125S 



URETHRA. 



tion of the urethra by the constant irritation 

 of the part. So also the irritation of the 

 menstrual and leucorrhoeul discharges, when 

 applied to the male urethra under states of 

 high excitation, induces a similar pathological 

 condition. 



Croupal exudations are sometimes found in 

 the urethra. These assume either a tubular 

 form, or the lymph is effused in the form 

 of long shreds.* The mucous follicles situ- 

 ated in the vicinity of the meatus are, ac- 

 cording to Kleeberg, of Konigsberg, liable 

 to a form of inflammation similar to that 

 which attacks the follicles of the genital 

 organs of the female. He thinks that it is 

 sometimes connected with clap, or gleet, and 

 often independent of either. It is indicated 

 by a swollen state of the circumference of the 

 mouth of the urethra, which is of a brownish 

 red colour. There is slight pain in making 

 water. The orifices of the lacunae become 

 closed by inflammation, and, in the course of 

 two or three days, pustules are formed in their 

 places, which break and discharge a yellow 

 pus. " The orifices of the large mucous fol- 

 licles are now seen dilated and surrounded by 

 a swollen dark-red border, and they discharge 

 a muco-purulent fluid into the urethra : if this 

 be washed off, and the glands compressed, the 

 fluid is distinctly seen issuing from these 

 openings." f The disease sometimes assumes 

 a chronic form.J 



The specific causes of inflammation of the 

 urethra are syphilis, gonorrhoea, and small 

 pox. Of these, gonorrhoea is the most fre- 

 quent. Syphilitic inflammation, producing 

 chancre, is by no means unfrequent, as 

 Ricord has proved. The disease makes its 

 appearance on the 6th, 8th, and 12th days 

 after connection. Inoculation from the dis- 

 charge produces the true syphilitic pustule. 

 It often attacks the meatus urinarius. 



Inflammation from gonorrhoea may be either 

 acute or subacute, or the disease may be viru- 

 lent or simple, the difference being in degree 

 rather than in kind. The disease begins in 

 the anterior part of the canal, and is supposed 

 to attack first the lacuna magna. Hunter 

 limited its specific extent to an inch and a 

 half from the meatus. The period of incuba- 

 tion of the poison varies from one to ten days, 

 and is sometimes prolonged even beyond this, 

 if we can believe the accounts of patients. 

 Hunter has known it to appear a few hours 

 after connection, and Sir Astley Cooper met 

 with a case in which it did not make its ap- 

 pearance until after fourteen weeks from the 

 time of inoculation. 



The pathological changes in the urethra from 

 this disease may be briefly described. The dis- 

 ease, commencing at the part indicated, if left 

 to take its own course, gradually extends itself 

 in a retrograde direction as far as the neck of 

 the bladder, and, in very severe cases, the 



* See Pathological Museum of the College of 

 Surgeons, Preparation No. 2576. 



t Zeitschrift f iir die gesammte Medicin, Band ii 

 Heft 2. 



J British and Foreign Med. Review, vol. iii. 



mucous membrane of this viscus becomes 

 involved. The urethral membrane is swollen, 

 red, and exceedingly vascular : this can only be 

 generally observed at the orifice, but it has 

 also been seen in the middle of the canal in 

 cases where, during an attack of gonorrhoea, 

 the urethra has been divided. The intensity 

 of the inflammation is not uniform. Thus, 

 the lacuna magna, and the beginning of the 

 spongy portion, are most severely attacked. 

 The inflammation attacks the lacunae, giving 

 rise to pain and swelling in various parts of 

 the canal ; even the spongy body itself be- 

 comes, by contiguity, implicated in the dis- 

 ease, and interstitial deposition of fibrin 

 takes place in its cells, causing unequal dis- 

 tension of this body during erection, and 

 hence painful chordee. Abscess in this body 

 is not very unfrequent. By continuity of 

 surface, the disease attacks the mucous lining 

 of Cowper's glands and the ducts of the 

 prostate, whilst through the ejaculatory ves- 

 sels it passes to the vesiculae seminales, and 

 by the vasa deferentia to the epididymis, 

 causing hernia humoralis. When the latter 

 structures become affected, the inflammation 

 of the urethra itself in a great measure sub- 

 sides, and the discharge ceases, usually to 

 reappear in a mitigated form. 



The inflammation of gonorrhoea is neces- 

 sarily of the catarrhal character. At the first 

 onset of the affection there is a slight weeping 

 from the meatus of a transparent fluid, in 

 which mucus particles are floating, probably 

 only the natural secretion of the urethra in 

 excess. This soon gives place to a semi- 

 puriform secretion, which glues the edges of 

 the orifice together. It afterwards becomes 

 more distinctly puriform, and at the height of 

 the inflammation, the discharge, which has 

 increased in quantity, puts on a greenish hue, 

 and is of a faint, sickly odour, as the disease 

 subsides. It changes again as to its character 

 in exactly the inverse order of its appearance. 

 It frequently leaves behind it a gleety dis- 

 charge. The seat of this discharge in gleet 

 is either the general mucous surface of the 

 urethra, the lacunae, or the anti-prostatic 

 ducts, and in many instances the ducts of the 

 prostate gland are alone affected in long per- 

 sistent gleets. 



When gonorrhoea coexists with chancre, 

 the discharge has usually a greyish or reddish 

 tint, or sanious aspect. 



Among the most important consequences 

 of this affection, we may mention simple 

 erosion and cicatrices from ulceration produc- 

 ing stricture, and, which is much more com- 

 mon, chronic thickening of the urethra giving 

 rise to stricture. If the diseased urethra be 

 examined after death, according to Hunter, 

 the fossa navicularis and its lacunae are found 

 more vascular than usual, and the lacunae 

 filled with matter. In more severe cases the 

 membranous part, Cowper's glands, and their 

 ducts, are involved in the disease. Littre 

 found, after examining forty cases, Cowper's 

 glands morbid in one only ; and Morgagni 

 met with only one or two instances of a 



