sutures, even when supported by secondary sutures, sometimes cut through
the tissues and do not achieve the desired result.
[Illustration: $1]
Degive’s method (see “Möller and Dollar’s Regional Surgery,” p. 304) can
then be employed. The hernial sac is opened under antiseptic
precautions, in order to break down any existing adhesions, and the skin
and edges of the hernial ring are transfixed with packing needles about
8 inches long. Above these is adjusted a clam, which is closed, by means
of a screw and firmly secured. The packing needles are then replaced
with horse-shoe nails, the points of which are bent round. In about a
week the necrotic tissue falls away, and recovery occurs even in severe
cases in which previous treatment had failed.
ACQUIRED HERNIÆ.
Acquired or accidental herniæ are not serious, and only deserve to be
studied in so far as they affect organs contained within the abdominal
cavity. They may result from violence, or may occur without the
intervention of any external cause.
Traumatic herniæ may occur at any point in the abdominal wall. Under the
influence of a violent blow from a waggon pole, a horn thrust, a kick, a
fall, etc., the muscular tunic of the abdominal wall is injured and
becomes fissured in the direction of its fibres. The peritoneum is
rarely affected. Being pushed outwards by the digestive viscera,
however, the peritoneum projects into the muscular layer, distends it,
separates the layers of subcutaneous tissue, and finally forms a
distinct hernia.
The consequent disturbances are more or less marked and the lesions more
or less variable, according to the part affected. In the lower region
fissure of the abdominal wall affects the rectus abdominis, obliquus
abdominis and transversus abdominis, and on the right side gives rise to
hernia of the abomasum or small intestine, on the left of the rumen. In
the lateral regions muscular fissures can be produced only in the
transversus and obliquus abdominis muscles. Hernia of the rumen is rare
on the left side. On the right side hernia of the intestine is more
readily produced.
In all cases where hernia is suspected, the hernial orifice should be
examined. Its situation will at once show which organ is affected.
Spontaneous herniæ are very rare in the domesticated animals. They occur
only in aged animals, and various reasons have been suggested to explain
their appearance. Certain herniæ of this character are only found in old
female animals which have borne a considerable number of young. Repeated
gestation produces elongation and relaxation of the muscular fibres from
the weight of the fœtus and its envelopes. In time, the abdominal walls
become thinner and thinner under the weight of the viscera, and thus
facilitate the slow formation of a hernia. Certain practitioners
consider that some of these spontaneous herniæ are due solely to the
pressure produced by the distended viscera, as for example in
greedy-feeding animals. In such cases the weight of the viscera would
cause, as in the previous case, a certain degree of anæmia and
emaciation of the abdominal muscles.
These spontaneous ventral herniæ are due in reality to changes in the
nutrition of the abdominal wall, the exact cause of which it is
difficult to ascertain. The elastic tunic becomes atrophied, and ceases
to act as an automatic girth; the muscular wall gradually becomes
sclerosed from the white line towards the sides, and having lost its
elasticity becomes distended and thinned.
These changes are not exclusively caused by old age, for they may be
found even in young animals.
Nothing can be done in cases of spontaneous herniæ. The qualities
originally pertaining to the abdominal wall cannot be restored, and
=treatment= is confined to applying suspensory bandages, and, where
possible, preparing the animals for slaughter.
HERNIA OF THE RUMEN.
=Causation.= Hernia of the rumen is, as a rule, of traumatic origin, and
always occurs in the left flank, either in the lower or middle regions.
Cases of spontaneous hernia of the rumen have been observed in very old
and anæmic animals, as well as in females which have borne many young
and which have suffered from spontaneous progressive hernia of the
uterus.
=Symptoms.= The symptoms are the same in all herniæ. Immediately after
the injury the abdominal organs show a tendency to escape in the
direction of least resistance. A fold of the rumen passes through the
muscular fissure, and a swelling soon becomes visible externally, which
alters the contour of the abdomen. Most frequently at this time traces
of the injury can be detected on the surface of the skin, either the
linear trace due to a horn thrust, the ill-defined lesion due to a kick,
or what not. There follows rapid swelling, which results from the
inflammatory reaction due to rupture of small vessels within the muscle.
A certain amount of sanguineous exudation and of œdematous swelling
occurs, and may at first suggest the existence of an abscess of the
abdominal wall. At the same time there is more or less fever, which may
continue for a few days, but the swelling seldom lasts very long; in two
or three days even, it becomes reabsorbed, commencing at the upper part
and diminishing progressively downwards.
Henceforth the hernia alone remains.
It is soft, compressible, and sometimes susceptible of reduction. On
palpation, the operator feels a rupture extending through the tunic and
the abdominal wall, sometimes even through the muscular tissue of the
rumen, in cases where the skin is neither perforated nor torn through.
The mucous membrane of the rumen is rarely ruptured.
Whether or not the peritoneum is injured, the rumen presses between the
lips of the wound, thrusts back the skin, and separates the connective
tissue, thus setting up local irritation and œdematous swelling. The
rumen may contract more or less close adhesions with the abdominal wall,
and even with the subcutaneous tissues.
Afterwards, when the exudate has been reabsorbed, palpation reveals a
different condition of things. The mass is uniformly fluctuating or
semi-fluctuating, and is surrounded at the base by an indurated ring of
very varying dimensions. The final indication—which, however, is not
invariably seen—deserves attention, viz., the change in volume of the
hernia at different moments, particularly during meals. This change in
size only occurs if the hernial orifice is large.
In cases of spontaneous hernia of the rumen, the condition is not fully
established at first. It is always progressive, and the lesion is
situated in the lower abdominal region. It increases in size from day to
day, from week to week, whilst the animals lose appetite and flesh.
Spontaneous herniæ are never accompanied either by exudation,
engorgement, fever, or traces of mechanical injury.
When only slightly developed, herniæ do not threaten life, a fact which
often prevents the owners troubling about them. Progressive herniæ may
become of considerable size, and two cases are recorded in one of which
the opening of the hernial sac was 13½ inches in length and 18 inches in
width, and in the other 28 inches in length and 24 inches in width. The
latter is the largest ever recorded.
=Complications.= Complications are not always grave. If the hernia is
little marked the function of the rumen is not greatly affected and its
rhythmic contraction continues. When the original injury has caused
rupture of the muscular tissue of the rumen, and the mucous membrane has
passed into the opening, it may become strangulated and gangrenous.
Finally, if the mucous membrane has been torn at the same time as the
muscular tissue (which is very uncommon), alimentary material may escape
into the subcutaneous connective tissue, setting up either cellulitis
and death by infection, or suppuration; abscess formation and rupture
towards the exterior, followed by a persistent sinus; or again septic
peritonitis, and death.
The same results may occur when the hernia is in a very low portion of
the abdomen; food accumulates in it, becomes stagnant there, sets up
local irritation and inflammation, and sometimes abscess formation with
external discharge, followed by fistula of the rumen.
Gastric fistula without secondary complications is compatible with life,
and even with fattening for slaughter, provided the peritoneum covering
the rumen becomes attached to the opposing surface of peritoneum around
the perforation. The fistula is then surrounded by a circular mass of
fibrous tissue, forming a kind of sleeve.
=Lesions.= The lesions are the same in all herniæ. They consist
primarily in rupture of the abdominal wall, and, later, of
sero-sanguinolent infiltration of the margins of the wound, similar to
that accompanying the formation of an abscess. Hernial swellings are of
very varying size. Apart from cases similar to those above described,
the swelling may be simply an inch or two in diameter, or it may attain
the dimensions of a hen’s egg or even of a man’s fist.
When the abdominal tunic only has been ruptured, as is most frequently
the case, the peritoneum is thrust outwards and forms a cavity, the
hernial sac. This sac is absent when the peritoneum is ruptured. Little
by little the surrounding connective tissue forms a pseudo-serous
hernial sac. But, nevertheless, in some cases there may be found,
immediately under the skin, the mucous membrane of the rumen in a state
of congestion and ready to become gangrenous.
=Diagnosis.= Easy in all cases.
=Prognosis.= Very variable. In the case of small herniæ situated in the
lateral regions of the abdomen the prognosis is not very grave. If,
however, the rupture is wide, and situated in the lower portion of the
abdominal walls in a dependant position, the hernial swelling steadily
grows in size in consequence of the weight of the food which is
constantly thrust in this direction by the contraction of the rest of
the rumen, and recovery is impossible. The only resource is to fatten
the animals as quickly as possible for slaughter.
HERNIA OF THE ABOMASUM.
=Causation.= This condition is due to causes similar to those above
mentioned, including mechanical violence. It is rare in adults, but much
commoner in young animals, especially in sucking calves, where the
abomasum is the most highly developed digestive compartment.
Hernia of the abomasum is produced essentially and almost exclusively by
horn thrusts inflicted when calves attempt to suck cows other than their
own mothers.
=Symptoms.= Hernia of the abomasum always occupies a certain position in
the lower part of the right flank, or, rather, in the space comprised
between the white line and the lower part of the circle of the
hypochondrium.
The immediate symptoms are similar to those of hernia of the rumen. They
include: progressive swelling, formation of a peripheral œdematous ring,
interstitial sero-sanguineous exudation, which becomes absorbed after a
few days; finally, the development of a hernia, formed as a rule by the
larger curvature of the viscus, which is in direct contact with the
abdominal wall.
=The lesions= are those common to all hernia, and usually include a
partially healed wound.
=Diagnosis.= The diagnosis is easy, particularly in calves, and the
possible existence of the condition should always be borne in mind when
dealing with injuries of the right pre-umbilical zone. An abscess of the
lower abdominal wall may occur at or near the umbilicus as a result of
omphalitis or umbilical phlebitis, but it is readily distinguished from
a hernia.
=The prognosis= is graver than in the case of hernia of the rumen, for
the displacement of the abomasum interferes with its regular function.
The prognosis varies, however, in accordance with the size of the
hernia. If the rupture is small, there is some chance that the abomasum,
on account of its longitudinal position, many penetrate but slightly
into the fissure.
If, on the other hand, the rupture is large, the prognosis becomes very
serious. It is sometimes best to slaughter the animal, if in good
condition; otherwise an operation is necessary.
HERNIA OF THE INTESTINE.
=Causation.= This is due to the same cause as hernia of the rumen—a blow
which, while injuring the skin only to a trifling extent, damages the
abdominal walls, and even the intestine itself.
=Symptoms.= The hernia is situated in the lower or lateral zone of the
right flank.
The symptoms present some peculiarities. The loop of intestine which has
passed through the aperture in the abdominal walls becomes distended by
the accumulation in it of semi-liquid alimentary material, and, acting
by its own weight, produces a hernial sac, which steadily grows in size.
The skin being very mobile, and the subcutaneous connective tissue very
loose, they readily yield and become separated. The inflammatory
symptoms disappear, and are followed by a swelling under the skin, which
is compressible all over, and can readily be reduced, whereupon it gives
forth a gurgling noise, or a sound as of borborygmus. Reduction is
easier when the animal is lying on its left side, or on its back.
=Complications.= Strangulation of the small intestine is the only
serious complication in this form of hernia, but it is very dangerous.
It occurs frequently when the rupture is somewhat highly-placed on the
lateral portion of the abdominal wall, because the loops of intestine
have a tendency to descend, thrusting away the skin owing to the weight
of material which they contain.
The partially digested food is apt to accumulate in the herniated loop,
and hernial engorgement, the first phase of strangulated hernia, rapidly
occurs.
Fermentation is set up in the half-digested food, and putrid gases are
generated. Thus the hernial sac becomes distended, the vessels are
compressed, circulation is arrested, and gangrene supervenes.
At this time gurgling sounds and a certain degree of tympanitic
resonance may be noted. These are followed by all the symptoms of
intestinal strangulation—namely, intense colic, which suddenly
disappears when the intestine becomes mortified, absolute loss of
appetite, stoppage of rumination, constipation, suppression of
defæcation, tympanites, and peritonitis.
=The diagnosis= is comparatively easy at an early stage, owing to the
peculiar character of the soft swelling, which is easily compressible.
At first there may be difficulty in distinguishing it from a collection
of serous fluid, but the facility with which the swelling can be reduced
removes any doubt.
=The prognosis= is always serious, on account of possible complications,
due to strangulation of the herniated loop. When the hernia is chronic,
reduction is much more difficult, there being, as a rule, adhesions
between the intestine and the hernial sac.
TREATMENT OF HERNIÆ.
Numerous attempts have been made to treat abdominal hernia in bovine
animals.
Irritant and vesicant applications to the skin have been recommended,
with the object of producing a large swelling, and thus thrusting back
the herniated mass into its proper position.
