Calculous Concretions
are of more frequent occurrence than is generally imagined, but they are not confined to the kidneys; there is scarcely a portion of the frame in which they have not been found, particularly in the brain, the glandular substance, and the coats of the intestines.
I cannot say with Mr.
[a]Blaine]
that I have seen not less than 40 or 50 calculi in my museum; but I have seen too many fearful examples of the complaint. There has been usually great difficulty in the urinary evacuation; and at length one of the calculi enters the urethra, and so blocks up the flow of the urine that mortification ensues.
M.
relates a case of renal calculus in a dog. He had occasionally voided his urine with some difficulty, and had walked slowly and with evident pain. August 30, 1827, a sudden exacerbation came on, and the dog was dreadfully agitated. He barked and rolled himself on the ground almost every minute; be made frequent attempts to void his urine, which came from him drop by drop. When compelled to walk, his hind and fore legs seemed to mingle together, and his loins were bent into a perfect curve; his flanks were drawn in; he could scarcely be induced to eat; and he evidently suffered much in voiding his fæces. Mild and demulcent liquids were his only food. Warm baths and injections were applied almost unceasingly, and in eight days he seemed to have perfectly gained his health.
In March, in the following year, the symptoms returned with greater intensity. His hind limbs were dragged after him; he rapidly lost flesh, and his howlings were fearful and continuous. The same mode of treatment was adopted without any good effect, and, his cries continuing, he was destroyed.
The stomach and intestines were healthy. The bladder was enlarged from the thickness and induration of its parietes; the mucous membrane of it was covered with ecchymoses; the kidneys were three or four times their natural size; and the pelvis contained a calculus weighing 126 grains, composed of 58 grains of uric acid and 58 of ammonia, with 10 grains of phosphate of lime.
Of the nature and causes of urinary calculi in the bladder we know very little. We only know that some solid body finds its way or is formed there, gradually increases in size, and at length partially or entirely occupies the bladder. Boerhaave has given a singular and undeniable proof of this. He introduced a small round pebble into the bladder of a dog. The wound perfectly healed. A few months afterwards the animal was killed, and there was found a calculus of considerable size, of which the pebble was the nucleus.
Occasionally the pressure of the bladder on the calculus which it contains is exceedingly great, so much so, indeed, as to crush the calculus. A small calculus may sometimes be forcibly extracted, or cut down upon and removed; but when the calculus is large, a catheter or bougie must be passed up the penis as far as the curve in the urethra, and then somewhat firmly held with the left hand, and pressing against the urethra. A scalpel should be taken, and an incision made into the urethra. The catheter being now withdrawn, and the finger or a pair of forceps introduced into the bladder, the calculus may be grasped and extracted.
There are some instances in which as many as 20 or 30 small calculi have been taken from the bladder of a dog. Twice I have seen calculi absolutely crushed in the bladder of a dog; and Mr. Blaine says that he found no fewer than 40 or 50 in the bladder of a Newfoundland dog. One of them had passed out into the urethra, and had so blocked up the passage that the flow of urine was prevented, and the animal died of mortification.
With much pleasure I refer to the details of Mr. Blaine with regard to the management of
vesical calculi.
"When a small calculus," says he, "obstructs the urethra, and can be felt, it may be attempted to be forced forward through the urethra to the point of the penis, whence it may be extracted by a pair of forceps. If it cannot be so moved, it may be cut down upon and removed with safety; but when one or more stones are within the bladder, we must attempt lithotomy, after having fully satisfied ourselves of their existence there by the introduction of the sound; to do which it must be remembered that the urethra of the dog in passing the bladder proceeds nearly in a direct line backwards, and then, making an acute angle, it passes again forwards to the bladder. It must be therefore evident, that when it becomes necessary to introduce a catheter, sound, or bougie, it must first be passed up the penis to the extremity of this angle; the point of the instrument must then be cut down upon, and from this opening the instrument may be readily passed forward into the bladder. The examination made, and a stone detected, it may, if a very small one, be attempted to be pushed forward by means of a finger passed up the anus into the urethra; but, as this could be practicable only where the dog happened to be a large one, it is most probable that nothing short of the operation of lithotomy would succeed. To this end, the sound being introduced, pass a very small gorget, or otherwise a bistoury, along its groove into the bladder, to effect an opening sufficient to admit of the introduction of a fine pair of forceps, by which the stone may be laid up and extracted."
Blaine's Canine Pathology, p. 180.
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