VESICAL CALCULUS.
In by far the greater number of cases of vesical calculus (93 per cent.*) the onset bladder symptoms consist of uneasiness in the vesi cal region, increased desire to urinate, increased frequency of mictu rition, an unsatisfied feeling after urination, and some smarting or pin-pricking at the under surface of the glans penis toward the finish of the vesical contraction. But this is not invariably so. In about seven per cent. of the cases, these being mostly made up of men about or over fifty with some slight enlargement of the prostate, the first noticeable symptom is blood passed intimately mixed with the urine. Careful cross-examination may elicit the fact that an unusual amount of exercise had been taken a few hours previous to the appearance of the blood; and still more frequently it will be found that an abdom inal attack of pain and vomiting has preceded this lnematuria by a few weeks. This attack of abdominal pain may or may not have been a characteristic renal colic. Often its import has been misun derstood.
The bleeding is usually seen only once, and does not recur until another over-exertion provokes another slight loss. Unless the exer tion or jolting has been severe the amount of blood is rarely great. Within a few months of the onset, frequency of urination and slight scalding or pain during the act accompany the appearance of blood. These three symptoms, linked together, will have a direct and con stant relation to exercise. It will be noted, however, that the prostate may be a little enlarged and that the urine deposits oxalates or uric acid. The average practitioner, finding the urine acid, clear, and of good specific gravity, will probably be indisposed to diagnose stone, and will be tempted to state that the hemorrhage is a relief to the prostate; and it is often only when the stone has produced a mild attack of cystitis that the sound will be used and the cause detected. The reason for the latency is, I believe, a slight upraising of the median lobe and a corresponding depression in which the calculus lodges, probably being trapped there originally on its descent from the kidney.
Case J., Pet. 71. About two years before com ing under observation he passed without pain and without any fre quency of urination a considerable amount of reddish blood which was intimately mixed with the urine. The blood disappeared with rest. These attacks were intermittent and probably dependent on increased exertion. Latterly he had had pain after micturition. The pain was increased by exercise. The prostate was enlarged, the urine was clear, sp. gr. 1.010, acid, and deposited a cloud of mucus.
A small uric-acid stone weighing 124 grains was removed by litho lapaxy.
Rev. H. C. P. aged 71. Two months before coming under ob servation he passed blood, at first in streaks and then intimately mixed with the urine. He had no frequency of micturition and no pain until a few days back, when he noticed a slight pricking in the penis after the act. He believed the blood held some relation to the amount of gardening he did. The prostate was enlarged, and behind its intra-vesical projection a small pea-sized stone was found and crushed.
C. P. H., aged 60. A year ago he passed coffee-colored urine with out pain or frequency. This passed off, but a sense of obstruction which he then experienced at the neck of the bladder was never quite lost. The discoloration of the urine returned occasionally, but it was never bright red until four months before I saw him. He then went a long drive in a drag and bright-red hematuria ensued. The color was almost like pure blood and accompanying it was much irritability of the bladder, with straining. A few weeks ago he began to suffer from ordinary symptoms of calculus, And on examination he was found to have an oxalate of lime calculus of small size lodged behind the upraised prostate. The surface of the oxalate was seen on cys toscopy to be patched with white phosphate of lime, which had probably been deposited during the slight attacks of cystitis. It was removed by litholapaxy.