URETHRA. 



Indeed, in many of the examples, the ftrifture is faid to 

 have prefented a great deal of that appearance. Mr. 

 Hunter adds, however, that he had feen the urethra con- 

 trafted for more than an inch in lencjth, owinir to its coats, 

 or internal membrane, being irregularly thickened, and 

 forming a winding canal. (P. Itj.) Somelim.?s, alfo, as 

 fir E. Home obferves, two ftriftures form within an inch 

 of each other, and the fpace betweea them becomes nar- 

 rower than the reft of the canal. 



A ftritiure, fays Mr. Hunter, does not arife, in all cafes, 

 from an equal contraftion of the urethra all round ; but, in 

 fome, from a contraftio:'. of one fide. And iir E. Home 

 informs us, that he has met with cafes where there were 

 three llriftures, rnd all on the fame fiJe of the urethra ; the 

 other being perfittly fmooth. This form of the difeafe 

 throws the paflage to the oppofite fide, and often renders 

 the introduftion of the bougie difficult. Mr. Hunter alfo 

 acquaints us, that the contrafted part is whiter and harder 

 than any other part of the urethra. Sometimes there are 

 more ftriftures than one ; and this eminent furgeon had feen 

 half a dozen in one urethra, fome of which were more con- 

 trafted than others. Indeed, fays he, many urethras, that 

 have a ftrifture, have fmall tightneffes in other parts of 

 them. 



The urethra naturally is not of the fame diameter 

 throughout its whole extent ; and fome parts of it are found 

 to be much more liable to ftridlure than others. In order 

 to determine with precifion the length, as well as width of 

 the urethra, fir E. Home took exa£t cafts of it in wax. 

 The fubjefts from which they were taken were of different 

 ages : one was between 70 and 80 ; the other, 30. The 

 length of the canal correfponded exaftly in both calls. 

 From the external orifice to the neck of the bladder was 

 9 inches ; but, in a note, this gentleman obferves, that, in 

 a relaxed ftate, the canal is commonly about 85 inches in 

 fcngth. From the external orifice to the bulb of the urethra 

 was 7 inches. The membranous part, extending from the 

 bulb to the proftate gland, li inch; and the canal palling 

 over the proftate gland was half an inch in length. 



The following were the diameters of the cafts of the 

 urethra in different parts. 



Years olil. 



At three-quarters of an inch from the external 7 

 orifice - - - - - - -J 



At 4^ inches from the external orifice * - 



At the bulb, 7 inches from the orifice 



In the membranous part direftly beyond the' 

 bulb, 75 inches from the orifice 



In the membranous portion near to the proftate 

 gland, 85 inches from the orifice 



Where the membranous part terminates, and 

 the proftate gland begins, 85 inchis from ' • 

 the orifice - - - - - . 1 



At the neck of the bladder, 9 inches from the 



80 



T a- 



t ■ 



TV 



30 



•7 [T 

 I I 



■rv 



orifice 



■} 



v.- 



Thefe dimcnfions, it is to be underftood, are much be- 

 yond thofe of the ca(y ftate of the urethra. 



The two parts of^ the urethra, which arc naturally the 

 moft narrow, are found alfo to be thofe moft liable to ftric- 

 ture. In faft, ftridures occur moft commonly jull behind 

 the bulb of the urethra, the diftance from the external ori- 

 fice being 65 or 7 inches. The fituation, next in order of 

 frequency, 13 about 45 inches from the orifice of the glans. 

 Striftures do alfo form at 3^ inches from this orifice, and 

 foraetimes almoft clofe to it. Mr. Hunter never met with 



Vol. XXXVII. 



a ftrifture in that part of the urethra which paffcs through 

 the proftate gland. P. 114. 



In fome cafes, as fir E. Home further remarks, the ex- 

 ternal orifice itfelf is contraded. When this happens, it is 

 fometimes the fource of confiJerable errors, the furgeon 

 fuppofing the whole canal to be naturally formed of the 

 fame fize. 



The prepuce alfo is very often contrafted, which is called 

 a natural phymofis. Sir E. Home believes, ■'ix. this more 

 frequently happens in thofe who are difpoled to ftridurcs 

 than other men. 



In almoft all the cafes which have come under this gentle- 

 mjan's care, there has been one ftrifture about feven inches 

 from the external orifice, whether there have been others or 

 not. Such part of the canal feems much more difpofed to 

 contraft than the reft of it. 



It is noticed by Mr. Hunter, that moft of the obftruc- 

 tions to the paflage of the urine, if not all, are attended 

 with nearly the fame fymptoms, fo that there are hardly fuf- 

 ficient marks for diflinguiftiing the different caufes. Few 

 patients take notice of The firft fymptoms of a ftriifture, till 

 they have either become violent, or have been the caufe of 

 olher inconveniences. For inftance, a patient (hall have a 

 confiderable ftriclure, without obferving that he does not 

 make water freely ; he fliall even have a tendency to inflam- 

 mation and fuppuration in the perineum, and not feel any 

 obftruAion to the paffage of his urine, nor fufpeft iliat he 

 has any other complaint than the inflammation in the peri- 

 neum. In all thefe obftruftions, the ftream of water be- 

 comes fmall, and that in proportion to the obftruftion ; but 

 this fymptom, though probably it is the firft, is not always 

 obfcrved by the patient. In fome tl.e urine is voided only in 

 drops, and then the diforder cannot efcape notice ; in others 

 the ftream is forked or fcattcred. (Hunter, p. 112.) Al- 

 though, as fir E. Home obferves, the firft progrefs of the 

 contraftion is generally very flow, yet, when once it has fo 

 far increafed, that the urethra is not wholly relaxed by the 

 force of the urine, its fubfequent advances are more rapid, 

 and new fymptoms are perceived. The uriiie is voided more 

 frequently ; does not pafs without a confiderable effort, at- 

 tended with pain, and a ftraining continues after the bladder 

 is emptied. If the patient accidentally catches cold, drinks 

 a glafs of fpirituous liquor, acid beverage, or punch, com- 

 mits an excefs in drinking wine, or removes quickly from a 

 warm to a cold climate, the urine will pafs only in drops, 

 or be entirely obftrudted ; thefe caufes, inducing in the con- 

 trafted part a fpafmodic aftion, by which it is clofed. Cold, 

 externally applied to the body (continues fir E. Home), 

 has fo great an effeft upon a fpafmodic ftrifturo, that a 

 patient who can make water without the fmalleft difficulty in 

 a warm room, upon attempting it in the open air fltall be 

 entirely unable to void a drop ; but, even in this difficulty, 

 if he returns to a warm room, and fits down fome little 

 time, the urine will come away. The experience of the 

 fame gentleman tends to prove, that the fymptoms o*^ ftric- 

 ture come on more frequently while the patient is leading a 

 fedeiitary than an aftive hfe. 



Perinanent ftriAures are generally attended with a dif. 

 cliarge of matter, or a gleet. This is often confidered by 

 tlie patier.t as the whole difeafe ; and fometimes it is not till 

 after the furgeon has long in vain tried every means that he 

 can imagine to effect a cure, that otlier fymptoms are no- 

 ticed, and a ftridurc at lall fufpeded. In difeafes of tlie 

 urethra, and alfo in thofe of the proftate gland and bladder, 

 there is ufually an uncafinefs about the perineum, anus, and 

 lower {)art of the abdomen ; and, as Mr. Hunter remarks, 

 the patient can hardly crofs liia legs without pain. 



3 1' Frequent 



