large size may be present in the kidney without producing any disorder
appreciable to the people about him. In cattle fattened on dry feed in
winter, on the magnesian limestone of New York, it is exceptional to find
the substance of the kidney free from calculi about the size of a grain of
wheat or less, and standing out as white objects in the general red of the
cut surface of the organ. Similarly around the papillÊ in the cuplike arms
of the pelvis we find minute, flattened or more or less rounded,
yellowish-white concretions. Even the large concretions may prove
apparently harmless. I have a calculus several ounces in weight which
filled the entire pelvis of the kidney, that was found by accident in a
fat carcass while being dressed. In work oxen, however, such concretions
may give rise to symptoms of kidney disease, such as stiffness of the
loins, shown especially in the acts of rising or turning, weakness of the
hind parts when set to pull a heavy load, an irritability of the kidneys,
shown by the frequent passage of urine in small quantity, tenderness of
the loins, shown when they are pinched or lightly struck, and it may be
the passage of blood or minute gritty masses with the urine. If the attack
is severe, what is called "renal colic" (kidney colic) may be shown by
frequent uneasy shifting of the hind limbs, shaking or twisting of the
tail, looking around at the flanks, and lying down and rising again at
short intervals without apparent cause. The frequent passage of urine,
the blood or gritty masses contained in it, and perhaps the hard, stony
cylinders around the tufts of hair of the sheath, show that the source
of the suffering is the urinary organs. In bad cases active inflammation
of the kidneys may set in. (See "Nephritis," p. 123.)
URETERAL CALCULI.
These are small stones which have passed from the pelvis of the kidney into
the canal (ureter) leading from the kidney to the bladder, but, being too
large to pass on easily, have blocked that canal and forced the urine back
upon the kidney. The result is the production of symptoms more violent than
in renal calculi, though not varying, save in intensity, from those of
renal colic. In case of complete and unrelieved obstruction, the secretion
of the kidney on that side is entirely abolished, and it becomes the seat
of passive congestion, and it may even be absorbed in greater part or as a
whole, leaving only a fibrous sac containing fluid with a urinous odor. In
small cattle, in which the oiled hand introduced into the last gut may
reach the affected part, the distended ureter may be felt as a tense,
elastic cord, extending forward from the point of obstruction on the
lateral wall of the pelvis and beneath the loins toward the kidney. If
relief is obtained by the onward passage of the stone a free flow of urine
usually follows, in the midst of which may often be found gritty masses. If
the outlets from both kidneys are similarly blocked the animal becomes
poisoned by the retention in the blood of the elements of the urine, and by
their reabsorption after secretion.
_Treatment of renal and ureteral calculi._--Treatment is not very
successful, as only the smallest calculi can pass through the ureter and
enter the bladder, and even if they should do so they are liable to a
progressive increase there, so that later they may cause the symptoms of
stone in the bladder. Fortunately, ordinary dairy, growing, or fattening
cattle rarely show evident symptoms of illness, and even though they do so
they can usually be fattened and slaughtered before the health is seriously
impaired. In work oxen the case is different, and acute symptoms may
develop, but even then the animal may often be fitted for the butcher. When
treatment is demanded it is primarily soothing and antispasmodic.
Fomentations with warm water over the loins should be persisted in without
intermission until relief has been secured. The soothing effect on the
kidney will often relieve inflammation and irritation, should the stone be
in that situation, while if in the ureter the warm fomentations will at
once soothe irritation, relax spasm of the muscular coat of the canal, and
favor an abundant secretion from the kidney, which, pressing on the
obstructing stone, may slowly push it on into the bladder. Large doses of
laudanum (2 ounces) or of solid extract of belladonna (2 drams) will not
only soothe the pain but relax the spasm and favor the onward passage of
the calculus. The animal should be encouraged to drink large quantities of
cool water to favor the free secretion of a very watery urine, which will
not only serve to obviate irritation and continued deposit caused by a
highly concentrated urine, but will press the stone onward toward the
bladder, and even in certain cases will tend to disintegrate it by solution
of some of its elements, and thus to favor its crumbling and expulsion.