One of the most popular of these applications is nitric acid of a
strength of 36° Baumé, applied to the skin twice at an interval of ten
days. Skilfully used, it gives good results in umbilical herniæ, but its
effects in ventral herniæ are less certain. It causes slow mortification
of the skin, abundant subcutaneous swelling, and produces an eschar,
which separates in about a fortnight.
An ointment of yellow chromate of potash (1 to 8) has been recommended,
and can be applied two or three times at intervals of eight or ten days.
Bandaging and various forms of local dressing have also been employed
from time to time. Serres employed simple bandages similar to those used
in cases of inguinal or crural hernia in human beings. These bandages
have a pad, which is applied over the hernial opening, but their action
is strictly palliative. They simply allow of the animal being kept a
certain length of time for fattening.
When the hernia has been reduced recourse may be had to bandages
saturated in melted pitch, care being taken to extend the dressing a
considerable distance beyond the limits of the hernial opening.
Successive layers of bandage are superposed across and across, and, to
make the dressing more solid, the pads may be reinforced with a sheet of
solid cardboard. This method only succeeds when the swelling is slight
and is situated elsewhere than in the lowest portions of the abdomen.
Some practitioners prefer a cloth bandage after reduction. The bandage
is ten to fifteen yards in length, and should be considerably wider than
the greatest measurement of the hernial opening. Such bandages can
easily be applied to calves, whose bodies are of regular shape, but in
adults, in which the body is of ovoid formation, they prove faulty, and
tend to slide backwards or forwards.
All these measures are merely more or less palliative and of temporary
effect.
The only rational and radical treatment is surgical. This is clearly
indicated when the hernia is recent and of small size. At a later stage,
when fibrous adhesions have formed between the various organs, and
reduction has become difficult, caution must be observed. Surgical
treatment is always a serious matter, and should only be attempted in
the case of valuable breeding animals, or those which cannot be sold for
slaughter.
Young animals are kept without food for twenty-four hours and are cast
on the side opposite the hernia; they can be placed on the right or left
side, or on the back, as seems most convenient. The site of operation is
disinfected, and the operation carried out with aseptic precautions. The
skin covering the swelling is incised and, the margins of the hernial
orifice having been examined, the sac is isolated. Next, an incision is
carefully made, any adhesions which may exist are broken down and the
herniated parts are reduced. It only remains to suture the wound with
silk or catgut, bringing the lips of the fissure together. Finally the
skin wound is firmly united, and a large suspensory bandage tightly
applied.
If the hernia is of long standing, and is irreducible on account of
numerous adhesions, operation may still be attempted. In that case the
incision must be an inch or two longer, all adhesions should be
destroyed, and the margins of the orifice need to be freshened so as to
insure their uniting.
During the days following operation, the animals should have light food,
principally gruel, mashes and cooked roots. But it must be borne in mind
that this operation is serious, and may possibly be followed by
eventration.
DIAPHRAGMATIC HERNIA.
The term diaphragmatic or mediastinal hernia denotes a condition in
which certain of the abdominal viscera penetrate into the thoracic
cavity. This displacement may be congenital, acquired, or accidental.
The accidental herniæ are of traumatic origin, and are often caused by
fractured ribs, which injure the diaphragm. The hernia is then purely
diaphragmatic.
Congenital or acquired herniæ are more frequently mediastinal; they
occur exactly in the median plane as a consequence of fissure of the
diaphragm above the ensiform cartilage, and cause a separation between
the two layers of serous membrane enclosing the posterior mediastinum.
The region immediately behind the diaphragm in the ox being occupied by
the large viscera—namely, the anterior conical portions of the rumen,
the reticulum, the omasum, and the liver—diaphragmatic or mediastinal
hernia is far from being common, though occasionally it may be
discovered or at least suspected.
=Causation.= The causes of diaphragmatic and mediastinal hernia are
closely connected with injuries in the region of the hypochondrium; with
arrest in the development of the diaphragm; or with accidental vertical
fissuring consequent on gestation or acute tympanites.
The fissure seems most commonly to occur between the point where the
œsophagus passes through the diaphragm and the ensiform cartilage of the
sternum, in which case mediastinal herniæ most commonly supervene. As,
on the other hand, the rumen, owing to its size, form and position,
cannot readily be displaced, the reticulum and omasum are the viscera
which most commonly pass into the thorax.
=Symptoms.= In true accidental diaphragmatic hernia visceral
displacement only occurs on the right side, and symptoms of this are
immediately apparent. The passage of the liver, reticulum, or omasum
into the right pleural sac compresses the lung, causes attacks of
dyspnœa and acceleration of the heart’s action.
[Illustration: $1]
Percussion may not reveal any important change, but on auscultation
digestive sounds can plainly be heard within the chest.
The symptoms are far from being well defined. They may be more or less
intense, and colic may or may not be present. Mediastinal hernia (Fig.
223) appears to develop slowly, and it is only by degrees that the
viscera become displaced.
There is then no sudden change, no clearly marked disturbance, but
simply a certain amount of digestive irregularity, together with loss of
appetite, cessation of rumination, slight indigestion, and moderate
tympanites. The disturbance is really due to obstruction in the
alimentary canal and displacement of the reticulum and omasum, so that
rumination and deglutition are affected.
Very often this condition may last for weeks, in either a stationary or
more or less aggravated form, so that there is an appearance of chronic
gastro-enteritis, motor dyspepsia, or chronic indigestion.
Though a diagnosis in this sense would be correct, the atony of the
rumen is not primary, but of mechanical origin.
One indication is constantly present, which might suggest indigestion
due to overloading of the rumen, and which is also seen in ulcerative
gastritis, viz., progressive stasis of food in the cavity of the rumen.
When the patients remain for some time under observation, this stasis
becomes every day more marked, and, being recognised, the diagnosis
becomes easier. Animals suffering from mediastinal hernia lose
condition, waste away, and in the end may die in a state of cachexia.
[Illustration: $1]
=Lesions.= The lesions vary greatly. In accidental diaphragmatic hernia
they are confined to rupture of the diaphragm, sometimes of the liver,
and to changes in the reticulum or omasum.
In intra-mediastinal hernia the layers of the mediastinum form a true
hernial sac, and if the lesion is of old standing the displaced viscera
may become attached to it, compressed, and partially strangulated.
=Diagnosis.= The diagnosis is very difficult, at all events in
mediastinal hernia, and can only be arrived at by a process of
exclusion. The most significant symptom is progressive stasis of food
within the rumen, suggestive of some obstacle in the alimentary canal.
=Prognosis.= The prognosis is extremely grave, because it is impossible
to reduce the hernia.
=Treatment.= No treatment is possible. The essential point is to confirm
the diagnosis as soon as possible and to slaughter the animal while it
is yet in good condition.
EVENTRATION.
Eventration belongs to the same group of lesions as herniæ, of which it
is merely a more serious form. It differs from them only in the fact
that the entire abdominal wall is injured. The skin, muscle, and
peritoneum are torn, and the digestive organs pass into direct
communication with the external air.
The name eventration has also been given to enormous subcutaneous
abdominal herniæ, in which the sero-muscular wall is injured over a
large area and the viscera become displaced and separate the
subcutaneous tissue layers while at the same time they alter the whole
shape of the abdomen.
=Causation.= The cause is always the same—some grave mechanical injury
to the abdominal wall, producing an extensive perforation. The injury
may be due to a horn thrust or to the animal falling on some sharp-edged
body.
=The symptoms= are very marked. Through the wound, the rumen, the
abomasum, or the intestine protrudes more or less. Generally it is the
small intestine which becomes displaced, because it is the most mobile
of the abdominal viscera. These organs soon become dried by contact with
the air, and may become infected, soiled, congested, thickened, torn, or
gangrenous. The successive development of these changes causes serious
and violent colic, accompanied by expulsive efforts; the animals throw
themselves on the ground, and may tear the mesentery, the intestines,
etc. At an advanced stage the animal may stand motionless, looking at
its viscera. Death may also be caused in a very short time by the
intense pain.
=Diagnosis= and =Prognosis=. The diagnosis is evident. The prognosis is
always very grave, although, of course, it depends on the condition of
the displaced viscera.
=Treatment.= It is often useless to attempt anything, and if the animal
is in suitable condition it is best, as a rule, to slaughter it.
If the accident is quite recent, and the viscera only slightly injured,
surgical treatment may be attempted. With this object, the displaced
organs are carefully and thoroughly washed with lukewarm boiled water,
or with some unirritating disinfectant, to guard against peritonitis,
and are then reduced.
The abdominal wound must afterwards be carefully sutured. This is
performed in two stages. The musculo-serous layer is first brought
together with catgut, or better still with silk, and the skin joined by
means of deep and closely placed stitches. To prevent these sutures
being torn out, and to support them, the abdomen is swathed in a broad
cloth bandage, tightly applied.
FISTULÆ OF THE DIGESTIVE APPARATUS.
Fistulæ of the digestive apparatus are of accidental origin and of
relatively small practical interest. In most cases they necessitate
surgical and other treatment of too delicate a kind and too prolonged a
character to justify the necessary expense. Their nature and origin
sufficiently suggest the course to be adopted.
[Illustration: $1]
These fistulæ are divisible into two varieties, gastric fistulæ and
intestinal fistulæ. Gastric fistulæ comprise fistulæ of the rumen,
reticulum, and abomasum. They may be of external origin, but in the
majority of cases they are produced by foreign objects accidentally
swallowed and eliminated through the medium of an abscess of the
abdominal walls. Their position and direction indicate their point of
origin. (Fistulæ of the rumen appear on the left side of the reticulum,
near the ensiform cartilage and middle line; those of the abomasum on
the right side, near the middle line.) In doubtful cases, chemical
analysis of the liquid which escapes will afford valuable information.
Acidity alone is a sufficient indication in fistula of the abomasum.
Fistulæ of the rumen and reticulum are difficult to close on account of
their low position in the abdominal wall, but, if great care is
exercised, they may be successfully treated. Those of the abomasum, on
the contrary, only tend to increase in size, and any surgical
interference still further favours the destructive action of the gastric
juice. As a rule, therefore, they cannot be treated.
Fistulæ of the second variety comprise all intestinal fistulæ. They may
be either accidental or artificial, and they are less grave than gastric
fistulæ, because they are rarely situated in the lower portions of the
abdomen. With time they may become closed either spontaneously or by
means of simple treatment tending to regulate the passage of food
through the bowel.
SECTION VII.
GENITO-URINARY REGIONS.
DISEASES OF THE URINARY APPARATUS.
=Symptomatology.= The urinary apparatus comprises the organs of
secretion (the kidneys) and those of excretion (the ureters, the
bladder, the urethra).
A thorough examination of the urinary apparatus should include, firstly,
that of the external organs (the sheath, glans penis and urethra) in the
male, and, in the female, the vulva, meatus and urethra; secondly, that
of the internal organs (the bladder, ureters and kidneys) in both sexes.
To carry out the external examination, the head must first be fixed and
the hind limbs hobbled. If necessary, the animal can be attached to the
side of a wall.
External examination comprises inspection and palpation, which is only
possible in males. Inspection will reveal at once the existence of
malformation, deformity, traumatic lesions, or tumours of the organs.
By palpation the sheath and glans penis can be examined, and cellulitis,
abscess formation, calculi in the urethra, obstruction of the extremity
of the canal by very fine gravel, as in the case of sheep, etc., can be
detected.
The inner margin of the right kidney may also be examined by external
palpation, though only in very thin animals. The examination is made
from the flank region, behind the last rib, in an upward direction and
towards the right (Fig. 227). The kidney, attached under the lumbar
region, sometimes extends back beyond the last rib, under the transverse
processes of the lumbar vertebræ. On the left the presence of the rumen
prevents any examination.
In sheep this examination requires special care.
Examination of the internal urinary organs must be made through the
rectum. It should be undertaken slowly and gently. In the male the hand
detects the condition of the organs contained within the pelvic cavity,
the fulness or emptiness of the bladder, or the existence of calculi
within it. More deeply seated can be felt the entire length of the right
ureter; its state of dilatation can be felt, and the existence of
diverticula of inflammation, if any, can be ascertained. The left ureter
cannot readily be examined, on account of the position of the rectum,
except as regards the posterior part, close to the bladder and the
rumen.
[Illustration: $1]
In the abdominal cavity the rectum, or rather the floating colon, turns
to the right, in such a way that, in spite of the shortness of the
meso-rectum and meso-colon, the hand can be passed as far as the right
kidney. It is, then, easy to discover whether this organ is sensitive to
pressure, hypertrophied, atrophied, cystic, etc. The paunch interferes
with examination on the left side.
