aspirated or tapped immediately above the symphysis 

 pubis, seeing that the retention of urine has distended the 

 bladder and elevated the peritoneal reflection ; or it is possible 

 to withdraw the urine by tapping through the rectum, above the 

 prostate and through the trigone at the base of the bladder, 

 which is also uncovered by peritoneum. 



Specific Urethritis (Gonorrhoea). Inoculation of the mucous 

 membrane of the urethra with the gonococcus occurs at the lips of 

 the meatus externus or just within the fossa navicularis. From 

 this starting place the whole length of the tube may become 

 involved by direct continuity of infection, and beyond it the 

 bladder and even the ureters and the kidneys may suffer from 

 the invasion. The openings of the glands in the mucous mem- 

 brane form convenient nesting places for the cocci. 



The lymphatics of the urethra absorb the septic material, and 

 convey the organisms, both gonococci and staphylococci, to the 

 upper set of inguinal lymphatic glands, and sometimes also to 

 the lower set, thus inducing the formation of a bubo. The 

 gonococci reaching the prostatic portion of the urethra may 

 enter one or other of the common ejaculatory ducts, and may 

 travel along this tube, pass the entrance of the duct from the 

 vesicle and through the whole length of the vas, to eventually 

 reach the globus minor of the epididymis, there to cause in- 

 flammation or epididymitis. The vas itself is usually involved 

 in the inflammatory process and is thus thickened, and often the 

 surrounding tissues of the cord become cedematus. In some 

 instances, before the actual inflammation of the epididymus 

 occurs, pain may be experienced on defecation, owing to the 

 hardened faeces pressing upon the lower end of the vas and the 

 seminal vesicle, both of which structures may have been already 



282 



