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/lit29465/1276/
1266 URETHRA. 
calculi or foreign bodies from the bladder, 
and thus becomes paralysed, and never after¬ 
wards recovers its normal tone. This is an 
unfortunate condition, as it admits of no 
remedy. 
The female urethra is occasionally the seat 
of inflammation : this is almost invariably of 
the catarrhal form, and may arise spontane¬ 
ously or as the consequence of gonorrhoea. 
The follicles at the meatus are especially liable 
to inflammation, in conjunction with the fol¬ 
licles of the vulva and margins of thenymphae. 
The disease is described by l)r. Oldham under 
the head of the “ Follicular Inflammation of 
the Vulva.” It consists of a number of slightly 
raised vascular points, clustering around the 
elevated border of the orifice of the urethra, 
and skirting the margins of the nymphæ. The 
points are isolated and small ; but, as the 
disease progresses, several of them coalesce, 
and here and there a minute speck of ulcera¬ 
tion may be seen in their centre ; but little or 
no swelling accompanies it. 
Dr. Ashwell has recognised the same dis¬ 
ease, and concludes that the same is alluded 
to by Dr. Churchill, where he speaks of “ a 
more circumscribed inflammation which may 
attack any portion of the vulva, and is often 
seen merely surrounding the orifice of the 
urethra, and occasionally confined to the 
clitoris.” * 
Specific inflammation of the urethra is 
usually the consequence of gonorrhoea. The 
disease seldom attacks the female urethra until 
after the vagina has been some time affected. 
It is easily recognised by a swelling or pouting 
of the meatus ; and on pressing upwards 
against the pubis the true gonorrhoeal dis¬ 
charge appears. It is accompanied with a 
sense of scalding on micturition and pain ; but 
the symptoms, for obvious reasons, are much 
milder than in gonorrhoea of the male. It is 
amenable to the same treatment. 
Tumours of various kinds are occasionally 
found connected with the meatus and the 
urethra itself ; the former have their seat 
especially in the inferior labium of the ure¬ 
thral orifice. The most common is the simple 
vascular tumour, first described by Morgagni 
as “ a red fungous excrescence, the size of a 
bean, sometimes to be observed [attached to 
the orifice of the urethra.” It has since been 
recognised by others ; and has been well de¬ 
scribed by Sir Charles M. Clarke. Sir C. 
Clarke describes it as a vascular tumour, arising 
from the meatus urinarius. “ Its texture is 
seldom firm ; it is of a florid scarlet colour, 
resembling arterial blood, and if violence is 
offered to it, blood of the same colour is ef¬ 
fused. It is exquisitely tender to the touch, 
and if an accurate examination of it be made, 
it appears to shoot from the inside of the 
urethra. Its attachment is so slight that it 
appears like a detached body lying upon the 
parts.” It is sometimes connected higher 
up with the urethra, and can then only be 
brought into view by introducing a catheter or 
* Ashwell, on the Diseases of Women. 
probe, and separating forcibly the walls of the 
urethra, when it will be found attached to the 
mucous membrane. 
Mr. Hughes, of Stroudwater, described a 
tumour “ of a red colour, and of a soft, spongy 
texture, with an irregular, jagged surface, 
connected with the meatus.” He removed 
the meatus, which completely included the 
disease. 
Carcinomatous tumours are also met with 
in connection with this part. They have been 
described by Boivin and Dugès. They are 
frequently associated with similar diseases of 
the uterus. They are generally of the ence- 
phaloid character, present a lobulated ap¬ 
pearance, and are exceedingly painful. If un¬ 
accompanied by disease of other organs, they 
can be successfully removed. 
Fungoid tumours of the malignant class 
spring occasionally from the mucous membrane 
of the urethra. After excision they have a 
great tendency to recur. They are occasion¬ 
ally associated with a similar disease of the 
bladder. 
The urethra sometimes becomes thickened 
along its whole extent. According to Clarke, 
this thickening exists principally in the cellu¬ 
lar membrane surrounding the urethra, and is 
accompanied by a varicose state of the cir¬ 
cumjacent veins. On examination, a bulbous 
tumour will be found behind the pubis, and if 
much pressure is made upon it, pain will be 
produced, but not of a severe kind.”* It is 
accompanied with a mucous discharge from 
the urethra and vagina. The vessels on the 
surface of the tumour become so large as to 
admit of being opened with a lancet. When 
the patient is erect the size of the vessels 
increases, and they diminish in the recumbent 
position. Sometimes a pouch forms in the 
urethra, in which a few drops of urine are 
lodged : this can be emptied by pressure with 
the finger. The mucous membrane covering 
the tumour is sometimes thick, occasionally 
thin and shining. The disease occurs princi¬ 
pally in married women who have had child¬ 
ren ; and, according to Clarke, in those with 
red or auburn hair and fair complexions. The 
disease seems to consist of an enlargement 
of the veins of the part, with hypertrophy of 
the cellular membrane. 
The female urethra is rarely the seat of 
stricture. I have made inquiries of some of 
the most experienced accoucheurs in London, 
and they agree that stricture of the female 
urethra is very rare. The circumstance clearly 
depends on two causes ; the first is the ex¬ 
treme natural dilatability of the urethra in 
women ; and the second is, that, although it 
is liable to gonorrhoeal inflammation, the dis¬ 
ease does not persist long in the canal, and 
consequently its tissues are not involved in 
protracted chronic inflammation, as is so com¬ 
mon in the male. 
Sir Benjamin Brodie, however, met with a 
case of stricture in the female urethra : it 
commenced at the extremity of the canal, 
* C. M. Clarke, on some of the Diseases of Fe¬ 
males.
        

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