[Illustration: $1]
In females the ureters and kidneys can be examined in the same way, but
the bladder and the canal of the urethra must be reached through the
vagina. About 2 or 2¼ inches from the vulva on the floor of the vagina
is the entrance to the urethra, covered with a special valve. The meatus
becomes visible by separating the lips of the vulva and the vaginal
walls. For this purpose a speculum _ad hoc_ can advantageously be used.
It is clear that if it is thought desirable to examine the bladder
through the rectum, which is not absolutely impossible, the vagina will
be interposed between the arm and the urinary organs, and the sensations
experienced will, therefore, be much less clearly defined (Fig. 226).
In passing a catheter for the purpose of emptying the bladder the end of
the sound should be introduced under the valve of the meatus. By
slightly lowering the back end of the sound, the front end is lifted
above the cul-de-sac, and the operator at the same time pushes gently
forwards. It is then only necessary to lift the hand, and the sound
passes readily into the urethra and the bladder.
Examination of the urine and even chemical analysis are of great
importance in diagnosing diseases of the urinary tract.
From the clinical point of view very complete analyses are not
necessary, but the tests for albumen, sugar, bile pigments and indican
are absolutely indispensable; and the same is true of microscopic
examination for ascertaining the presence or absence of epithelial
cylinders, blood corpuscles, pus corpuscles, etc. It is important also
to note the colour and odour and the quantity passed.
These examinations are by no means difficult. Albumen is detected by
adding a few drops of acetic acid to the urine, and heating, or by
adding nitric acid and Esbach’s liquid. Esbach’s albumenimeter is
sufficiently exact to discover the approximate amount of albumen
present. Sugar is detected by the use of Fehling’s solution, bile
pigments by nitric acid, and indican by adding a few drops of 10 per
cent. chloride of calcium solution and hydrochloric acid. Should indican
be present a more or less deeply tinted indigo blue circle appears,
resulting from its oxidation.
Hippuric acid is precipitated by pure hydrochloric acid.
CHAPTER I.
POLYPI OF THE GLANS PENIS AND SHEATH.
In young animals the extremity of the glans penis and the margins of the
sheath are not infrequently studded with polypi, soft swellings of
papillomatous or verrucous appearance, sometimes of considerable size,
which interfere with micturition, and deform the glans. The existence of
these growths is shown by very well marked signs—viz., difficulty in
micturition, deformity of the sheath, deviation of the jet of urine,
obstruction in the passage of the penis, and more or less marked
deformity of the penis itself.
These polypi are of the same nature as those so common in dogs, viz.,
papillomata.
=The diagnosis= is very easy. On digital examination the growths are
almost always found at the base of the sheath.
At an early stage the =prognosis= is benign, provided intervention is
promptly undertaken. If the disease is of old standing, or is not
treated, the animals may become somewhat thin. They suffer pain, caused
by retention of urine and inflammation of the sheath; urethritis may
even be set up.
=The treatment= is fairly easy, and is exclusively surgical; but as it
necessitates casting the animals the bladder should first be examined
per rectum, and operation should never be attempted until the bladder
has been emptied so as to avoid possible rupture. The animal being fixed
on its back, the penis is withdrawn from the sheath, and the polypi can
then be snipped off with scissors, the wounds being slightly cauterised
to arrest hæmorrhage: in the case of the sheath, rather extensive wounds
must sometimes be produced; these may be sutured.
To prevent the wounds afterwards becoming infected and suppurating, the
sheath should be regularly washed out with an antiseptic solution and
the animal kept on a very clean bed.
INFLAMMATION OF THE SHEATH.
This condition is much more common in the ox than in the horse on
account of the different anatomical structure of the parts, and the
methods of keeping and using oxen.
=Causation.= Several predisposing causes undoubtedly exist. The sheath
is prolonged beneath the abdomen to a considerable distance beyond the
glans. It is narrow, deeply seated, and, during micturition, not even
the point of the penis passes beyond it. The urine, therefore, soils the
interior, or a certain quantity may be retained, according to whether
the orifice is more or less obstructed by urinary sediment, sebaceous
material, manure, or other material. Moreover, experience shows that of
all the large ruminants, those used for outdoor work are the most
affected.
Of the occasional causes, if we except sebaceous and urinary products,
the most important is mechanical violence, such as the lacerations or
wounds produced by the bed-piece of the trevis when the animal is being
shod. The working ox throws its whole weight on this bed-piece, on which
it lies on one side or the other, according to the foot which is being
lifted. The sheath is compressed, and if the animal is heavy and
struggles, the parts may be abraded and torn, or the sheath and even the
glans may be crushed. In less dangerous cases the connective tissue may
be lacerated by the edge of the bed-piece. Any injury so inflicted is
aggravated by dirt in the neighbourhood.
=Symptoms.= The first signs which attract attention are of a general
character, and seldom very strongly marked. The animal shows slight
fever, dryness of the muzzle, is restless and continually moves about,
as though to get rid of the pain it feels. The hind limbs are frequently
lifted. In this attitude it makes efforts to urinate, but urine is
passed very slowly, and the act seems painful; then, later on, the
appetite diminishes, rumination is suspended, and, as in all intense
forms of cellulitis, complications may occur.
The local symptoms are more suggestive. The slowness and difficulty with
which urine is passed at once attracts attention to the diseased parts.
Examination immediately reveals extreme sensitiveness of the sheath,
although as yet there is only slight engorgement. At a later stage a
large swelling develops and extends along the abdominal wall on either
side, sometimes upwards into the groin. In certain cases the sheath may
be totally obstructed by sebaceous and inflammatory material, and in the
absence of surgical assistance the bladder may become ruptured.
Inflammation most frequently ends in the tardy formation of an abscess,
which shows little tendency to open spontaneously. It is usually
accompanied by gangrene and by mortification of a mass of skin and
subcutaneous tissue, sometimes of portions of the abdominal tunic. Such
grave complications may even lead to the opening of an artery, and to
fatal hæmorrhage.
All these symptoms develop comparatively slowly. Abscesses scarcely ever
appear before the twelfth or fifteenth day, but when the disease is not
treated it may continue as long as five or six months. On the other
hand, resolution is the ordinary termination under suitable treatment.
=Diagnosis.= The diagnosis is easy when the exact facts can be
ascertained. The difficulty in micturition is the chief indication. At a
later stage, local swelling and acute sensitiveness are characteristic.
=Prognosis.= The prognosis is grave, having regard to possible
complications and the chronic character which the inflammation tends to
assume.
=Treatment.= When the sheath is filled with sebaceous material or
foreign substances it may be necessary to cleanse it daily with mild
antiseptic injections. Some practitioners recommend laying open the
external orifice, an operation which may be performed in the standing
position. This, however, is not without danger, and infection may easily
occur.
When the subcutaneous connective tissue surrounding the sheath and the
glans penis is infiltrated and inflamed, the inflammatory swelling must
be examined every day, so as to detect the abscesses as early as
possible, and open them without delay. Under some circumstances deep
firing in points produces very favourable results.
When an abscess has caused partial necrosis of the sheath, it is well to
pass a drain and wash out the parts frequently with antiseptic
solutions. For this purpose a counter-opening is made through the skin
opposite the fluctuating point. The mucous membrane of the sheath is
then cautiously punctured, and a seton or strip of gauze is passed by
means of a seton needle, so as to allow of constant drainage.
PERSISTENCE OF THE URACHUS.
This condition is an infirmity or congenital anomaly, rather than a
morbid condition. Persistence of the urachus after birth and after
separation of the cord is due to the fact that the canal which
communicates with the bladder fails to close up. The urine, instead of
escaping through the urethra, passes along the urachus, and the animal
urinates through its umbilicus.
=Causation.= The causes are simple. Certain practitioners have suggested
that sex has some influence, this being an anomaly occurring more
frequently in males than in females. From investigations which have been
carried out, it would appear that, in some cases, persistence of the
urachus is due to an imperforate condition of the urethra; in other
cases, to its obstruction by accumulations of mucus of a caseous
appearance, which enter the urethra and completely block the passage.
Finally, in other cases the urachus simply persists while no lesion
exists on the side of the urethra.
Whatever the original cause, escape of urine by the umbilicus produces
irritation, which may end in complications, infection of the unhealed
umbilical wound, infection of the canal of the urachus itself and the
bladder, or even infection of the peritoneum.
=Symptoms.= At first, persistence of the urachus is shown by permanent
or intermittent discharge of urine through the umbilicus. Usually this
discharge is only seen from five to eight days after birth, when the
necrosed cord is detached; in most cases it is continuous, for the
opening is abnormal and has no sphincter.
Contact with the air and the wound causes the urine to undergo a kind of
ammoniacal fermentation and to irritate neighbouring tissues, such as
the stumps of the umbilical vessels, the interstitial connective tissue,
and even the skin. The wound constitutes an excellent culture medium for
microbes. The umbilicus becomes swollen and œdematous, and soon exhibits
a saccular swelling, 2 to 4 inches in diameter, which, on palpation,
proves to be hot and painful; its centre is occupied by the opening of
the urinary fistula. A probe passed into this fistula travels upwards
and backwards (see Fig. 183).
At a later stage other complications, including omphalitis and
omphalo-phlebitis, may set in. The most frequent of the delayed
complications is purulent cystitis, with the formation of purulent
concretions in the bladder, which may occur even after the fistula of
the urachus has healed. In other cases the canal of the urachus
contracts and becomes obliterated towards the bladder. A blind fistula
then persists, with an opening at the umbilicus, or, the parts having
healed externally, all that remains is a phlegmonous swelling with the
characteristic symptoms.
=Diagnosis.= A thorough examination will invariably allow of urinary
fistulæ being distinguished from other diseases of the umbilicus, the
escape of urine at this point being so suggestive.
=Prognosis.= The prognosis is rather grave, on account of the
complications, which are possible, and, in fact, usual, unless the
disease is promptly diagnosed.
=Treatment.= Formerly as a preventive measure a ligature was applied to
the whole mass of the cord at birth, but this ligature in no way
prevents the canal of the urachus persisting after the atrophied portion
separates. Cauterisation of the urinary fistula with Rabel’s fluid or
tincture of iodine can have no good result, unless the urethra is
permeable.
If the urethra is obstructed it is evidently from that side that
treatment should be attempted, either by displacing the mucoalbuminous
plugs with a catheter or in some other way. Such intervention is very
delicate and difficult in the case of young animals. Sometimes it is
better to allow the discharge of urine from the umbilicus to continue,
and to recommend that the animal should be rapidly fattened for the
butcher.
In practice, pervious urachus may be treated by suturing, by firing
across the fistula, and sometimes by blistering. The first step in all
cases is to see that the urethral passage is free. English veterinary
surgeons claim to have had a fair measure of success from these methods.
If a radical cure were thought desirable, the abdomen would have to be
opened, and the operator would proceed to isolate the urachus, resect
it, and suture the base of the bladder by bringing together its external
surfaces. The operation, though not perhaps impossible, is of no
practical value.
CHAPTER II.
DISEASES OF THE BLADDER.
ACUTE CYSTITIS.
Cystitis, or inflammation of the bladder, may be divided into two
varieties: simple (acute or chronic) cystitis, and chronic cystitis due
to the presence of calculi.
Simple acute cystitis occurs most commonly in the cow, less frequently
in the ox, and rarely in the pig or sheep. Female animals are more
subject to it than males.
It consists of more or less acute inflammation of the vesical mucous
membrane. The inflammation sometimes extends to the muscular coat and
the peri-vesical tissues, setting up local or general peritonitis.
=Causation.= The internal causes to which Cruzel attributes the disease
are rather open to question. Retention of urine in particular is common
in working oxen, which only pass urine when resting, and this would be
more likely to produce distention, paralysis, or rupture of the bladder
than true inflammation; it is doubtful whether inflammation would even
follow the chronic irritation resulting from frequently repeated
over-distention.
The ingestion of irritant plants certainly has a more marked action.
Irritant principles eliminated by the kidneys might not injure them,
although they would bring about changes in the vesical mucous membrane,
with which they would remain in contact for some time.
More frequently cystitis is the result of inflammation due to continuity
of tissue, and forms a complication of urethritis, vaginitis, and the
conditions set up by retention of the after-birth. It may also result
from ascending infection causing pyelo-nephritis, or ascending infection
of any kind which eventually attacks the bladder. It is a very common
consequence of the use of unclean catheters, but only in equines and
females, as the catheter is not passed in the ox or bull until after
urethrotomy.
In by far the majority of cases it is of infectious, and not of toxic,
origin.
