other calculi found in those organs. They may be arrested at any 

 jioint of the urethra, from the neck of the bladder back to the bend 

 of the tul>e beneath the anus, and from that point down to the extrem- 

 ity of the penis. I have found them most frequently in the i^apilla 

 on the extreme end of the penis, and immediately behind this. 



The symptoms are violent straining to urinate, but without any dis- 

 charge, 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 maj'^ 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 the pelvis in 

 the median line from the neck of the bladder back t-o 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 distended tube fluctuating on pressure. 



Treatment 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 with- 

 drawn 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 that organ is to be withdrawn from its sheath until the nodule is exposed 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 intra-pelvic portion 

 of the urethra, the incision must be made beneath the anus and the 

 calculus extracted with forceps, 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 teaspoonf ul of carbolic acid in a pint 

 of water. 



Preputial calculus. — Calculus in the sheath or hilocular 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 Avith sweet-oil. 