This is a principle which must never be lost sight of in the treatment of
calculi. The immersion of the stone in a liquid of a lower specific gravity
than that in which it has formed and grown tends to dissolve out the more
soluble of its component parts, and thus to destroy its density and
cohesion at all points, and thereby to favor its complete disintegration
and expulsion. This explains why cattle taken from a herd on magnesian
limestone in spring, after the long, dry feeding of winter, usually have
renal calculi, while cattle from the same herd in the fall, after a
summer's run on a succulent pasture, are almost always free from
concretions. The abundance of liquid taken in the green feed and expelled
through the kidneys and the low density or watery nature of the urine have
so opened the texture and destroyed the density of the smaller stones and
gravel that they have all been disintegrated and removed. This, too, is the
main reason why benefit is derived from a prolonged stay at mineral springs
by the human victims of gravel. If they had swallowed the same number of
quarts of pure water at home and distributed it at suitable times each day,
they would have benefited largely without a visit to the springs.
It follows from what has been just said that a succulent diet, including a
large quantity of water (gruels, sloppy mashes, turnips, beets, potatoes,
apples, pumpkins, ensilage, succulent grasses), is an important factor in
the relief of the milder forms of stone and gravel.
_Prevention._--Prevention of calculus especially demands this supply of
water and watery rations on all soils and in all conditions in which there
is a predisposition to the disease. It must also be sought by attempts to
obviate all those conditions mentioned above as causative of the malady.
Sometimes good rain water can be furnished in limestone districts, but
putrid or bad-smelling rain water is to be avoided as probably more
injurious than that from the limestone. Unsuccessful attempts have been
made to dissolve calculi by alkaline salts and mineral acids, respectively,
but their failure as a remedy does not necessarily condemn them as
preventives. One dram of caustic potash or of hydrochloric acid may be
given daily in the drinking water. In diametrically opposite ways these
attack and decompose the less soluble salts and form new ones which are
more soluble and therefore little disposed to precipitate in the solid
form. Both are beneficial as increasing the secretion of urine. In cases in
which the diet has been too highly charged with phosphates (wheat bran,
etc.), these aliments must be restricted and water allowed ad libitum. If
the crystals passed with the urine are the sharp angular (octahedral) ones
of oxalate of lime, then the breathing should be made more active by
exercise, and any disease of the lungs subjected to appropriate treatment.
If the crystals are triangular prisms of ammonia-magnesium phosphate or
starlike forms with feathery rays, the indications are to withhold the feed
or water that abounds in magnesia and check the fermentation in the urine
by attempts to destroy its bacteria. In the latter direction plenty of
pure-water diuretics, and a daily dose of oil of turpentine in milk, or a
dose thrice a day of a solution containing one-tenth grain each of biniodid
of mercury and iodid of potassium would be indicated.
In considering the subject of prevention, it must never be forgotten that
any disease of a distant organ which determines the passage from the blood
into the urine of albumin or any other colloid (uncrystallizable) body is
strongly provocative of calculus, and should, if possible, be corrected.
Apart from cases from geological formation, faulty feeding, and other
causes, the grand preventive of calculus is a long, summer's pasturage of
succulent grasses, or in winter a diet of ensilage or other succulent feed.
The calculi formed in part of silica demand special notice. This agent is
secreted in the urine in the form of silicate of potash and is thrown down
as insoluble silica when a stronger acid displaces it by combining with the
potash to its exclusion. In cases of siliceous calculi, accordingly, the
appropriate chemical prevention is caustic potash, which being present in
the free state would attract to itself any free acid and leave the silica
in its soluble condition as silicate of potash.
STONE IN THE BLADDER (VESICAL CALCULUS, OR URETHRAL CALCULUS).
Stone in the bladder may be of any size, but in the ox does not usually
exceed half an inch in diameter. There may, however, be a number of small
calculi; indeed, they are sometimes so small and numerous as to form a
small, pulpy magma by which the bladder is considerably distended.
_Symptoms._--The symptoms of stone in the bladder may be absent until one
of the masses escapes into the urethra, but when this occurs the escape of
urine is prevented, or it is allowed to pass in drops or driblets only, and
the effect of such obstruction becomes manifest. The point of obstruction
is not always the same, but it is most frequently at the S-shaped curve of
the penis, just above the testicles or scrotum. In cows and heifers the
urethra is so short and becomes so widely dilated during the urination that
the calculi easily escape in the flow of liquid and dangerous symptoms
practically never appear.