=Symptoms.= At first the symptoms are obscure. They commence with slight
colic, and are afterwards characterised by frequent, difficult and
painful micturition and by the small quantity of urine passed on each
occasion.
The urine, moreover, is modified in appearance. At first it contains a
small quantity of blood, and is reddish, or at least of a darker tint
than is usual. Later it becomes thick and whitish, and contains greyish
films of epithelium, and the _débris_ of fibrinous coagula. The
microscope reveals in it the presence of pus corpuscles, flat polygonal
cells with large nuclei, and sometimes red blood corpuscles.
Locally almost all that can be detected in male animals is a little
tenderness of the neck of the bladder on rectal examination, and in
females on examination of the meatus urinarius by means of a speculum.
The vaginal mucous membrane then appears inflamed around the meatus,
which itself is exceedingly sensitive.
In cases of very marked inflammation, accompanied by partial necrosis of
the mucous membrane or the production of false membranes, the
temperature rises as high as 104° Fahr. (40° C.), appetite disappears,
colic is extremely acute, and violent efforts to pass urine are
continually made until the animal is completely exhausted. The patient
then refuses to walk about, but frequently lies down, arches its back,
and constantly makes efforts to urinate, which are abortive or end only
in the passage of little jets of fluid.
The urine passed contains little greyish necrotic fragments or _débris_
of false membranes, suggestive of diphtheria. In female animals the
canal of the urethra may also become obstructed, and rupture of the
bladder, though rare, occasionally occurs.
In the ordinary forms inflammation persists for two to three weeks, then
diminishes in intensity, and either ends in recovery or becomes chronic.
In the grave forms, where inflammation and infection extend to the
peri-vesical tissues and the peritoneum, death by peritonitis is the
rule.
On post-mortem examination, the mucous membrane is seen to be of a
greyish colour, and sloughing or gangrenous over surfaces of varying
size, whilst the surroundings are infiltrated, blackish and greatly
thickened. The whole of the connective tissue layer which supports the
peritoneum near the base of the bladder, and also the adipose tissue
around the bladder, are markedly inflamed. At this stage
pelvi-peritonitis or generalised peritonitis may occur as complications.
In the simple forms the mucous membrane is desquamating, infiltrated,
and covered with granulations of apparent healthy appearance.
=Diagnosis.= The diagnosis is comparatively easy, the external symptoms
being so clearly defined. There is a difficulty, however, in
distinguishing this disease from cystitis caused by a calculus. In male
animals this latter form of cystitis is characterised by frequent
spasmodic contractions of the accelerator urinæ. In acute cystitis, on
the contrary, the contractions are temporary only and of no importance.
Lastly, in female animals cystitis due to calculus formation is quite
exceptional, owing to the large diameter and shortness of the urethra.
When nephritis and cystitis co-exist certain signs indicate the fact.
=Prognosis.= The prognosis varies, according to the acuteness of the
disease and the character of the urine and epithelial _débris_, which
afford valuable information.
=Treatment.= The treatment should be directed towards relieving the
vesical and pelvic pain and modifying the local conditions.
Hot fomentations to the loins and flanks relieve pain. The
administration of bicarbonate of soda and of cold drinks, such as
barley-water, decoctions of couch grass and pellitory, mucilage, etc.,
are of service. These materials are readily taken by the patients, and
have a soothing effect. Camphor also produces good results, but benzoate
of soda is most useful on account of the disinfectant action produced
within the bladder, as a consequence of the benzoic acid being
separately eliminated by the kidney. Repeated washing out of the bladder
with antiseptic solutions has been recommended, but is open to
criticism. Such treatment is difficult in male animals, owing to the
special formation of the glans penis and urethra, and in female animals
it is by no means easy. In all cases of acute cystitis, in fact, the
passage of the catheter is painful, and as a metal, gutta-percha or hard
rubber sound is used, the mere contact of the tip of the instrument
injures the diseased mucous membrane, makes it bleed, and gives rise to
danger of autoinoculation, with the possibility of serious results.
Those who recommend this method of treatment can never have followed
closely the development of a grave case of acute cystitis, and if the
practice is at all permissible, only a soft catheter should be used.
In chronic cystitis, on the other hand, washing out the bladder might be
useful.
CHRONIC CYSTITIS.
Chronic inflammation of the bladder is still rarer than acute cystitis.
It usually attacks females as a consequence of acute inflammation,
though the condition may be chronic from the first, in which case the
early stages are commonly overlooked.
=Symptoms.= The chief functions of the body do not appear to be
disturbed, although the urine seems abnormal. Micturition is difficult,
slow, and somewhat painful, and is followed by long-continued tenesmus.
The urine appears whitish, purulent, slimy, or of a deeper tint, rapidly
becoming blackish. It is of ammoniacal or fœtid odour, and decomposes
quickly.
The period of development may be prolonged, and recovery rarely occurs
spontaneously. The condition often leads to ascending infection,
inflammation of the ureters, pyelitis, and nephritis.
On post-mortem examination of animals slaughtered before complete
wasting has occurred the vesical mucous membrane is found to be
thickened, granulating, or suppurating. The muscular tissue shows
infiltration and localised sclerosis, and is very irregularly thickened,
inelastic, and wanting in contractile power. The peri-vesical tissues
may be chronically inflamed.
=Diagnosis.= The diagnosis is easy, provided the peculiar
characteristics of the urine are noted, and an examination is made
through the vagina of the condition of the walls of the bladder, of the
ureters and of the kidneys.
=Prognosis.= The prognosis is grave, because treatment would occupy too
much of the practitioner’s time to allow it to be rigorously carried
out, and therefore animals are usually slaughtered.
=Treatment.= Treatment comprises the use of many of the drugs used in
acute cystitis, particularly benzoate of soda, benzoic acid, and
bicarbonate of soda. The medicines comprised in the balsamic group are
also valuable, viz., turpentine, tar, and terpine.
In this chronic form the bladder should be irrigated, but this must be
done with strict aseptic precautions, the fluids used being cooled
boiled water, boric acid or borax solution of 3 per cent, strength, or
solution of fluoride of soda of a strength of 15 grains to the quart.
We need not point out the difficulties of pursuing this treatment in
ordinary practice. As a rule, treatment is confined to internal
medication whilst the animals are fattened.
URINARY LITHIASIS. CALCULUS FORMATION.
Normally the urine contains in solution certain salts, such as urates,
hippurates and phosphates of lime, magnesia or ammonia. Under certain
circumstances, in animals predisposed to the condition, these salts are
precipitated in the kidneys, ureters or bladder, and form powdery or
sandy deposits known as sediments; or, on the other hand, calculi,
produced by the adhesion of the powdery masses. This constitutes urinary
lithiasis.
The sediments are of a greyish-yellow colour.
The calculi are generally rose-coloured, white or somewhat grey. They
contain oxalates and carbonates of lime and magnesia, earthy phosphates,
etc. In appearance and shape they vary greatly. They may resemble coral
or may form growths of a rounded, polyhedric or raspberry appearance.
Some are hard and resistant; others friable. They vary in size between
that of a grain of sand and a hen’s egg or more. A large calculus is
usually solitary; the smaller sizes are often multiple.
Calculi occur in oxen and sheep, but more particularly in the latter
species. They develop slowly without producing any marked external
signs, and often it is only when the urethra becomes obstructed and
urine is retained that the diagnosis is established. Calculi are rare in
females in consequence of the dilatability of the urethra.
CALCULI IN BOVINE ANIMALS.
=Causation.= The older writers believed that calculi developed through
winter feeding and a stinted supply of water. Nowadays this would not
apply to well-managed establishments, water being provided regularly,
and winter feeding comprising roots, etc., rich in water. Experience and
observation have shown that the chief cause is excessive feeding,
calculus formation occurring most frequently in animals which are most
richly fed.
Nevertheless, it would be a mistake to overlook the effects of
temperament and constitution. In human medicine the importance of
hereditary predisposition and of the special diathesis is undeniable
(uric or gouty diathesis). In veterinary medicine the same thing
applies, for, apart from rich feeding, it is not uncommon to meet with
cases of gravel in animals living under the most diverse conditions,
although the issue of the same parents.
Certain infections of the urinary passages, though trifling at first, or
at least of slow development, are also capable of causing mineral
deposits in the urinary passages, a fact which Moussu considers to be
proved by his success in experimentally reproducing given forms of
pyelo-nephritis.
=Symptoms.= The symptoms are often overlooked, as long as the calculus
deposits affect only the kidneys, their increase in that part not giving
rise to alarming symptoms. It is certain that the eventual passage of
the calculus through the ureter towards the bladder causes nephritic
colic, but this form of colic is little understood, and has never been
well described. Writers have simply mentioned cases of colic accompanied
by great tenderness in the lumbar region, temporary suspension of the
secretion of urine, and more or less marked dysuria.
Nothing resembling the extremely grave symptoms of nephritic colic in
mankind has been described, though probably there is little difference
in the complaint as it affects the bovine species.
When the sediment or the calculus reaches the bladder there is a
tendency for it to be passed during micturition. The signs then become
more strongly marked, because they point to obstruction of the urethra.
If the deposit is simply of the nature of sediment, there is merely a
little difficulty in urination, accompanied by some moderate amount of
pain, and sediment is afterwards found within the sheath or adhering to
the groups of hair at its extremity.
If, however, the deposit is in the form of small calculi, these are
pushed towards the neck of the bladder and the urethra, which then
appears to be obstructed.
The obstruction may occur at the origin, at the ischial curve, or at the
=S=-shaped curve of the penis (Fig. 226). Henceforth strongly marked and
unmistakable symptoms rapidly develop. Vesical colic appears, owing to
retention of urine, and rapidly acquires extreme intensity, though it
instantly ceases with rupture of the bladder in cases where no treatment
is attempted. This form of vesical colic is accompanied by continual but
unsuccessful efforts to urinate and by spasmodic contractions of the
accelerator urinæ.
Appetite and rumination cease, and the animal shows extreme anxiety.
Palpation along the course of the penis reveals unusual tenderness, and
the calculus can sometimes be felt near the =S= curve, though more
frequently in the ischial arch. The litter is not soiled with urine.
Cautious rectal examination proves the bladder to be extremely
distended, or, in the case of rupture having occurred, entirely
collapsed. In the latter case the spasmodic contraction of the
accelerator urinæ completely ceases soon after rupture, and the animal
appears to be recovering. This deceptive calm is due to the
disappearance of the vesical colic, but the animal’s condition is still
graver in consequence, and it must of necessity die. Rupture of the
bladder is followed by inundation of the peritoneal cavity with urine,
which is partly reabsorbed by the peritoneum, producing a kind of
urinary intoxication, so that despite the elimination of certain
volatile principles through the lungs (the breath has an odour
suggestive of urine), the animal very soon dies.
In many cases, also, the urine is not aseptic, and after rupture of the
bladder acute peritonitis supervenes and carries off the patient in from
six to ten days.
Even when the urine appears to be aseptic, chronic exudative peritonitis
is produced by the irritant action of the urine on the peritoneal
endothelium. The exuded liquid mixes with the urine, and the animal soon
shows marked ascites. Despite this condition, some animals have been
known to survive as long as from three to six weeks without showing very
marked disturbance.
Death is the inevitable sequel after a longer or shorter time. When
large calculi have been arrested, or rather developed, in the bladder
the same symptoms occur should the calculus be thrust towards the neck
of the bladder so as completely to obliterate the passage. This,
however, is a very rare accident. As a rule the obstruction is merely
temporary, and the resulting vesical colic and retention last but a
short time. The displaced calculus falls back again into the lower part
of the bladder, where it is retained, and the urinary passages again
become free.
=Diagnosis.= The diagnosis is sometimes extremely easy, but it may
present serious difficulty.
When the urethra is obstructed, the symptoms are so striking that there
can scarcely be any doubt; but the diagnosis of renal calculus,
nephritic colic, calculus in the bladder, and rupture of the bladder
demands more attention. Examination of the urinary organs through the
rectum then proves of great service.
=Prognosis.= The prognosis is grave in all cases, because of the
possibility of the urinary passages being obstructed, so that surgical
interference is necessary.
=Lesions.= The lesions caused by urinary calculi may vary greatly.
Though insignificant and scarcely apparent in certain cases, they are
often very marked, and comprise simple or suppurative pyelitis,
inflammation of the ureters, hydro-nephrosis, cystitis of varying
intensity, urethritis, and inflammation of the sheath.
