URETHRA. 



Frequent intercourfe with women generally renders ftric- 

 tiires worfe. Under thefe circumftances, fays fir E. Home, 

 the membrane of the urethra is kept longer in a (late of con- 

 traftion ; and the part difpofed to Itrifture lofes the power 

 of relaxing itlelf again. Although the palTage i;i not com- 

 pletely clofed, it 13 rendered much narrower, and remains in 

 an extremely tender ftate. Hence, the paflage of the urine 

 irritates it, and in a few hours a difcharge of matter comes 

 on fimilar to that from gonorrhoea. In certain inftances, 

 the contra6lioa is fo great, that it ftops the emiiTion of the 

 femen altogether, and forces it back into the bladder ; while 

 in fome other cafes tliis fluid pafTes through the ftrifture 

 after the orgafm has taken place, but with little or no 

 force. 



There is one circumftance which has a great tendency to 

 make a ftrifture be millaken for a gonorrhoea ; viz. the pain 

 ill making water is confined to the fame fpot in both dif- 

 eafes. A Itrifture in the membranous part of the urethra 

 does not render the part itfelf particularly fenfible ; but all 

 the painful fcnfations are felt about an inch and a half from 

 the orifice of the glans penis. This is a general faft, and 

 unaccountable as it may feem, it is not more extraordinary 

 than the burning pain felt in the glans, in cafes of ftone, 

 even when the whole of the urethra is perfectly found. 



When a ftrifture is in an advanced ftage, the difeafed 

 part is at all times much narrower than the rell of the canal. 

 The ftrifture, however, according to fir E. Home, ftill re- 

 tains a power of contrading and relaxing itfelf; in the con- 

 trafted ftate, clofing up the paffage ; in the relaxed ftate, 

 allowing the urine to pafs through it in a fmall ftream. In 

 tliis ftate the ftream is fo fmall, and the exertion neceffary 

 to empty the bladder fo great, that the patient can feldom 

 be wholly ignorant of his complaint. 



The fpafmodic contraftion, upon any irritation being ap- 

 plied to the part, is, as fir E. Home defcribes, very great. 

 This is known by the urine being unable to pafs in a ftream; 

 and by the extreme difficulty of now paffing a fmall bougie, 

 which, in the relaxed ftate of the canal, met with no refiftance. 

 The bougie alfo, if allowed to remain a few minutes, is not 

 unfrequently grafped fo tight by the fpafmodic contraftion, 

 that it cannot be withdrawn without confiderable force. 

 The bougie, when examined (continues fir E. Home), puts 

 on an appearance exaftly refembling what would have been 

 produced, if a piece of packthread had been tied round it. 

 In this ftage, the fpafmodic contraftions, although more 

 violent, occur lefs frequently than while the ftrifture was in 

 a more recent ftate. When the ftrifture has been of fome 

 years ftanding, the coats of the bladder become thickened, 

 in order to increafe the power of this organ to expel the 

 urine, the evacuation of which is rendered difficult by the 

 obftruftion. The bladder, in this thickened ftate, does not 

 admit of the ufual dilatation, fo that the patient is obliged 

 to make water every three or four hours, or oftener. See 

 Home's Praft. Obf. on StriAures. 



In addition to the foregoing fymptoms, we have further 

 to enumerate, ampngft the numerous effefts of ftriftures in 

 the urethra, nofturnal emiffions ; and, in irritable patients, 

 a variety of unufual fenfations about the membranous part 

 of the urethra, conveying to the mind the idea of fome- 

 thing crawling or fluttering. In many cafes alfo, there is a 

 periodical difcharge, brought on by cold, or other occa- 

 fional caufes. When this happens, the inflammation extends 

 to the bladder ; the frequency of making water is very much 

 increafed ; and the urine very turbid. Sometimes the blad- 

 der inflames more violently, and fecretes purulent matter, 

 which pafles out after the urine. In ftill worfe attack5, the 

 difcharge from this vifcus is glairy, like the white of an egg. 



and of a ftrongly tenacious confiftence. The difcharge of 

 pus and gelatinous mucus with the urine, has been regarded 

 as particularly evincing an ulcer, or calculus in the bladder ; 

 but it is a fymptom which arifes from any irritation of that 

 organ, and is frequent in cafes of old ftridlures. 



