associated with albumen and casts in the urine than the acute form, find
in some instances these conditions of the urine may be the only
prominent symptoms of the disease. Though it may supervene on blow,
injuries, and exposures, it is much more commonly connected with faulty
conditions of the system--as indigestion, heart disease, lung or liver
disease, imperfect blood formation, or assimilation; in short, it is
rather the attendant on a constitutional infirmity than on a simple
local injury.
It may be associated with various forms of diseased kidneys, as
shrinkage (atrophy), increase (hypertrophy), softening, red congestion,
white enlargement, etc., so that it forms a group of diseases rather
than a disease by itself.
_Symptoms._--The symptoms may include stiffness, weakness, and increased
sensibility of the loins, and modified secretion of urine (increase or
suppression), or the flow may be natural. Usually it contains albumen,
the quantity furnishing a fair criterion of the gravity of the
affection, and microscopic casts, also most abundant in bad cases.
Dropsy, manifested in swelled legs, is a significant symptom, and if the
effusion takes place along the lower line of the body or in chest or
abdomen, the significance is increased. A scurfy, unthrifty skin,
lack-luster hair, inability to sustain severe or continued exertion,
poor or irregular appetite, loss of fat and flesh, softness of the
muscles, and pallor of the eyes and nose are equally suggestive. So are
skin eruptions of various kinds. Any one or more of these symptoms would
warrant an examination of the urine for albumen and casts, the finding
of which signifies renal inflammation.
_Treatment_ of these cases is not always satisfactory, as the cause is
liable to be maintained in the disorders of important organs elsewhere.
If any such coincident disease of another organ or function can be
detected, that should be treated first or simultaneously with this
affection of the kidneys. In all cases the building up of the general
health is important. Hence a course of tonics may be given (phosphate of
iron 2 drams, nux vomica 20 grains, powdered gentian root 4 drams,
daily) or 60 drops of sulphuric acid or nitrohydrochloric acid may be
given daily in the drinking water. If there is any elevated temperature
of the body and tenderness of the loins, fomentations may be applied,
followed by a mustard pulp, as for acute inflammation, and even in the
absence of these indications the mustard may be resorted to with
advantage at intervals of a few days. In suppression of urine,
fomentations with warm water or with infusion of digitalis leaves is a
safer resort than diuretics, and cupping over the loins may also
benefit. To apply a cup, shave the skin and oil it; then take a
narrow-mouthed glass, rarify the air within it by introducing a taper in
full flame for a second, withdraw the taper and instantly apply the
mouth of the glass to the skin and hold it closely applied till the
cooling tends to form a vacuum in the glass and to draw up the skin,
like a sucker.
As in the acute inflammation, every attention must be given to secure
warm clothing, a warm stall, and pure air.
TUMORS OF THE KIDNEYS.
Tumors, whether malignant or simple, would give rise to symptoms
resembling some form of inflammation, and are not liable to be
recognized during life.
PARASITES.
To parasites of the kidney belong the echinococcus, the larval, or
bladder worm, stage of the small echinococcus tapeworm of the dog.
_Dioctophyme renale_, the largest of roundworms, has been found in the
kidney of the horse. Its presence can be certified only by the passage
of its microscopic eggs or of the entire worm. Immature stages of
roundworms, either _Strongylus equinus_ or a related species, may be
found in the renal artery or in the kidney itself.
SPASM OF THE NECK OF THE BLADDER.
This affection consists in spasmodic closure of the outlet from the
bladder by tonic contraction of the circular muscular fibers. It may be
accompanied with a painful contraction of the muscles on the body of the
bladder; or, if the organ is already unduly distended, these will be
affected with temporary paralysis. It is most frequent in the horse, but
by no means unknown in the mare.
_Causes._--The causes are usually hard and continuous driving without
opportunity for passing urine, cold rainstorms, drafts of cold air when
perspiring and fatigued, the administration of Spanish fly or the
application of extensive blisters of the same, abuse of diuretics, the
presence of acrid, diuretic plants in the fodder, and the presence of
stone in the bladder. As most mares refuse to urinate while in harness,
they should be unhitched at suitable times for urination. Spasms of the
bowels are always attended by spasm of the bladder, hence the free
passage of water is usually a symptom of relief.
