Chapter XI: Part 11

Fatty degeneration of the kidneys is by no means unknown in the domestic animals. It has been observed in dogs and cats (Rogers, Goubaux, Vulpain, Trasbot). In dogs it has been erroneously set down as a characteristic lesion of rabies. Like fatty degeneration of other organs, it is also met with in old and overfed individuals of meat producing breeds of animals, in which the tendency to early maturity and rapid and excessive fattening has been fostered from generation to generation. In man small, granular, fatty kidney is a common result of chronic parenchymatous nephritis, and often coincides with fatty liver. Chronic poisoning by arsenic or phosphorus is another cause, as it is of fatty degeneration in other organs.

Vulpain has attributed it to a lack of active exertion and of general tone, associated with excessive amylaceous feeding, sluggish, shallow breathing and tardy elimination. Goubaux and Trasbot attach great importance to the compulsory retention of urine in house dogs, cats and horses. The damming back of the urine in the convoluted tubes and glomeruli, temporarily arrests secretion, and the inactive and compressed cells tend at once to granular and fatty degeneration.

_Lesions._ The gland is sensibly increased in size, and pale, yellowish or straw yellow. The capsule is easily detached from the cortical substance, contrary to what is the case in chronic productive inflammation. The cortical substance is increased in thickness, and pale, the pallor being largely in ratio with the duration or extent of the fatty degeneration. The cut surface may be glistening and unctuous to the touch. It is softer than usual, rather friable, and if scraped, furnishes a serous or grayish pulp in which oil globules are prominent features, together with granular epithelium and free granules that dissolve readily in ether. Tubules are varicose and unequal at different parts. The medullary portion has undergone little change. It may be paler at certain points, with some shrinking of its substance and increase of firmness.

_Symptoms._ As a rule the disease occurs in pampered, overfed and obese animals, and in those of the improved breeds which have great power of digestion, assimilation and fattening. It is especially to be looked for after close confinement on full, stimulating, amylaceous diet. Symptoms are not usually recognized during life. There is, however, a lessening of the urinary secretion, and, as the disease advances, albuminuria. When examined microscopically this is found to contain characteristic elements, such as granular epithelial cells, the granules soluble in ether, oil globules, and at times crystals of cholesterine (Beale). A diagnosis based on the mere presence of oil globules may, however, be fallacious, as these may be present in animals that have just been heavily fed on oleaginous food, and again the oil used to smear the catheter may float in the urine and prove misleading. Under such circumstances vaseline or glycerine may be substituted on the catheter. Scriba induced fatty urine by injecting fat or oil emulsion into the blood, and Chabrie by ligating the large intestine. Trasbot says that cylindroid casts may be present. As in other grave kidney affections, dropsies supervene as the disease advances. These may show in the limbs, in the abdomen, or in other serous cavities. A steadily advancing anæmia with pallor of the mucosæ, listlessness, weakness, debility and sluggishness are to be noted.

_Prognosis._ Since the disease is rarely diagnosed until it has reached an advanced stage, it usually progresses steadily to a fatal issue. If, however, it can be detected at an earlier stage, it may be palliated, or held in abeyance, for a length of time varying with the extent of the lesions. As it is very largely a disease of meat producing animals and as the subject is at first in a condition of marked obesity, it can usually be turned over to the butcher without material loss.

_Treatment._ If the disease has resulted from the inbred propensity to fattening, the family that shows the disposition must be subjected to a somewhat different regimen, open air exercise must take the place of confinement in warm stables, a rather bare pasturage is valuable for herbivora, and a restricted diet in which the oleaginous, saccharine, and amylaceous constituents do not predominate, is strongly indicated. Crossing with a strange male having many of the desirable qualities of the herd, but which is more vigorous may be resorted to. When the secretion of urine becomes scanty an abundance of pure water, or a diet of succulent grass or roots or ensilage or even small doses of alkaline diuretics may be resorted to. Any source of arsenic or phosphorus poisoning should be cut off, and as an antidote to phosphorus, oil of turpentine may be given in small doses. This agent may, indeed, replace the alkalies as a diuretic, bringing in an element of tone for the mucosa which is not to be despised. Or balsam of copaiba or buchu leaves may be substituted.

