VARIETIES OF CHRONIC URETHRITIS.
Chronic urethritis presents itself under three different forms: 1. The acute inflammation subsides to a certain extent, but re mains subacute, with occasional acute exacerbations accompanied by a thick, purulent discharge for an indefinite period. In this form of chronic inflammation there is continual discomfort, with more or less pain and smarting on urination. Generally, too, the prostate is in volved to a certain extent, giving rise to a feeling of fulness and tension in the perineum, with frequent urination.
2. The discharge becomes thin and watery, being sometimes so scanty that nothing is visible save a drop or two of muco-purulent fluid escaping from the meatus in the morning. This is the most frequent form of the disease, and is not usually attended by discom fort. It may depend upon : (a) A simple catarrhal condition of the mucous membrane, such cases involving the element of constitutional and local predisposition. (b) Congested and granular patches in the mucous membrane. (c) Organic stricture. (d) Urethral polypi and papillomata. These are very rare conditions, but cases in which polypoid growths were removed through the endoscope are reported by Griinfeld and others. The author has operated several times for urethral papillomata with a resulting cure of obstinate gleet. (e) Ab scesses or fistuku resulting from acute urethritis, and becoming chronic. (f) Dilatation and pocketing, with chronic inflammation of the lacuna Inagua. (g) Urethro-prostatic catarrh. (h) Posterior urethritis, i.e., chronic follicular prostatitis. (t) Folliculitis. (j ) Cowperitis. (k) Tubercular infection.
3. In this form of chronic urethritis the inflammation is appar ently recovered from, but after a variable period of time, during which possibly the individual does not have his attention called to his ure thra, there develops, as a consequence of sexual excesses, intemper ance, or the like, a thin muco-purulent discharge.
The distinctive features of the various phases of chronic urethritis are dependent upon differences in the degree of activity of the inflam matory process ; such differences do not warrant a distinct differen tiation of chronic urethritis and gleet. As a rule, however, the dan ger of contagion is directly proportionate to the degree of purulency of the discharge. It must, however, be considered in this connection
that, as already suggested, it is possible that the discharge of virulent urethritis may lose its purulent and ordinary infectious qualities as far as its capacity for imparting acute vaginitis is concerned, but may nevertheless become transformed in such a manner that it is still capable of setting up various uterine, peri-uterine, salpingian, and ovarian troubles in the female.
Some of the cases of so-called gleet consist in the appearance, under sexual excitement, and almost uniformly on rising in the morn ing, of a slight, sticky moisture at the meatus. In most of these cases the annoyance produced by the disease is entirely of a mental character. The author is sometimes inclined to think that such pa tients would experience a feeling of disappointment if they failed to detect on rising in the morning the usual tear of urethral secretion.
The appellation of psychic gleet, although a little far-fetched, would not be inappropriate as applied to such cases. Some of these pa tients are unable to detect the secretion, except on squeezing the ure thra. The pertinacity with which such individuals will vigorously "milk" the urethra for the purpose of exhibiting a chop or two of mucus as an. evidence of their alleged deplorable condition is worthy of a better cause. Probably fifty per cent. of these cases are kept up by this pernicious practice. Most individuals, upon being ques tioned, will acknowledge that they are in the habit of seeking for the discharge a number of times daily, and they are considerably sur prised when informed that their enthusiastic search for something that they do not wish to find, is mainly responsible for their woes. The pathological condition in this variety of gleet is simple hyper secretion of mucus by the follicles of the urethra. The author is con vinced, moreover, that quite a proportion of cases in which the dis charge is more pronounced are dependent upon a catarrhal state of the mucous membrane, with a coincident hypersecretion of mucus, as a result (1) of habitual over-stimulation of the glands and (2) of their enlargement.