_Symptoms._--The symptoms are frequent stretching and straining to
urinate, with no result or a slight dribbling only. These vain efforts
are attended by pain and groaning. On resuming his natural position the
animal is not freed from the pain, but moves uneasily, paws, shakes the
tail, kicks at the abdomen with his hind feet, looks back to the flank,
lies down and rises, arches the back, and attempts to urinate as before.
If the oiled hand is introduced into the rectum the greatly distended
bladder may be felt beneath, and the patient will often shrink when it
is handled.
It is important to notice that irritation of the urinary organs is often
present in impaction of the colon with solid matters, because the
impacted intestine under the straining of the patient is forced backward
into the pelvis and presses upon and irritates the bladder. In such
cases the horse stands with his fore limbs advanced and the hind ones
stretched back beyond the natural posture and makes frequent efforts to
urinate, with varying success. Unpracticed observers naturally conclude
that the secondary urinary trouble is the main and only one, and the
intestinal impaction and obstruction is too often neglected until it is
irremediable. In cases in which the irritation has caused spasm of the
neck of the bladder and overdistention of that organ, the mistake is
still more easily made; hence it is important in all cases to examine
for the impacted bowel, forming a bend or loop at the entrance of the
pelvis and usually toward the left side. The impacted intestine feels
soft and doughy and is easily indented with the knuckles, forming a
marked contrast with the tense, elastic, resilient, overdistended
bladder.
It remains to be noted that similar symptoms may be determined by a
stone or sebaceous mass, or stricture obstructing the urethra, or in the
newborn by thickened mucus in that duct and by the pressure of hardened,
impacted feces in the rectum. In obstruction, the hard, impacted body
can usually be felt by tracing the urethra along the lower and posterior
surface of the penis and forward to the median line of the floor of the
pelvis to the neck of the bladder. That part of the urethra between the
seat of obstruction and the bladder is usually distended with urine and
feels enlarged, elastic, and fluctuating.
_Treatment._--Treatment may be begun by taking the animal out of
harness. This failing, spread clean litter beneath the belly or turn the
patient out on the dung heap. Some seek to establish sympathetic action
by pouring water from one vessel into another with dribbling noise.
Others soothe and distract the attention by slow whistling. Friction of
the abdomen with wisps of straw may succeed, or it may be rubbed with
ammonia and oil. These failing, an injection of 2 ounces of laudanum or
of an infusion of 1 ounce of tobacco in water may be tried. In the mare
the neck of the bladder is easily dilated by inserting two oiled fingers
and slightly parting them. In the horse the oiled hand introduced into
the rectum may press from before backward on the anterior or blind end
of the bladder. Finally, a well-oiled gum-elastic catheter may be
entered into the urethra through the papilla at the end of the penis and
pushed on carefully until it has entered the bladder. To effect this the
penis must first be withdrawn from its sheath, and when the advancing
end of the catheter has reached the bend of the urethra beneath the anus
it must be guided forward by pressure with the hand, which guidance must
be continued onward into the bladder, the oiled hand being introduced
into the rectum for this purpose. The horse catheter, 3-1/2 feet long
and one-third inch in diameter, may be bought of a surgical-instrument
maker.
PARALYSIS OF THE BLADDER.
Paralysis of the body of the bladder with spasm of the neck has been
described under the last heading, and may occur in the same way from
overdistention in tetanus, acute rheumatism, paraplegia, and hemiplegia,
in which the animal can not stretch himself to urinate, and in cystitis,
affecting the body of the bladder but not the neck. In all these cases
the urine is suppressed. It also occurs as a result of disease of the
posterior end of the spinal marrow and with broken back, and is then
associated with palsy of the tail, and, it may be, of the hind limbs.
_Symptoms._--The symptoms are a constant dribbling of urine when the
neck is involved, the liquid running down the inside of the thighs and
irritating the skin. When the neck is unaffected the urine is retained
until the bladder is greatly overdistended, when it may be expelled in a
gush by the active contraction of the muscular walls of the abdomen;
this never empties the bladder, however, and the oiled hand introduced
through the rectum may feel the soft, flabby organ still half full of
urine. This retained urine is liable to decompose and give off ammonia,
which dissolves the epithelial cells, exposing the raw, mucous membrane
and causing the worst type of cystitis. Suppression and incontinence of
urine are common also to obstruction of the urethra by stone or
otherwise; hence this source of fallacy should be excluded by manual
examination along the whole course of that duct.
