STONE, OR GRAVEL. 103 



that point down to the extremity of the penis. I have found them 

 most frequently in the papilla on the extreme end of the penis, and 

 immediately behind this. 



Symptoms of urethral calculus. The symptoms are violent strain- 

 ing to urinate, but without any discharge, or with the escape of water 

 in drops only. Examination of the end of the penis will detect the 

 swelling of the papilla or the urethra behind it, and the presence of 

 a hard mass in the center. A probe inserted into the urethra will 

 strike against the gritty calculus. If the stone has been arrested 

 higher up, its position may be detected as a small, hard, sensitive 

 knot on the line of the urethra, in the median line of the lower surface 

 of the penis, or on the floor of pelvis in the median line from the 

 neck of the bladder back to the bend of the urethra beneath the anus. 

 In any case the urethra between the neck of the bladder and the point 

 of obstruction is likely to be filled with fluid, and to feel like a dis- 

 tended tube fluctuating on pressure. 



Treatment of urethral calculus may be begun by an attempt to 

 extract the calculi by manipulation of the papilla on the end of the 

 penis. This failing, the calculus may be seized with a pair of fine- 

 pointed forceps and withdrawn from the urethra ; or, if necessary, a 

 probe-pointed knife may be inserted and the urethra slightly dilated, 

 or even laid open, and the stone removed. If the stone has been 

 arrested higher up it must be extracted by a direct incision through 

 the walls of the urethra and down upon the nodule. If in the free 

 (protractile) portion of the penis, that organ is to be withdrawn from 

 its sheath until the nodule is exposed and can be incised. If behind 

 the scrotum, the incision must be made in the median line between 

 the thighs and directly over the nodule, the skin having been rendered 

 tense by the fingers and thumb of the left hand. If the stone has 

 been arrested in the intrapelvic portion of the urethra, the incision 

 must be made beneath the anus and the calculus extracted with for- 

 ceps, as in stone in the bladder. The wound in the urethra may be 

 stitched up, and usually heals slowly but satisfactorily. Healing will 

 be favored by washing two or three times daily with a solution of a 

 teaspoonful of carbolic acid in a pint of water. 



Preputial calculus (calculus in the sheath, or ~bilocular cavity}. 

 These are concretions in the sheath, though the term has been also 

 applied to the nodule of sebaceous matter which accumulates in the 

 blind pouches (bilocular cavity) by the sides of the papilla on the end 

 of the penis. Within the sheath the concretion may be a soft, cheesy- 

 like sebaceous matter, or a genuine calculus of carbonate, oxalate, 

 phosphate and sulphate of lime, carbonate of magnesia, and organic 

 matter. These are easily removed with the fingers, after which the 

 sheath should be washed out with castile soap and warm water, and 

 smeared with sweet oil. 



