The discharge in most cases is thin, rather watery, and of a whit ish color. It becomes thick and yellowish, however, under the in fluence of the various causes enumerated as productive of chronic urethritis. A patient suffering with gleet is continually liable to acute exacerbations of his urethral difficulty upon the occurrence of the slightest exciting cause. The origin of the discharge, in cases in which no local lesion of the urethral mucous membrane can be discovered, is the numerous mucous follicles lining that portion of the urethra corresponding to the site of the chronic inflammation. There is more or less epithelium mingled with the discharge, and it will be found that one of the characteristic features of gleet is a rapid formation and removal of the delicate epithelial cells lining the ure thra. This is particularly pertinent as applied to those cases of chronic inflammation dependent upon chemical or traumatic interfer ence with the canal, such as is afforded by strong injections and in judicious instrumentation. When congested, granular, or abraded patches exist in the course of the canal, there is a constant hyper secretion of mucus or muco-pus, with exfoliation of the epithelium upon the surface of the lesion. In this condition, as well as in stric ture, the current of urine, as it passes over the diseased portion of the canal, rolls up into strings or threads the desquamated epithelium and muco-purulent deposit upon the surface of the diseased mem brane. These strings appear in the urine as the delicate thready filaments—Tripper-faden—which, as every practical surgeon is well aware, are almost invariably indicative of urethral disease. The majority of surgeons attribute this appearance of the urine to stric ture, but this is a mistake, for it will be found in many cases in which stricture cannot be detected, and is in such cases dependent upon urethral catarrh and general desquamation of epithelium. In stricture a condition of chronic inflammation exists posterior to the narrowing of the canal; as a consequence of obstruction at this point there is more or less pouching of the urethra at the posterior surface of the stricture. This dilated portion of the canal loses its elasticity and contractility, and, as a consequence, forms a more or less passive pouch upon its floor, in which a drop or two of urine almost invari ably remains and decomposes. As a consequence of this decompo sition, the inflammation and consequent muco-purulent secretion are enhanced. It is from this point that the gleety discharge and thready urinary filaments characterizing stricture are derived.
The author desires to emphasize particularly the influence of powerful injections in the production of chronic urethritis. He has had a number of cases come under his observation in which the pa tients had used powerful solutions of carbolic acid, sulphate of zinc, permanganate of potassium, etc., in the early stages of urethritis, and in the majority of these cases he has had an endless amount of trouble in curing the disease. The obstinacy of such cases is undoubtedly
dependent upon chemical destruction of the epithelium lining the canal. This, being repeated from day to clay, eventually results in a permanently abraded condition of the entire mucous membrane, which necessitates the rapid proliferation of epithelium for the pur pose of repair; this epithelium being, however, of a low grade and, moreover, governed to a certain extent by the influence of physio logical habit, is thrown off as rapidly as formed, and, as a result, the canal remains in a perpetually raw and inflamed condition. It is by no means necessary that injections should be acutely painful when used to accomplish this untoward result.
Still more important factors in the production of chronic ure thritis are intemperance and faulty sexual hygiene. The use of alco hol predisposes all of the tissues of the body to inflammatory pro cesses, this being particularly true of the mucous membranes, which become highly irritable; it has, moreover, a special effect in over stimulation of the sexual apparatus, both through the medium of the nervous system and more directly by the production of irritating properties in the urine. The majority of individuals contracting urethritis are more disturbed by the interruption of their customary fornication than by any immediate or remote danger or inconveni ence produced by the disease. They are possessed also with the • fatuitous idea that any form of •sexual stimulation short of actual intercourse is not injurious; as a consequence, they associate inti mately with women of loose character, whom they can caress and take liberties with, and, as a result, keep the sexual system in a con stant state of excitement. This is fully as disastrous in its effects as natural sexual indulgence, if, indeed, it is not worse. As soon as our patients are satisfied that a discharge no longer exists, or, in many instances, as soon as the discharge has greatly diminished in quantity, they begin their sexual indulgences. They come to us in the fault-finding manner of the average venereal patient, and ascribe the unfavorable progress of the urethritis to improper treatment; seldom will they acknowledge sexual excitement or indulgence, or the use of alcoholic beverages. Were it not for the sexual and alco holic elements iu the production of gleet, the author is satisfied that comparatively few cases of urethritis would last over six or eight weeks.
A lack of rest is another important element favoring chronic ure thritis. In every case of virulent inflammation in which the patient is so situated that he is compelled to be on his feet the greater part of the time, to walk about or indulge in muscular strains, lifting, etc., we may expect a stubborn course of the disease. As a corollary, it is to be inferred that patients enjoying facilities for comparative quiet will recover promptly in the majority of instances.