STONE IN THE BLADDER 363 



in performing the section. In carrying out this part of the operation the 

 knife should be well under control. This incision is made from within 

 outwards, deliberately but with caution, always remembering that the 

 rectum lies immediately beneath, and stands in danger of being cut. 

 Such a result, it need hardly be pointed out, would not only seriously 

 complicate the case, but place the animal's life in jeopardy. 



Exploring the Bladder. The urethra having been laid open as 

 far as it is deemed requisite to admit the passage of the stone, an ex- 

 ploration with the finger should be made. While the left forefinger, 

 already in the bladder, explores the neck of the organ, the right hand, 

 acting through the rectum, will, as far as possible, force the bladder 

 backward in order to bring a larger area of surface within reach of the 

 finger. Here a long index finger offers a distinct advantage, and should 

 the operator fall short in this particular, he may take advantage of such 

 help as his most practical assistant may be able to afford him. As a 

 rule we are only capable of manipulating the neck and parts immediately 

 beyond it, but by means of the short metallic sound, presently to be 

 described, we are enabled to recognize any marked alteration in the 

 naturally smooth, satin-like surface of the lining membrane. By careful 

 exploration we may, for example, satisfy ourselves of the existence of 

 tumour, false membrane, calcareous encrustation of the mucous layer 

 so often found in association with calculous disorder. A knowledge of 

 the presence or absence of these morbid conditions constitutes a distinct 

 advantage in estimating the immediate 

 success of the operation and prospec- 

 tive result of after-treatment. 



Dilating the Urethra and Cer- 

 vix Vesica. Having devoted a few 

 minutes to the very interesting and 

 instructive task above referred to, we 

 now proceed to dilate the urethra and 

 neck of the bladder. It is a great con- 

 solation, when confronted with a large 

 stone, to know that this portion of the 

 urinary passage is capable of consider- 

 able relaxation and dilation. Sudden Fig. 154. -Dilator 

 and spasmodic attempts at dilation is 



bad practice, and should on no account be resorted to. For effecting the 

 opening out of the urinary channel the three-bladed dilator (fig. 154), 

 constructed on the plan of a human anal dilator, but with longer blades 

 and with a correspondingly large range of action, will be found effective. 



