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Persons afflicted with stricture, and urinating in the streets, may almost be detected from the singular attitude they are obliged to assume to prevent the urine from inconveniencing them, and also from the time occupied in discharging it. Some few minutes after making water, when dressed and proceeding on his way, the patient finds his shirt become moist by some drops of urine that continue to ooze from the penis; and it is only as these annoyances accumulate, he begins to think he is laboring under some other disease than the gleet. The next symptom he will experience will be a positive but temporary difficulty in passing his water—perhaps a total inability to do so; it will, however, subside in a few minutes. This will lead him to reflect, and he will even appease his fears by inclining to think it may be the consequence of his last night’s excess: he resolves to be more careful for the future, and he gets better; his contemplated visit to his usual professional adviser, if he have one, is postponed, and a few more weeks go by without a return of the last symptom. The next attack, which it is very difficult to avert, and which is sure to accompany the succeeding debauch, or to follow a cold or fatigue, does not so speedily subside; the patient finds that he can not complete the act of making water without several interruptions, and each attended with a painful desire resembling that induced by too long a retention of that fluid. In that state he eagerly seeks medical assistance; the treatment generally adopted consisting of some sedative, immersion in a hot bath, or the passage of a bougie. Relief being thus easily obtained, professional advice is thus thrown up, and the symptoms are again soon forgotten. Before proceeding further with the more severe forms and consequences of stricture, which may now be fairly said to have commenced in earnest, a brief anatomical description of the urethra may enable the reader to understand how the constriction or narrowing of that canal takes place.
I have elsewhere stated the urethra to be a membranous canal, running from the orifice of the penis to the bladder, and situated in the lower groove formed by the corpus spongiosum.
The difference of opinion entertained by some of our first anatomists, on the structure of the urethra, is deserving of notice; for only in proportion to the correctness of our knowledge of it, can we arrive at a just definition of its diseases.
One party assert it to be an elastic canal—whether membranous or muscular they do not say—endowed with similar properties of elasticity to India rubber, or to a common spring. That it is elastic, is beyond doubt; but the mere assertion is no explanation of its mode of action.
Others, from microscopical observations, declare it to consist of two coats—a fine internal membrane, which, when the urethra is collapsed, lies in longitudinal folds—and an external muscular one, composed of very short fasciculi of longitudinal fibres, interwoven together, and connected by their origins and insertions with each other, and united by an elastic substance of the consistence of mucus. This is the more satisfactory of the two.
They account for the occurrence of stricture in this way. They say that “a permanent stricture is that contraction of the canal which takes place in consequence of coagulable lymph being exuded between the fasciculi of muscular fibres and the internal membrane, in different quantities, according to circumstances.”
A spasmodic stricture they define to be “a contraction of a small portion of longitudinal muscular fibres, while the rest are relaxed; and as this may take place, either all round, or upon any side, it explains what is met with in practice—the marked impression of a stricture sometimes a circular depression upon the bougie, at others only on one side.”
With respect to the change consequent upon permanent stricture, dissection enables us, in some degree, to arrive at the truth. Excrescences and tubercles have been found growing from the wall of the urethra; but in the majority of instances, the only perceptible change is a thickening of the canal here and there, of indefinite length; but whether it be occasioned by the exudation of coagulable lymph, or whether it be the adhesion of ulcerated surfaces, which I contend are more or less present in gleet, is not so easy to determine; at all events, it is undoubtedly the result of inflammation.