GONORRHOEA. 



fijie itfelf to the fpecific diflance, but reaches all along the 

 urethra. Severe pain is alfo frequently experienced in tiie 

 periiiosuai. Sometimes the accelcratores urim mufcles are 

 afFefted 1 with the fpafmodic contraftions, of which feme 

 mention has already been made. Such fpafm is particularly 

 apt to come on when the patient has juft finiflied making 

 water ; it (hews itfelf by the manner in which the lad drops 

 of urine are expelled ; and it is generally attended with con- 

 traftions of the ereftores mufcles. Sometimes the inflam- 

 mation is fo great as to occafion a fwelling, and even an ab- 

 fcefs in the cellular membrane. It has already been ob- 

 ferved, that the moft common fituation of fuch fuppuration 

 is in Cowper's glands ; b>it the fmall glands of tike bulb 

 may alfo be affefted in a fimilar manner, and the irritation, 

 in certain inftanses, is found to extend even to the bladder 

 itfelf. 



When the latter organ is once affefted, it becomes more 

 fifceptible of every kind of irritation, fo that very diflrcfling 

 complaints are apt to be produced. It is no longer capable 

 of bearing the degree of diftention of which it is capable 

 in the healthy ftate. Hence the patient cannot hold his 

 ■water in the ufual way ; but no fooner does the inclination to 

 difcharge it arife, than he is immediately compelled to make 

 the evacuation, nutwithilanding the fevere pain, which, while 

 the urine is efcaping, is felt in the bladder, and efpecially 

 about the glans penis. This pain has been compared with 

 what is experienced in a fit of the ftone, and it lafts for fome 

 time after the evacuation is completed. 



The ureters, and even the kidnies, are fometimes fympa- 

 thetically affefted, when the bladder is confiderably inflamed 

 or irritated. Such an occurrence, however, is exceedingly 

 uncommon. Mr. Hunter mentions his having feen an in- 

 flammation of the peritonxum brought on by a fevere affec- 

 tion of the bladder in gonorrhoea ; and others have obferved 

 ; violent inflammation of the kidnies from the fame caufe. 

 See Encyclopedic Methodique partie Chirurgicale, tom. i. 

 ' 584. ) It has already been mentioned that a chordee is one 

 f the occafional effefts of a gonorrhoea. It arifes in general 

 rrom inflammation ; but in fome cafes it appears to be en- 

 tirely of a fpafmodic nature. 



When the inflammation is not confined to the urethra and 

 its glaads, but fpreads further, it attacks the fubftance of 

 •he corpus fp»ngiofum, where it occafions an extravafation of 

 -oagulating lymph, v.-hich, uniting the cells together, makes 

 I'le urethra incapable of yielding and being ftretched in the 

 fame degree as the corpora cavernofa. Hence, during an 

 erection, the penis becomes bent forward. The adhclion of 

 the cells of the corpus fpongiofum urethn together, which 

 is the caufe of chordee, in general, come'! on in confe- 

 .queiice of mere inflammation of the canal ; but occafionally 

 it is the effed of a fpecies of inflammation, which is feen ac- 

 companying certain ill-conditioned chancres. A chordee 

 often continues after all the other fymptomsof a gonoiThcea 

 have quite ceafed. 



A chordee is fometimes altogether fpafmodic, in which 

 cafe it is feen to difappear and re-appear alternately, at in- 

 determinate interval*. At one time the creftions, which 

 are fo common in cafes of gonorrhoea, happen without being 

 attended with any curvature of the part ; while at other pe- 

 riods the chordee takes place in a great degree ; the intervals 

 of time between thefe changes being fometimes remark- 

 ably fhort. 



A fwelling of the tcfticles is a frequent confequence of a 

 gonorrhoea. It may happen in any llagc of the difealc ; 

 but, perhaps, it take's place moft frequently when tli? com- 

 plaint is on the dc<-line. It was confidered by Mr. Hunter 

 a.^ an affection arifing from fympathy. It is feen attending 

 Vor.. XVI. 



any kind of irritation in the urethra, whether occafioticd tij 

 injeftions, bougies, or any other circumllanct. In many 

 cafes, the fwelling comc.4 on aud difai>pcars very fuddcniy, or 

 foems to leave one tefticle to attack the other. 



