FURTHER INVESTIGATIONS INTO THE CAUSATION OF STRICTURE OF THE URETHRA IN GONORRHŒA

Definition.-In the series of cases under review stricture has been diagnosed where organic obstruction to the passage of a sound along the anterior urethra has occurred and where subsequent urethroscopy has corroborated. (i) The accepted causes of stricture as a sequela of gonorrhoea are: Injudicious treatment leading to longcontinued urethritis 1, 2; recurrent infection 3; urethral trauma during the acute and subsiding stages of the disease 4 5; infiltrations having their origin around the mouths of the ducts of Littre's glands, stricture being likely to occur at the sites where drainage of retained inflammatory exudates is bad, chiefly at the bulbomembranous junction 6; urethral abscess. 7 (2) Syphilis alone may cause stricture of the urethra by cicatrisation of a chancre occurring in the first u inch of the urethra,8 or by cicatrisation of gummata in the same region.9 The writer, in a previous article,'0 attempted to show that stricture of the urethra occurs more often (78 per cent.) in cases where infection with syphilis was coincident with, or in some cases preceded, infection with gonorrhoea. A series of 50 cases was reviewed briefly, and it was stressed that in all cases of stricture, syphilis ought to be suspected and a blood Wassermann should be performed, followed by a provocative dose of " 9I4 " if necessary, and repeated. Since then I have treated some 2,500 cases of venereal disease, and have diagnosed stricture in 38 cases. Ninety-four negroes attended for treatment, and stricture was found in 9 cases, although it has been stated that negroes are not commonly troubled with stricture of the urethra." Of the 38 cases of stricture seen, one was obviously