_Treatment._--Treatment is only applicable in cases in which the
determining cause can be abated. In remedial sprains of the back or
disease of the spinal cord these must have appropriate treatment, and
the urine must be drawn off frequently with a catheter to prevent
overdistention and injury to the bladder. If the paralysis persists
after recovery of the spinal cord, or if it continues after relief of
spasm of the neck of the bladder, apply a pulp of mustard and water over
the back part of the belly in front of the udder, and cover with a rug
until the hair stands erect. In the male the mustard may be applied
between the thighs from near the anus downward. Daily doses of 2 drams
extract of belladonna or of 2 grains powdered Spanish fly may serve to
rouse the lost tone. These failing, a mild current of electricity daily
may succeed.
INFLAMMATION OF THE BLADDER (CYSTITIS, OR UROCYSTITIS).
Cystitis may be slight or severe, acute or chronic, partial or general.
It may be caused by abuse of diuretics, especially such as are
irritating (cantharides, turpentine, copaiba, resin, etc.), by the
presence of a stone or gravel in the bladder, the irritation of a
catheter or other foreign body introduced from without, the septic
ferment (bacterium) introduced on a filthy catheter, the overdistention
of the bladder by retained urine, the extrication of ammonia from
retained decomposing urine, resulting in destruction of the epithelial
cells and irritation of the raw surface, and a too concentrated and
irritating urine. The application of Spanish flies or turpentine over a
too extensive surface, sudden exposure of a perspiring and tired horse
to cold or wet, and the presence of acrid plants in the fodder may cause
cystitis, as they may nephritis. Finally, inflammation may extend from a
diseased vagina or urethra to the bladder.
_Symptoms._--The symptoms are slight or severe colicky pains; the animal
moves his hind feet uneasily or even kicks at the abdomen, looks around
at his flank, and may even lie down and rise frequently. More
characteristic are frequently repeated efforts to urinate, resulting in
the discharge of a little clear, or red, or more commonly flocculent
urine, always in jets, and accompanied with signs of pain, which persist
after the discharge, as shown in continued straining, groaning, and
perhaps in movements of the feet and tail. The penis hangs from the
sheath, or in the mare the vulva is frequently opened and closed, as
after urination. The animal winces when the abdomen is pressed in the
region of the sheath or udder, and the bladder is found to be sensitive
and tender when pressed with the oiled hand introduced through the
rectum or vagina. In the mare the thickening of the walls of the bladder
may be felt by introducing one finger through the urethra. The
discharged urine, which may be turbid or even oily, contains an excess
of mucus, with flat shreds of membrane, with scaly epithelial cells, and
pus corpuscles, each showing two or more nuclei when treated with acetic
acid, but there are no microscopic tubular casts, as in nephritis. If
due to stone in the bladder, that will be found on examination through
rectum or vagina.
_Treatment_ implies, first, the removal of the cause, whether poisons in
feed or as medicine, the removal of Spanish flies or other blistering
agents from the skin, or the extraction of stone or gravel. If the urine
has been retained and decomposed it must be completely evacuated through
a clean catheter, and the bladder thoroughly washed out with a solution
of 1 dram of borax in a quart of water. This must be repeated twice
daily until the urine no longer decomposes, because so long as ammonia
is developed in the bladder the protecting layer of epithelial cells
will be dissolved and the surface kept raw and irritable. The diet must
be light (bran mashes, roots, fresh grass), and the drink impregnated
with linseed tea, or solution of slippery elm or marsh mallow. The same
agents may be used to inject into the rectum, or they may even be used
along with borax and opium to inject into bladder (gum arabic 1 dram,
opium 1 dram, tepid water 1 pint). Fomentations over the loins are often
of great advantage, and these may be followed or alternated with the
application of mustard, as in paralysis; or the mustard may be applied
on the back part of the abdomen below or between the thighs from the
anus downward. Finally, when the acute symptoms have subsided, a daily
dose of buchu 1 dram and nux vomica one-half dram will serve to restore
lost tone.
IRRITABLE BLADDER.
