URETHRA. 



acftion. He obferves, that this faft of the firm nature of a 

 ftriAure, pointed out by Mr. Hunter, is a fufEcient proof 

 to himfelf, that a ftridlure cannot be fpafmodic ; and that 

 even if the difeafed part of the urethra were originally muf- 

 cular and contraftile, the condenfation and callofity of the 

 part muft be attended with lofs of the contraftile power. 



Mr. C. Bell argues, that it is from confounding the effeft 

 of the proper mufcles of the urethra, the canal has been 

 imagined to poffefs a mufcular property. " I made," fays 

 he, " the following fimple experiment, in order to put this 

 to the teft. I got a fmall ivory ball, to which I attached a 

 thread. I introduced the ball into the urethra. I made 

 the man endeavour all he could to pufh it out, but he could 

 not; neither was it retained in the flighteft degree, when 

 pulled by the thread. I thought it might be more fatif- 

 faftory, if I imbued the ball with fomething ftimulating. 

 I tried coarfe foap and fpirits ; but ftill there was no power 

 in the urethra to retain the ball, or to pufh it forth. This 

 could be done only by the urine behind it, and the operation 

 of the bladder, or the ejaculator ferainis. I need not add, 

 that this experiment was made upon a part of the urethra 

 anterior to the feat of the ejaculator feminis. In the cburfe 

 of praftice I find, that, when the filver ball is introduced 

 down to the ejaculator feminis, it is refilled bv that niufclc, 

 efpeciaUy when the parts are irritable. I find it fometimes 

 thrown out of the grafp of the mufcle ; but vidien puflied 

 fairly into the finus of the urethra, which is into the middle 

 of the mufcle, the ball is allowed to remain." (Letters 

 concerning Difeafes of the Urethra, p. 95, Lond. 1810.) 

 The fame gentleman alfo endeavoured to afcertain whether 

 the urethra had any aftion on fluids. He employed a g'afs 

 tube to throw an injeftion into the urethra, the end of the 

 tube being conftrufted for pading into the orifice of the 

 paffage. PrefTure was made on the urethra five inches 

 down. By elevating the tube or column, the fluid diftended 

 the urethra ; but no irregularity in the height of the fluid 

 in the tube indicated any mufcular power of the urethra to 

 difcharge its contents. When the urethra was dift:ended, 

 the (lighten touch upon it with the finger elevated the fluid 

 in the tube ; but no effort of the patient produced the 

 effeft. When he made the effort, it was with the ejaculator 

 feminis behind the part of the urethra compreifcd by the 

 fingers. (P. 96.) The conclufion drawn by Mr. Bell 

 from thefe fafts is, that the part of the canal, anterior to 

 the mufcles which furround it, has no m.ufcular power. 



Mr. Bell thinks, that we can be at no lofs to account for 

 fpafm in the pofterior part of the urethra, fince five inches 

 of the canal in that fituation are furrounded by mufcles ; 

 the accelerator urinae or ejaculator feminis, the fphinfter 

 veficx, the comprefTor proftatae, and the levator ani. And 

 he adds, that it muft never be forgotten, that it is the fenfi- 

 bility of the urethra which governs their contraftion. 



Although we conceive, that the mufcles in the perineum 

 have in fome degree the effeft which the foregoing writer 

 imputes to them, he is far from having convinced us that the 

 membrane of the urethra is not endued with mufcular power. 

