URINARY CALCULUS. 83 



IMPERFORATE ANUS. 



This is a congenital imperfection. The rectum terminates in a cul 

 de sac, at various distances from the ordinary location of the anus ; 

 in some instances, it is so near the skin as to form a prominence, by 

 the constant collection of fasces. In such cases, the operation is 

 easy and simple : a free opening being made in the proper direction, 

 with regard to the bladder or vagina, the meconium escapes, and 

 the edges are prevented from uniting, by the interposition of a piece 

 of lint. In other instances, it is impossible to reach the cul de sac; 

 then it is necessary to form an artificial anus. This is done by open- 

 ing the descending colon immediately under the left kidney, making 

 the incision through the skin and fascia, so as to expose the posterior 

 portion of the bowel, which is not covered by peritoneum at this 

 part ; a sphincter is said to be formed in the loins, though it is 

 necessary to wear a pad. 



URINARY CALCULUS. 



Calculi are generally formed in the kidneys by a precipitation of 

 earthy substances, and when they pass freely and frequently, the 

 disease is termed gravel ; when they are retained and become large, 

 the disease is called stone. 



The symptoms of stone in the kidneys are pain in the loins, irri- 

 tation and retraction of the testicle, bloody urine, and inflammation 

 of the kidney. The passage of the stone through the ureter causes 

 most acute and severe pain in the loins and groin, faintness, and 

 sickness of stomach, which may last for several days, and is only 

 relieved by the stone entering the bladder. 



The treatment for d. jit of the gravely as these attacks are called, 

 consists in bleeding, warm bath, large doses of opium, soothing 

 enemata, diluent and diuretic drinks, spirits of turpentine, &;c. The 

 ordinary result is the passage of the calculus ; but sometimes it is 

 retained in the kidney, increasing in size, and assuming the branch- 

 ing f )rm of the pelvis, calices, and infundibula. It does not always 

 produce inconvenience, but generally is attended with wasting of the 

 organ, or suppuration, the abscess bursting into the colon or loins. 



A small calculus, lodging in the bladder, and not being discharged 

 through the urethra, serves as a nucleus for further deposit; any 

 foreign body, such as a needle, drop of blood, or bullet, may strve, 

 also, as a nucleus. The symptoms of stone in the bladder are, 

 frequent, sudden, irresistible, unrelieved desire to make water ; pain 

 in the glans penis, and elongation of the prepuce ; sudden stoppage 

 of the stream in urination, and its rc-establishment by change of po- 

 sition — the urine being mixed with mucus and sometimes with blood ; 

 but nothing but a sound can positively prove its existence. Many 



