STONE IN THE BLADDER 



359 



rare instances, as one recently related to me by Mr. F. Wragg of London, 

 not only does the stone occupy the pouch, but, enlarging by accretion 

 in the direction of the interior of the viscus, comes also to project into 

 the proper cavity of the bladder (fig. 149). This is an important condition 

 to consider in relation to the success of the operation of lithotomy, as 

 will hereafter be explained. Where the stone becomes thus encysted it 

 may or may not be accessible per rectum in a standing posture, or to 

 the sound through the urethra, according to the extent to which it has 

 extended from the pelvis in the direction of the abdominal cavity. If, 

 however, the horse be placed on his back, the stone will be caused to fall 

 towards the spine, and thus be brought within reach of the hand. 



Keferring again to the general 

 symptoms of stone, it may be 

 remarked that they undergo 

 various modifications of char- 

 acter and intensity, according 

 to the size, nature of the sur- 

 face, and the relations of the 

 calculus with the general cavity 

 of the bladder. 



Stones of large dimensions 

 occasion much pain and suffer- 

 ing, especially where the surface 

 is* rough and the stone free to 



move from place to place with the movements of the body. Here the 

 mucous membrane suffers much irritation, and, with the muscular coat, 

 becomes considerably thickened. As a result, the walls of the bladder lose 

 their expanding power, and, by failing to open out for the accommodation 

 of the incoming urine, provoke and render necessary frequent acts of 

 micturition. Inflammation and purulent urine are among the worst con- 

 sequences of a heavy rough calculus. 



Smooth calculi (which are rare), and such as are confined in pouches 

 of the mucous layer, occasion much less disturbance, and may even fail 

 to excite suspicion of their presence. 



Treatment. Various methods, physiological, chemical, and surgical, 

 have in turn been practised and extolled for the prevention and eradi- 

 cation of stone, and each succeeding decade, with its larger experience 

 and resource, has called forth either the condemnation or modification of 

 the one. or the improvement and consolidation of the others. For a con- 

 siderable period belief and reliance in the efficacy of internal remedies was 

 largely entertained; but as time advanced, and the teachings of anatomy, 



Fig. 149. Stone Empouched in the Fundus, and extending 

 into the Cavity of the Bladder 