Some horses, and especially mares, show an irritability of the bladder
and nerve centers presiding over it by frequent urination in small
quantities, though the urine is not manifestly changed in character and
no more than the natural quantity is passed in the twenty-four hours.
The disorder appears to have its source quite as frequently in the
generative or nervous system as in the urinary. A troublesome and
dangerous form is seen in mares, which dash off and refuse all control
by the rein if driven with a full bladder, but usually prove docile if
the bladder has been emptied before hitching. In other cases the
excitement connected with getting the tail over the reins is a powerful
determining cause. The condition is marked in many mares during the
period of heat.
An oleaginous laxative (castor oil 1 pint) will serve to remove any
cause of irritation in the digestive organs, and a careful dieting will
avoid continued irritation by acrid vegetable agents. The bladder should
be examined to see that there is no stone or other cause of irritation,
and the sheath and penis should be washed with soapsuds, any sebaceous
matter removed from the bilocular cavity at the end of the penis, and
the whole lubricated with sweet oil. Irritable mares should be induced
to urinate before they are harnessed, and those that clutch the lines
under the tail may have the tail set high by cutting the cords on its
lower surface, or it may be prevented from getting over the reins by
having a strap carried from its free end to the breeching. Those proving
troublesome when "in heat" may have 4-dram doses of bromid of potassium,
or they may be served by the male or castrated. Sometimes irritability
may be lessened by daily doses of belladonna extract (1 dram), or a
better tone may be given to the parts by balsam copaiba (1 dram).
DISEASED GROWTHS IN THE BLADDER.
These may be of various kinds, malignant or simple. In the horse I have
found villous growths from the mucous membrane especially troublesome.
They may be attached to the mucous membrane by a narrow neck or by a
broad base covering a great part of the organ.
_Symptoms._--The symptoms are frequent straining, passing of urine and
blood with occasionally gravel. An examination of the bladder with the
hand in the rectum will detect the new growth, which may be
distinguished from a hard, resistant stone. In mares, in which the
finger can be inserted into the bladder, the recognition is still more
satisfactory. The polypi attached by narrow necks may be removed by
surgical operation, but for those with broad attachments treatment is
eminently unsatisfactory.
DISCHARGE OF URINE BY THE NAVEL, OR PERSISTENT URACHUS.
This occurs only in the newborn, and consists in the nonclosure of the
natural channel (urachus), through which the urine is discharged into
the outer water bag (allantois) in fetal life. At that early stage of
the animal existence the bladder resembles a long tube, which is
prolonged through the navel string and opens into the outermost of the
two water bags in which the fetus floats. In this way the urine is
prevented from entering the inner water bag (amnion), where it would
mingle with the liquids, bathing the skin of the fetus and cause
irritation. At birth this channel closes up, and the urine takes the
course normal to extra-uterine life. Imperfect closure is more frequent
in males than in females, because of the great length and small caliber
of the male urethra and its consequent tendency to obstruction. In the
female there may be a discharge of a few drops only at a time, while in
the male the urine will be expelled in strong jets coincidently with the
contractions of the bladder and walls of the abdomen.
The first care is to ascertain whether the urethra is pervious by
passing a human catheter. This determined, the open urachus may be
firmly closed by a stout, waxed thread, carried with a needle through
the tissues back of the opening and tied in front of it so as to inclose
as little skin as possible. If a portion of the naval string remains,
the tying of that may be all sufficient. It is important to tie as early
as possible so as to avoid inflammation of the navel from contact with
the urine. In summer a little carbolic-acid water or tar water may be
applied to keep the flies off.
EVERSION OF THE BLADDER.
This can occur only in the female. It consists in the turning of the
organ outside in through the channel of the urethra, so that it appears
as a red, pear-shaped mass hanging from the floor of the vulva and
protruding externally between its lips. It may be a mass like the fist,
or it may swell up to the size of an infant's head. On examining its
upper surface the orifices of the urethra maybe seen, one on each side,
a short distance behind the neck, with the urine oozing from them drop
by drop.
This displacement usually supervenes on a flaccid condition of the
bladder, the result of paralysis, overdistention, or severe compression
during a difficult parturition.
