OCR Text |
Show 240 SYMPTOMS or THE sroNr; IN THE mannerOE SOUNDING AND FEELING THE STONE. greatly increased after exercise, or the shaking of a carriage, We see the patients coming to an hospital in the greatest tor ment, from the rough stone jolting in the bladderas, and fre quently blood is passed with the urine. 1 3. Difliculty in retaining the urine. This dribbling of the urine from the bladder is produced by the irritability and painful state of the bladder; these causing a relaxation in the muscular fibres surrounding the neck of the bladder and the urethra. 4. Very frequently when the urine is flowing in full Stream, it stops suddenly, without a cessation of the stimulus to evacu- ation. This arises from the stone falling upon the orifice of the urethra; or rather it. happens in this way, that when the bladder is full, and of course distended towards the rectum, as well as in its fundus, as the bladder is emptied, this lower .. ___- norm" d i" mi , ,. , , 'I n a. . t\\\i\t\\"\m w part rises, and lifts the stone opposite to the beginning of the urethra. If the patient be placed upon his hands and knees, ,3 While making water, and this sudden stoppage occurs, it is a f‘ particularly strong indication of stone in the bladder, €Sp8= cially if the urine flows on Changing to the more recumb ent posture. Yet this may be produced by a pendulous tumour in the neck of the bladder, or from the prostate gland. 5. A sense of weight and fulness in the rectum , the piles, or the falling down of the gut, often accompany this disease. But they also accompany every disease in the neck of the bladder. 6. Mucous sediment from the urine is another efl‘ect of stone in the bladder. This proceeds from the excitement of the stone promoting an unusual secretion, to sheath and guard the coats of the bladder. This, however, may proceed also from inflammation in the inner coat of the bladder, or from stone or matter formed in the kidney. " In which case, it would be consummate cruelty to examine the patien‘ let him have the warm bath. and an opiate. '41:dean to bar} 0F SOUNDING AND FEELING THE STONE. THE presence of a concretion in the bladder is to be ascertained by the use of the catheter, or the sound as it is called, introduced into the bladder ; and by the finger in the rectum , the size and place of lodgment of the stone is judged of. The sensation conveyed by the sound, when it strikes or rubs on a stone, though not to be described, is yet sufficiently distinct, and not liable to be mistaken when once it has been felt. There are, however, circumstances which may lead to a very erroneous conclusion. 1. When there is disease in the inner coats of the bladder, if that disease has gone so far as to change the natural secretion of the surface, then sabulous matter lodges there, or concretes upon the surface. The sound grating over this matter may give the sensation of a stone. 2. A stone impacted into the urethra lodges there ; tor a fistu- Ious sinus by the side of the urethra, allowing the. urine to lodge there, a concretion is formed, one point of which per- haps projects into the natural canal of the urethra. When in this case the sound is introduced, the rub is conveyed to the hand, and the sensation, as if of a stone in the bladder, is felt. v ,5 "i . ~ ' WON) M09917! ' |