PROSTATIC URETHRA, LOWER OR PRE-PROSTATIC PORTION. Gradual depression of Crista Galli. MEMBRANOUS URETHRA. of the distance from its top is a fine slit, which is often barely visible, but sometimes gapes widely, or can be spread by manipulation of the instrument. It is the opening of the utriculus masculinus. In favorable cases it can be explored completely, and then we can see below, at the lateral margins of the sinus pocularis, two smaller slits; the openings of the ejaculatory ducts. Sometimes neither of these is visible; or, only one can be seen; again one is seen as a slit, and the other as a round opening. Indeed, the size and shape of these openings are nearly as varied as those of the ureteral mouths. They are sometimes filled with a viscid secretion, and are more prominent when diseased. Within the sinus pocularis the mucous membrane is dark pink. The surrounding wall at this point is still dark red, contrasting with the brighter hue of the caput. A small hyperæmic spot, or congested area of perhaps three or four mm. diameter is often found here and is the cause of some iritation. I found such a condition in four cases which had been treated as sexual neurasthenics, and successfully relieved their symptoms by correcting this condition. We next come to the inferior portion of the prostatic urethra, showing the lower projection of the crista, or verumontanum, reversing the panorama of the upper end; that is, the central projection gradually becomes more depressed, until it disappears entirely, while the lumen from being arched, or horseshoe shaped, gradually flattens out as we approach the membranous urethra, where it assumes a rounded pinhole form. (Fig. III.) This preprostatic region is a favorite seat of congested areas, possibly on account of the proximity of the compressor urethræ muscle, the strong contraction of whose fibres disturbs the circulation so frequently during the day. At this point bleeding is very apt to be produced by introduction of the urethroscope, or cystoscope, or any other instruments, unless due care is exercised. We next come to the membranous portion inclosed in the fibres of the compressor muscles. We here see the mucous membrane squeezed into very fine folds, as if shirred about the central lumen; which latter is rounded and the size of a large pinhole. (Fig. IV.) Perhaps its appearance may be best described as resembling a small embroidered round hole, the threads touching each other at the cen tre, and radiating thence in contact with each other. The color here varies normally from pale pink to pale rose, with a darker shade in the depressions, which gives the pretty radiating picture as described. This portion is least liable to disease, showing a normal appearance more often than any other part of the canal. But an extension of inflammation by continuity of tissue, either from the front or rear is not infrequent, the mucous membrane assuming a deeper rose color and a more swollen appearance, while the radiations are more or less smoothed out. Some fibrous infiltration is at times met with here, often the result of injury due to a too energetic use of the sound. We now pass out of the triangular ligament and reach the beginning of the anterior urethra. From this point forward, the most diverse lesions and anatomical pictures are successively presented. First, we see the cul-de-sac of the bulb, which normally has a deeper red color than any other part of the whole canal, and with a purplish tinge. Here the shape of the lumen is slit like, running antero-posteriorly; and the mucous membrane lies in large folds, four or six in number, but subdivided usually by narrower folds. (Fig. V.) The slit shape of the lumen is due to the action of the ischio-cavernosus and bulbo-cavernosus muscles on either side, and the abundant tissues in this region produce the large folds. The walls of the canal in this region are best examined by eccentrating the lumen and sweeping the tube around the circle, so as to bring every part of the canal at this level under observation. This part is the most frequent seat of lesions, and naturally so; because it is the bottom of the anterior urethra, slightly below the level of the opening in the triangular ligament, and because immediately behind this opening is the membranous portion surrounded by the powerful compressor muscle, which ordinarily obstructs the further passage of bacteria and other infectious matter. Such inflammatory agents find a safe lodgment here in the protecting folds of membrane, even the stream of urine, but partially washing them away. Some of the lesions seen here are: congested areas of various degrees and extent; ulcerations, superficial and deep, often granulating; erosions and abrasions, papillomata and polypi, and exudates of lymph and fibrous tissue, indicating |