1. Inflammation

A. Catarrhal Inflammation

It commonly commences with a more or less acute or inflammatory stage, and subsequently passes into a protracted or chronic (blennorrhoic) stage. It results from chemical or mechanical irritation by substances that have been introduced from without, or it may be developed spontaneously in children from a scrofulous, or in aged people from a gouty diathesis, and in either it may be connected with impetigo;j though it has its origin most frequently in gonorrhoeal contagion (gonorrhoeal catarrh).

We find the anatomical characters to be those belonging to catarrh generally; in the acute stage there is, according to the violence of the process, redness, injection, tumefaction of the urethral mucous membrane, or secretion of puriform mucus; in the chronic stage there is tumefaction of the mucous membrane, enlargement of the follicles, relaxation of the sinuses, and a white or colorless secretion. The inflammation is either uniformly diffused over the urethra, or is limited to one or more spots. The latter is especially the case in genuine gonorrhoea of the male urethra; we here find not only the navicular fossa, but every point as far as the prostatic portion, and especially the vicinity of the bulb of the urethra, liable to become the seat of the disease. When the gonorrhoea is very violent and obstinate, a small tubercular swelling, which results from the deposition of fibrinous matter in the spongy tissue of the urethra, is found at these points of the urethra. This subject has not hitherto received the attention it deserves, either in regard to gonorrhoea itself, or in reference to the pathology of stricture consequent upon gonorrhoea, and to the gonorrhoeal ulcer of the urethra.

The terminations and consequences of gonorrhoea are various. The most common result, which is caused by great violence of the affection, by improper dietetic and therapeutic treatment, and by repeated attacks, is condensation and hypertrophy of the submucous tissue, fusion of the latter with the mucous membrane, and conversion of the corpus caver-nosum into a white, resistant, fibrous, cartilaginous tissue. The entire urethra sometimes undergoes this metamorphosis, subsequent to repeated and mismanaged attacks of gonorrhoea, but more commonly detached portions only are affected, and this gives rise to partial contraction or stricture.

Stricture of the urethra occurs in various shapes: the urethra is sometimes contracted to the extent of several lines, the parietes presenting a cartilaginous appearance, and the lining membrane being either smooth or having nodulated projections, or longitudinal folds; sometimes the stricture forms a rounded protuberance or an angular band encircling the entire canal or only surrounding a portion of the circumference; at others, again, it appears in the shape of an irregular cicatrix, which causes the surrounding mucous membrane to be puckered up.

The strictures may be solitary, or after a recurrence of gonorrhoeal attacks, there may be two, three, four, and more. Their seat corresponds to the seat of the previous inflammation. We have a unique preparation in the museum of Vienna, of a urethra of a man who had repeatedly been affected with gonorrhoea; it presents 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.

1 [See note, p. 22. - Ed].

The degree attained by the stricture varies; we not unfrequently find it so excessive, that the contracted part scarcely permits the passage of the finest bristle.

The essential character of stricture consists in the same alterations of this submucous and mucous tissue which we observe accompanying and following violent inflammation of the mucous membranes, when it involves the submucous cellular tissue; it does not bear any specific character. The inflammation attacks the spongy substances of the urethra at those spots at which the diseased action was most developed, and gives rise to a deposit of the fibrinous matter in its meshes, which induces the above-mentioned swellings in the urethra. If resolution does not ensue this product remains, and the corpus cavernosum is converted above it into a wheal, varying in extent, shape, and thickness, and consisting of fibrous and fibroid tissue; this is the more liable to induce a narrowing of the urethra, as it possesses a great tendency to contract, and the liability increases in proportion as the sound layer of the corpus cavernosum diminishes. The stricture is most considerable when the corpus cavernosum is involved throughout its entire thickness. It is evident that when the metamorphosis affects the innermost layer of the corpus cavernosum only, the gonorrhoea may be followed by dilatation of the urethra, and we actually find this to be the case in violent though diffused gonorrhoea.

The stricture, consequently, consists of the corpus callosum urethrae, which is converted into a fibroid callus with which the mucous membrane, including its epithelial and submucous layer, has become identified. It is in no way related to cancer, and particularly not to so-called scirrhus. However, mechanical irritation frequently brings on excoriation, inflammation of the tissue, and ulceration, which in favorable cases may be put a stop to after the passage of the urethra has been re-established, though it often involves the deeper parts, destroys the urethra, and induces urinary fistulae.

Strictures maintain a tendency in the urethral mucous membrane to inflammatory attacks, which gradually extend to the bladder, the urinary passages, and the seminal ducts. They also lead to a dilatation of the urethra beyond the contracted part, to dilatation and hypertrophy of the bladder, and dilatation of the ureters.

Those excrescences which are termed warts by medical practitioners, and which are probably polypous or condylomatous growths of the urethral mucous membrane, and which are said to be particularly liable to accompany stricture, are another consequence of gonorrhoea. We have observed them very rarely.

Lastly, we find gonorrhoeal inflammation degenerating into ulceration, causing the gonorrhoeal ulcer, which has not been as yet sufficiently investigated in the dead subject, and which not unfrequently gives rise to very fine capillary fistulae.

True polypi, particularly of the female urethra, probably occur as a consequence of repeated and tedious catarrhal affections. I have found them in one preparation in the prostatic portion of the male urethra.

B. Exudative Processes Of The Urethra

In very rare cases we find primary croup occurring on the urethral mucous membranes; it induces a circumscribed or a tubular exudation, according to the intensity of the process, and occurs chiefly in children.

In the course of hectic fever, brought on by suppuration in the vicinity, we occasionally see more or less numerous aphthous exudations and erosions on the urethral mucous membrane.

C. Pustular Inflammation

We frequently observe variolous pustules in the urethra, when the disease is very intense on the general tegumen-tary surface. As in other mucous membranes, it is accompanied by an exudative process of varying intensity.

2. Ulcerative Processes

Besides the gonorrhoea! ulcer, the ulcerating stricture and the ulcerative processes, with which the urethra is attacked from without (the prostate), and to which it is more or less exposed in conjunction with the penis, we have to notice the primary syphilitic ulcer - chancre of the urethra. Cicatrices left by ulceration, and especially by the last variety, must be carefully distinguished from gonorrhceal stricture, though this is rendered extremely difficult, as the cicatrix almost invariably induces stricture.

3. Adventitious Formations

In addition to the fibroid tissues occurring after gonorrhceal inflammation, and especially in strictures, to the problematic carunculae or warts of the urethra, we find that tubercle and tubercular ulceration (Tuberculosis urethrae) are formed in the urethra, though only in conjunction with tuberculosis of the entire urinary apparatus. The urethra is also attacked by cancer and cancerous ulceration; in the male sex this accompanies, or is the consequence of, carcinoma of the penis, and especially of the glans.