SYMPTOMS - RENAL CALCULUS.
The symptoms indicating the presence of stone in the kidney are various; they are seldom all present in the history of any given case, and they are liable to be modified, or to remain in abeyance, by cir cumstances which are determined by the position the calculus occu pies in the gland or its outlet. The most common symptom is that of pain, which may be either direct or reflected. By direct pain is meant that which is more or less constantly complained of in the region of the kidney. It is, as a rule, aggravated by movement of the body. In many cases, though there is some degree of pain or uneasi ness when the patient is at rest, it becomes intense on his engaging in work which necessitates movements of the body. On this ground alone I have operated on several occasions with success though all other symptoms of renal calculus were absent. In the case of a cor tical stone this, in fact, may be the only symptom. The pain is usually increased by pressure over the kidney or when the loin is grasped with the hand. Then there is the violent paroxysmal pain know as kidney colic, when a stone is on the move and is making its way down the ureter toward and into the bladder. Probably this represents the most unbearable form of suffering, and as a rule calls for the use of an anodyne. These paroxysms are often accompanied by rigors, vomiting, cramp, and profuse perspiration. There is usually a frequent desire to pass water. Then we have the reflected pains; of these, the most common are those down the groin and in the testicle, the gluteal region, and along the inner side of the thigh and leg. The former are often accompanied with more or less retraction or drawing up of the testicle. The paroxysm of intense pain often termi nates abruptly, and the patient is at the same time not 'Infrequently conscious that something has suddenly dropped from the ureter into the bladder. Later on he may also be aware that the calculus has escaped from the bladder, being voided in the act of micturition.
I have met with several instances of individuals with some per sonal experience of this disorder who have felt quite sure that the stone had not left the bladder, being too large to escape by the ure thra. This has led to the introduction of a litho trite without waiting for the stone to increase in this position, and the immediate crushing of the calculus and its evacuation. Thus a slight and safe operation is substituted for one when by the size of the stone the difficulty and risk are proportionately increased. Because a patient is not con scious of spontaneously voiding stone during micturition and obtain ing evidence of it, this by no means implies that he has not done so. Most stones of recent descent from the kidneys are, I believe, usually voided during defecation, when the expulsive acts are as a rule most advantageously performed.
Hmmaturia, or the passing of blood with the urine, is a frequent sign of calculus in the kidney, as it is also when the stone is in the bladder. In the former case it is variable in amount and is due to the scratching of the soft parts by the movement of the calculus. I have known it profuse in a case where a calculus was accidentally dislodged from its position within the kidney by a severe fall. Some clays after this occurred I cut clown on the kidney and removed from the cortex an oxalate stone which, though not large, was much spiked ; the hemorrhage ceased in the course of a few days and the patient made a good recovery. Of course, where there is blood, albumin in a corresponding proportion will be found in the urine. Instances are, however, met with where the irritation of a stone causes albumi nuria independently of hemorrhage, as I have known it to entirely dis appear after the removal or spontaneous escape of the foreign body. It must not be forgotten that in recurring attacks of renal colic the symptoms may be much modified by reason of the comparative ease with which calculi move along parts dilated by previous attacks of this kind.