URETHRITIS AND NEURALGIA OF THE URETHRA.

Inflammation of the canal by which the urine is conducted and discharged from the bladder is termed urethritis.

There is no organ of the female anatomy that is oftener the seat of local inflammation.

The acute and chronic inflammations that affect the male urethra, also affect that of the female, only perhaps to a more limited extent, owing to the comparative smaller mucous surface of the tube, it being only from an inch to an inch and a half in length.

Inflammation is oftener confined to this portion of the urinary apparatus than is generally supposed, because any derangements of these parts is at once attributed to the bladder, and it is an actual fact that many women have doctored uselessly for years, for the one, when it was the other that was diseased. Symptoms of urethral inflammations are so very similar to inflammations of the bladder that the points of distinction are easily overlooked.

The trouble begins with frequent desire to void urine and a continual bearing down or straining sensation, which may be accompanied with a sense of heat suggesting to the minds of the most chaste and pure women, sexual desire, which the gratification of that indulgence does not relieve nor satiate, but, on the contrary, the sexual passion becomes only exaggerated. It is only the strongest force of character and Christian fortitude that keep some of these unfortunate women in the path of rectitude and virtue, and it is only the scientific specialist who can appreciate the real cause. In many instances women, truly noble in character, have fallen from their high estate, because uncontrollable impulses swept them into the maelstrom of licentiousness, which might have been averted, if they had known of whom to seek proper advice.

This irritation is often innocently and ignorantly acquired in early girlhood by fingering the parts, or practicing masturbation, which sets up an inflammatory condition of the urethra that becomes chronic, and in time may entail the terrible consequences to which I have already alluded. For that reason mothers should not be over-delicate; they should not only keep a watchful eye on their children when in seclusion, but should make it their holy duty to gradually initiate their children into a knowledge of physiology and of the diseases that may result from any violation of youthful virtue.

Why is it that many children who have been reared in an atmosphere of sanctity, children who have enjoyed from their earliest recollection moral and spiritual administration, have fallen into vice and depravity? The reader should stop to answer this question for herself, while I too will answer it for her.

It is because moral teachers overlook the fact that human beings are dual; that we are all animal, however spiritual, and that the functions of the animal nature must be understood in order that the spiritual nature can control them.

A false delicacy has entirely neglected this part of the education of our children, which I stamp as the height of stupidity and hypocrisy.

Among other causes of this malady is hot and acrid urine, or gravelly discharges from the bladder, cutting and irritating the mucous membrane in its passage; abrasions of this nature often lay the foundation for ulcers. When the urine is in that condition, it is probably due to a complication of diseases of the bladder, the kidneys and the liver. A chemical and microscopical examination of the urine will be the only means of settling these questions.

The urethra often takes on the inflammations of the neighboring tissue or organs; disease of the vulva or of the vagina will spread itself to the urinary canal. I have seen cases in which the whole trouble was traceable to a catarrh of the neck of the womb.

Gonorrhoeal infection of the vagina will in the great majority of cases extend itself to the urethra as well as to the cavity of the womb and neighboring organs.

If treatment in these complicated cases is to be successful, it must be directed to the disease in all of its strongholds; this, of course, can only be done under the direction of a skillful specialist.

There is a predisposition on the part of the mucous surfaces to become infected by eruptions of the eruptive fevers, and the urethra is particularly liable to this invasion. Children who have had the measles and scarlet fever will often be troubled with frequent and smarting micturition and after convalescence from all the other symptoms of the respective fevers, they are still more or less annoyed for weeks or months with a urethritis. I have had cases of this nature that dated back years. If the early treatment is neglected and the case becomes chronic, it generally spreads to the bladder, which also becomes similarly affected.

Smallpox pustules are apt to break out in the urethra during the acute stage of the disease, and excite a very itching and painful urethritis. Dysentery in children may give rise to the disease. In adults I have noticed the affection in connection with typhoid fever, but this generally passes off with convalescence. Hemorrhoids or piles give rise to urethral inflammation which does not yield to treatment, but subsides at once after the removal of the piles. The application of a Spanish-fly blister to any part of the body may also cause a stranguary or a urethritis.

Mothers may become uneasy, as to the cause of the muco-purulent discharge from the urethra of their little girls. I have known them to entertain suspicion of some specific infection being introduced into the genitals, in some mysterious manner; a little inquiry into the history of every case, dispels these absurd delusions, and it will be found that pinworms have caused the inflammation. In adults, however, the subject should be made the object of particular inquiry. During delivery, the passage of the child’s head exerts great pressure on the urethra, so that it may be crushed or torn across. Women may be troubled with derangement from this cause for a long time, or for their whole lives, if the real cause of their ailment is not recognized. Displacements of the womb in different directions, principally when it is tipped backwards so that its neck impinges on the urethra or neck of the bladder, compresses the canal, so that its caliber is diminished, and a painful obstruction and retention of urine ensue.

Papillated growths and mucous polypoids that were so small that they were hidden from external sight, but readily detected by scientific methods of examination of the urethra, by means of the urethral specula, were the exciting causes of some cases that came under my treatment. The unfortunate victims were under the impression that their kidneys or their bladders were diseased. The numerous quack medicines advertised for the cure of these maladies were copiously consumed, doing, of course, more mischief than good. The removal of the growths in each instance at once put a stop to any further inconvenience.