=Treatment.= All farmers who fatten their animals know that the use of
alkaline drugs, such as bicarbonate of soda, together with diuretics,
linseed, barley and pellitory diminish the danger of urinary calculus
formation. Bicarbonate of soda is often given with this object, and is
excellent in cases where lithiasis does not extend beyond the production
of sandy or muddy deposits. By rendering the urine more alkaline it
prevents the growth of sabulous deposits, and may even cause slow but
progressive solution of concretions already formed. When, on the other
hand, the urethra is obstructed, and urine is retained, early surgical
treatment (urethrotomy) alone offers any chance of preventing rupture of
the bladder.
Certainly it is possible, as recommended by the older practitioners, to
try massage of the glans penis and urethra opposite the obstruction,
and, after withdrawing the penis, to attempt to loosen and eject the
obstructing matter. But such attempts very frequently fail, because the
material is too firmly fixed, and no time must be lost.
Urethrotomy is usually practised at one of two points, according to
circumstances—firstly, opposite the ischial arch; and, secondly,
opposite the =S=-shaped curve.
=Ischial urethrotomy= is the promptest method of affording relief, and
should always be preferred whenever there is danger of rupture of the
bladder.
It is performed in the standing position, but is only possible when the
animal is not too fat.
In other cases urethrotomy is performed opposite the point where the
calculus is fixed, and aims at removing the obstruction. It can only be
practised after casting the animal; but, in this case also, it is
indispensable that the animal should not be excessively fat, as in such
cases a secondary urinary abscess is almost certain to form.
Should the animal be so fat as to render treatment difficult, it is best
to slaughter it at once.
URINARY CALCULI IN SHEEP.
Urinary calculi are commoner in sheep than in oxen, and seem to depend
more on the breed and on conditions of feeding. They are almost
exclusively confined to animals which are richly fed, to show animals,
and to males. In exceptional cases they are seen, under ordinary
conditions of feeding, in aged subjects.
Calculus formation can moreover be induced experimentally, and in a
relatively short time, by giving certain rations—_e.g._, 7 lbs. per day
of maize, lentils and beans for adults, and 3 lbs. for lambs. The other
favouring circumstances, viz., hereditary gouty diathesis and infection,
are less well established than they are in the case of the ox.
In sheep the symptoms are still less characteristic than in oxen, for
which reason gravel in sheep merits special description.
It shows itself in the passage of turbid urine, forming a deposit at the
extremity of the sheath, which becomes somewhat inflamed. The colic
resulting from retention of urine is shown by depression, want of
appetite, dysuria, and generalised convulsive shivering fits.
The patients lie down in the sterno-abdominal or sterno-lateral
position. They constantly suffer from attacks of general violent
shivering, and die after twelve, twenty-four, or forty-eight hours.
On post-mortem examination the bladder is found to be ruptured, or the
urethra obstructed.
=Diagnosis.= The diagnosis involves no difficulty, provided the method
of feeding is understood. In many cases the shepherds themselves
perfectly recognise the cause of the symptoms.
=Prognosis.= The prognosis is very grave, it being impossible to pass
the catheter on account of the perineal valve in the urethra, while it
is difficult to operate, the urethra being very small and deeply
embedded in a thick layer of fat.
=Treatment.= The only resource is massage along the urethra, which may
sometimes break up the mass of sediment or move the obstructing
calculus. One remark may, however, be made, viz., that in the majority
of cases the urethra is obstructed at its extremity by local
accumulations of sediment behind the spiral filiform prolongation of the
penis.
It is then sufficient, and experienced shepherds have no hesitation in
performing the operation, to remove the spiral filament, thus
facilitating the expulsion of the sediment and affording relief. If both
methods, viz., massage and section of the filament, fail, the animal
should be slaughtered, so as to avoid rupture of the bladder, which
would render the flesh useless as food.
From a preventive standpoint, all sheep which are richly fed should
receive an allowance of some slightly alkaline drink.
PARALYSIS OF THE BLADDER.
Paralysis of the bladder is somewhat frequent in female, but very rare
in male, animals. In the majority of cases it is the consequence of
difficult parturition, or is a post-partum complication.
It is characterised by incontinence of urine or retention with overflow.
The continuous discharge soils the hind quarters, hocks, shanks,
pasterns, etc., and the urine decomposes and causes irritation; it soon
sets up urinary eczema in all the parts with which it comes in contact,
a condition which can only be successfully treated by removing the
cause.
=The prognosis= is grave, for methods of treatment are few, and of
doubtful efficacy.
=Treatment.= If the condition results from post-partum infection, this
must naturally first receive attention. Should the infection have
disappeared whilst incontinence of urine still continues, the
administration of tonics, _e.g._, tincture of nux vomica in daily doses
of ¾ to 1 drachm for ten days or so in the case of a bovine animal, and
a stimulating application to the lumbo-sacral region, may bring about
recovery.
But if, in spite of such treatment, the incontinence persists, it is
better, from an economic standpoint, to treat the urinary eczema with
astringents, etc., and quickly to fatten the animal.
EVERSION OF THE BLADDER.
Eversion of the bladder only occurs in female animals after difficult
parturition. The viscus is turned completely inside out, as occurs in
eversion of the uterus, the base of the bladder becoming invaginated in
the cavity of the bladder itself, and afterwards passing into the
urethra and vagina. The bladder thus becomes totally displaced, and
appears between the lips of the vulva, resting on the inferior
commissure, and forming a mass the size of an orange.
Eversion cannot occur unless the ligaments of the bladder have become
relaxed, stretched or ruptured. Expulsive efforts and the pressure of
the intestinal mass complete the process, the peritoneum and
peri-vasicular layers of connective tissue being torn.
=Diagnosis.= The diagnosis of eversion of the bladder presents no
difficulty. The everted mass appears to have a narrow neck opposite the
meatus, and is seen to form a reddish, unctuous mass. The mucous
membrane now forms the external coat and appears covered with mucus so
long as inflammation does not occur.
The urine continually escapes from the ureters (which open on the
surface of the mucous membrane) as it is formed, and flows away by the
lower commissure of the vulva. The vulva is half open, and the
prominence formed by the bladder projects beyond it.
=Prognosis.= The prognosis is grave, because reduction is difficult, and
may be accompanied by rupture of the organ; also because even in
favourable cases it is invariably followed by acute cystitis.
=Treatment.= Treatment is confined to reduction. Before attempting this,
measures must be adopted to prevent straining, either by passing a rope
round the animal’s body, thus causing it to flex the vertebral column,
or by puncturing the rumen or performing tracheotomy. The open hand is
then applied to the surface of the swelling, which is gently compressed
and thrust in turn through the meatus and urethra. The portions nearest
to the urethra should first be returned. It is sometimes necessary to
use both hands, and even to employ a catheter with a large round head,
to reduce the eversion effectually. After reduction a truss or vulval
clamp should be applied. Subsequent treatment consists in the
administration of sedatives—_e.g._, laudanum, mucilaginous drinks,
barley-water, pellitory, etc.
HÆMATURIA.
Hæmaturia, _i.e._, the passage of blood-stained urine, is in itself only
a symptom, which may accompany very varying conditions, such as the
congestion peculiar to the early stages of nephritis, traumatic lesions
of the kidneys, ulceration of the uriniferous tubules, or of the pelvis
of the kidney, lesions of the ureters, bladder, etc., etc. The term,
therefore, does not indicate a disease, but nevertheless in bovine
practice the term hæmaturia has acquired a special significance.
This hæmaturia of bovine animals is clinically indicated by the presence
of blood in the urine; anatomically by lesions of the bladder, sometimes
also of the ureters. It is probable that some forms at least of the
condition will ultimately be proved to be due to the piroplasmata, but
in the present state of our knowledge the disease can only be described
from the clinical standpoint. The reader is recommended to refer to the
article on “Bovine Piroplasmosis,” _ante_.
Pichon in 1863 and Sinoir in 1864 introduced the name “hæmaturia” in the
course of their remarkable investigations concerning the disease. Vigney
in 1845 and Gillet in 1862 had previously described it, and it has since
formed the subject of constant researches.
Detroye in 1891 termed it “essential hæmaturia,” and Galtier in 1892
gave it the name of “hæmorrhagic cystitis.” Boudeaud in 1894 also used
the term “hæmaturia of bovine animals.” In Germany the disease is known
as “stallroth” (stable-red).
=Geographical distribution.= Hæmaturia is a perfect scourge in certain
countries. It seems to have made its appearance in the departments of
the West of France, the Mayenne and the Sarthe, afterwards spreading
into the Maine-et-Loire and the Indre. At the present day, it inflicts
great ravages in the Creuze, the Corrèze, Haut-Vienne, Cantal and
Haute-Loire districts. It has been described in Germany, Belgium, and
Italy. These forms are probably due to _Piroplasma bigeminum_.
=Causation.= The most varying opinions have been advanced regarding its
cause. Pichon believed its appearance was due to changes in cultivation,
which between 1830 and 1860 completely altered the general appearance of
the country and the conditions of breeding in the old province of Maine.
Land reclamations and the use of lime dressings have been mentioned, as
well as the introduction of the Durham breed of cattle. Sinoir
practically adopts the latter view, for he considers that the crossing
with the Durham breed, while increasing the precocity, has diminished
the powers of resistance of the indigenous cattle.
But in course of time these ideas have become modified, and
investigation has taken a new direction. Detroye regarded the disease as
a microbic and easily transmissible disorder, while Galtier in the
following year described it as merely a chronic hæmorrhagic cystitis,
produced by the consumption of irritant plants in animals previously
suffering from distomatosis. In Germany, Arnold attributed “stallroth”
to coccidia developing in the epithelium of the vesical mucous membrane.
Cruzel considered the disease to be due entirely to poor feeding.
Boudeaud thought the same. He says that hæmaturia affected one-tenth of
the whole of the oxen in the south of the Indre and the north of the
Creuze, in parts where the arable soil is thin and poor in phosphoric
acid. Furthermore, he suggests that dressings with lime and phosphates
would result in the disappearance of hæmaturia.
We cannot admit that poor forage and feeding alone are sufficient to
produce hæmaturia, for one frequently sees poorly nourished animals pass
through all the stages of wasting and most profound cachexia without
ever showing signs of this particular ailment. Besides, hæmaturia may
attack animals in good condition.
Detroye’s early opinion as to the infectious or microbic nature of the
disease seems scarcely more acceptable, for it now appears certain that
the organism originally described is incapable of producing the disease.
Galtier’s theory is still less admissible. According to the Lyons
professor, hæmaturia occurs only in animals suffering from distomatosis.
The liver, he says, being affected by the growth of liver flukes, no
longer performs its proper work of destroying toxins, and if under these
conditions the animals eat improper food containing ranunculaceæ,
sedges, rushes, etc., the toxic principles of these plants are absorbed.
Then, he adds, these principles being no longer destroyed, are
eliminated by the kidneys, their stay in the bladder causes irritation,
and hæmorrhagic cystitis is set up, this being afterwards maintained by
microbic agents in the bladder.
This very specious theory, all the points in which may readily be
refuted, in our opinion falls to the ground before the simple fact that
hæmaturia occurs in animals which present no trace of distomatosis on
post-mortem examination, and that, furthermore, it is not seen in the
lower regions of the departments of the Nord, the Pas-de-Calais and the
Somme, where ranunculaceæ and other irritant plants are common and
distomatosis rages.
Moussu states that he has proved that hæmaturia is very rare in young
animals and is exceptional before the age of two and a half years or
three years; that it attacks oxen as often as cows; that it is
particularly common in low regions; and that it is scarcely ever seen
above a height of 800 yards. Careful investigation, moreover, shows that
the passage of blood occurs just as frequently in winter, when the
animals are housed, as in spring, when at pasture.
=Lesions.= The lesions of hæmaturia are to be found in the bladder,
though in exceptional cases they may also affect the ureters and
kidneys. They have been described by Pichon and Sinoir, but as these
observers regarded the condition as a disease of the blood due to poor
feeding, etc., they did not attach much importance to them. Detroye has
described the different appearances very well, though Moussu states that
he has never met with the “blisters” which he mentions.
The first period is accompanied simply by abnormal vascularity of the
bladder, which appears in the form of true varicosities of the submucous
vessels and intra-mucous capillaries. But if this lesion is primary, it
does not correspond to the period during which blood-stained urine is
passed, and is not sufficient to explain it. It always appears in the
form of a more or less abundant hæmorrhagic intra-mucous, sub-epithelial
spotting.
