398 STONE cases of dyspepsia. The treatment should be mainly constitutional, including good air and nutritious diet. Dilatation of the stomach is usually caused by obstruction of the pylorus, but it sometimes, though rarely, occurs with- out it. The organ often becomes enormously distended, and tilled with undigested and fer- mented matter, and the muscular coat exceed- ingly thin. Regulation of the diet is the prop- er treatment. The most important functional diseases of the stomach are dyspepsia and gas- tralgia. (See DYSPEPSIA.) Gastralgia is a painful nervous affection, sometimes of the most excruciating nature. It often accompa- nies dyspepsia, and sometimes the structu- ral diseases. When existing alone and in an acute form, it may be caused by the presence of obnoxious ingesta. It sometimes results from malaria, frequently accompanies inter- mittent fever, and is sometimes associated with gout. It rarely attacks old persons or those under the age of puberty. Prof. Alfred Stille states that it is often produced by chew- ing tobacco. The remedies during the attack are anodynes. Morphine may be given by the mouth or by hypodermic injection. Bismuth has been used, it is said, with good results, but it is not generally relied on. A few drops of chloroform with water often give speedy re- lief. The general treatment will depend upon regulating the bodily functions and the diet. When of a malarious origin the preparations of quinia are indicated, in full doses. STOXE. See ROCKS. STONE, the common name of calculus in the urinary bladder, for the composition of which see CALCULI and GRAVEL. The prominent symptoms are irritability of the bladder with frequent irresistible desire to pass water, and occasional stoppage of the stream, with pain in various parts of the urinary system, and sometimes the presence of blood, mucus, and pus in the urine. None of these, however, can be depended on, the only sure diagnosis rest- ing on making the stone perceptible to the ear and fingers by means of a metallic sound introduced through the urethra, and brought into direct contact with the foreign body ; even with this instrument, several introductions in various positions of the body are sometimes necessary for its detection. The symptoms vary in intensity according to the size and roughness of the stone, the state of the urine, and the condition of the bladder. Stone is formed by a precipitation of the urinary salts either in the kidney, passing thence to the bladder, or primarily in the bladder. In the latter case a foreign body may be the nucleus. Stone may be removed from the bladder by 1, solution ; 2, extraction as a whole through the urethra ; 3, extraction through an opening ar- tificially made into the bladder (lithotomy); 4, crushing into fragments of such a size that they can pass through the urethra (lithotripsy). 1. Solution may be attempted by remedies taken by the mouth or injected into the blad- der. IJric acid calculi have been treated by the administration of alkalies, and the phosphatic by the injection of a solution of nitric acid. These methods have from their inefficacy fallen into disuse. 2. Extraction by the urethra is now done only in females ; in them the canal is so short and dilatable that a stone of con- siderable size can be removed by this method. 3. Lithotomy is indicated in all males under puberty, and in others when the stone is large or there are several ; when the urethra is stric- tured; when the bladder is in such a condi- tion as to be unable to bear the repeated in- troduction of instruments, and the irritation caused by the fragments resulting from litho- tripsy; and when the kidneys are not much diseased. The operation may be done by inci- sion above the pubes (the supra-pubic), through the perineum (the perineal), or through the rectum, or rectum and perineum (the recto-ves- ical). The supra-pubic and that through the rectum and perineum are usually employed only in cases in which, from the size of the stone or other causes, removal through the pe- rineum is impossible. The perineal operations are three in number, the lateral, bilateral, and median. The lateral operation is in general the best, and it may be performed as follows : A grooved steel staff or sound of full size is introduced, the bladder being moderately dis- tended, the patient on his back, with shoulders elevated, thighs separated widely in order to ex- pose the perineum, and the hand grasping and bound to the foot ; the patient being etherized, an incision is made on the left side of the peri- neum from about an inch before the anus down- ward and outward to a point midway between the anal opening and the tuberosity of the iscbium, the muscular fibres being divided down to the staff ; the left index finger passed into the wound keeps back the* rectum, and at the same time feels at the membranous part of the urethra the groove, which is entered by the knife and conducts it to the bladder, the ure- thra and about half an inch of the prostate being divided; the finger is then introduced, dilating the opening; the finger being with^ drawn, the forceps are introduced, opened, ana the stone seized, if possible, with the first gush of fluid from the wound, and then extracted by slow, steady, and undulating movements, dilating and not tearing the soft parts. If properly performed, and the after treatment not interfered with by haemorrhage, inflamma- tion, sloughing, or other complications, the urine begins to flow by the urethra in about a week, and the wound heals completely in four or five weeks. In the bilateral operation, a curved incision, with the convexity upward, is made from one side of the perineum to the other, between the anus and the urethral bulb, dividing both sides of the prostate by a double bistoury. The median operation differs from the preceding in that the incision is vertical and in the median line, and the prostate is not cut, but is dilated, and somewhat lacerated, by
