DISTURBANCES OF NUTRITION OF TIIE FEMALE URETHRA.
But from the comparatively small area affected, th?y are neither symptomatically nor therapeutically as important as the cor responding affections in the male. These affections are often only stages of one and the same process, and we will therefore not treat them each one separately. Their etiology, symptoms and treatment are closely re lated.
The causes of these disturbances of nutrition lie either in the individual affected, or they come from without. Certain states of the urine may affect the urethral mucous membrane. A water rich in salts, or ammo niacal, one containing fungi, or rich in membranous threads (diphtheritis of the bladder) or one containing infected blood clots, may naturally cause hyperaemia, catarrh and ulceration of the mucous membrane. Diseases of the bladder and kidneys are, therefore, important predisposing causes of the affections that we are considering, especially as many of them ne cessitate introduction of the catheter, and possibly a direct lesion of the mucous membrane. The urethra often partakes of affections in its neigh borhood, such as chronic and acute inflammations of the labia minors, catarrh of the vagina, and of the cervix. Thus urethritis has been found as a complication of the scrofulous diathesis, and with impetiginous skin eruptions, (Streubel); and specific catarrhal inflammation of the membrane has been seen in scarlatina and measles. Variolous pustules occur there in small-pox. Scanzoni found them twice. The same observer found in the urethra of a girl nineteen years old, dead of measles with acute disintegration of the blood, more than twenty follicular ulcers. Typhus, dysentery, and puerperal septicmmia oft,en cause considerable nutritive disturbances in the walls of the urethra. There may spread from the labia minora and the introitus the ulcerations of syphilis, lupus, car cinoma, tuberculosis, diphtheria, and elephantiasis. Besides this it is well known that in pregnancy, in consequence of active and passive hy perfemia and mechanic,a1 displacement, the urethra is often affected; and it may be contused and even torn across in a non-instrumental delivery.
Again, dislocations of the unimpregnated uterus, tumors of other pelvic organs or inflammatory conditions affecting them, and hemorrhoids, may involve the urethra to a greater or less degree.
The following external injuries may cause urethral diseases: lesions from cohabitation, especially in young women, catheterism, the attempt to introduce foreign bodies (masturbation), wounds from falls and blows, etc. It is easy to see that catarrhal conditions of the urethra may ensue -from the use of unclean specula, or the careless employment of the finger, or compressed sponge, for dilatation of that canal.
Most frequently, however, these affections occur conjointly with mala dies of the vagina, and especially together with virulent vaginal catarrh. Suchanek found in 166 cases the vagina and urethra both affected in 122, urethral gonorrhcea alone being present only in 3 cases. Hence we see that the virulent urethritis feminre is usually secondary, and spreads from the mucous membrane of the introitus or the vagina; the urethra itself being usually too well protected to be directly infected.
normal conditions the mucosa of the orificium externum urethrre is pale red in color. In conditions of bypertemia it becomes rosy, cherry, or brownish red; the mucous membrane swells; and the canal per vaginam is felt to be warmer and thicker than usual. At first the amount of secretion is not increased. In urethral catarrh not only is the meatus reddened and the small glands swollen, but there ap pears a light mucous or muco-purulent fluid, often containing bubbles of air, which flows in considerable amount, as soon as pressure is applied t,o the urethra, from the orific,e. From the non-dilated, healthy urethra no drops Call be expressed; but in the catarrhal secretion of urethritis we find pavement epithelium, mucus and pus corpuscles, and vibriones. 1Vhen ulceration has occurred we may find in addition according to cir cumstances connective tissue and elastic fibres (I3iirensprung in chancre), and larger cells with nuclei (in lupoid ulcers) and multi-uucleated giant cells with detritus and blood-corpuscles (in epithelioma).