Over the hæmorrhagic area, which may be of very varied dimensions,
ranging from those of a small pin’s head to those of a lentil, the
epithelium is swollen and loosened, and so separated from the
surrounding parts as to have lost its vitality. This patch of separated
epithelium soon falls away, leaving an epithelial ulceration of the
mucous membrane. The subjacent clot rapidly breaks up in contact with
the liquid in the bladder, and is replaced by a small ulceration which
becomes the seat of continual capillary hæmorrhage. Nevertheless, the
neighbouring tissues react, and the process of repair may end either in
true cicatrisation, which appears to be rare, or more frequently in the
formation of exuberant granulations, which are also of the nature of a
soft, bleeding vegetation. This vegetation is either sessile or
pedunculated, and is of very varying size.
The wall of the bladder also reacts, becoming sclerosed and thickened
beneath the granulations, so that, in animals which have long suffered
from hæmaturia, it may entirely have lost its dilatability.
When the disease has existed for a certain time, sub-epithelial
hæmorrhages, ulcerations, vegetations and points of sclerosis may all
co-exist, a fact which shows that the disease does not develop all at
once, but that, on the contrary, every little lesion develops separately
and continuously. This fact also explains the length of time for which
blood may be passed, despite the presence of old or healed lesions.
Finally, in very old standing cases dating from several years back
(Moussu saw an animal aged twenty-eight years which had suffered from
this disease for more than twenty years, but in a very intermittent
fashion), it is not exceptional to find numerous papilliform vegetations
1 or 2 inches in length, either with a fine pedicle or largely sessile,
invading one-half or two-thirds of the internal surface of the bladder.
These vegetations sometimes, though rarely, invade the ureters. When
they occur towards the point where these conduits enter the bladder,
they obstruct the passage of urine, and lead to the development of
hydro-nephrosis or pyelo-nephritis.
=Symptoms.= The early symptoms often escape notice, because general
disturbance is rare. The first appreciable signs are cystitis and
frequent urination.
The urine passed is turbid, particularly towards the end of the act of
urination; then it is of a pink or red colour, and all intermediate
shades between a pale pink and a bright arterial red colour may be
observed.
The patients sometimes seem to pass unaltered blood in the urine, but on
microscopic examination this blood is found to be extremely diluted.
Provided the bladder is not gravely infected by the (secondary)
penetration of germs into its cavity the blood corpuscles remain normal,
or are scarcely changed. As soon as the bladder, however, becomes
secondarily infected an almost immediate change takes place; the red
blood corpuscles become crenated, broken up and dissociated; the
hæmoglobin is also partly dissolved and modified, and at this stage the
urine is red-brown or coffee-coloured, according to the length of time
it has been retained in the bladder.
In other cases, chiefly when hæmaturia has existed for some time, the
extravasated blood coagulates in the bladder, and the urine passed
contains filamentous clots the size of a man’s thumb, a pigeon’s egg, or
more. If the clots formed are too large to be passed, which is often the
case in the ox, they may obstruct the urethra, causing retention of
urine and all the accidents which accompany this condition, even
including rupture of the bladder. This, in the ox, is a frequent
termination. In the cow the dilatability and shortness of the urethra
render retention of urine much rarer. It is certainly possible, however,
and it is not exceptional, to find from 4 to 6 lbs. of clotted matter in
the distended bladder. All these conditions can be detected by rectal
exploration, and by attention to the symptoms of obstruction of the
urethra.
Whenever there is retention of clots dysuria is extremely marked and, so
to speak, permanent, the animals having continual tenesmus.
Hæmaturia observes a slow, progressive course, which, in time, ends in
death by exhaustion, though this is not invariably the case. Hæmaturia
is frequently intermittent, and, after having been very marked for weeks
or months, may suddenly or gradually cease, and only reappear a long
time afterwards. This fact is explained by a study of the development of
the lesions. When ulceration occurs the sub-epithelial vessels of the
mucous membrane, which have contributed to the formation of the
hæmorrhagic spot, are widely open, and a capillary hæmorrhage results;
but as soon as a small clot forms in this position, or local capillary
thrombosis occurs, the hæmorrhage ceases, with the result that the
hæmaturia disappears. Unfortunately, however, the obliterating clots are
not permanent, any more than the local thrombosis—or, in the event of
their proving permanent, another small lesion develops at a different
point, and this lesion may at any time cause the reappearance of the
hæmaturia; the process goes on until the animal succumbs. Should the
lesions heal successively, spontaneous recovery may take place, but such
recovery is exceptional.
The animals may not appear to suffer from the passage of blood for weeks
or even months, but after a time they become less capable of replacing
the loss. They become anæmic, the number of corpuscles falls from the
normal figure of from six to seven millions of red corpuscles per cubic
millimètre to three millions, two millions, one million, and even to
five hundred or eight hundred thousand.
The richness in hæmoglobin simultaneously diminishes; wasting progresses
to the point of cachexia, and the appetite diminishes while diarrhœa
appears; swellings are noticeable about certain parts of the body; and
the animals, continuing to pass blood, die in a state of absolute
exhaustion, without apparent suffering.
This termination is the most common, unless slaughter is determined on,
and is very different from the premature end which follows the formation
of clots and obstruction of the urethra.
Externally the patients only show feebleness, pallor of the visible
mucous membranes, and difficulty in urination. The bunch of hair at the
lower commissure of the vulva is always soiled with blood-stained urine
or little clots.
Hæmaturia may cause death by exhaustion in from six weeks to two months,
but not infrequently it lasts for months or even years.
=Diagnosis.= The diagnosis presents no difficulty when the urine can be
examined; but in the periods of intermittence no opinion can be
advanced. These intermittences are so frequent that in parts of the
country ravaged by this disease it is a usual custom, when selling, to
grant or refuse guarantees for a longer or shorter term.
The condition can be distinguished from parasitic hæmoglobinuria
(piroplasmosis) or from Brou’s disease (a febrile disease of rapid
development) by simply examining the urine or blood.
=Prognosis.= The prognosis is extremely grave, for, up to the present,
no really efficacious treatment has been discovered, and although some
animals may live for years without their lives being in any way
endangered, this cannot possibly be foreseen, and there is no economic
advantage in keeping them.
=Treatment.= No curative treatment is known.
It is true that iron salts, tonics, Rabel’s liquid, decoctions of
certain plants, such as plantain, have been recommended, but apart from
the fact that they are of doubtful efficacy, they cannot be used over
long periods. All these preparations also tend to increase the
coagulability of the blood; but considering that the disease is beyond
question of a parasitic character, good results cannot always be
expected of them.
Preventive treatment appears more hopeful, although even in this
connection, the best informed appear to have considerable doubts. All
those who have studied the question agree in recommending drainage of
the pasturages, and their improvement by the use of various manures,
particularly superphosphates and lime. These improvements alter the
character of the pasture, render the soil healthier, and may perhaps
prove sufficient to diminish or prevent the local growth of the germs.
Under such conditions, Boudeaud declares that he has seen hæmaturia
disappear from farms where it had previously been in permanent
possession. It has also been recommended that the affected cattle should
be sent elsewhere to places where the disease does not exist, and
experience shows that spontaneous recovery is more frequent under such
conditions.
It is probable that, during attacks of hæmaturia in a contaminated
country, successive parasitic infestations occur, which would explain
the persistence with which blood is passed, a symptom which does not
occur in a healthy country. This view, however, is still only an
hypothesis.
CHAPTER III.
DISEASES OF THE KIDNEYS.
CONGESTION OF THE KIDNEYS.
Congestion of the kidneys is not a morbid condition in the strict sense
of the term, for it is merely the forerunner of nephritis caused by
infectious diseases or intoxications (primary active congestions) or the
final consequence of other diseases, such as diseases of the heart or
liver, mechanical compression of the vena cava or renal veins (secondary
passive congestion, cardiac kidney).
Nevertheless, under certain circumstances the development of nephritis
may be arrested at the primary congestive stage, and it is only then
that an opportunity occurs of studying it as a definite complaint.
=Causation.= All infections accompanied by lesions of the kidneys, and
these are numerous (gangrenous coryza, anthrax, parasitic
hæmoglobinuria), produce congestion of the kidneys.
Cold also acts directly under certain conditions, as do large doses of
diuretics, irritant foods the principles of which are eliminated through
the urine (fermenting or putrid sugar-pulp, for example), and foods rich
in resins, essential oils, various glucosides, tannin, etc. (young
shoots of trees during the spring-time).
=Symptoms.= The symptoms are difficult to define accurately, and the
diagnosis can only be arrived at with the aid of the history.
Renal congestion produces pain, indicated by dull colic and repeated and
ineffectual attempts to urinate, suggesting acute cystitis. The patients
lose appetite, and present all the general symptoms of marked visceral
inflammation, viz., fever, acceleration of breathing, somewhat
tumultuous action of the heart, etc.
External or internal examination of the kidneys reveals abnormal
sensitiveness. The urine is of a dark or bright-red tint, owing to the
presence of red blood corpuscles. These blood corpuscles are
precipitated on placing the fluid in a tall glass, and can be detected,
together with renal epithelium, by microscopic examination.
=The diagnosis= is somewhat difficult, and it requires very careful
attention to distinguish between congestion of the kidney and true
nephritis.
=The prognosis= should always be reserved until it is certain that acute
nephritis will not ultimately develop.
=The treatment= consists in removing the cause of the congestion; rich
foods, or foods containing irritant principles, should, therefore, be
avoided, as also the administration of diuretics, etc.
Otherwise, the treatment is similar to that employed in all visceral
inflammations: bleeding to the extent of two to four quarts, according
to the size of the animals, warm poultices to the loins and flanks, dry
friction, mucilaginous drinks and emollient decoctions of barley or
pellitory. The animals should be kept in a warm place.
In cases of passive and secondary congestion, treatment must be directed
towards improving the condition of the organ primarily affected, whether
it be the heart, liver, or lymphatic glands.
ACUTE NEPHRITIS.
The term nephritis applies to inflammation of the renal tissues.
Clinically, two forms only can be distinguished, the acute and the
chronic.
As regards its pathological anatomy, the inflammation may principally
affect either the interstitial tissue or the epithelial parenchyma, a
fact which has suggested the division of the condition into epithelial
nephritis, interstitial nephritis, and mixed nephritis. Clinically, such
distinctions are impossible; and in reality all forms of nephritis are
to a varying degree mixed, the lesions predominating in one or other of
the constituent tissues. These lesions depend on the extent, intensity,
and duration of the inflammatory attack, whatever the primary causes.
All the constituent tissues of the kidney may be affected,
simultaneously or individually: the Malpighian corpuscles, the
convoluted tubules, the collecting tubules, or the interstitial
connective tissue.
=Causation.= Cold seems to be an important factor. All acute or chronic
intoxications in which the toxic principles are eliminated by the
kidneys, such as poisoning by cantharides, fermented beet pulp, young
shoots of trees or toxic plants, may cause acute nephritis.
Infectious diseases, such as gangrenous coryza, hæmoglobinuria,
tuberculosis and post-partum infections, also play an important part,
whether the nephritis be direct, that is to say, the result of the
infecting agent itself, or indirect, _i.e._, produced by toxins
generated in the body. In female animals gestation is an often
unsuspected cause. Moussu believes that albuminuria is frequent during
gestation, and although in most cases it is only of moderate degree, he
thinks it is often associated with subacute nephritis, which might be
aggravated by an accidental cause.
Many forms of nephritis are overlooked in consequence of their slight
character.
=Symptoms.= The early symptoms are similar to those of congestion of the
kidney, viz., dull colic, excessive sensitiveness over the region of the
loins, passage of pink urine, loss of appetite, and fever. At a later
stage, in cases of acute nephritis due to cold, the animal stands with
the limbs close together and remains stationary, arching the loins and
back, which are held stiffly. The animal obstinately refuses to move in
consequence of the pain produced by so doing.
The general condition becomes grave, respiration is rapid, the pulse
frequent, the artery tense, the muzzle dry, the accessible mucous
membranes are injected, and appetite is almost entirely lost.
Urine is frequently passed, but the act causes pain, and the quantity is
small. Absolute anuria is rare, and does not last long.
The urine is generally sanguinolent, at least at first, but to a very
varying extent. It is always albuminous, the quantity of albumen varying
enormously, and on microscopic examination, is usually found to contain
red and white blood corpuscles, epithelium from the kidney hyaline or
epithelial cylinders, and, towards the end, pus corpuscles.
Œdema or anasarca, though common in mankind, does not occur in a very
marked form, except in intense acute nephritis. Epistaxis is also rare.
=Diagnosis.= The diagnosis requires some care, because unless the urine
be examined the symptoms might lead to error. Nevertheless, it is always
possible to distinguish between this condition and hæmaturia or
accidental renal hæmorrhage.
=Prognosis.= The prognosis is grave, because absolute recovery is rare,
and because the condition is very apt to become chronic.
