URETHRITIS.
Urethritis is the most frequent disease affecting the male genito urinary tract. It is usually contracted during sexual intercourse and is so exceptionally acquired in any other way that it has been termed the most venereal of the class of diseases to which it belongs. The most common term for urethritis is gonorrhoea. This is a mis nomer for several reasons : First, because it implies a discharge or morbid flow of semen; second, because it implies a disease of an unvarying type of specificity. The generic term urethritis is accu rate as applied to the affection in the male, inasmuch as it not only implies an inflammation of the urethral mucous membrane, but is sufficiently comprehensive to embrace all the varying forms of the disease whatever their origin. Neisser's discovery of the gonococcus has, however, in all probability permanently fixed the generic term gonorrhoea in its application to a specific type of inflammation affect ing the mucous membranes in both the male and female. If we accept the specific character of the gonococcus, a broad line of clini cal differentiation is at once established in urethritis. We are still compelled to recognize, however, certain cases in which the presence or absence of the gonococcus cannot be accepted as proving or dis proving the origin of the disease in any particular venereal act. This is especially true in cases in which the affected individual has in dulged at more or less frequent intervals with different females, and has suffered from previous urethral infection. Under such circum stances the recent attack may have been due to the development of gonococcal auto-infection from a focus originating in some prior attack of inflammation. In other instances the patient presents himself with a non-gonococcal discharge, and we are called upon to decide as to its specificity. Here we are compelled to acknowledge that the gonococci may have been present, but have disappeared. Practically, therefore, we are often essentially in the same position as before the discovery of the gonococcus. Especially is this true from a medico-legal standpoint. The sources of error in the diag nosis of the origin of urethritis are so numerous that it is never safe to pronounce a case of urethritis to be of specific origin, whether the gonococcus be present or not, unless the affected individual can be shown to have been perfectly healthy before the development of urethritis, or to have had intercourse with a woman suffering from virulent vaginitis, or to have a history of a more or less recent attack of gonorrhoea. This caution is particularly necessary in passing an opinion in the case of a married person.
The discovery of the gonococcus has not changed the views of the author regarding the origin of gonorrhoea and its congeners. This
class of affections, in common with chancroid, may still be classed as filth diseases which originate de novo in the female. The author believes that germ infection of one kind or another is the foes et origo of the majority of cases of urethritis. It is not probable, however, that the germs producing such infection are always and invariably the same. Gonorrhoea is as old as the human race, but that the gonoccoccus was originally the result of a special act of creation seems incomprehensible. The development of the gonococcus, and indeed of all germs capable of producing urethral inflammation, has been along evolutionary lines. We cannot accept the spontaneous generation of germs of a specific type. We may, however, believe in the transformation of innocuous germs by virtue of their adaptation to environment, into germs of a specifically pathogenic character. The female generative apparatus constitutes the most favorable en vironment for the development of, and acquirement of pathogenic properties by, germs that could be imagined. Protection from air and light, and the presence of heat, moisture, and decomposable secretions of various kinds constitute an excellent field for bacterial evolution. Pathological discharges and exposure of the parts to sources of local irritation constitute an additional and important factor. In un cleanly women, both pathological and physiological discharges of the male are allowed to accumulate and undergo decomposition. The semen is a highly complex organic substance, the decomposition of which in all probability results in the development of toxins of a highly irritating character.
Whether or not the gonococcus be accepted as the cause of a certain specific type of urethritis, the fact remains that the environmental conditions which have been mentioned constitute the point of departure of germ evolution, the products of which are capable of producing mucous inflammation of varying grades of severity, ranging from a simple form of urethritis to the gonococcal variety of virulent inflam mation. Precisely what germ is the progenitor of the gonococcus in the process of evolution would be difficult to determine, but the differ ence between the specific microbe and certain germs which are nor mally present in the urethra of the male and vagina of the female is not very great. The dissimilarity between the gonococcus and the pus microbe is not so marked as to exclude the possibility of the transformation of the one into the other under favorable circum stances of environment. That we are unable to imitate this process of evolution is a valid argument against the theory.