STONE IN THE BLADDER 357 



be arrested in the urethra, resulting in obstruction and over-distension 

 of the organ, with the usual train of symptoms indicative of abdominal 

 pain. In some examples of the disorder the gait during progression is 

 wide and straddling, and when at rest the hind-limbs are occasionally 

 raised from the ground as if in pain. 



The diagnosis is, in the majority of cases, unattended with difficulty 

 where proper methods of enquiry are pursued, but, as we shall presently 

 show, the detection of stone sometimes taxes the resources of the ablest 

 diagnostician. Tumours in the bladder, croupous cystitis, organic disease 

 of the kidneys, and various other ailments pertaining to the urinary recep- 

 tacle may, and do, occasion symptoms only distinguishable from those 

 of calculous disorder by a careful and searching exploration of the bladder 

 per rectum, and by catheter or sound through the urethral canal. In 

 regard to this latter part of the enquiry it need hardly be urged that upon 

 it the diagnosis mainly depends. Exploration of the bladder per rectum 

 seldom fails to reveal to us any decided enlargement occurring within or 

 without it, but the tact and discrimination of the surgeon is often sorely 

 tried in distinguishing between a calculus and certain forms of tumour 

 which now and again present themselves there. In searching for stone, the 

 mind, and with it the hand, naturally turns to related organs, and, remem- 

 bering the possible enlargement of the prostate gland, seeks first to deter- 

 mine the condition of this organ in particular whenever vesicular calculus 

 is suspected. Tumefaction of the prostate is fortunately not difficult of 

 recognition. The backwardness and fixed condition of the swelling, its 

 intimate connection with the neck of the bladder, its peculiar outline of 

 form and yielding nature, serve at once to distinguish it from stone. 

 Tumours in the bladder usually disclose themselves by their diffuse, and 

 maybe also by their lobulated and fixed condition. 



The bladder should now be explored by means of a long sound passed 

 through the urethra, assisted, in the case of a horse, by the hand of the 

 examiner passed into the rectum. In searching the bladder for stone the 

 organ is allowed to become moderately distended with urine, when, first 

 in a standing, and then in a recumbent, posture, the sound (after being 

 well oiled and disinfected) is introduced into the urethra, and gently forced 

 on until it enters the bladder. It is now moved slowly backward and 

 forward with a rotatory action, so as to bring the metal point of the 

 instrument into contact with every part of the interior surface of the 

 bladder, the operator noting at the same time any roughness or irregu- 

 larity of surface or resistance it may meet with, or any sound or impression 

 it may convey. If the result is not satisfactory, the position of the patient 

 must be changed by turning the animal first on one side and then on the 



