The urethra is sometimes inflamed from constitutional causes, or sympathetically : thus stone or calculus in the bladder and kidneys frequently leads to urethritis ; some substances taken into the stomach produce the disease, as asparagus, cantharides, and turpentine, and arsenic if administered in large doses, espe cially if the poison be allowed to accumulate in the system.
In persons of a gouty diathesis, urethritis occasionally occurs, followed by a discharge of muco-pus. According to Prout, " gouty irritation of the urethra often assumes all the characters of gonorrhoea, and is not only attended by a profuse discharge, but with great irritation and scalding in passing water." During the prevalence of influenza, I have witnessed a severe attack of urethral inflam mation accompanied with copious puriform secretion, and attended with the ordinary symptoms of clap ; under the influence of a purge it passed off entirely in a few days. Suppression of cutaneous eruptions, according to the German pathologists, not unfrequently causes urethritis. Inordinate indulgence in venery, and masturbation, produce inflamnia tion of the urethra by the constant irritation of the part. So also the irritation of the menstrual and leucorrhoeal discharges, when applied to the male urethra under states of high excitation, induces a similar pathological condition.
Croupal exudations are sometimes found in the urethra. These assume either a tubular form, or the lymph is effused in the form of long shreds.* The mucous follicles situ ated in the vicinity of the meatus are, ac cording to Klecberg, of K6nigsberg, liable to a form of inflammation similar to that which attacks the follicles of the genital organs of the female. He thinks that it is sometimes connected with clap, or gleet, and often independent of either. It is indicated by a swollen state of the circumference of the mouth of the urethra, which is of a brownish red colour. There is slight pain in making water. The orifices of the lacunae become closed by inflammation, and, in the course of two or three days, pustules are formed in their places, which break and discharge a yellow pus. " The orifices of the large mucous fol licles are now seen dilated and surrounded by a swollen dark-red border, and they discharge a muco-purulent fluid into the urethra : if this be washed off, and the glands compressed, the fluid is distinctly seen issuing from these openings." t The disease sometimes assumes a chronic form.t The specific causes of inflammation of the urethra are syphilis, gonorrhoea, and small pox. Of these, gonorrhoea is the most fre
quent. Syphilitic inflammation, producing chancre, is by no means unfrequent, as Ricord has proved. The disease makes its appearance on the 6th, 8th, and 12th days after connection. Inoculation from the dis charge produces the true syphilitic pustule. It often attacks the meatus urinarius.
Inflammation from gonorrhea may be either acute or subacute, or the disease may be viru lent or simple, the difference being in degree rather than in kind. The disease begins in the anterior part of the canal, and is supposed to attack first the lacuna magna. Hunter limited its specific extent to an inch and a half from the meatus. The period of incuba tion of the poison varies from one to ten days, and is sometimes prolonged even beyond this, if we can believe the accounts of patients. Hunter has known it to appear a few hours after connection, and Sir Astley Cooper met with a case in which it did not make its ap pearance until after fourteen weeks from the time of inoculation.
The pathological changes in the urethra from this disease may be briefly described. The dis ease, commencing at the part indicated, if left to take its own course, gradually extends itself in a retrograde direction as far as the neck of the bladder, and, in very severe •cases, the mucous membrane of this viscus becomes involved. The urethral membrane is swollen, red, and exceedingly vascular : this can only be generally observed at the orifice, but it has also been seen in the middle of the canal in cases where, during an attack of gonorrhoea, the urethra has been divided. The intensity of the inflammation is not uniform. Thus, the lacuna magna, and the beginning of the spongy portion, are most severely attacked. The inflammation attacks the lacuna:, giving rise to pain and swelling in various parts of the canal ; even the spongy body itself be comes, by contiguity, implicated in the dis ease, and interstitial deposition of fibrin takes place in its cells, causing unequal dis tension of this body during erection, and hence painful chordee. Abscess in this body is not very unfrequent. By continuity of surface, the disease attacks the mucous lining of Cowper's glands and the ducts of the prostate, whilst through the ejaculatory ves sels it passes to the vesicule seminales, and by the vasa deferentia to the epididymis, causing hernia humoraks. When the latter structures become affected, the inflammation of the urethra itself in a great measure sub sides, and the discharge ceases, usually to reappear in a mitigated form.