90 DISEASES OF THE URETHRA. 



is reddened, injected, swollen, and coated with punform secretion. It 

 is a matter of importance for the prognosis and treatment of gonorrhoea 

 to know that, hi the first and second week of the complaint, the ana- 

 tomical changes only involve the anterior portion of the urethra 

 the fossa navicularis which is very richly endowed with glands; 

 and it is not until afterward that the lesions extend to the mem- 

 branous and prostatic portions of the urethra. In very severe cases, 

 the inflammation of the mucous membrane is accompanied by inflam- 

 mation and infiltration of the corpora cavernosa, which not only dimin- 

 ish the calibre of the urethra, but render a uniform enlargement 

 of the penis during erection impossible. Far more rarely submucous 

 abscesses form in severe gonorrhoea, or, what is a much more serious 

 accident, inflammation and suppuration of the prostate occur. The 

 lymphatics of the penis may also become implicated in the inflamma- 

 tion, and sympathetic swellings of the inguinal glands are not unfre- 

 quent complications of the disease, although suppuration in such cases 

 is quite exceptional. 



The most common complications of gonorrhoea are inflammation 

 of the epididymis and catarrh of the bladder. These affections both 

 make their appearance about the end of the first or second week, that 

 is, at the time when the pars prostatica becomes involved in the in- 

 flammation, and when opportunity is afforded for the extension of the 

 inflammation to the vasa deferentia and neck of the bladder. 



In chronic gonorrhoea the mucous membrane is swollen and stud- 

 ded here and there with fungous granulations. Its follicles are en- 

 larged and its secretion is more mucous. In many cases, circumscribed 

 spots, and sometimes extensive tracts of the submucous tissue, are 

 hypertrophied, indurated, and firmly attached to the mucous mem- 

 brane. It is to this that most urethral strictures are due. 



SYMPTOMS AND COURSE. The commencement of a clap is an- 

 nounced by an itching sensation at the mouth of the urethra, which 

 does not amount to pain, accompanied by a scanty secretion of a trans- 

 parent, clear mucus. At the same time the meatus seems slightly 

 reddened, and its lips are usually agglutinated by the dried secretion, 

 a thin scale of which is also spread over the tip of the glans. An in- 

 creased desire to pass water then sets hi ; the patients often have noc- 

 turnal pollutions, and during the day suffer from frequent erections, 

 which often induce thoughtless persons to indulge in further excesses. 

 Gradually, generally in the course of a day or two, the sense of itch- 

 ing in the urethra gives place to a burning pain, extending from the 

 meatus to the fossa navicularis. This pain increases, and, during the 

 act of micturition, is extremely severe. The inclination to pass water 

 becomes more frequent than before, so that with each effort a few 