Even in the male the signs of illness are at first very slight. A close
observer may notice the cylinders of hard, earthy materials encircling the
tufts of hair at the opening of the prepuce. It may further be observed
that the stall remains dry and that the animal has not been seen to pass
water when out of doors. The tail may at times be gently raised and
contractions of the muscle (accelerator urinÊ) beneath the anus (Pl. IX,
fig. 2) may take place in a rhythmical or pulsating manner. As a rule,
however, no symptom is noticed for two days, only the animal is lacking in
his usual spirits. By this time the constantly accumulating urine has
distended the bladder beyond its power of resistance and a rupture occurs,
allowing the urine to escape into the cavity of the abdomen. Then dullness
increases; the animal lies down most of his time; he becomes stupid and
sometimes drowsy, with reddish-brown congestion of the lining membrane of
the eyelids; pressure on the abdomen causes pain, flinching, and perhaps
groaning, and the lowest part of the belly fluctuates more and more as the
escaping urine accumulates in greater and greater amount. If at this stage
the oiled hand is introduced into the rectum (last gut), the animal
flinches when pressure is made downward on the floor of the pelvis, and no
round, distended bladder is felt. If the same examination is made prior to
the rupture, the rounded, tense, elastic bladder is felt extending forward
into the abdomen, containing one or two gallons of liquid. There may be
uneasy shifting of the hind limbs and twisting of the tail, also frequent
lying down and rising, but these symptoms are exceptional.
When the obstruction is low down between the thighs (at the S-shaped
flexure), the line of the pulsating urethra from the anus downward may be
felt distended with liquid, and though, by the hard swelling of the
urethra, it is seldom easy to distinguish the exact seat of the stone, yet
there is usually tenderness at the point of obstruction, and from this it
may be accurately located.
_Treatment._--The treatment of stone in the bladder or urethra consists in
the removal of the stone by incision and the use of forceps. (Pl. XI, fig.
4.) When the stone has been arrested at the S-shaped flexure just above the
scrotum, the patient being lean, the thickened tender part of the penis may
be seized between the fingers and thumb of the left hand, while the
calculus is exposed by a free incision with the knife held in the right. If
there is no other obstruction between this point and the bladder, and if
the latter has not yet ruptured, a flow of urine should take place from the
opening. If there is no escape of liquid, a catheter or sound, one-fourth
of an inch in diameter, must be passed up through the canal (urethra) until
it is arrested by the next stone, on which a similar incision should then
be made to effect its extraction. In case the stone has been arrested in
the portion of the urethra which is in front of the arch of the hip bone
and inside the pelvis, it can be reached only by making an opening into the
urethra beneath the anus and over the arch of the hip bone, and from this
orifice exploring the urethra with fine forceps to the neck of the bladder
or until the stone has been reached and extracted. Owing to the small size
of the canal (urethra) to be opened and the great thickness of erectile
tissue to be cut through, the operation requires a very accurate knowledge
of the parts, while the free flow of blood is blinding to the operator. A
staff should always be passed up through the urethra from the lower wound,
if such has been made, or, in case of its absence, through the whole length
of the penis, that organ having been drawn out of its sheath until the
S-shaped curve has been effaced and the course of the canal rendered
straight. Upon the end of this staff the incision can be made with far more
confidence and certainty. The operation can be undertaken only by a skilled
veterinary anatomist, but the hints given above may be valuable in showing
the stock owner when he is being properly served in such a case.
In outlying districts, where no skilled operator can be had, a transverse
incision may be made with a clean, sharp knife through the root of the
penis, just over the arch of the hip bone, when the urine will flow out in
a full stream. The attendant bleeding may be ignored, or if profuse it may
be checked by packing the wound firmly with cotton wool for several hours.
The urine will continue to escape by the wound, and the ox should be
fattened for the butcher.
The immediate relief is not to be looked upon as a permanent cure, as the
calculi in the affected ox are usually numerous, and later attacks are
therefore to be looked for. Hence it is desirable to fatten and kill such
cases after a successful operation. If a breeding animal is too valuable to
be killed, he should be subjected to preventive measures, as laid down
under "Stone in the kidney," page 139.