When the small white kidney (granular, fatty) results from chronic nephritis, the prevention and treatment would be as for that disease. Little hope is to be entertained of entire restoration to health.

AMYLOID KIDNEY. LARDACEOUS OR WAXY KIDNEY.

This condition of the kidney has been found in the ox (Gerlach) and dog (Rabe, etc.). There are usually similar degenerative lesions in the liver, pancreas, intestines and other organs. It is usually a concomitant of some chronic wasting disease (chronic nephritis, tuberculosis, etc.).

_Morbid Anatomy._ The kidney is usually enlarged, pale and on section waxy or glistening. Soaked in dilute compound tincture of iodine it shows spots of a walnut or mahogany brown color. The glomeruli are well marked and show the earlier changes, later the tubes do so excepting the epithelium. The latter is swollen, granular, fatty.

_Symptoms._ There may have been those of chronic nephritis. Rabe has noticed in dogs dropsy of the limbs, ascites, emaciation, anorexia, followed by uræmia, coma, weakness, vomiting, and if the kidney alone was affected great lowering of temperature (35.9°C). With hepatic complication there was greater weakness, giddiness, and higher temperature (39.6°C). Urine is usually increased (in man albuminous) and the casts have shown the anyloid reaction. They tend to be fatty or finely granular. Casts may, however, show anyloid reaction when the kidney, post mortem, does not (Jaksch).

_Diagnosis_ from Bright’s disease is often impossible.

_Treatment_ is essentially the same as in chronic nephritis, and is not hopeful.

Trasbot recommends KI 3 to 7 grs., or tinct of iodine 3 drops for shepherd dog. Ol. terebinth and alkaline diuretics are also commended.

RENAL CALCULUS.

This is much more common than is supposed. Small calculi formed in the tubuli uriniferi of cattle on dry winter feeding often pass without recognition, and habitually disappear on rich spring and summer grass.

If retained in the pelvis until increasing size forbids their passage through the ureter they form pelvic calculi.

If retained in the bladder so that they cannot enter the urethra they form cystic calculi.

Pelvic calculi or concretions are often (in cattle and swine) mere scales lying in chalices. They may fill the whole pelvis and send branching processes into chalices.

_Causes._ They are attributed to phosphaturia, lithæmia or uric acid diathesis, oxaluria, etc. In cattle they are associated with dry feeding and are common on all magnesian limestone soils. There are usually catarrh of the kidney and the presence of bacterial ferments and colloids (pus, albumen, etc.). (Sharing and Ord.) Calculi or gravel is preceded by renal catarrh, but this is aggravated by the crystalline deposit. Bacteria act also in producing NH_{3}O, which instantly precipitates ammonio-magnesian phosphate. Retention of urine greatly favors the precipitation.

_Symptoms._ A white or brownish yellow deposit in the last urine discharged collects on the floor. Cloudy urine. Passage of crystals—round—or angular. Colic. Lameness in one or both hind limbs. Arched back. Sensitive loins. Pain paroxysmal. Attempts to urinate. Little passed but often with drops of blood. Sudden relief when the calculus enters the bladder.

Retained in the kidney it may cause no suffering in meat producing animals, but in horses it usually causes stiffness or lameness especially under violent effort. Also hematuria; blood globules are found in the deposit when placed under the microscope. There may be sepsis and specially cloudy offensive urine.

_Diagnosis_: May be confounded with renal tuberculosis, or sarcoma or oxaluria. Examine for bacillus, small cells, or oxalate of lime or oxalic acid.

_Prophylaxis._ In the early stages give succulent, watery food, ensilage, roots, potatoes, spring grass, and water ad libitum.

_Treatment._ Salt may tempt the patient to drink. Nitro-muriatic acid is a solvent and antiseptic. Or alkalies with salicylate of soda. Also tonics. Quiet pain by morphia and other anodynes. Use piperazine.

These failing, an operation on the kidney may be considered.

HYDRO-NEPHROSIS.

A common result of calculus or other obstruction, causing increasing pressure of urine in the pelvis and absorption of the parenchyma, and finally leaving a mere urinous sac.