 In the firii: place, the two experiments, above related, are 

 by no means fo decifive as the author fancies therii. The 

 firft with the ivory ball proves nothing ; except that this 

 body was not expelled at once by the mufcular power of 

 the canal. But it is conceivable, that fuch power might 

 exift, and yet operate rather fo as to grafp and retain the 

 foreign body, than force it out. Nor is it explained how 

 much time was allotted to the experiment ; a point effential 

 to be known : becaufe it is not to be fuppofed that the ivory 

 ball would be inftantly forced out again. The experiment 

 fyf the injeftion is alfo nugatory ; becaufe as a lliraulating 



fluid was not ufed, (perhaps only water,) it is not likely 

 that any particular contraftile aftion of the urethra would 

 be thus excited. In oppofition to Mr. Bell's opinions, 

 therefore, we continue to beheve that the membrane of the 

 urethra pofleflTes a contraftile power. We think in this 

 manner alfo, becaufe there are certain phenomena, which 

 cannot be explained by the contraftion of any of the miifcles 

 with which the urethra is embraced. Thus, for inftance, a 

 bougie may frequently be eafily introduced as far as a ftric- 

 ture ; the patient fuffers little uneafinefs, and no refiftance is 

 experienced ; but no fooner is the paflage irritated by the 

 preflure of the bougie againft the obftruftion, than it con- 

 trafts and grafps the inftrument with manifell force. Much 

 refiftance is now felt on withdrawing the bougie ; and it is 

 in a great meafure continued, till the inftrument is quite out 

 of the urethra. There are few furgeons of any experience 

 who have not obferved this faft. Did the refiftance depend 

 upon a fpafm of the mufcles in the perineum, it could only 

 laft while the bougie was in the contiguous part of the 

 urethra. We find, however, that even the laft inch of the 

 bougie is evidently grafped. The experiments of Haller 

 are alfo at variance with the conclufions above related ; for 

 he diftinftly mentions, that chemical ftimulants will make 

 the urethra contraft. Indeed, as a late writer obferves, the 

 mufcular power of this canal may be proved almoft in any 

 inftance, by introducing a bougie of moderate fize into the 

 healthy urethra, and lightly fupporting the end that pro- 

 jefts from the penis in a horizontal pofition. If tlie aftion 

 of the urethra is then watched with attention, it will be 

 found, that the power which expels the inftrument, in other 

 words, the contraftion of the urethra, is uniform through 

 its whole extent. The point of the bougie is not puflied 

 forward more quickly while it moves through the bulb of 

 the urethra, where the canal is furrounded with ftrong 

 mufcles, than it is afterwards ; but, on the contrary, its 

 motion is exceedingly flow, and perfeftly equal throughout, 

 until the whole of the inftrument is expelled, and the point 

 fairly drops from the orifice of the urethra. (Howfliip's 

 Praft. Obf. on Difeafes of the Urinary Organs, p. 180.) 

 Thefe coniiderations are alfo favoured by analogy, fince 

 comparative anatomy demonftrably proves, that in the 

 larger animals, particularly the horfe, whof^ ftrufture is 

 more eafy of inveftigation, and the fuiiftions of the urethra 

 precifelv the fame as in man, the ftrong mufcular fibres, en- 

 circling the urethra, cannot be overlooked. Op. Cit. 

 p. 182. 



On the whole, however, it does not appear to us, that 

 the queftion is of great importance in a praftical point of 

 view ; fince the treatment of ftriftures fliould in all proba- 

 bility be condufted on precifely the fame principles, whether 

 the fpafm, that fometimes has a fliare in increafing the im- 

 pediment to the exit of the urine, depend upon the muf- 

 cularity of the membrane of the urethra itfelf, or upon the 

 mufcles fituated near the canal, efpecialiy as their aftion is 

 faid by Mr. Bell himfelf to be entirely governed by the 

 fenfibility of tlie paflage. We think alfo, that the term 

 fpafmodic ftriftiire might as well be dropped, and that no 

 cafe ought to be called a ilrifture, until there is fome per- 

 manent contraftion, ariiing from a change of ftrufture, in 

 the difealed part of the urethra. Nor does it appear to us, 

 that any material fight is thrown upon the mode in whick 

 the difeafe is formed, by imputing fo much to fpafm as fe- 

 veral writers have done. 



Accordin T to Mr. Hunter, the difeafe generally occupies 

 no great l-ngth of the paflfage ; and in moft of the cafes 

 which he had feen, it extended no further in breadth, than 

 if the pii-t had been furrounded with a piece of packthi-ead. 



Indeed, 