It should be added that when the bladder is filled with a soft magma a
catheter may be introduced through the whole length of the urethra to be
used in pumping water into the bladder. This water is extracted through the
same channel when it has been charged with the suspended solids by
manipulations of the bladder with the oiled hand introduced through the
rectum.
CALCULI, OR GRAVEL, IN THE PREPUCE, OR SHEATH.
This is usually a collection of gravel, or a soft, puttylike material which
causes distinct swelling of the sheath and gives it a soft, doughy feeling
when handled. It may be removed in part by the oiled fingers introduced
into the cavity, assisted by manipulation from without, or a tube may be
inserted until the end extends behind the collection and water pumped in
until the whole mass has been evacuated. Should even this fail of success,
the sheath may be slit open from its orifice back in the median line below
until the offending matter can be reached and removed. In all such cases
the interior of the sheath should be finally lubricated with sweet oil or
vaseline. It is unnecessary to stitch up the wound made in the sheath. (See
"Inflammation of the sheath," p. 155.)
[Illustration: PLATE IX.
KIDNEY AND MALE GENERATIVE AND URINARY ORGANS.]
[Illustration: PLATE X.
MICROSCOPIC ANATOMY OF THE KIDNEY.]
* * * * *
DISEASES OF THE URINARY ORGANS.
DESCRIPTION OF PLATES.
PLATE IX. Kidney and male generative and urinary organs.
Fig. 1. Kidney of the ox. (From Handbuch des Vergleichenden Anatomie des
Haus S‰ugethiere, vol. 7, 1890.) A, renal artery carrying blood into the
kidney; V, renal vein carrying blood from the kidney back to the heart; H,
ureter, the tube carrying the urine from kidney to bladder. It is formed by
the union of a number of branches which begin as cups (calices), each
inclosing the tip of a conical mass of tissue from which the urine
excludes.
Fig. 2. Genital and urinary organs of the bull. (From Leisering, Mueller,
and Ellenberger, Handbuch des Verg. Anat. des Haus S‰ugethiere.) the serous
membrane enveloping the testicles; 3, the right testicle, outer view; 3',
left testicle, inner view; 4, epididymis, or the beginning of the excretory
canal of the testicle; 4', globus major, or the head of the epididymis;
4'', globus minor, or the tail of the epididymis; 5, vas deferens, the duct
through which the seminal fluid reaches the ejaculatory ducts; 5', pelvic
dilation of the vas deferens; 6, vesicula seminalis. The vesiculÊ seminalis
are two oval pouches, which, in addition to their own secretions, receive
the semen conveyed by the seminal ducts and hold it in reserve until
copulation; 7, membranous or intrapelvic portion of the urethral canal
covered by Wilson's muscle; 8, part of the prostate gland, covered by
Wilson's muscle; 9, Cowper's gland. This gland, like the prostate gland,
secretes a fluid which is thrown into the urethal canal in abundance
immediately before ejaculation; by this means the expulsion of the semen is
facilitated; 10, ejaculator seminis, or accelerator urinÊ muscle; 11,
penis; 11', cut portion of same; 12, cut suspensory ligaments of penis; 13,
sheath, or prepuce laid open; 14, retractor muscles of sheath; 15,
cremaster muscle cut at superior extremity; 16, duplicature of peritoneum;
17, ureters carrying urine from the kidneys to the bladder.
PLATE X. Microscopic anatomy of the kidney.
Fig. 1. In this figure the minute apparatus for the secretion, collection,
and discharge of the urine into the pelvis of the kidney (see preceding
plate) is shown. The course is as follows: The urine is secreted from the
blood vessels in the little round bodies called glomeruli (12), and by the
minute cells in the curved tubes (11, 9, 10, 8), and passes through the
convoluted and straight tubes (7, 6) into the larger tube (1), and then out
into the pelvis, thence through the ureters into the bladder. The fluid and
salts dissolved in the urine are taken from the blood, and the minute blood
vessels are therefore very abundant in the kidneys, as is shown by the
branches and network on the left of the figure. The blood passes into the
kidney in the artery (13), which then divides into branches which pass into
the glomeruli (12) and also forms network around the secreting tubules (11,
9). The urine and salts pass from these vessels through the cells lining
the tubules into the latter, and are discharged as described above. The
blood is again collected in veins drawn black in the figure.