RENAL TUMORS.

1. _Non-malignant_: Fibroma.
Lipoma.
Angioma.
Adenoma.
Papilloma.
2. _Malignant_: Sarcoma.
Carcinoma.

RENAL PARASITES.

Echinococcus: Herbivora, Omnivora.
Bilharzia Crassa: Egyptian cattle.
Strongylus Gigas: Horse, ox, dog, man.
(Cysticercus Tenuicollis: Ruminants: Pig).
Tænia serrata: Dog. Pelvis.
Sclerostoma equinum: (renal arteries, _kidney pelvis_), soliped.
Stephanurus dentatus: Pig, (pus cavities).
Trichosoma plicata: (Urinary bladder), dog.
T. felis: (Cat), bladder.
Indetermined embryos: Kidneys, dog; small tumors.
Cytodites nudus: Kidneys; hens.
Œstrus, (Gast. Hemorrhoidalis): Bladder walls: horse.
Mucorimyces: Kidneys; dog.
Coccidia: Kidney, Horse, dog, goose.

INJURIES OF THE URETERS.

Lesions by bullets, arrows, stabs, bruises and lacerations in
parturition, treads, wheels, tumors, ulcers, calculi, tubercles,
parasites. Course. Pathology: transverse division may cause
hydronephrosis, or septic peritonitis. Symptoms: uncertain,
traumatism, bloody urine, arched, stiff, tender loins, straining,
recumbency, groaning in turning or rising, rectal palpation of
distended ureter, of ascitic fluid, pitting on pressure of loin, flank
or groin, liquid drawn through a cannula is urinous, urine still
discharged by normal channel. Crystals in urine, worm ova. Treatment:
compresses, fomentations, sinapisms, anodynes, balsams,
antispasmodics, extraction of calculus, lateral implantation of
urethra.

From their deep and protected position it might be plausibly concluded that the ureters were secure against every kind of traumatism. This however, is not the case, since in both man and animals they have been known to have been injured by bullet wounds, arrow wounds, and stab wounds of various kinds. In dystokia with laceration of the womb, vagina or bladder the ureter is liable to be injured. By blows and kicks it may even be ruptured or torn across, and also by sudden and severe mechanical compression of the abdomen as when run over by a wagon or trodden on by a horse, ox, or other large animal. Tumors of various kinds may grow in, or press upon the ureter, ulcers with thick indurated margins or base may obstruct the passage, or calculi, or worms may block and give rise to overdistension and even rupture. Kopp describes obstruction by multiple calculi with saccular dilation in front, close to the kidney in a cow. Cadiot records cases of thickening of the mucosa by numerous cysts as small as hempseed. Intra-abdominal tumors of the spermatic cord have been known to block the passage. Again tubercles have formed on the urethra, and polypi on the trigonum vesicæ have blocked the ureter and produced all the evil consequences of calculus, parasites, etc.

_Course._ The progress of the disease will vary greatly according to the nature of the lesion. With complete rupture of the ureter the urine as a rule escapes into the peritoneal cavity. If the urine is aseptic this may not lead to serious results and the edges of the wound cicatrizing, the urine is imprisoned in the ureter and pelvis of the kidney, and leads to final atrophy of the kidney and hydronephrosis. When on the other hand infecting matter escapes with the urine, as in perforating ulcer, tubercle, glanders, cancer, infective catarrh of the kidneys or ureter, such infection is brought in contact with the whole peritoneal surface, where secondary infections follow. In cases associated with penetrating wounds, wounds resulting from dystokia, calculus or parasitic obstruction, similar infection is to be dreaded.

