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Ashhurst collected the reports of 28 cases thus treated, ten of which recovered a mortality of 64.2 per cent. Ashhurst remarks that he has seen an extraperitoneal rupture of the anterior wall of the bladder caused by improper use of instruments, in the case of retention of urine due to the presence of a tight urethral stricture.
The conclusive point is the recognition of a gonorrhœal discharge or of threads in the urine. The disease may persist or may relapse, and the patient may be laid up for weeks or months, and may finally be crippled in one or in several joints. The treatment besides that of the urethral disease or of the ophthalmia consists in rest until all pain and sensitiveness have disappeared.
One of the most constant symptoms is a copious perspiration, the patient being literally bathed in sweat. The urine is diminished in quantity, but as a rule is normal in composition; as in other acute infective conditions, albumen and blood may be present. Retention of urine may result from spasm of the urethral muscles, and necessitate the use of the catheter.
It has been remarked that Thomas Adams, Lord Mayor of London, who died at the age of eighty-two, had in his bladder at the time of his death a stone which filled the whole cavity, and which was grooved from the ureters to the urethral opening, thus allowing the passage of urine.
In the extensive use of iodoform as a dressing instances of untoward effects, and even fatal ones, have been noticed, the majority of them being due to careless and injudicious application. In a French journal there is mentioned the history of a man of twenty-five, suspected of urethral ulceration, who submitted to the local application of one gram of iodoform.
The following lines of treatment are recommended: A ration or feed that favors the formation of calculi should not be fed to animals; inflammation of the sheath should receive prompt treatment this consists in irrigating the part with warm, soapy or alkaline water, followed by an antiseptic wash; we may attempt to work the urethral calculi forward and out of the S-curve in the urethra; if this is unsuccessful, urethrotomy for their removal may be attempted.
During periods of great sexual excitement the nerves of the urethra and corona seem to possess a peculiar sensitivity and are powerfully stimulated by the violent peristaltic contractions of the muscles in the urethral walls during ejaculation.
Flajani speaks of the termination of the ureters in the pelvis; Nebel has seen them appear just beneath the umbilicus; and Lieutaud describes a man who died at thirty-five, from another cause, whose ureters, as large as intestines, terminated in the urethral canal, causing him to urinate frequently; the bladder was absent.
It is not uncommon for needles, hair-pins, and the like to form nuclei for incrustations. Gross found three caudal vertebrae of a squirrel in the center of a vesical calculus taken from the bladder of a man of thirty-five. It was afterward elicited that the patient had practiced urethral masturbation with the tail of this animal.
Concerning her enuresis, in its relation to urethral eroticism, the patient relates the following: "When I pressed myself against my mother's or brother's thigh, not only 'the good' came, but frequently also urine with it. At about eight years old there was often a very strong compulsion to urinate, especially at night, which would cause me to wet my bed.
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