The degree of anuria and the respiratory difficulty are of great service
in confirming the prognosis. As soon as urine is freely passed the
prognosis becomes more favourable.
=Treatment.= Among the most effective methods of treatment must be
included bleeding, which always produces some improvement. Dry friction
over the kidneys and flanks, hot moist applications, and the application
of a sheep-skin to the loins are also of service. Internally,
mucilaginous drinks, diuretic decoctions and milk give the best results.
The proportion of albumen rapidly diminishes, dysuria becomes less
marked, urine is passed in greater quantities, and in from eight to ten
days all the alarming symptoms disappear. Bicarbonate of soda may then
be given for a fortnight.
In very grave cases camphor, bromide of camphor, injections of
camphorated oil (1 to 2½ drachms internally, or 1 to 1¼ drachms in
subcutaneous injections) give excellent results in modifying the pain
and moderating the inflammation.
From ½ to 1 drachm of digitalis in powder, or better still an injection
of from 5 milligrammes to 1 centigramme of digitalin may also be given
when dyspnœa is very great and is accompanied by anasarca. Medicines
such as oil of turpentine and considerable doses of nitrate of potash,
however, are contra-indicated.
CHRONIC NEPHRITIS
True chronic nephritis, _i.e._, a condition strictly limited to the
renal tissue, and unaccompanied by pyelitis, is still little known among
our domestic animals. The symptoms characterising it have not always
been carefully noted, and the diagnosis is very often uncertain.
Nevertheless, one of the most common forms has been carefully studied by
Seuffert, viz., chronic hypertrophic nephritis.
=Causation.= Chronic nephritis is the common sequel to the acute forms,
whatever their origin, but it may also occur primarily from repeated
chills produced by such conditions as exposure to heavy continued rain
when at grass, chills contracted during cold nights and the great
variations in temperature in spring and autumn. The conditions, however,
thus produced are rather of the nature of subacute nephritis than of
chronic nephritis, properly so called.
These forms of chronic nephritis may also occur primarily in consequence
of chronic hepatic lesions with pressure on the posterior vena cava,
producing blood stasis in the kidneys. Finally, they may represent the
delayed effects of slight lesions which have escaped notice and have
developed during grave diseases or as a consequence of repeated
gestation.
From the anatomico-pathological standpoint, the only conditions hitherto
recognised are the chronic hypertrophic forms of nephritis (large, white
sclerotic kidney with lardaceous degeneration and sometimes marbling).
This is probably because the animals are slaughtered as soon as they
suffer in condition, but if they were kept long enough they would
undoubtedly suffer also from the atrophic chronic forms of nephritis
found in man and in the dog. In the case of man observation has shown
that these two forms only represent different stages in the development
of one disease, the large, hypertrophied kidney of the early stages
afterwards undergoing marked progressive atrophy.
=The symptoms= are at first so vague that diagnosis would be impossible
on a single examination. Seuffert states that the condition develops as
follows:—
The first sign, loss of appetite, is soon followed by constipation and
dull colic, due to congestion of the kidney; the pain is often so great
as to cause intermittent groaning.
The urine passed is always turbid, and sometimes blood-stained, but this
staining rarely lasts longer than a week. The urine then gradually
resumes its normal appearance, is passed in small quantities, and
contains more or less albumen. The yield of milk markedly and
progressively diminishes.
If treatment is resorted to at this stage laxatives and diuretics appear
to effect a real improvement. Unfortunately, however, the apparent
improvement is but temporary; the kidneys become hypertrophied, and the
right soon occupies the whole of the sublumbar space, its margin
extending as far as the extremity of the transverse processes near the
anterior angle of the hollow of the flank.
This hypertrophy and the extreme sensitiveness can be detected by
external palpation. Internal examination confirms the facts so observed
as regards both the kidneys.
The patients eat little and become thin, whatever treatment be adopted.
They progressively waste, and die after some months in a state of
marasmus, exhausted and intoxicated.
It is very probable that the digestive disturbances are complicated by
respiratory and cardiac trouble, as in man and the dog; but neither
cardiac nor uræmic disease of the kidney has been recorded.
=Diagnosis.= When the urine is analysed the diagnosis becomes
comparatively easy. Persistent albuminuria and hypertrophy of the
kidneys during the early stages are significant indications. There can
be little hesitation except in so far as pyelo-nephritis and
hydro-nephrosis are concerned, but the conditions are distinguished by
the character of the urine in the two latter cases, together with the
condition of the pelvis of the kidney, and of the ureters.
=Prognosis.= The prognosis is grave, and Seuffert believes that recovery
never occurs. This is also true, generally speaking, as regards all
forms of chronic nephritis.
=Treatment.= As the disease must be regarded as incurable there is
really no justification for treatment. Nevertheless, if for special
reasons the owner wishes to keep the animals for a certain time, as in
the case of a cow near its time of calving, recourse may be had to the
internal treatment suggested in acute nephritis, viz., mucilaginous
drinks, diuretic infusions, milk, bicarbonate of soda, stimulating
applications to the loins, etc.
HYDRO-NEPHROSIS.
Hydro-nephrosis, _i.e._, retention of urine in the pelvis of the kidney
and in the collecting and secreting tubules, is a somewhat common malady
of the bovine species. It is usually confined to one kidney.
[Illustration: $1]
=Causation.= Anything which obstructs the discharge of urine through the
ureters may cause hydro-nephrosis. Thus, vesical tumours pressing on the
orifices of the ureters, calculi which have become fixed in them,
torsion or “kinking” of the ureters, may bring about hydro-nephrosis.
The urine secreted by the kidney being unable to escape, accumulates in
the pelvis of the kidney, in the ureter, and uriniferous tubules,
producing dull colic, which escapes observation, or the exact cause of
which is not discovered, because the second kidney vicariously acts for
the one affected, and urination continues regularly. Secretion
continuing in spite of the obstruction, that portion of the ureter above
the obstructed point, together with the pelvis and the uriniferous
tubules, gradually becomes dilated, until the whole mass of the kidney
is hypertrophied.
The ureter sometimes becomes enlarged to the size of a man’s arm, the
kidney double, treble, or quadruple its normal side: the interlobular
divisions are lost, and each circumscribed lobule soon forms a cystic
cavity varying in size. The pressure due to the accumulated urine causes
the renal tissue, first the medullary substance and afterwards the
peripheral zone, to undergo atrophy.
The kidney is represented by a vast cystic cavity, and the lobules by
culs-de-sac; the cortical layer may become atrophied to such a degree as
to form merely a fibrous sheath, the primary constituent elements of
which are difficult to discover. From 20 to 40 pints of liquid may
sometimes be found in the cystic kidney.
=Diagnosis.= The condition is rarely diagnosed, because, as one of the
kidneys continues to act, no acute disturbance follows. Only in cases
where the cystic kidney projects into the flank are suspicions aroused.
Examination per rectum will then permit of the diagnosis being made.
=Prognosis.= Hydro-nephrosis being, as a rule, unilateral, the prognosis
is not very grave as regards immediate danger. As the condition is
hopeless, however, the lesions being irreparable, the animal should be
prepared for slaughter.
=Treatment.= Practically there is no treatment. Puncture of the cystic
cavity or even the removal of the hydro-nephrotic kidney certainly
suggests itself, but, as such operations are usually opposed to the
interests of the owner, they are rarely or never practised.
INFECTIOUS PYELO-NEPHRITIS.
[Illustration: $1]
The term “infectious pyelo-nephritis” describes an inflammation which
may involve any portion of the mucous membrane of the urinary tract, and
which is produced by a special bacillus. As a rule, this inflammation
commences in the mucous membrane of the calices and pelvis (pyelitis).
It afterwards extends into the depths of the uriniferous canaliculi
(nephritis), but in grave and old-standing cases the mucous membrane of
the ureters and the bladder may also be affected. The disease had long
been known in France (Rossignol, 1848). It was afterwards described in
Germany (Siedamgrotsky, 1875; Pflug, 1876), in Switzerland (Hess, 1888),
and also in France (Lucet, 1892; Masselin and Porcher, 1895).
=Causation.= Female animals are more frequently affected than males,
because the lesions are produced by an ascending infection, originating
very frequently in genital infection after delivery. Nevertheless,
calculus formation is also an important factor in producing the disease.
Many different agents are capable of producing pyelo-nephritis. Hofflich
in 1891 described a bacillus about 2 to 8 micromillimètres in length,
which stained readily with aniline colours and with Gram solution. Lucet
in 1892 found a short bacillus which did not stain with Gram, and later
another thin bacillus which did. Kitt has described cocci, but no other
organisms. Masselin and Porcher discovered a cocco-bacillus which
stained with Gram and reproduced the disease in an animal lent by
Moussu, after a single intra-vesical injection of the culture. Cadéac
has met with staphylococci, and Moussu has discovered various bacilli,
some resembling the colon bacillus, and pyogenic streptococci.
There is no doubt that many different organisms may produce
pyelo-nephritis by ascending infection. The most common seem to be forms
of paracoli, such as the _Bacillus ureæ_. Moussu nevertheless believes
that Hofflich’s bacillus, which was rediscovered by Porcher, is that
which produces typical pyelo-nephritis. It grows in the bladder without
producing cystitis, and is succeeded by an ascending infection of the
ureters without causing primary ureteritis, the local inflammation
occurring chiefly, it would seem, in the pelvis and the kidney. All the
other organisms which Moussu has tested have caused lesions of cystitis
and of ureteritis, together with those of pyelo-nephritis.
In these latter cases the pyelo-nephritis assumes the acute form, and is
accompanied not infrequently by cellulitis and abscess formation in the
tissue around the kidney.
=Symptoms.= Pyelo-nephritis develops in one of two principal forms, the
slow chronic form, which is the most frequent, or an acute or subacute
form, much more rapid in its development.
The chronic form for a time escapes notice. There is no doubt that at
first some general disturbance occurs, such as diminution of appetite,
disturbed nutrition, unhealthy general appearance, staring of the coat,
tightness of the hide, wasting, etc., but such symptoms are in no wise
characteristic, being found in all grave diseases.
The signs only become really significant from the clinical standpoint
when the urine appears modified in character, and such modification does
not occur until the pelvis of the kidney and the kidneys themselves are
already gravely diseased.
The urine is then turbid, of a brownish colour, and charged with
sediment, filaments of mucin, pus corpuscles, and earthy phosphates. On
analysis it is found to contain more or less albumen.
At a late stage it may even become glairy, blood-stained, or of the
colour of blood, and when the pelvis or the calices of the kidney are
ulcerated may, on standing, deposit considerable quantities of red blood
corpuscles.
[Illustration: $1]
Exposed to the air, the urine rapidly assumes a brown tint and smells
strongly of ammonia.
Percussion of the loins in the region of the kidneys causes pain, as
does external palpation by the flank. On rectal examination at this
period the ureters are found to be distended and hard, and they give the
impression of rigid or bosselated fibrous cords, sometimes as large as a
child’s arm. The corresponding kidney, often both kidneys, are enlarged,
sometimes to double or treble their normal volume, and are painful on
pressure and fluctuating, at least in the region of the pelvis. On
vaginal examination the meatus urinarius is usually found to be
inflamed, rough and turgid.
In this condition the animals rapidly lose flesh, the appetite becomes
irregular, the general condition gradually gets worse, and they die as a
result of continued uro-septic fever or uræmic troubles.
The acute form takes a much more rapid course, with fever, more marked
general disturbance, acceleration of pulse and breathing, the passage of
turbid and sometimes purulent urine with a strong ammoniacal smell.
Pyo-nephrosis is the most frequent and characteristic end. Ordinary
chronic pyelo-nephritis may also occur in these cases, and the acute
course may be determined simply by accidental ascending infections.
=Diagnosis.= During the early stages diagnosis is extremely difficult,
unless a careful examination of the urine be made. Afterwards it becomes
easy, the appearance of the urine and the indications furnished by
rectal exploration being perfectly characteristic. In very exceptional
cases there may be some doubt, as where the urine remains normal, in
spite of hydro-nephrosis, or where there is old-standing hæmaturia or
renal tuberculosis. In simple hæmaturia the lesions are confined to the
bladder and ureters, the kidneys not being affected, and in renal
tuberculosis the diagnosis can always be confirmed by the use of
tuberculin.
=Prognosis.= The prognosis is extremely grave, for the lesions produced
are irreparable, and, moreover, local intervention is impossible.
=Treatment.= There is no curative treatment. All that is possible is
palliative treatment with the object of facilitating the function of the
kidney and of disinfecting the urinary passages by administering
antiseptic substances which are excreted by the kidney. It is not
possible, however, to administer active drugs of this kind (_e.g._,
combinations of carbolic acid). As the kidney acts badly it soon ceases
to eliminate such substances, and the condition would not be improved,
but aggravated.