The _symptoms_ are by no means clear, unless the injury result from external traumatism, or when it can be detected by rectal exploration. There may be blood staining of the urine, stiffness of the loins, lameness in one hind limb, tenderness of the lumbar vertebræ and of their transverse processes on pinching, frequent straining to pass urine, a disposition to remain recumbent, pain and groaning when rising, or when turned in a narrow circle. Under rectal examination the blocked ureter may sometimes be recognized, its cystic end shrunken and empty, up to the seat of obstruction, and its renal end, from the hypersensitive seat of obstruction forward, full, rounded, elastic and firm. If the ureter has been ruptured, it may be impossible to distinguish it, but the presence of urine free in the peritoneum may be detected through the rectum as it may often be through the abdominal walls. Sometimes the urine infiltrates the subperitoneal connective tissue, and forms a pasty swelling on the loin or flank. In either case a hollow needle inserted will draw off a liquid having an urinous odor. That this urine has escaped in front of the bladder may be safely inferred from the continued discharge of urine by the urethra and by the absence of cystic swelling, heat and tenderness. If the kidney can be reached by rectal exploration it is felt to be firm and resistent up to the period of rupture of the ureter.

In case of obstruction by calculus, crystals and even small calculi may be passed in the urine, there is usually a history of previous attacks of renal colic, and the suffering is manifestly extreme. In case of worms (strongylus gigas) the use of the centrifuge on the urine, may possibly secure in the sediment specimens of its ova. The existence of tumors or tubercles can usually be clearly made out.

_Treatment_ will be as varied as the lesion. Simple ureteritis may be met by wet compresses, sinapisms, and internally by balsams and anodynes. Calculi and parasites may be passed with some aid perhaps from fomentations, antispasmodics, and diluents. Obstinate cases can only be successfully met by surgical interference. The resulting wounds in the ureter, like ruptures, perforating ulcers and strictures may be met by Van Hook’s “_lateral implantation_”: the divided cystic end of the ureter is ligatured and on the cystic side of the ligature a longitudinal incision is made, large enough to admit the divided extremity of the renal portion, and through each of the two sides of this last a fine ligature is passed; these ligatures are then passed into the lumen of the cystic portion of the ureter through its longitudinal incision and brought outward through its walls; next the renal end is inserted into the incision in the cystic end and the two are firmly sewed together by the two ligatures. When a small portion of an ureter must be excised it may sometimes be possible to save a valuable animal by such an expedient.

In some cases of rupture into the vagina or uterus an available fistula may sometimes be established into one of these.

URETERITIS.

From wounds, calculus, parasites, infection, injuries in parturition.
Symptoms: in wounds of ureter. Course: danger of infection of kidney
or bladder. Treatment: for calculus, antispasmodics, anodynes,
fomentations, for parasites arsenious acid, for catarrhal conditions,
balsams, buchu, salicylates, etc. Operation. Uretero-vaginal fistula.

This may arise from the passage of a rough calculus, from wounds of the ureter sustained in kicks and blows or by being run over by wheels (dogs, cats), it may be due to the blocking of the tube by a parasite such as strongylus gigas, echinococcus, etc., or it may be the result of extension of an infectious inflammation backward from the kidney or forward from the bladder. Again it may be the result of a lesion of the ureter in cases of dystokia.

The _symptoms_ are obscure but there is likely to be frequent straining and passage of urine, tenderness of the loins, all the more significant if confined to one side, lameness or halting on the corresponding hind limb, and on examination through the rectum the swollen and tender cord representing the ureter may be recognizable. In case of calculus or other obstruction the ureter may be felt to be swollen, elastic and tender back to a slight nodular, painful, firm swelling at the seat of obstruction.

_Course._ In all such cases there is always danger of inflammation (infections or otherwise) of the kidney with degeneration and loss of structure and function, the organ being reduced to a simple urinous cyst (hydronephrosis). In some cases, however, the obstruction (calculus, parasite) may escape into the bladder and a recovery follow. Slight infections, too, may improve and advance to complete convalescence.

_Treatment_ will depend much on the causative factor: Calculus must be treated by anodyne antispasmodics, and fomentations, and in case of relief by measures calculated to prevent its formation anew: parasites may be treated by arsenious acid, oil of turpentine, and other parasiticides which are secreted by the kidneys: catarrhal and infected conditions may be met by balsams, buchu, salicyclic acid and even peppers. In case of calculus which does not give promise of passing, even a surgical operation may be thought of, especially in the smaller house animals.