The fwelling of the teilicle generally logins witJi a foft, 

 pulpy tumefaftion of its glandular part, which becomes ra- 

 ther painful when handled. The tumour afterwards incrcafct 

 in fize and firrancfs, aud produces confidcrable pain. The in- 

 flammation feldom ends ill fuppuration, though foraeinftancej 

 of this kind are met witli. The epididymis (efpecially it5 

 lower end) is ufually the hardeft part ; but, frequently, the 

 induration and fwelling attack the whole of the epididymis, 

 and form a fort of knob at its upper part. The fpcr;r.atic 

 chord alfo is often affected, efpecially the vas deferens, which 

 is thickened, and exceedingly tender. Sometimes the vein* 

 of the tellides arc varicofc. 



The inflammation of the teilicle, as well as that of the ure- 

 thra, is frequently attended with fympathetic fymptoros of 

 irritation in oUier parts ; for inllance, pain at the lower end 

 of the fpine, a fenfe of weaknefs in the loins, colic paint, 

 naufea, flatuluiice, diforder of the digefiive organs, &c. 



The fwelling of the teilicle is noticed to take place re- 

 markably often jutl when the pain in the urethra has iubfided, 

 aud the difcharge has flopped ; or elfe the truth is, that 

 on the teilicle becoming afi"eCted, the fymptoms of icritation 

 in tlie urethra immediately ceafe. Here it is foracwhat diffi- 

 ctdt to determine which is the caufe, and wliich the effedl. 

 However, it is worthy of remark, that it is not uncommon 

 for the teilicle to begin to fwell at the very momeat v hen the 

 inflammation of the urethra, and the difcharge, are becoming 

 worfe. Sometimes the epididymis alone is affefted ; fome- 

 times only the vas deferens ; and, on other occafions, only 

 the fpermatic chord. No reafon can be afligned, «hy one 

 of thefe parts (hould be affefted rather than the rell. The 

 inflammation of tl.efe organs is frequently attended with a 

 fl;rangury, efpecially when the difcharge is fuppreffed ; 

 and, indeed, it is remarked, that the ftoppage of the run- 

 ning generally brings on a tendency of that diftrelliiig com- 

 plaint. 



Another occafional effeft of a gonorrhoea is a fwelling of 

 the lymphatic glands in the groin, a f)-mptom, which is of 

 the fame nature as the inflammation of tlic teilicle, but 

 much more common. It has been fuppofed that the tume- 

 faftion of the glands depends, on the abforption of fome of 

 the matter from the urethra ; but Mr. Hunter contended 

 againft thi« opinion. He thought that, in gonorrhoea, the 

 matter was feldom abforbed, and he derived tliis fentimeiit 

 partly from feeing that a lues venerea was feldom the con- 

 fequence of this difeafe. However, this argument will liavo 

 no weight with thofe praftitioners, who diibclieie in the doc- 

 trine that the poifons of gonorrhoea and the venereal difealc 

 are of the fame nature. Another confideration, which iuflu- 

 enced Mr. Hunter,"will meet with more general approbation. 

 It was tlie i'act, that any fim]ile mechanical irritation of irrita- 

 ble organs is capable of exciting an inilammatjoii of their 

 abforbents, and of the glands to which fuch vcffels run. 

 Now, fince the lymphatics and tlieir glands ufually inflame 

 bo'fore fuppuration has taken place in the part originally 

 affecled, and their inflammation often fiibfides as foon as this 

 lall occurrence begins, we muil conclude, that the fwelling 

 of the inguinal glands, in gonoiThxa, .irifet altogether from 

 the irritation iii the urethra. It is obferved alfo, that 

 fuch fwellings ahiioft always admit of refolution, while 

 thofe which originate from the abforption of venereal matter 

 from chancres very frequently fuppurat.-, burll, and turu 

 into fyphilitic ulcers. It is tj-ae.howc%er, that fwellings pf 

 the iiin-iiinal glands, induced bv die Irritation of goncrrha*. 

 3 L do 



