If the stone becomes impacted in the ureter, serious consequences may ensue. The irritation of the foreign body in this situation may set up in flammation, and give rise to thickening and contraction immediately above the seat of the impediment. Higher up the ureter becomes greatly dis tended, and the pelvis of the kidney may suffer dilatation. In some cases the pressure of the secreted fluid, accumulating in the channels above the obstruction, may flatten out the kidney into a thin-walled cyst. This is one form of hydronephrosis.
When the stone has entered the bladder, urgent symptoms begin to be noticed. This affliction is more common in boys than in girls ; probably for purely mechanical reasons. The urethra iu girls is short, straight, and, when the child stands upright, almost vertical. In boys it is long and sinuous with a double bend. In the bladder the stone produces great irritation. Priapisnris common ; and there is usually pain, which is in creased by exercise. During micturition the boy cries with pain, which he refers to the end of the genital organ, and endeavours to relieve by squeez ing and rubbing the part with his fingers. The flow of urine often stops suddenly, from the stone being carried by the flow of water into the neck of the bladder, and there forming an impediment to the escape of the urine. Consequently the water is voided with effort, and the straining may give rise to prolapse of the rectum. Actual retention may occur, the stone being tightly grasped by the sphincter vesicpe, and impacted at the beginning of the prostatic urethra. A little pure bright blood may be passed at the end of micturition, and the urine often gives evidence of se vere catarrh of the bladder. Any of these symptoms occurring in a boy should make us inquire very carefully into the cause of his complaints. It must not, however, be forgotten that very similar symptoms may arise from different reasons. Dr. West has pointed out that in cases where the prepuce is abnormally long, with a narrow opening, its edges may become very sore on account of the difficulty and delay with which urine is forced through the orifice ; and this may give rise to much pain in micturition.
Diagnosis.--On account of the frequency with which uric acid concre tions are found in the urine of children, it is evident that the delicate membrane lining the tubules of the kidney is liable to be exposed to injury from the sharp edges of the crystalline masses. Consequently, lamor
rhage in such cases is no matter for surprise. The wonder, indeed, is that it is not a more common symptom of uric acid sand in young persons. That it is not so is probably due to the fact that the uric acid is commonly deposited from the urine in the bladder itself, and not at a higher point in the urinary apparatus. Sir Thomas Watson has recorded his opinion that many of the obscure cases of heematuria in the adult may be referred to renal calculi. In the case of children it may be laid down as a rule that renal hpemorrhage occurring in a child otherwise healthy, and accompanied by no symptoms, nor by from other parts of the body, is, in the majority of cases, to be attributed to the irritation of crystalline masses in the tubules, calices, or pelvis of the kidney.
Not long ago I saw a little boy, aged ten months, who for six weeks had been passing water mixed largely with blood. Sometimes for a few days together the water would be clear, but the lrematuria speedily re turned. The specimen brought with the child was bright crimson in col our, and consisted of blood and urine intimately blended together. It had a slightly acid reaction. Many blood-corpuscles were seen under the mi croscope, bit' no crystals of uric acid could be detected, although the med ical attendant had occasionally found them in the sediment. The child had been brought up by hand and fed upon cow's milk and water. He had no teeth, could not stand, and showed signs of being under-nourished. The bowels were confined habitually ; otherwise he seemed to suffer no dis comfort, and was said never to be peevish or fretful.
As the infant was evidently insufficiently fed, I rearranged his diet, order ing one meal in the morning of oatmeal (one teaspoonful) with cow's milk, two meals of Nestle's milk food, and two or three meals of Mellin's food with cow's milk diluted with a third part of barley-water. I also prescribed a mixture containing the infusions of senna and gentian, so as to act gently upon the child's bowels.