92 DISEASES OF THE URETHRA. 



relapses, but exposure to cold and over-exertion seem to have- a similar 

 effect. 



The symptoms and course of gonorrhoea present a good deal of 

 variation. First of all, they vary in the degree and duration of the in- 

 flammatory symptoms, and the pain, redness, and swelling of the ure- 

 thral mucous membrane. A classification of the affection into various 

 species, such as the erysipelatous, eynochal, erethetic, and torpid, has 

 been based upon this variation, without, however, any practical advan- 

 tages being derived from such arrangement. Generally the inflam- 

 matory symptoms of a first clap are far more severe than those of the 

 second and third, but there are exceptions to this rule. In severe 

 gonorrhoea, with intense hyperasmia, rupture of small blood-vessels 

 with haemorrhage often occurs, imparting a reddish or brownish hue to 

 the discharge. Although this haemorrhage is not at all dangerous, yet 

 the " bloody," or " black," or " Russian clap," has a terrible reputation 

 among the laity. The flexion which the penis undergoes during erec- 

 tion (known as chordee) is of greater moment. These flexions result 

 from a loss of elasticity on the part of the inflamed portion of the cor- 

 pus cavernosum, which prevents it from participating in the enlargement 

 of the penis. It sometimes happens that the inflamed portion of the 

 corpus cavernosum undergoes permanent atrophy, and that thenceforth 

 the penis when erect is distorted. Sometimes, too, when the atrophy 

 extends entirely through the corpus cavernosum at one point, ever 

 afterward erection is only practicable from the root of the organ up to 

 that point. Among the less serious accidents which may occur during 

 gonorrhoea, is the formation of small abscesses about the urethra. 

 Severe pain, increased by pressure, and a hard circumscribed swelling 

 about the urethra, are the characteristic signs of the formation of such 

 abscesses. They nearly always run a favorable course, whether they 

 perforate externally or into the urethra. A much more dangerous but 

 also a more rare complication of gonorrhoea is inflammation of the 

 prostate. We may infer that the prostate is the seat of hyperaemic 

 swelling, from the unpleasant sense of pressure in the perinaeum 

 of which the majority of patients with gonorrhoea complain, as well as 

 from the enlargement and induration of the prostate so often seen in 

 old persons, chiefly in those who have had gonorrhoea in their youth. 

 If the prostate be much inflamed, there is an extremely unpleasant 

 sense of pressure, or a dragging, throbbing pain in the perinaeum, extend- 

 ing into the bladder and rectum, which is greatly aggravated upon the 

 passage of the urine or the faeces. Both in the perinaeum and through 

 the rectum we can feel a tumor of varying size. Micturition becomes 

 more and more difficult, and the dysuria may increase to absolute 

 retention of urine. If the inflammation go on into suppural ion, an ab 