Fig. 2 illustrates the manner in which the blood is distributed in the
glomerulus (_f_), and also to the secreting tubules (_e_).
Fig. 3 shows the relation between the blood vessel in the glomerulus (_e_)
the tubule which conducts the urine therein secreted from the blood vessel;
(_c_) represents a glomerulus from which the urinary tubule has been
removed.
PLATE XI. Calculi of kidney and bladder.
Fig. 1. Calculus, or stone, from the kidney. These are in the pelvis or
portion of the ureter receiving the urine. The prolongations are casts of
the branches of the pelvis. See the plates of the kidney for further
description.
Fig. 2. Calculus made up of oxalate of lime magnified 215 times.
Fig. 3. Phosphatic calculus containing a nucleus of uric acid, sawed
through to show concentric layers.
Fig. 4. Straight forceps used in removing stones from the bladder.
Fig. 5. Casts of the minute tubules of the kidney found in the urine in
various kinds of kidney disease. Highly magnified.
* * * * *
[Illustration: Plate XI.
CALCULI OF KIDNEY AND BLADDER.]
FOOTNOTES:
[1] Encyklop. der Thierheilk., Vol. IV, p. 208.
DISEASES OF THE GENERATIVE ORGANS.
By JAMES LAW, F. R. C. V. S.,
_Formerly Professor of Veterinary Science, etc., in Cornell University._
[Revised by Adolph Eichhorn, D. V. S.]
GENERAL DISCUSSION.
Diseases of the generative organs are practically confined to animals which
are kept for reproduction and the dairy. The castration of the bull
condemns these organs to inactivity and protects them from the many causes
of injury attendant on the engorged blood vessels in the frequent periods
of sexual excitement, on the exposure to mechanical violence, and on the
exposure to infective inoculation. In three respects the castrated male is
especially subject to disease: (1) To inflammation and tumefaction of the
cut end of the cord that supported the testicle and of the loose connective
tissue of the scrotum; (2) to inflammation of the sheath and penis from the
accumulation of gravel in the former, from which the penis is not usually
protruded in passing water; and (3) to bruising, abrasion, and inflammation
of the sheath and penis during suspension in the stocks for the purpose of
shoeing. Apart from these the ox is practically almost exempt from the
inflammations and injuries of the genital organs. The same applies to the
castrated heifer. Inflammation may occur in the broad ligament of the womb
whence the ovary has been removed or infective inflammation in the
abdominal cavity (peritonitis) in case the operation has been performed
through the flank, as it usually is in the young heifer. Apart from these,
the castrated heifer is practically immune from any trouble of the
generative apparatus. Even the virgin heifer is little subject to such
troubles, though she is not exempt from inflammations, and above all, from
morbid growths in the ovaries which are well developed and functionally
very active after the first year, or in precocious animals after the first
few months of life. The breeding cow, on the other hand, is subjected to
all the disturbances attendant on the gradual enlargement of the womb, the
diversion of a large mass of blood to its walls, the constant drain of
nutrient materials of all kinds for the nourishment of the fetus, the risks
attendant and consequent on abortion and parturition, the dangers of
infection from the bull, the risks of sympathetic disturbance in case of
serious diseases of other organs, but preeminently of the urinary organs
and the udder, and finally the sudden extreme derangements of the
circulation and of the nervous functions which attend on the sudden
revulsion of a great mass of blood from the walls of the contracting womb
into the body at large immediately after calving.
In reviewing this class of diseases, therefore, we have to note, first,
that they are almost exclusively restricted to breeding animals, and
secondly that in keeping with the absolute difference of the organs in the
male and female we find two essentially distinct lists of diseases
affecting the two sexes.
EXCESS OF VENEREAL DESIRE (SATYRIASIS IN MALE, OR NYMPHOMANIA IN FEMALE).
This may occur in the male from too frequent sexual intercourse, or from
injury and congestion of the base of the brain (vasodilator center in the
medulla), or of the posterior end of the spinal cord, or it may be kept up
by congestion or inflammation of the testicles or of the mucous membrane
covering the penis. It may be manifested by a constant or frequent
erection, by attempts at sexual connection, and sometimes by the discharge
of semen without connection. In bad cases the feverishness and restlessness
lead to loss of flesh, emaciation, and physical weakness.