SIMPLE URETHRITIS.
Predisposing Causes. —1, Diathetic conditions ; 2, chronic urethral disease; 3, morbid states of the urine; 4, sexual abuses ; 5, dietetic excesses and irregularities; 6; alcoholism. It is obvious that any condition of the system which gives rise to irritability of the mucous membranes predisposes to of these structures. It is possible that this argument cannot be applied with equal pertinency to all mucous membranes, but it certainly applies quite forcibly to the urethra. Especially is this true of such diathetic conditions as rheumatism and gout, in which the urine is likely to be loaded with the products of retrograde tissue metamorphosis, which products may be both mechanically and chemically irritating. Lithmmia and oxalinia are especially potent factors in this respect, producing as they do their corresponding conditions of perturbation of the composi tion of the urine, viz., lithuria and oxaluria. The, urine in lithmmia is not only likely to be heavy and concentrated by virtue of its dispropor tionate amount of solids, but the uric-acid crystals present are exceed ingly irritating to the mucous membranes of the genito-urinary tract. There is no question but that lithuria is responsible for certain catarrhal conditions of the superior portion of the genito-urinary apparatus. This catarrhal condition is possibly not so manifest in the urethra, yet the mucous membrane, by virtue of the irritating properties of the urine, is in an extremely vulnerable condition. This constitutes a standing invitation to infection and sources of irri tation of all kinds. Irritability of the nervous supply of various tis sues, which means essentially irritability of the tissues themselves, is another important factor incidental to the gouty or rheumatic dia thesis. Closely associated with the gouty diathesis are the effects of dietetic indiscretions and excesses, and indulgence in alcoholic beverages.
As is true of all organs of the body, excessive action is a pre disposing cause of inflammation. In the case of the urethra sexual excesses and masturbation are the source of much mechanical dis turbance, glandular hyperactivity with excessive secretion of mucus, and possibly slight traumatisms, these various factors 'causing a catar rhal state of the mucous membrane which affords excellent soil for microbial action, and exaggerates the results of irritation of all kinds.
By far the most important factor in the predisposing causes of simple urethritis is chronic disease of the genito-urinary tract, what ever its origin may have been. Most of the so-called cases of bas tard clap or simple urethritis are due to the effects of sexual, alco holic, or dietetic excesses upon a urethra already damaged, and in which the products of microbial action, particularly the products of simple decomposition, are present. This must be remembered as bearing very pertinently upon cases of suspected gonorrhoea in which the virtue and probity of one or both parties to the venereal act may be brought in question.
Exciting Causes.-1, Trauma; 2, bacteria (non-specific) ; 3, tox ins; 4, chemical irritation; 5, sexual strain. It is unnecessary to ex patiate upon traumatism as a factor in the production of urethritis. It should be remembered, however, that traumatism in a perfectly healthy and approximately aseptic urethra may be followed by little or no inflammation; often, indeed, by no phenomena which can be properly characterized as nrethritis. In the presence, however, of some latent condition of disease—i.e., a chronic source of infection,
traumatism bears a very important relation to the etiology of acute urethritis. A very pertinent illustration of the relation of trauma tism to pre-existing conditions of infection of the urethra is found in the results of operations or instrumental manipulations of the canal in the presence of stricture or congested and granular patches on the urethral mucous membrane.
In considering the• relation of bacterial infection to simple ure thritis, it is well to remember the fact that various forms of bacteria and their products are capable of producing irritation and inflamma tion of mucous membranes. The pus microbe or its derivatives, and possibly the ordinary germs of decomposition, may per se, or by virtue of their products, produce urethritis. The author will not dis cuss here the relation of the bacterium coli commune to inflamma tions of the genito-urinary tract. It appears highly probable that the line of demarkation between the pus microbe and the colon bacillus would be very difficult to demonstrate. A point worthy of consid eration is that the secretions from disease of the urethra, originally of gonococcal origin, but from which all specific characters have dis appeared, (as in certain cases of chronic urethritis, folliculitis and prostatitis and in certain inflammations of the female genito-urinary tract), are capable of producing inflammation of the male urethra. That the toxins evolved by microbial action may cause urethritis is almost if not quite certain. Any chemical irritant may produce urethritis, which sometimes assumes a severe type. The well-known experiment of Swediam- with aqua ammonioe will be remembered in this connection.
In discussing the exciting causes of simple urethritis it is neces sary to correct the fallacious notion that normal secretions in the female are capable of exciting urethritis in the male. It is nothing unusual for the apology to be offered that the man has had inter course with the woman just before, after, or during the menstrual discharge. The inference that the menstrual discharge may pro duce urethritis is as old as the Bible, as will be noted by a perusal of the fifteenth chapter of Leviticus. The Jewish tradition that the female is unclean for a certain period following menstruation is prob ably based upon this common but erroneously applied observation. Menstrual fluid, unless decomposed or mixed with the products of bacterial evolution of one kind or another—whether the germs be autogenetic or heterogenetic is inconsequential—cannot possibly pro duce urethritis. Apparent contradictions are due either to the auto genesis of urethritis in a previously damaged urethra, or to the wash ing down of the products of an old infection from the upper portion of the female sexual tract by the outflowing menstrual secretion. The menstrual secretion has been accepted as an etiological factor in urethritis; the water-closet theory has been repudiated, but the author entertains the belief that the latter theory has at least a basis of probability, while the former is positively absurd.
The "strain" theory of the origin of urethritis is a very popular one, but is perhaps the most fallacious of all. It is probable that sexual excess alone is never productive of the disease. Sexual excess in the presence of a diseased urethra is, however, another matter and under such conditions is a very important factor among the ex citing causes of urethritis. As a predisposing factor, on the other hand, it is all-important.