What is the true nature of a stricture ? I believe that a stricture (I speak of the per manent class) may result from the organisa tion of lymph effused upon the surface of the mucous membrane, as in the formation of bridle strictures. Secondly, that it may arise from the healing or cicatrisation of an ulcer, in which case a fibrous puckering is produced. Thirdly, that it may arise from hypertrophy of the elastic layer beneath the mucous mem brane. Fourthly, from deposition of lymph between the urethra and spongy body ; and, lastly, from deposit and organisation of lymph in the cells of the spongy body ; and that these conditions may all co-exist.
When the strictured part is laid open, it will be found that at the exact seat of stricture the mucous surface is raised; and beneath this the submucous elastic lamina is observed dis tinctly thickened, of a firm texture, and de prived more or less of its natural elasticity, this thickening passing off gradually and in sensibly in a longitudinal direction until it altogether disappears and the canal resumes its natural diameter, or is dilated or contracted according to circumstances. The thickening usually extends equally around the urethra, so that the opening of the canal is in the middle of the stricture, but in some instances it is confined to one side. On attempting to dissect the urethra from the sublacent spongy body, it will be found that its ac hesion at the seat of stricture is so complete, that it cannot be raised without much difficulty, and in many cases the separation of the two struc tures cannot be accomplished at all. The spongy body itself is frequently thickened, and the delicate tissue forming the septa of its cells is much hypertrophied.
Causes of Most strictures are the result of inflammation of the urethra. Long persistent and neglected claps constitute by far the most common of the causes of the disease.
I have no hesitation in admitting that the indiscriminate use of stimulating injections may be fairly set down as the occasional cause of stricture. Masturbation, and the too frequent indulgence in the venereal act, may be enu merated amongst the occasional causes of the disease.
of stone with It often happens that calculus in the bladder co-exists with stricture in the urethra, and the con nection between the two diseases appears easily accounted for. But some curious cir cumstances occasionally occurring in these cases, render it very doubtful whether we are justified in indiscriminately attributing the formation of stone to the impediment to the discharge of water from the stricture ; nay, the circumstances to which I allude rather tend to prove the converse of the proposition, namely, 'that the stricture depends on the ir ritation in maintained by the pre sence of stone in tire bladder. The inference
appears legitimately deducible from the fact, that cases of severe stricture have been entirely cured by the removal of the •stone from the bladder by lithotomy.
Diseased lacunce. — of the lacuna; becomes the seat of chronic inflamma tion, and is converted into a small indurated tumour, varying from the size of a hemp-Seed to a horse-bean. It becomes imbedded in spongy body.-1- According to Sir B. Brodie, the usual situation is about two or three inches from the orifice, but it is sometimes perceptible close to the frtanum, at others within the scrotum.
Rokitansky mentions a curious form of disease occurring after repeated attacks of go norrhoea. " The urethra presented numerous cartilaginous protuberances, from the size of a millet-seed to that of a pea, in part coalescing, and scattered over the inner surface as far back as the bulb, leaving the passage, however, of adequate dimensions." $ Obstruction from other The urethra is sometimes occupied by verrucous vegeta tions, the result of gonorrhoea. Numerous instances of this are given by Ricord ; they are usually found • near the meatus, and are remarkably vascular; but sometimes they exist in the membranous, or even the pro static, portion. They are distinguishable by their greater vascularity from another form of excrescence or caruncle, which co-exists occasionally with stricture. Both, however, are formed in consequence of irritation of the urethral membrane, and represent simple or ganised structures connected with the urethra by a base or stem.
Hunter met with two, and these were in cases of very old stricture, where the urethra had suffered considerably. Home says, that with all his opportunity in inspecting these diseases in the dead body, he never met with them. Rokitansky§ also affirms their extreme rarity. Chelins* says, " they are found as little masses of soft warts behind the stric ture ; at other times they are found before the stricture ; they are similar to those growths observed on the prepuce and glans. I have seen in one person, who had frequent claps, the urethra filled with round excrescences from an inch behind the fosses vavieularis." Blorgagni found one in a case of stricture.± These excrescences are developed from the mucous membrane as the result of simple as well as specific irritation, and are limited in the extent of their growth by the walls of the canal.