STONE IN THE BLADDER 367 



to avoid undue fulness of the alimentary canal, and facilitate digestion. 

 An enema of warm water administered once or twice during the twenty- 

 four hours before its performance will serve to keep the rectum empty and 

 soothe the irritable bladder. Small doses of potassic bicarbonate, and 

 opiates, if necessary, may be given at intervals where pain is indicated. 



The Operation. In performing the operation of crushing, the horse 

 is thrown as for castration, and when under the influence of chloroform 

 the urethra is opened 

 in precisely the same 

 manner and place as 

 directed for litho- 

 tomy. The neck of 



the bladder is then Fig< iss.-Lithotrite 



dilated, and the 



lithotrite (fig. 158), nicely warmed and smeared with oil, is passed into it. 

 The blades of the instrument are then drawn as far apart as may be 

 necessary to receive the stone. The next step is to bring the calculus 

 fairly between them. To accomplish this the lithotrite should be held 

 by one hand applied near the blades, the screw being in charge of an 

 assistant who will also steady the instrument while the seizure is being 

 effected. With the other hand in the rectum the operator now proceeds 

 to manipulate the stone, and by a little careful manoeuvring directs it 

 into the jaws of the lithotrite. The assistant, on being instructed, will 

 then turn the screw until 

 the calculus is secured. 



Having obtained a good 

 hold of the stone a half- 

 turn is given to the litho- "^ Fig> 159 _ Forceps for Lithotripsy 

 trite, first towards the right, 

 then the left, so as to determine if any portion of the mucous membrane 

 has been included in the grasp of the instrument. To obviate this it is 

 usual in man to operate with the bladder distended with urine, but in 

 the horse the fluid quickly drains away through the perineal wound, and 

 cannot therefore be made available for keeping the walls of the organ 

 away from the calculus. 



When the stone has been satisfactorily secured, the screw is brought 

 again into action, and the operation of crushing proceeded with. This 

 done, the broken fragments are freed from the lithotrite and removed with 

 the forceps (fig. 159) and scoop (fig. 160), aided by repeated injections of 

 warm carbolized water as directed for lithotomy. 



Should the operation prove troublesome and protracted, it may be 



