In those instances where the inflammation has not spread along the whole canal, these symptoms are not so pronounced, their severity varying much in different cases, being usually more acute in a first attack than in subsequent ones, unless there has been an interval of several years between the infections. There is always a mucopurulent secretion, the abundance and pus like character of which affords a good criterion of the severity of the attack. The urethra being freely supplied with a network of capillary blood vessels, there is frequently, on account of the inflammation, a trickling away of a few drops of blood with the discharge, giving the linen a characteristic sanguineous stain.
The amount of the pus discharged is greatest during the night and toward morning, and less during the day, partly because the patient usually urinates only once or twice during the night, while during the day he performs this function at frequent intervals, and thus washes away the discharge with the stream of urine, not permitting it to collect in abundance. In addition to this he suffers at night from the injurious effects of exercise during the day.
During this inflammatory stage of the disease the patient should be kept confined to bed in order to give the parts as much rest as possible, though it is often impossible to accomplish this without his compromising himself, unless he takes a trip away from home "for the benefit of his health", or on some other pretext.
The acute stage usually reaches its worst during the second week, and then still more serious troubles supervene. Almost the entire length of the urethra is now swollen and inflamed; it is tender upon pressure and there is a feeling of anguish in the testicles, which is rendered worse by walking or jarring.
A patient in this stage can usually be recognized by a careful observer; when he sits down he does so with the greatest deliberation, in such a manner as to protect his perinffium from pressure; if he crosses his legs, it is done with the greatest care and with the assistance of his hands. His inguinal glands are swollen and tender, and he suffers with pain in the back. He is now really ill and bed is the proper place for him. As in every disease where there is suppuration, his temperature rises, he has chills, and is pale, worried, anxious, without appetite, and constipated. Whatever comfort the patient may have during the day is apt to turn into torture during the night. In the earlier days and nights of the stage of acute urethritis he has a morbidly increased sexual desire and increased ability for copulation. These symptoms are usually provoked by the warmth of the bed, but even independently of this the symptoms are aggravated at night. So great is the increase of the voluptuous sensations that patients often seek relief by masturbation or fornication.
Many of them, feeling that they must have relief, visit the brothels in spite of the known dangers to the women, and to those who use them afterward. It is well for men to lay this point to heart, since a most dangerous class of poisoned and venomous men are going about, unrestrained by the law, with uncontrollable passions.
These voluptuous sensations, at first quite agreeable, early become eminently unpleasant, and the sexual irritation soon causes the patient the most aggravated suffering. Very frequent and surprisingly vigorous erections occur and the penis becomes distorted, much to the mental anguish and chagrin of the patient, for every man thinks more of the normal shape of his private organs than of any other part of the body.
The penis is sometimes forcibly drawn against the abdomen by the powerful erections, and frequently undergoes a series of most painful spasmodic convulsions. With these erections there are apt to be frequent debilitating and involuntary ejaculations of semen, and these erections and ejaculations are sometimes so intense that they cause rupture of the inflamed and congested urethra, so that blood is mingled with the pus and semen. This variety is called "Eussian clap".
Sometimes the erections are so strong that they last for hours at a time, and in some cases there is a symptom, called chordee, in which the penis becomes arched like a bow, with the concavity downward.