CONCRETIONS (STONES) OF THE KIDNEY, BLADDER, AND URINARY PASSAGES (Symptornatology, see Langstein, vol. iv.) These stones are found most frequently in children in the southern part of Hungary and in Russia, also (according to personal communi cation to the author) very frequently in India. Stones in the bladder occur mostly in boys, possibly on account of the long and narrow urethra.
In skiagraphy we possess a means of clearing these diagnoses which are often exceedingly difficult (stones in the kidney). Small friable con cretions, however, do not show on the plate (Albers-Schonfeld).
Rovsing recommends in nephroiithiasis forced drink cures of three liters of distilled water daily (in adults), to be taken in single portions of S ounces; this will reduce the size of the stones. Alkaline mineral waters will make these grow from deposits. For larger stones in the kidney nephrotomy or nephrolithotomy (for these see surgical text-books), which are less dangerous than to carry concretions in one's body which may cause arrosions, infections of the substance of the kidney, and occlusion of the urinary passages.
The diagnosis of vesical stones in children is made easy by the bimanual palpation of the empty bladder through the rectum and the abdominal wall (see Appendicitis); otherwise cystoscopy, skiagraphy. Probing is frequently almost impossible in small boys, though this must be tried carefully. In these we shall also at first try a drink cure in small concretions. Litholapaxy, the ideal method in adults, cannot be used in children on account of the narrow urethra and long narcosis required. In large stones we will have to do a sectio alta (technic the same as in adults).