73 DISEASES OF THE BLADDER. 



attitude of the body is varied. Quite frequently, too, they are lodged 

 and embedded in pouches and diverticuli in its wall. The mucous 

 membrane is either in a state of catarrh or of catarrhal ulceration. The 

 muscular tunic is usually hypertrophied ; yet, if the calculus be smooth 

 and light, all of these appearances may be absent. 



SYMPTOMS A.ND COURSE. Sometimes, but not very often, patients 

 with " stone " have a distinct perception that there is a foreign body 

 in their bladder which changes its place as the posture of the patient 

 is altered. A more important and constant symptom is pain about the 

 bladder, which is aggravated by walking, driving, or riding, and which 

 is relieved by lying upon the back. The pain darts along the penis to 

 the glans, and causes the patient, especially if he be a child, to pull 

 upon the prepuce, so that in children an cedematous thickening or ab- 

 normal length of the prepuce is to be regarded as a characteristic, or, 

 at least, as a suspicious sign of vesical calculus. During micturition, 

 the stream of urine is often suddenly interrupted, owing to obstruction 

 of the neck of the bladder by the stone. If the patient change his 

 attitude, his ability to pass water is frequently restored. Even though 

 the beginning of the act of micturition be easy and painless, yet, tow- 

 ard its close, there is usually the most acute suffering. This is com- 

 bined with aching in the testicles, thighs, and lumbar region, with 

 spasmodic contraction of the anus, and even with general reflex phe- 

 nomena. The whole of these symptoms, however, together with occa- 

 sional haematuria, are insufficient to establish a diagnosis; and we 

 should make it a rule never to pronounce a positive opinion until the 

 presence of a stone has been reduced to a certainty by means of the 

 sound. 



TREATMENT. The possibility of dissolving large vesical calculi, by 

 means of internal medication, must be pronounced as hitherto un- 

 proved, although theoretically such possibility cannot well be denied. 

 Means have been proposed of rendering the urine alkaline, or else of 

 increasing its acid reaction, according to the chemical constitution of the 

 stone. The former task, as is well known, is far easier of accomplish- 

 ment than the latter, as the carbonates and vegetable salts supplied 

 to the system are discharged with the urine as alkaline carbonates, 

 while it is quite difficult to augment the quantity of acid in the urine. 

 Theoretically, the benzoic acid, which is excreted in the form of hippu- 

 ric acid, is adapted for the solution of a phosphatic calculus. But the 

 continued exhibition of this remedy in large doses is forbidden, owing 

 to its pernicious action upon the digestive organs. The administration 

 of tartaric and citric acid might also have a good effect in the solution 

 of phosphatic calculi; but these harmless articles have never come 

 into use. Indeed, as soon as a stone in the urinary passages has been 



