The chances of stricture increase very much with each fresh attack of gonorrhoea, and the patient who presents himself to a doctor with this lesion will usually give a history of having had more than one infection, or else a recrudescence, or fresh outbreak, of the single original infection. The important point to remember is that even the mildest case of clap is liable to be followed by a stricture unless it be thoroughly and promptly treated, and that the length of its persistence and convalescence has more to do with the formation of stricture than the sharpness of the acute stage.
A few points more mostly recapitulated are to be considered regarding stricture. Especially bear in mind that strictures develop very slowly, constantly tending to become firmer and denser with the lapse of time, and often failing to produce symptoms until many years after the patient has considered himself thoroughly cured.
On account of their slow advancement through the progressive changes it is unusual to find the inodular, or densest form, in patients under thirty years of age unless they contracted gonorrhoea when mere children. A stricture which is soft and of comparatively large calibre before thirty years of age will probably, if untreated, become a tight inodular stricture after the patient has passed the fortieth year of life. These ages are, of course, only approximately correct, and are merely the average figures.
If a man have had relapses, or several fresh infections, the outlook is so much the more grave, and almost invariably is a permanent injury to his procreative organs gonorrhceal patient may have cystitis, or inflammation of the bladder, for several years during the late twenties and early thirties without suffering much impairment of his general health, but after he approaches forty and thereafter, the stricture having become denser and more contracted, the urine decomposes, on account of the incomplete evacuation of the bladder, and the septic process travels up the ureters to the kidneys, setting up a severe and dangerous nephritis, or kidney inflammation, or a pyelitis, with accumulations of pus in those glands. These conditions make a wreck of his health and place him upon the verge of a precipice over which he may fall at the slightest infraction of the laws of hygiene, or upon the receipt of any injury or accident; and they assuredly knock off many years from his allotted expectation of life. The prognosis is of course more unfavorable if the patient is blameworthy in his habits, or unfortunate in his temperament and heredity.
EPIDIDYMITIS AND ORCHITIS, OR INFLAMMATION OF THE EPIDIDYMIS AND TESTICLE.
Inflammation of the testicle itself orchitis is not so very frequent, while inflammation of the epididymis, the convoluted canal which is accessory to the testicle, is the most common of all the complications of gonorrhoea. "Swelled testicle" is the popular term which is applied to both these affections indiscriminately, though it is not strictly proper, since the testicle itself is less often involved than the epididymis, which lies in close relationship to it within the scrotum.
In order to understand the subject clearly, a short anatomical description of the seminiferous glands and ducts must here be studied. These semen producing and semen conveying structures are of capital importance in procreation, and if they are obliterated the essentials of virility are withered and the man is thenceforth practically a neuter.
The scrotum is a pendulous double bag which contains the testicles and epididymes and a portion of the spermatic cords. It consists mainly of a brownish integument, or skin, which is very thin and provided with scattered hairs and sebaceous follicles, and of dartos an exceedingly vascular connective tissue layer, containing unstriped muscular fibres, and lying immediately beneath the skin.
In the median line, extending from the anus forward, along the under side of the scrotum and penis, is seen a dark seam, or raphe, which, especially when the scrotum is contracted under the influence of cold, rises up as a prominent ridge. From the scrotal part of this raphe the dartos sends in a partition of fibrous tissue, the septum scroti, to the under surface of the penis, thus dividing the scrotum into two lateral compartments. Under certain influences, e.g., cold, the unstriped, or involuntary muscular fibres of the dartos cause the scrotum to contract, so that it is closely applied to the testicles, while under other influences, e.g., warmth, they relax, so that the scrotum is flabby and pendulous.