This condition is illustrated in Fig. 2, which shows the hard and tough stricture which surrounds the soft mucous membrane that lines the urinary canal. When irritated or inflamed, as the result of a cold or other cause, the mucous membrane becomes swollen and thickened, and, as the stricture will not yield and enlarge, the result is that the urethra is almost completely closed, and it becomes impossible to pass the urine. Great pain is experienced, and the surgeon has to be called to draw off the urine with a catheter, which, at best, is a very difficult and painful operation, when the urethra is so irritable and constricted.
Treatment. In the earlier stages of the malady, relief is given by the skillful use of instruments for dilating the canal, or, where this fails by the operation of urethrotomy, for which we employ an improved and ingenious instrument, by which the stricture is readily and almost painlessly divided.
Improved Methods. Our surgeons have operated upon many hundreds of bad cases by a very ingenious and almost painless method, that requires no use of bougies in the after-treatment. This saves the patient an immense amount of pain and annoyance, and enables him to go home almost immediately after the operation.
The ordinary after-treatment, by dilatation with bougies, is very tedious, and often more painful than the operation itself, so that our peculiar method of treatment has been hailed with joy by those familiar with the old and unnecessarily-painful systems of treatment. Besides, our more improved method has been followed by far more perfect cures in every case operated upon.
In many of the cases coming under our observation and treatment, there have been several strictures, as illustrated in Fig. 3, which shows the urethra constricted at three different points, besides a congenital contraction at its mouth or meatus.
Spermatorrhea not infrequently results from stricture of the urethra, even when the affection is quite slight. Our attention was first called to this subject by the consideration of the numerous cases in which epileptic convulsions or "fits," and other serious diseases of the nervous system in children, have resulted from an unnatural contraction of the prepuce or foreskin, constituting what is termed phimosis.
Every surgeon of experience has met with many of these cases of reflex irritation. It occurred to us, that, inasmuch as these contractions of the foreskin give rise to nervous diseases of an alarming nature, may not an unnatural narrowing of the urethral canal, which must have exactly the same effect in retarding the flow of the urine, give rise to irritable nervous affections in adults. May not unnatural irritation and excitement of the sexual organs, so set up, cause loss of semen to occur during sleep, and consequent nervous and general debility?
It is a well recognized fact that the urethral canal should bear a certain definite and proportionate size to that of the penis, just as the length of the arm should naturally bear a certain proportion to the length of the body. In the case of some parts of the body, disproportionate development of the part may not give rise to anything further than unsightliness; but when we find the small size of the urethra retarding the free passage of the urine, then we may expect, if this condition is long continued, to find more or less irritation of the urethra and, perhaps, of the bladder, also. When there is a contraction of the urethra at its external orifice, or at any point along its course, unnatural pressure is put upon the urinary canal behind the constricted portion, and these parts must bear an undue strain during the passage of the urine.