B—The lacunæ and the cut end of bougie, to show the continuation of the urethra.
Now, this canal being extensively supplied with nerves, that have more extensive communication with others than any particular ones have in the whole body, and made up, as before stated, of surficial and muscular membranes, and exposed to the performance of several duties which are often unduly called into exercise, can not be supposed to be exempt from the consequences of such misappropriation; and therefore it is very liable to inflammation. From the sensitive nature of the tube, it is very obnoxious to spasm, which may be partial, general, temporary, or continuous: hence spasmodic stricture. This condition is of course dependent upon many causes, excess of diet, fatigue, cold, &c., irritating the general system; when from the local irritation previously set up in the urethra by the forenamed causes—a neglected gleet or clap—the urethra is not long in participating in it: the phenomena are the symptoms recently narrated. Highly restorative as the powers of nature may be to remove disease, she does not appear readily disposed to interfere with the processes set up in the machine she inhabits, for self-defence, to protect itself from the constant irritation produced by the daily flow of acrid urine, which in several cases often produces ulceration; coagulable lymph is thrown out in the cellular structure of the particular diseased part, thereby thickening the walls thereof, and constituting permanent stricture, it appearing preferable to impede a function which a narrowing of the urethric canal does, namely, that of urinating, than of allowing ulceration to ensue, whereby the urine would escape into the neighboring parts, and occasion great devastation, and probably death. Permanent stricture, as its name implies, outlives the patient; it never yields, unassisted by art. I have described the ordinary symptoms of stricture, especially that form induced by gonorrhœa. Stricture may arise from other causes. Inflammation, in whatever way set up, if allowed to go on or remain, will give rise to stricture, and the celerity or tardiness with which it takes place depends upon circumstance. An injury from falling astride any hard substance, blows, wounds, contusions occasioned by riding, the presence of foreign substances, the injudicious use of injections, and lastly, which is as frequent a cause as any one of those heretofore enumerated, masturbation. The violent manual efforts made by a young sensualist to procure the sexual orgasm for the third or fourth time continuously, I have known to be of that degree that irritation has been communicated to the whole length of the urethra, extending even to the bladder; and retention of urine, in the instance I allude to, ensued, and required much attention before it could be subdued. Excessive intercourse with females will give rise to the same effects; not so likely as in the case preceding, inasmuch as the former can be practised whenever desired, while the latter needs a participator. The act of masturbation repeated, as it is, by many youths and others, day after day, and frequently several times within each twenty-four hours, must necessarily establish a sensitiveness or irritability in the parts, and alteration of structure is sure to follow.
The positive changes which take place in stricture in the urethral passage are these: there ensues a thickening and condensation of the delicate membrane and the cellular tissue underneath, which may possibly unite it to the muscular coat. This thickening or condensation is the result of what we call effusion of coagulable lymph. It will be rather difficult to explain the process; but lymph is that fluid understood to be the nutritious portion of our sustenance or system, and which is here yielded up by the vessels which absorb it, and which vessels abound, with few exceptions, in every tissue of our body. However, it will suffice to say, that where inflammation takes place, there is an alteration of structure, and that alteration is generally an increase. In stricture, this increase or thickening takes place, as I observed before, in particular parts of the urethra, but where the inflammation is severe, no part is exempt, and whole lengths of the passage become occasionally involved. It is true, certain parts are more predisposed than others, as, for instance, the membranous, bulbous, and prostatic portions of the canal; but there are oftentimes cases to be met with where these parts are free, and the remainder blocked up. This effusion or thickening assumes various shapes, and selects various parts of the urethra. The subjoined diagram will convey a tolerably perfect idea of the malady in question; indeed it is a beautiful specimen of simple stricture.
| A—The cut edges of the corpus spongiosum. B—The urethra. C—The stricture. View larger image |
A—The cut edges of the corpus spongiosum.
B—The urethra.
C—The stricture.
To continue the description of the formidable consequences of neglected stricture.
In protracted and neglected cases, that part of the urethra between the stricture and bladder becomes dilated, from the frequent pressure of the urine upon it, induced by irritability of the bladder, which has an increasing desire to empty itself. In process of time, complete retention of urine will ensue, ulceration will take place at the irritable spot, and effusion of urine into the surrounding parts will follow; and the consequences will be, as in the instance of the spasmodic affection, fatal, unless controlled by the skilful interference of the surgeon.