Benzoate of soda in doses of 2 to 2½ drachms per day dissolved in
diuretic liquids is the most useful drug, and sometimes holds the
disease in check for a sufficient time to allow of the animals being
fattened.
Treatment also comprises certain prophylactic precautions. As the
infection which produces pyelo-nephritis originates in the genital
tract, it is desirable to protect all animals in a receptive condition
(those about to calve or having recently calved) from infection; hence,
when the disease is detected in a cow-shed, the patients should be
isolated, and the shed thoroughly disinfected.
SUPPURATIVE NEPHRITIS AND PERINEPHRITIS.
Suppuration of the kidney may occur under two conditions. In the
majority of cases such suppuration occurs as a complication of
pyelo-nephritis; less frequently it is the consequence of infection from
within or infection of adjacent parts, leading to the formation of an
abscess.
When it results from an ascending infection the kidney becomes swollen,
congested and inflamed, and soon displays localised minute hæmorrhages.
Pus then forms within the calices, in the large straight tubes, and
diffuse suppuration invades all the uriniferous tubules. The enlarged
kidney is yellowish, firm under the knife, and when sections are
compressed pus exudes from the openings of the tubular canaliculi.
When suppurative nephritis has resulted from accidental infection of
internal origin, an abscess is found to have produced more or less
extensive atrophy of a portion of the kidney while not affecting the
rest of the organ.
It is only in those favourable cases where the renal abscess opens into
the pelvis that suppuration may invade the whole of the kidney,
producing diffuse suppurative nephritis by secondary infection of the
uriniferous tubules. Such complications are rare. Usually the abscess
empties through the pelvis, and recovery may occur.
More frequently suppurative pyelo-nephritis develops, together with
ureteritis, cystitis, dilatation of the ureters, dilatation of the
pelvis of the kidney, and dilatation of the collecting tubules of the
pyramids, the final stage resembling the lesions of pyo-nephrosis.
Perinephritis and perinephritic cellulitis, _i.e._, inflammation with or
without abscess formation in the connective tissue and adipose layer
surrounding the kidney, always occur in cases of suppurative nephritis
or pyelo-nephritis. Such inflammations may also, in exceptional cases,
follow direct mechanical injury, but they almost invariably represent
complications, the organisms infecting the kidney passing through the
tissues and the layer of fibrous tissue, or extending by the lymphatic
paths, finally attaining the fatty tissue surrounding the kidney and
there undergoing multiplication. The fatty tissue is infiltrated with
reddish serosity, is inflamed, and may become the seat of large
abscesses communicating with or separate from the abscesses of the
kidney itself.
=Symptoms.= Suppurative nephritis is characterised by fever, loss of
appetite, arrest of rumination, and frequent attempts to urinate. These
attempts are painful, are accompanied by groaning, and end in the
passage of an insignificant quantity of blood-stained and purulent
urine.
Palpation, more especially palpation of the right flank, percussion over
the region of the loins, and examination of the kidneys through the
rectum are painful. Wasting is rapid.
If the suppurative nephritis develops rapidly, and particularly if it be
accompanied by perinephritis, the patients refuse to rise and appear to
be suffering from paraplegia, although not really so, both sensation and
motor power persisting in a greater or less degree. Probably the
condition is accompanied by reflex pain and irritation of the nerve
trunks of the lumbo-pubic plexus.
On the other hand, when suppurative nephritis tends to develop slowly
and assume a chronic form, lesions of pyo-nephrosis gradually develop,
and are identical in appearance with those of hydro-nephrosis, except
that the ureters, the pelvis and the dilatations corresponding to the
lobules, are filled with pus.
[Illustration: $1]
=Diagnosis.= The diagnosis is not very difficult. The urinary trouble
and the composition of the urine itself always arouse suspicion. The
diagnosis is confirmed by careful and methodical examination _per
rectum_; the inflammation of the fatty tissue surrounding the kidney can
usually be detected.
=Prognosis.= The prognosis is extremely grave, and almost always fatal,
particularly in cases of diffuse nephritis.
=Treatment.= No curative treatment can be absolutely relied on.
Treatment, if attempted, is limited to the methods suggested for
pyelo-nephritis. Mucilaginous, emollient, and diuretic drinks, and daily
doses of 2 to 3 drachms of benzoate of soda given in the drinking water,
cause some improvement.
[Illustration: $1]
Stimulation of the region of the loins also undoubtedly has a favourable
effect, and should always be practised, particularly where perinephritis
is developing. It may check the course of the disease and prevent the
formation of abscesses. On slaughtering animals suffering as above
described the layer of tissue surrounding the kidney is found to be
lardaceous and fibro-fatty.
Any treatment through the bladder is contra-indicated, for even the
passage of a catheter may cause severe injury of the urethra or the
vesical mucous membrane and produce a fatal aggravation.
If these conditions are diagnosed early, while the function of the
kidney is more or less preserved, and if the animal is still in good
condition, it should be slaughtered.
THE KIDNEY WORM (SCLEROSTOMA PINGUICOLA) OF SWINE.[7]
Footnote 7:
From Report of the U.S.A. Bureau of Animal Industry, 1899, p. 612.
(Louise Taylor.)
In the United States of America a worm is frequently found in the fat
surrounding the kidneys of pigs, and is supposed by farmers to be the
cause of paralysis of the hind limbs.
This so-called kidney worm of hogs (_Sclerostoma pinguicola_) should not
be confounded with the kidney worm (_Dioctophyme viscerale_) of dogs and
man. Both of these parasites belong to the same zoological family
(Strongylidæ), but to different subfamilies and genera. The kidney worm
of dogs grows to a length of 1 to 3 feet. The kidney worm of hogs is
much smaller, attaining at most something less than 2 inches in length.
[Illustration: $1]
The body of the worm is plump, mottled in color—red, yellow, white,
black—according to the organs visible beneath. The average female is
about 37 mm. and the average male 32 mm. in length. The worms seem to
occur in pairs, usually in cysts or canals; thus, upon the examination
of two kidneys with their surrounding fat, fifteen specimens were found,
seven males and eight females. The connective tissue layers between the
fat were found to be the most general seat of infection, and the cysts
were numerous and closely packed together. Although a cyst usually
contained two worms, a male and a female, sometimes three were found
together, two females and one male, or just as often one female and two
males. The cysts contained pus, which bathed the parasites, and in which
were thousands of eggs in the segmentation stage. Still, other cysts,
upon being cut into, were found without parasites and in a necrotic
condition.
It will be noticed that _Sclerostoma pinguicola_ is colloquially known
as the kidney worm. In no case, however, has Miss Taylor found it in the
kidney substance, but only in the tissue surrounding this organ; the
lard appears to be its _normal_ habitat, at least.
Just how the eggs leave the kidney fat or enter the bodies of fresh hogs
has not been demonstrated, but it does not seem unreasonable to suppose
that they eventually find their way out with the urine. Indeed, Dean
reports eggs found in the urine. From analogy one is led to believe that
no intermediate host is required, but that in all probability the
embryos develop for a short time in water, casting several skins, and
they eventually gain access to the hogs either through contaminated
drinking water or food.
Because of the hog’s habits, it is difficult to see any practical
measures which can be adopted to prevent infection. Feeding from troughs
and supplying plenty of pure drinking water will decrease but not
exclude the disease. Leuckart’s advice to the Germans, “Swine should be
kept in a less swine-like manner,” holds good in all countries and in
connection with all diseases. It is equally impossible to suggest
practical methods of treatment. This is all the more true because it
seems probable that a number of distinct complaints are popularly
grouped together by the farmer as kidney-worm disease.
CHAPTER IV
GENITAL APPARATUS.
=Semiology.= The examination of the genital apparatus properly so called
is easy in animals of large size, whether male or female, but is more
delicate and difficult, and is sometimes partially impossible, in small
creatures.
In male animals it comprises the examination of the testicles by
inspection and palpation, of the vas deferens, and of the intra-pelvic
genital organs (vesiculæ seminales, prostate, etc.).
Inspection and palpation of the scrotum reveals hypertrophy, atrophy,
œdematous or sanguineous infiltrations, inflammation of the tunica
vaginalis, and tumours of the testicle. Intra-pelvic examination partly
covers the same ground as examination of the pelvic portion of the
urethra, and, provided the anatomical relationships of the different
organs encountered are known, there is no difficulty in detecting the
position of possible lesions (Fig. 226).
In small male animals, such as he-goats and rams, rectal exploration is
confined to the use of one or two fingers.
In female animals examination comprises inspection, intra-vaginal
examination, and rectal examination.
Inspection reveals lesions of the vulva and clitoris.
Vaginal examination with the hand establishes the condition of the walls
of the vagina, the neck of the uterus, and the vaginal culs-de-sac.
If a lesion is detected, its character can easily be ascertained by
means of a speculum, which exposes the base of the vagina, the
prominence formed by the uterus, or any particular part of the vagina
itself. Examination with the speculum is the only useful method in young
female animals, heifers in particular, on account of the narrowness of
the genital tract.
In small female animals, such as she-goats, ewes and sows, the fingers
alone can be employed.
As regards examination of the uterus, the direct method gives little
exact information, and examination by the rectum is to be preferred. By
passing the arm into the rectum and gently pressing downwards towards
the base of the pelvis, the hand can be brought in contact with the body
of the uterus, which can be moved and displaced from right to left; the
horns of the uterus can be felt and followed from the body of the uterus
as far as the Fallopian tubes and the ovaries. By this means the state
of the uterus, its degree of sensitiveness and mobility, as well as the
state of the Fallopian tubes and of the ovaries, can all be ascertained.
The examination also reveals the existence or non-existence of
gestation, during which the uterus becomes hypertrophied and is
displaced in a forward direction towards the right flank, at the same
time descending in front from the base of the pelvis over the abdominal
wall and under the mass of the intestinal convolutions.
[Illustration: $1]
VAGINITIS.
Inflammation of the vaginal conduit may be primary or secondary. It
usually follows difficult parturition, but may occur under various
circumstances. From the clinical standpoint three varieties are
distinguished: simple or contagious acute vaginitis; croupal vaginitis;
and chronic vaginitis.
ACUTE VAGINITIS.
=Causation.= Deep-seated genital injuries leading to metritis, excessive
and prolonged strains due to painful labours, accidental injuries caused
by obstetrical operations, etc., are followed by more or less acute
vaginitis.
Suppurative inflammation of Gartner’s canals, irritant and caustic
injections, and foreign bodies likewise cause local irritation, which
may become complicated by infection and eventually produce vaginitis.
The infective organisms may be numerous and varied.
=Symptoms.= The vagina being closed to external inspection, the symptoms
are not very apparent. At first, acute vaginitis is suggested by
swelling of the vulva, pruritus, and dysuria. The lips of the vulva are
œdematous, injected, sensitive and of a brownish-red or violet-red
colour on the internal surface. Sometimes they are excoriated and torn.
The period of full development is accompanied by the escape from the
vulva of a serous, mucous, muco-purulent or purulent discharge of
varying odour. Urination is painful and defæcation difficult.
Examination of the vagina by means of a speculum shows the mucous
membrane to be excoriated, ultra-sensitive, ulcerating or suppurating at
certain points. The parts are hot.
The general symptoms are little marked, and without importance. The
usual termination consists either in recovery, which may be spontaneous,
or in passage to the chronic form.
The =diagnosis= is easy, and the =prognosis= favourable, provided the
vaginitis has not been caused by severe mechanical injuries, capable of
setting up cellulitis or the formation of deep abscesses of the pelvis.
=Treatment.= One of the principal reasons why vaginitis persists is the
retention of morbid products in the vaginal culs-de-sac. Treatment ought
therefore to aim chiefly at removing these by soothing, astringent, and
antiseptic injections. Soothing injections should first be tried. They
consist of lukewarm water at body temperature, decoctions of
black-cherry bark, poppy-heads, linseed, etc. After a few days, when the
excessive sensibility has disappeared, antiseptic and astringent
solutions may be used, such as crystallised alum, 150 grains to the
pint; sulphate of zinc, 75 grains to the pint; carbolic acid, lysol,
cresyl, etc., 150 grains to the pint.
Injections of permanganate of potash of the strength of 150 grains to
the pint and of solutions of iodine at a strength of 1 in 2,000 are more
active, but require more careful handling. Hydroxyl diluted with from 3
to 5 parts of water is also of great efficacy. Strong solutions should
never be used, because they cause irritation and expulsive efforts.