URETHRA. 



12G3 



rarity. Chelins * says, " they are found as 

 little masses of soft warts behind the stric- 

 ture ; at other times they are found before the 

 stricture ; they are similar to those growths 

 observed on the prepuce and glans. I have 

 seen in one person, who had frequent claps, 

 the urethra filled with round excrescences 

 from an inch behind the fossa nav'wularis." 

 Morgagni found one in a case of stricture, -j- 



These excrescences are developed from the 

 mucous membrane as the result of simple as 

 well as specific irritation, and are limited in 

 the extent of their growth by the walls of the 

 canal. 



We sometimes meet with a more perfectly 

 organised structure in the urethra in the form 

 of polypi. They, however, are by no means 

 common. Rokitansky met with one in the 

 prostatic part of the urethra, in which situa- 

 tion they are usually found. 



In the Museum of the Royal College of 

 Surgeons there is a preparation (2578 ) of the 

 urethra of an ox, with a large polypus hanging 

 from the verumontanum. 



Irritable Urethra. This condition may be 

 recognised by the following symptoms : there 

 is slight increased vascularity of the canal as 

 indicated by the redness of the meatus : the 

 lips of the meatus are glued together in the 

 morning by mucus, slightly tinged : there is a 

 very trifling discharge, scarcely sufficient to 

 discolour the linen ; this is increased by indul- 

 gence in wine ; a sense of uneasiness is per- 

 ceived along the canal, and this extends to 

 the testicles and the rectum. The patient 

 has a more frequent desire than natural to 

 pass his water, the stream is diminished, and 

 a scalding sensation is experienced at the 

 extremity of the glans whilst the urine is 

 passing. These symptoms are exacerbated 

 by indulgence in venereal pleasures, and are 

 often associated with increased acidity of the 

 urine ; not unfrequently pain is experienced 

 down the thighs in the course of the nerves, 

 and the patient suffers a slight febrile attack. 

 This state exists, very frequently, altogether 

 independently of gonorrhoea, and appears really 

 to result from a mental cause, the patient being 

 strongly impressed, after a suspicious con- 

 nection, with the idea of impending gonorrhoea. 

 Under the use of diluents and the warm 

 bath this disease very generally passes off. The 

 true pathology of this state 1 believe to con- 

 sist in an increased vascularity of the urethra 

 and its follicles, with a similar condition of 

 the glands of Cowper and the prostate, under 

 the influence of nervous irritability. 



The prostatic part of the urethra is liable 

 to irritation from long continued masturba- 

 tion. The orifices of the ejaculatory ducts 

 are the special sources of this irritation, but 

 the general mucous surface around partakes 

 of the disease. 



Neuralgia of the Urethra. The urethra 

 and neck of the bladder are consentaneously 

 affected in this disease. The periodic and 



* Chelius' Surgery, translated by South, vol. li. 

 p. 35G. 



f Liv. xix. ch. 23. 



remittent forms of neuralgia attack the 

 urethra : the periodic disease is characterised 

 by deep shooting pains in the canal extending 

 over the loins and sacrum, and down the 

 thighs, occurring in paroxysms, and generally 

 accompanied by sudden and urgent desire to 

 micturate. The attacks recur at a certain 

 hour, generally night and morning, or every 

 second or third day, and during the intermis- 

 sions the patient is altogether free from pain. 

 The urine is thrown out in jets, and some- 

 times stops suddenly, and many of the ordi- 

 nary symptoms of stone in the bladder are 

 present, and hence the great importance of 

 the diagnosis, for there is no doubt that, under 

 this condition, many patients have been sub- 

 jected needlessly to the operation of litho- 

 tomy. The sound alone can decide the 

 question. This disease may originate en- 

 tirely from the ordinary causes of neuralgic 

 affections, or it may depend on local causes, 

 as the use of stimulating injections, the fre- 

 quent use of the catheter, constipated bowels, 

 worms in the rectum : it is often associated 

 with acrid urine, and either leads to, or is ac- 

 companied with, hypertrophy of the detrusor 

 urines.* 



IN THE FEMALE. The female urethra 

 is a short tube by which the urine alone is ex- 

 creted. It commences at the neck of the 

 bladder, and terminates at the meatus urin- 

 arius. The direction of the urethra in the 

 female is similar to the first or pelvic division 

 of that of the male ; thus it descends slightly, 

 and, passing forwards, in nearly a straight 

 direction, beneath the pubis, it makes a 

 gentle ascent just at its termination : it there- 

 fore forms a curve, the concavity of which 

 faces upwards, the convexity downwards, to- 

 wards the anterior wall of the vagina, in which 

 it appears imbedded, and to which it is so 

 closely connected, that it is almost impossible 

 to separate one from the other. In its course 

 it perforates the triangular ligament, which is 

 stretched across beneath the arch of the pubis, 

 and is but an imperfect representative of the 

 corresponding part in the male. The urethra 

 thus forms the first and smallest of the three 

 outlets beneath the pubis. 



The commencement of the urethra is situ- 

 ated within the pelvis, behind the symphysis 

 pubis, to which it is suspended by the appa- 

 ratus which supports the neck of the blad- 

 der : its next division is directly beneath the 

 inferior pubic ligament, and is connected to 

 it by condensed cellular membrane : the last 

 portion of the urethra passes between the 

 origins of the crura clitoridis, and terminates 

 by a rounded aperture at the anterior part of 

 the vagina, and a little in front of the pubic 

 arch : this aperture is called the meatus 

 urinarius. 



The female urethra is invested by a muscu- 

 lar apparatus, analogous to that surrounding 

 the membranous portion of the male canal : 

 thus Santorius described some tranverse and 

 circular fibres connected with this part, the 

 latter being situated deepest, and the former 

 * Rowland, On Neuralgia, 