In rupture of the ureter in dystokia the walls of the womb or vagina have usually suffered, and a recovery with a ureterouterine or uretero-vaginal fistula is not unknown.

ACUTE CATARRHAL CYSTITIS.

Acrid diuretics, by mouth or skin, microbian infection, retention of
urine, urethral calculus, parasites, spasm, enforced suspension of
micturition, unclean catheter, adjacent infection, chill. Lesions:
hyperæmia of mucosa, thickening, vascular distention, clouding of
epithelium, muco-purulent secretion, alkaline fermentation, ammonia,
liquefaction of cells, erosion. Symptoms: Slight fever, stiff,
straddling gait, urine scanty, cloudy, alkaline, penis or clitoris
semi-erect, smearing of tail or prepuce. Crystals of triple phosphate.
Treatment: Antiseptics, boric or salicylic acid, gum arabic,
astringent antiseptics, laxatives, flax seed, slippery elm, anodynes,
diluents, piperazine, drainage, rest, restricted laxative diet,
warmth, avoid stimulants.

_Causes._ Cystitis is caused in all animals by irritant diuretics like cantharides, copaiba, or oil of turpentine given by the mouth or applied to an extensive cutaneous surface. It is an error, however, to conclude with Williams that this is the sole cause. The very existence of calculi virtually implies bacterial infection, and fermentation. The presence of free ammonia in the urine usually implies fermentation, and fermentation must be looked upon as practically synonymous with microbian invasion. That bacteria may be present without serious injury is undoubted. The protective power of the healthy mucosa is very great. But when the mucosa is weakened, microbes that would otherwise be harmless, find a ready infection atrium, and triumph over the weakened tissues. Hence retention of urine and overdistension of the bladder as in urethral calculus, blocking of the urethra by a parasite, spasm of the sphincter vesicæ, compulsory retention as in the mare in harness, the dog kept indoors, or in railway car on a long journey, or in mares so travelling, may become the occasion of cystitis. Even in cases in which no microbe is present at first, this reaches the bladder by the introduction of an unclean catheter, or by extension from an uretheritis, vaginitis or metritis, or even from a peritonitis, or infected urachus. Or the infection may descend from a suppurating kidney. Another occasion of microbian invasion is the congestion which attends on exposure to cold.

_Lesions._ Hyperæmia of the cystic mucosa, with dilation and tortuous deviations of the larger vessels, thickening of the membrane, and distension and clouding of the epithelial cells, with a thick covering of tenacious mucus containing epithelial, pus, or white blood cells. As the disease advances epithelium is desquamated abundantly, and degenerates with production of free nuclei and pus. Along with these are microbes, usually the bacillus coli communis, and various cocci. In the fully established disease there is liable to be alkaline fermentation, and the liberated ammonia dissolves the epithelial cells, leading to extensive desquamation and raw granulating surfaces, so that the disease tends to run in a vitiating circle, the alkali dissolving the epithelium and increasing the microbian development and fermentation, which in its turn produces an increasing quantity of ammonia.

_Symptoms._ There is slight hyperthermia or none, stiff or straddling gait, frequent passage of urine in small quantities and cloudy, or straining without passage, the penis or clitoris is semi-erect, eversion of the lips of the vulva is frequent, and the bladder is tender (through prepubian wall, vagina or rectum). If a finger is inserted into the bladder in the mare the thickening of the walls can often be recognized. The urine often contains precipitated crystals of ammonio-magnesian phosphate, and even clots of blood. It has an alkaline reaction even in herbivora.

_Treatment._ The danger centres around the bacteridian fermentations, and a main object must be to disinfect the bladder. This will be all the more effectual if the lotions used are of an acid reaction. Thus boric acid or salicylic acid in 3 per cent. solution, injected after evacuation of the bladder and repeated a number of times a day may soon establish a healthy action. If the bladder is especially irritable a boiled weak solution of gum arabic will form a suitable medium. Other antiseptics are often used as creosote (0.5:100), carbolic acid (3:100), chloride of zinc (3:100), chlorate of potash (3:100), mercuric chloride (1:5000), silver nitrate (0.5:100), or astringents are often better: PbA, ZnSO_{4} tannic acid, ferri chloridi in dilute solution so as not to cause pain.

