418 DISEASES OF THE URINARY ORGANS. 



secondary ; the bladder is generally involved as the result 

 of the extension of the new growth from the uterus, vagina, 

 or rectum, or rarely by metastasis. 



Calculi are frequently found in the bladder, varying greatly 

 in size and number. In some cases there is a single calculus 

 four or five inches in diameter ; in others, small gravel-like 

 particles. 



The appearance of the larger stones varies according to 

 their composition. The uric-acid calculus is generally round 

 and hard, its surface smooth, and from a yellow to a red 

 color. Mixed or triple-phosphate calculi are also frequent. 

 They are white, soft, and friable, with roughened surfaces; or 

 occur as incrustations on the mucous surface of the bladder- 

 walls. Caldum-oxalate or mulberry calculi are brownish in 

 color, hard, and rounded, with irregular nodular surfaces. 



THE URETHRA. 



Inflammation of the urethra, which is in most instances due 

 to the gonococcus of Neisser, is a frequent and especially 

 serious disease, in its consequences, in the male. In the great 

 majority of cases the inflammatory process involves the entire 

 extent of the urethra, though it may be confined to that por- 

 tion anterior to the cut-off-muscle anterior urethritis. The 

 gonococci rapidly penetrate between the epithelial cells beyond 

 the reach of antiseptics and astringents. 



The mucous membrane is intensely congested and swollen, 

 and from it comes a thick, purulent exudate. 



If the posterior urethra is involved, the gonococci are very 

 apt to invade the vas deferens, and excite an acute inflamma- 

 tion of the epididymis ; the prostate gland may be likewise 

 involved ; the bladder, however, is but rarely affected. 



The inguinal lymphatic glands are frequently enlarged, the 

 inflammatory process sometimes terminating in suppuration. 



Rarer complications of gonorrhoeal urethritis are arthritis 

 and inflammations of the pericardium and endocardium, and 

 even at times of the pleura and the spinal meninges. 



Chronic urethritis not infrequently follows the acute. Gono- 

 cocci have been found as long as six years after an original 



