It is possible to have a chronic gonorrhea with little or no true gleet, the infection being latent, but nevertheless persisting. In gleet the discharge varies from a thin watery flow to one which is profuse and purulent, most noticeable in the morning on rising, when the meatus may be occluded by adhesion of the surfaces and there appears the so-called “morning drop.” Careful investigation of the urethra will generally disclose at least some constriction, with tender areas along the anterior urethra. To successfully treat the disease these areas and constrictions should be determined and suitably medicated. For this purpose two instruments especially are necessary--the _bulbous bougie_, for which a sound of the same size is an unsatisfactory substitute, and the _endoscope_, through which the lesions may be not only viewed but suitably treated. The peculiar discharge comes from a lesion of one of the following varieties--either from isolated areas of inflamed mucous membrane with underlying exudate, from follicles and vesicles which fail to completely empty themselves, or from preëxisting strictures. The endoscope will easily reveal the first and second of these; the bulbous bougie the first and third, while further examination by the rectum may be necessary to decide in regard to the seminal vesicles. [Illustration: FIG. 28 Bulbous sound.] The bulbous _bougie_ is an instrument of great importance in urethral work. It should be carefully sterilized before introduction, and the urethra should be cleansed before its use. The instrument should be gently passed into the urethra; its course will be obstructed by any constriction which will give rise to stricture of smaller caliber than the bougie itself, while the discomfort or pain which it will excite as it passes over a tender or ulcerated area will be significant. The urethra is most distensible at its bulbous portion, while its caliber varies in different individuals, ranging ordinarily from 30 to 35 of the French scale, while the urethral diameter is about four-tenths of the circumference of the penis. We owe more to the studies of Otis in this matter than to any other investigator. He also showed that the size of the meatal opening is not a criterion as to the size of the urethra; that the contracted meatus often produced a certain degree of reflex and spasmodic stricture behind it, and that when the meatus is too small to permit the introduction of such an instrument as the urethra should take it should be enlarged, the operation for its enlargement being known as _meatotomy_, which may be easily effected with a blunt bistoury under the local use of cocaine. The meatus having been enlarged to suitable size, any consistent and organic constriction which then prevents the passage of the bougie should be considered a stricture and treated accordingly. Such a constriction may be of recent origin, when it will be found easily dilatable, or it may be old, resillient, and tough.