Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 4: Pla [corr.: Ple] - Wri
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit29465/1267/
URETHRA. 
1257 
tended with excessive irritation along the 
whole course of the canal, and the prostate 
gland becomes hypertrophied in consequence. 
Sir Benjamin Brodie mentions a remarkable 
case of this description. In this case the 
urethra, behind the obstruction, was so di¬ 
lated, that, whenever the patient attempted to 
pass his urine, a fluctuating tumour, as large 
as a small orange, was felt in the perinæum. 
It was punctured, and immediately the urine 
gushed out in a full stream. 
The escape of calculi from the bladder 
often occasions dilatation of the urethra into 
pouches ; and such dilatations occur inde¬ 
pendent of ulceration. 
On dissection of these pouches, the mucous 
membrane is usually found injected and 
thickened, presenting fungous yegetations, 
and occasionally coated with lymph. 
The urethra deviates frequently from its 
normal direction : thus, in large scrotal herniæ, 
and hydroceles of large size, it takes a ser¬ 
pentine course : so also, when tumours press 
on the canal, its course is altered. The same 
happens in enlargement of the prostate gland, 
and from the projection of its middle lobe, 
the urethra divides itself into two streams. 
Abscesses also distort the canal from its na¬ 
tural direction. Tumours in the pelvis, as a 
collection of hydatids between the bladder and 
rectum, in consequence of the influence they 
exert on the bladder, frequently distort the 
urethra from its normal direction. This dis¬ 
tortion occurs more especially to the pelvic 
part of the canal. Under these circumstances 
the urethra is generally lengthened to a greater 
or less extent. 
Solutions of continuity result either from 
mechanical injury, or from disease. The urethra 
may be wholly or in part divided. Most 
commonly, if the division be incomplete, a 
small fistulous opening remains for a short 
time, which subsequently, if let alone, com¬ 
pletely closes. Incisions through the mem¬ 
branous part of the urethra, as in the opera¬ 
tion of lithotomy, speedily cicatrise. 
The most serious injuries to the urethra 
are those resulting from blows or falls on the 
perinæum, especially when they are accom¬ 
panied by fracture of the ossa pubis. In these 
cases there is either partial or complete solu¬ 
tion of continuity. The membranous part of 
the urethra, from its position beneath the 
pubic arch, most frequently suffers. The na¬ 
ture of the injury may be generally recognised 
by the escape of blood with the urine, or by 
complete retention of urine. An elastic ca¬ 
theter, carefully introduced, will in the former 
case generally grate against the torn part In 
complete division of the urethra, if the patient 
survive the injury, the torn ends are, in 
the progress of the cicatrisation and con¬ 
traction, brought into apposition, and the con¬ 
tinuity of the tube is restored : stricture is 
the almost necessary consequence. If, how¬ 
ever, the cure is not accomplished, urinary 
fistula is the unfortunate result. When the 
complete division of the urethra, is accom¬ 
panied with fracture of the pubis, the two 
ends of the canal are frequently so completely 
separated, that extensive extravasation of urine 
ensues, and the case is generally fatal. 
Severe contusion of the urethra, inde¬ 
pendent of rupture, sometimes leads to ul¬ 
ceration or sloughing, and occasionally gives 
rise to stricture by inducing chronic inflam¬ 
mation of the injured part. 
Laceration of the urethra occasionally hap¬ 
pens from the introduction of foreign bodies, 
or from the escape of fragments of calculi, 
especially after the operation of lithotrity. 
The torn part generally heals under simple 
treatment, or the urine is infiltrated into the 
spongy body, and abscess is the consequence. 
Laceration often attends violent efforts to 
force a stricture with the sound or catheter : 
these injuries usually happen at the under 
part of the canal, and frequently heal if all 
violence be desisted from. In a case of la¬ 
cerated urethra brought into the London 
Llospital, a large pouch as big as a small 
orange was formed in the scrotum, into which, 
when the man attempted to micturate, the 
urine was forced ; he then squeezed it through 
the natural passage. By degrees this pouch 
gradually contracted, and no vestige of it 
remained. 
Inßammation of the urethra, whether com¬ 
mon or specific, is usually of the catarrhal 
form : common inflammation is comparatively 
rare ; but it may be excited by chemical and 
mechanical stimuli, or it may depend entirely 
on constitutional indisposition : thus strong 
injections hare been known to induce every 
symptom of severe urethritis simulating an 
attack of gonorrhoea; but the disease is speedily 
arrested by ordinary antiphlogistic treatment. 
Under the head of mechanical causes may be 
enumerated the introduction of the catheter 
or bougie, and other foreign bodies, and the 
passage of calculi entire or in fragments, and 
blows on the perinæum. 
The urethra is sometimes 'inflamed from 
constitutional causes, or sympathetically : thus 
stone or calculus in the bladder and kidneys 
frequently leads to urethritis ; some substances 
taken into the stomach produce the disease, 
as asparagus, cantharides, and turpentine, and 
arsenic if administered in large doses, espe¬ 
cially if the poison be allowed to accumulate 
in the system. 
In persons of a gouty diathesis, urethritis 
occasionally occurs, followed by a discharge 
of muco-pus. According to Prout, “ gouty 
irritation of the urethra often assumes all the 
characters of gonorrhoea, and is not only 
attended by a profuse discharge, but with 
great irritation and scalding in passing water.” 
During the prevalence of influenza, I have 
witnessed a severe attack of urethral inflam¬ 
mation accompanied with copious puriform 
secretion, and attended with the ordinary 
symptoms of clap ; under the influence of a 
purge it passed off entirely in a few days. 
Suppression of cutaneous eruptions, according 
to the German pathologists, not unfrequently 
causes urethritis. Inordinate indulgence in 
venery, and masturbation, produce inflam ma-
        

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