In pregnancy, after the third month, the womb rises out of the pelvis, so as to accommodate its increasing size. This naturally drags the bladder upwards, and so stretches the urethra that it becomes sore and extremely irritable. To relieve this distress until the parts have accommodated themselves to their new relations, the Femina vaginal capsules are of the greatest value, and without the slightest ill effect arising from their use. Vaginal irrigations of hot water are also of decided benefit, especially before using a capsule.

Mix. A teaspoonful to be given to an adult every four hours till relieved.

The symptoms of inflammation of the urethra are always very pronounced, because the mucous membrane of the urethra is the most sensitive part of the bladder. In the healthy state the coloring of the lining membrane is of a pale red; when inflamed or catarrhal, it assumes a dark red, or a cherry color. The membrane is also considerably swelled and puffed, and feels hot to the touch, and imparts a burning sensation to the patient. The muco-purulent secretion excoriates or chafes the skin, so that the parts look angry and red in the neighborhood; this is oftener observed in children. The characteristic symptom of frequently urinating is never absent, while very little is passed at a time, yet the straining to pass water continues, after the last drop is voided.

The treatment is cleanliness to begin with. In grown people, the entire vulva and vagina must be rinsed out with a warm borax solution, in the proportion of one teaspoonful of the powdered borax dissolved in a quart of water. In little children the same object, that of cleanliness, is to be accomplished with a small ear syringe.

After the external parts and the vagina are thoroughly cleansed, then, by means of a hard rubber syringe, No. 1, three or four syringefuls of clean borax water are injected into the urethra for the purpose of cleaning that too. To relieve the straining and frequent desire to micturate, which is accompanied with more or less pain, I give:—

NO. V.

Mix. A teaspoonful in a wineglassful of water three or four times a day for an adult; children in proportion.

The patient must confine herself to a bland liquid diet, principally of milk, raw eggs beaten up in bouillon or broth. Vegetables may be eaten, but they are not to be seasoned with anything but salt; and alcoholic liquors, wine or beer must also be suspended for the time being.

NEURALGIA OF THE URETHRA.

The female urethra is sometimes the seat of simple neuralgia, by which is meant a painful condition in which there is no apparent disease or inflammation of the tissues.

This pain assumes often a spasmodic character; that there is a cause for this is certain, but it is as a rule remote from the sensation which attracts attention. It is often found to be the symptom of some of the diseases to which I have already referred. These are ulcerations, displacements, or inflammation and congestion of the neighboring organs. Abnormal growths or tissues will often be painfully reflected on the nerves of the urethra. I remember a case of internal hemorrhoids, which was never suspected by the patient because there were no painful symptoms pointing to the rectum, but in which the urethra was very painful in its entire extent. The suffering from this urethral neuralgia had lasted for years, but disappeared at once, on the removal of the piles. I have called attention to a catarrhal inflammation of the urethra, from stretching occasioned by the ascending womb after the third month of pregnancy; there is a similar pathological process after the seventh month of gestation, when the pregnant womb begins to descend again into the pelvic cavity, and this is particularly marked in the pregnancy with the first child, when the pain is often very severe.

If in a first pregnancy there is no abnormal disproportion between the dimensions of the child’s head and the maternal pelvis, or if there be no abnormal position of the child, then there is an obstetric rule that the womb, or rather the child’s head, begins to descend into the pelvis after the seventh month of gestation, so that it can accommodate or conform itself to the maternal parts. This occasions a drag on the urethra downwards and backwards, which is painfully annoying, and there is a constant inclination to pass water.

There are two mechanical methods of relieving this distressing symptom; one is to obtain as much rest as possible in the recumbent position, and the other is to wear an abdominal supporter or bandage around the lower abdominal region, so as to take the weight off the urethra. The internal medication consists of an occasional dose of a mild laxative medicine.

In the newly married, the urethra becomes sometimes the seat of a painful spasmodic contraction; this is due to a tense hymen, which should be slightly nicked with a pair of scissors. Exposures to colds will also cause neuralgia. Fresh beer and sour wine make the urine irritating, and also occasion painful symptoms.

A thorough examination of the mucous membrane of the urethra which does not reveal any inflammatory condition or abnormal growth, establishes its neuralgic character. The next step will naturally be to make such a careful examination of all the surrounding tissues and organs, for the purpose of ferreting out the real cause. When the cause is removed or cured, it will also relieve the urethral pain. In the absence of a clear comprehension of the true nature of the malady, the treatment must be palliative. The sitz-bath is always one of the most palliative measures for all sorts of pelvic pains and aches. Vaginal injections of hot water, not too hot, from 105 degrees to 108 degrees, are another sort of general panacea,—the quantity of fluid should be large, from half to one gallon, in which a teaspoonful of pulverized borax has been dissolved. If the pain is very severe, then a Femina vaginal capsule should be used every night before retiring, and immediately after having used the vaginal irrigation. The bed should always be previously warmed with a hot bottle, unless it is very warm weather.

If the urine is irritating, a cupful of buchu tea three or four times a day, or German chamomile tea, should be drunk between meals. If these measures do not give relief, then consult an honest, competent physician, in whose integrity you can rely.