728 S U R G 
Besides the symptoms already mentioned, a very acute, 
scalding pain is experienced in making water, which fre¬ 
quently can only be discharged by drops, or in an extremely 
small broken stream. The patient is also incessantly troubled 
with a sensation as if he wanted to make water, and is obliged 
to be repeatedly emptying the bladder of what little colltcts 
in it. 
In the neighbouring parts, a variety of other affections are 
occasionally produced : pain, soreness, and uneasiness, may 
be experienced all over the pelvis; and the scrotum, testicles, 
perineum, anus, and hips, may become disagreeably sen¬ 
sible. The testicles often require to be suspended in a bag- 
truss, and are so irritable, that the least exertion makes them 
swell. The inguinal glands may inflame and enlarge also, 
producing the kind of swelling termed a sympathetic bubo. 
In many instances the bladder is unusually irritable, and 
cannot bear the least distension, so that the patient is, almost 
every five minutes, obliged to make water with violent pain, 
not only in the bladder itself, but likewise in the glans penis; 
and such pain frequently continues after the urine is dis¬ 
charged. 
The consequences of the inflammation are various. Some¬ 
times the discharge stops, and the testicle swells; sometimes 
the prepuce inflames and is thickened to an amazing extent. 
If this happens while it is below the glans, the penis is 
strangulated; a disease named paraphymosis. When inflam¬ 
mation comes on while the skin is before the glans, and it 
cannot be retracted, the disease is named a phymosis. 
The treatment of gonorrhoea is resolved into two very 
simple principles—to subdue the inflammation at first, and 
stimulate the vessels when the disease becomes chronic. The 
inflammation of the prepuce and the testicles requires very 
active depletory treatment. 
Of the great variety of diseases of these organs, strictures 
in the urethra are perhaps the most frequent, and most 
serious. They prevent the free evacuation of the bladder; 
greatly disturb, if not entirely destroy the function of genera¬ 
tion ; and often give origin to constitutional symptoms 
which sometimes increase to an alarming degree, and even 
prove fatal. 
The whole extent of the urinary canal is lined by a deli¬ 
cate membrane, which is constantly covered with a viscid 
fluid, secreted by numerous glands, whose ducts open on its 
internal surface by orifices which are called lacumae. 
It is highly vascular, and is endowed with so much 
nervous sensibility, that irritating bodies applied to it often 
affect, or even derange the whole system. 
It has a considerable degree of contractility, is evidently 
elastic, and perhaps may possess a muscular power, although 
no muscular coat has yet been demonstrated; but to what¬ 
ever cause this contractility be owing, it is well known it 
does not contract upon irritation. 
The contraction which forms a stricture in the urethra 
may take place round the whole circumference of the canal; 
it may arise chiefly at a particular point of the circumfer¬ 
ence ; or, it may extend along a considerable extent of its 
surface, and thus produce obstructions of different forms. 
The stricture once begun, continues no longer the than 
cause which first produced it continues to operate. But if 
the parts are kept long in this state of contraction they gene- 
rail y are attended with a degree of inflammation ; the mem¬ 
brane of the urethra acquires a morbid degree of thickness; 
the surrounding parts are altered in structure ; and this change 
of form and appearance remains after the cause which origi¬ 
nally produced them has ceased to operate. 
That spasmodic strictures do exist appears from the im¬ 
pressions made on bougies which have been passed through 
them, and from the examination of the parts after death; 
for although complete obstructions to the bougie were found 
when alive, yet not the smallest remains can be observed on 
dissection. 
When there has been a permanent stricture, the natural 
structure of the urethra is changed, and the morbid altera¬ 
tions it has undergone may be seen on dissection. There is 
E R Y. 
commonly a contraction at one particular part of the canal; 
and the appearance of it has been compared to that which 
would have been given had a packthread been tied round it, 
or in slight cases it is mere narrowing. 
The mode of curing strictures by means of constitutional 
remedies and dilating the passage with a catheter having 
been fully’ laid down under Pathology, we are not re¬ 
quired to say more here on the subject, but may at once 
recur to the graver consequences of this disease—to fistulae 
in perinseo, and diseased prostate. 
When the urethra is very much obstructed, nature often 
endeavours to procure relief by ulceration on the inside of 
that part of the urethra which is within the stricture. Hence, 
the urine insinuates itself into the loose cellular membrane of 
the scrotum and penis. The extravasation of this fluid be¬ 
comes the cause of suppuration, wherever it is diffused, 
and even of mortification, first of all the cellular, substance, 
and then of several portions of the skin. If the patient 
survives, all these sloughs are detached, leaving a free com¬ 
munication between the urethra and external surface. Every 
opening thus produced, is termed a fistula in per in mo. 
Sometimes the urine finds its way into the corpus spongio¬ 
sum urethrae, becomes diffused through the whole of this tex¬ 
ture, and injected into the glans penis, occasioning mortifi¬ 
cation of the parts in which it is lodged. 
When the effused urine forms only a circumscribed tu¬ 
mour, an incision may be made into the swelling, and an 
elastic gum catheter introduced and worn. When the effu¬ 
sion is extensive, and strictures are the cause, a complete 
cure cannot be accomplished without removing them. But, 
in general, this indication cannot be fulfilled in time to 
prevent all the mischief arising from the extravasation of 
urine. An attempt indeed should be made to pass a bougie; 
for, sometimes, the stricture is, more or less, removed by 
the ulceration. When this is the case, Mr. Hunter advises 
the almost constant use of bougies, in order to procure a 
passage onward into the bladder. However, if it were pos¬ 
sible, in this state of things, to introduce a bougie through 
the whole course of the urethra, there can be little doubt, 
that the most advantageous plan would be that of making 
the patient keep an elastic gum catheter continually in the 
passage. This instrument would at once conduct the urine 
outward, hinder any more from being effused, and act, 
like a bougie, on the remains of the stricture. In cases of 
this nature, the larger the catheter is which can be intro¬ 
duced the better, as it will not only act more quickly on the 
remains of the stricture, but will be more likely to hinder 
a further extravasation of urine. 
In the cases under consideration, we are advised by 
Mr. Hunter to endeavour to unload the bladder, and prevent 
the further effusion of urine into the cellular substance, by 
making an opening into the urethra, somewhere beyond the 
stricture; but the nearer to it, the better. 
Introduce a director, or staff, into the urethra, as far as 
the stricture. Cut down on the extremity of the instrument, 
and extend the incision a little farther towards the anus, so 
as to open the urethra beyond the stricture. 
When the stricture is opposite the scrotum, Mr. Hunter re¬ 
commends making an opening into the urethra in the peri¬ 
neum ; but, here, we cannot have the end of the staff to 
guide us, and we must trust to our anatomical knowledge. 
The rest of the operation resembles that for the cure of a 
false -passage. A flexible gum catheter should then be intro¬ 
duced, and the wound healed. 
Great attention should still be paid to the inflammation, 
produced by the diffusion of the urine. Free incisions ought 
to be made, in order to give vent |to this fluid as well as the 
purulent matter. When there are sloughs, of course the sur¬ 
geon ought to prefer dividing them to cutting the living 
parts; yet this consideration must not lead him to omit 
making the requisite openings in the most depending situ¬ 
ations. 
When the total obstruction of the urethra and the extra¬ 
vasation are ascertained to depend upon the lodgment of 
calculi 