The protruding organ may be washed with a solution of 1 ounce of
laudanum and a teaspoonful of carbolic acid in a quart of water, and
returned by pressing a smooth, rounded object into the fundus and
directing it into the urethra, while careful pressure is made on the
surrounding parts with the other hand. If too large and resistant it may
be wound tightly in a strip of bandage about 2 inches broad to express
the great mass of blood and exudate and diminish the bulk of the
protruded organ so that it can be easily pushed back. This method has
the additional advantage of protecting the organ against bruises and
lacerations in the effort made to return it. After the return, straining
may be kept in check by giving laudanum (1 to 2 ounces) and by applying
a truss to press upon the lips of the vulva. (See Eversion of the womb.)
The patient should be kept in a stall a few inches lower in front than
behind, so that the action of gravity will favor retention.
[Illustration: PLATE XI.
CALCULI AND INSTRUMENT FOR REMOVAL.]
INFLAMMATION OF THE URETHRA (URETHRITIS, OR GLEET).
This affection belongs quite as much to the generative organs, yet it
can not be entirely overlooked in a treatise on urinary disorders. It
may be induced by the same causes as cystitis (which see); by the
passage and temporary arrest of small stones, or gravel; by the
irritation caused by foreign bodies introduced from without; by blows on
the penis by sticks, stones, or by the feet of a mare that kicks while
being served; by an infecting inflammation contracted from a mare served
in the first few days after parturition or one suffering from
leucorrhea; by infecting matter introduced on a dirty catheter, or by
the extension of inflammation from an irritated, bilocular cavity filled
with hardened sebaceous matter, or from an uncleansed sheath.
_Symptoms._--The symptoms are swelling, heat, and tenderness of the
sheath and penis; difficulty, pain, and groaning in passing urine, which
is liable to sudden temporary arrests in the course of micturition, and
later a whitish, mucopurulent oozing from the papilla on the end of the
penis. There is a tendency to erection of the penis, and in cases
contracted from a mare the outer surface of that organ will show more or
less extensive sores and ulcers. Stallions suffering in this way will
refuse to mount or, having mounted, will fail to complete the act of
coition. If an entrance is effected, infection of the mare is liable to
follow.
_Treatment_ in the early stages consists in a dose of physic (aloes 6
drams) and fomentations of warm water to the sheath and penis. If there
is reason to suspect the presence of infection, inject the urethra twice
daily with borax 1 dram, tepid water 1 quart. When the mucopurulent
discharge indicates the supervention of the second stage a more
astringent injection may be used (nitrate of silver 20 grains, water 1
quart), and the same may be applied to the surface of the penis and
inside the sheath. Balsam of copaiba (1 dram daily) may also be given
with advantage after the purulent discharge has appeared.
Every stallion suffering from urethritis should be withheld from
service, as should mares with leucorrhea.
STRICTURE OF THE URETHRA.
This is a permanent narrowing of the urethra at a given point, the
result of previous inflammation, caused by the passage or arrest of a
stone, or gravel, by strong astringent injections in the early
nonsecreting stage of urethritis, or by contraction of the lining
membrane occurring during the healing of ulcers in neglected
inflammations of that canal. The trouble is shown by the passage of
urine in a fine stream, with straining, pain, and groaning, and by
frequent painful erections. It must be remedied by mechanical
dilatation, with catheters just large enough to pass with gentle force,
to be inserted once a day, and to be used of larger size as the passage
will admit them. The catheter should be kept perfectly clean and washed
in a borax solution and well oiled before it is introduced.
URINARY CALCULI (STONE, OR GRAVEL).
These consist in some of the solids of the urine that have been
precipitated from the urine in the form of crystals, which remain apart
as a fine, powdery mass, or magma, or aggregate into calculi, or stones,
of varying size. (See Pl. XI.) Their composition is therefore determined
in different animals by the salts or other constituents found dissolved
in the healthy urine, and by the additional constituents which may be
thrown off in solution in the urine in disease. In this connection it is
important to observe the following analysis of the horse's urine in
health:
Water 918.5
Urea 13.4
Uric acid and urates .1
Hippuric acid 26.4
Lactic acid and lactates 1.2
Mucus and organic matter 22.0
Sulphates (alkaline) 1.2
Phosphates (lime and soda) .2
Chlorids (sodium) 1.0
Carbonates (potash, magnesia, lime) 16.0
-----
1000.0