Attacks of the preceding kind may bring on peritonitis, 

 and the patient is carried off. Sometimes alfo the inceffanc 

 irritation of the ftrictured part, by the efforts to make 

 water, brings on a gradual diminution of the canal, and, in 

 a few inftances, a total obhteration of a portion of it. This 

 laft event cannot happen without deftroying the patient, un- 

 lefs another outlet be formed for the urine. Complete ftric- 

 tures, therefore, as fir E. Home remarks, are only met with 

 where fiftulac in perinxo have been produced. 



Some patients with ftriftures feem extremely liable to 

 complete paroxyfms of fever ; that is to fay, they often 

 have a cold, hot, and fweating ftage of febrile diforder in 

 regular fucceflioa. The fweating is alfo remarked to be 

 much more profufe than in a common ague. 



Strittures in the urethra likewife occafion a fwelling of 

 the tefticle. When permanent and confiderable, they are 

 alfo apt, under particular circumftances, to caufe ftrangury 

 and retention of urine. If a patient goes fuddenly from a 

 warm into a cold fituation ; if he drinks too freely of wine ; 

 eats high-feafoned dirties; catches cold; commits any fpecies 

 of intemperance ; or delays making water too long, after 

 feeling the inclination, he expofes iximfelf to the danger of 

 thefe latter grievances. 



The caufes of ftriitures in the urethra are not known 

 with any degree of certainty. The origin of the difeafe is 

 often imputed to the effefts of gonorrhoea, or to the method 

 of curing it. Mr. Hunter, however, conceives that there are 

 many reafons why this dotlrine is not likely to be correft. 

 Stridldres, he obferves, are common to molt paflfages in the 

 human body ; they often occur in the osfophagus ; in the 

 inteftines, efpecially the reftum ; in the anus ; in the pre- 

 puce producing phymofis ; and in the lachrymal du£t, 

 without any previous difeafe. They fometimes happen in 

 the urethra itfelf, without ever having been preceded by any 

 venereal complaint. Mr. Hunter faw an inftance of this 

 kind in a young man of nineteen, who had had a ftrifture 

 for eight years, and which therefore muft have begun when 

 he was only eleven years of age. The cafe was treated at 

 firft as the ftone or gravel. The patient was of a weak 

 fcrophulous habit, and the ftrifture in the mod ufual place, 

 about the membranous part of the urethra. Mr. Hun- 

 ter had alfo feen a ftriAure in a boy only four years of age, 

 and a fiftula in the perineum in coufequence of it. He re- 

 minds us alfo, that ftriftures are as common in perfons who 

 have had gonorrhoea flightly, as in thofe who have had it 

 violently. They are alfo never found to come on during the 

 inflammation which attends a clap, nor for fome time after 

 the infeftion is gone. Thirty and forty years fometimes _ 

 elapfe between the cure of a gonorrhoea and the beginning 

 of a ftrifture, the health being all that time perfedlly good. 

 If ftriftures arofe in confequence of the inflammation ac- 

 companying this diforder, we (hould expeft to find them of 

 fome extent, becaufe the inflammation is itfelf of fome ex- 

 tent ; and we fliould alfo expeft to find them moft frequent 

 in that part of the urethra which is ufually the feat of go- 

 norrhoea. But the fad is, they are not fo frequent there as 

 they are in other parts of the urethra. Sir E. Home, how- 

 ever, differs from Mr. Hunter on this point, in thinking, 

 with moft other furgeons, that gonorrhoea is a very general 

 caufe of ftriftures. 



It is fuppofed by many, fays Mr. Hunter, that ftricftures 



arife from the ufe of injeftions in the cure of gonorrhoea ; 



^ but 