The bowels should be kept open by an occasional saline laxative, pain moderated by codeine, and abundance of pure water and a laxative diet enjoined. Linseed tea, and infusions of slippery elm or marsh mallow have long been employed, and by soothing and relaxing the bowels they act favorably on the urinary mucosa. Stimulants of the urinary track like buchu, uva ursi or copaiba in small doses, or antiseptics like creosote, boric acid, salicylic acid, piperazine, are available in slight cases or when the acute symptoms have subsided somewhat. With prior infection of the kidneys, the latter may be used. Constant drainage may be necessary to avoid distension.

Perfect rest is absolutely essential, a restricted laxative diet, and a careful avoidance of cold, and stimulants.

When urine is retained it should be removed with a thoroughly aseptic catheter.

In case of blood clots in the bladder, wash out with a boiled normal salt solution.

ACUTE CROUPOUS CYSTITIS.

This has been found to follow the use of cantharides and other irritant diuretics, and to follow on certain specific diseases. Its nature is that of catarrhal inflammation, but with a fibrinous product or false membrane formed more or less extensively on the inflamed mucosa.

_Symptoms_ are essentially those of catarrhal cystitis from which it is distinguished by the presence in the urine of flakes of the fibrinous membrane.

_Treatment_ is essentially the same as in the catarrhal form, to which may be added the injection of a solution of 4 grains scale pepsin to the ounce of sterilized water. The boric acid solution may be of the strength of 20 per cent. Irrigate two or three times a day.

CHRONIC CATARRHAL CYSTITIS.

This may begin as such or it may continue after an acute attack. It has been noticed in horse, ox, and dog.

It may be associated with calculi, gravel, papilloma, and bacterial invasion especially by the colon bacillus.

_Lesions._ The mucosa and muscular coat are thickened, corrugated, puckered and contracted so that the bladder will not contain more than a few ounces of urine. The surface of the mucosa is discolored, mottled and variegated, slaty blue, brown, red, purple, or even black, with ulcers, encrustations of triple phosphate, and fungoid elevations. In dogs especially, the prostate is often enlarged.

_Symptoms._ Frequent urination accomplished with pain, groaning, or whining and it may be with sudden arrest. There may be incontinence, the urine dribbling almost continuously from the penis or vulva and in the latter case trickling down the thighs. The presence of pus and mucus tends to mat the hairs, and a strong urinous and ammoniacal odor is emitted.

Palpation of the prepubian region often, and of the vagina or rectum always causes pain and wincing. Temperature is normal.

Urine is albuminous in ratio to the amount of pus, or above that, and is then suggestive of kidney disease and likely to be complicated by casts.

Complicating lesions of the womb, vagina, prostate, and kidney are to be carefully looked for, also cystic papilloma.

_Prognosis._ Recovery though not uncommon is too often but partial and it is usually desirable to fatten the animal.

_Treatment._ Rest, moderate laxative diet, pure drinking water ad libitum, warmth, antiseptic irrigation.

CYSTITIS IN THE OX.

_Special Symptoms._ Beside general disorder there is a disposition to decubitus, but with frequent rising to urinate though the bladder is not filled to repletion. Then the urine is passed in a slow stream by abdominal contraction, and without pulsating contractions of the urethra at the ischium which are so marked in calculus. Cystitis is greatly aggravated by overdistension, and if the bladder is paralyzed is very liable to go on to rupture.

Galtier considers enzootic hæmaturia as essentially a hæmorrhagic cystitis, due to marshy soils, disordered liver, often distomatosis, and irritation of the urinary organs by the poisons which the liver was helpless to destroy or eliminate.

The _treatment_ of cystitis in cattle does not differ materially from that of the horse.

The hæmorrhagic form demands prevention by drainage, cultivation and the use of phosphates to the soil.

CYSTITIS IN DOGS.

The _special symptoms_ in dogs are uneasiness and frequent changes of place. The patient passes urine often in small quantity, and with whines or cries. He walks slowly and stiffly with the back arched, and compression of the abdomen and especially of the prepubian region is painful to a marked degree. The tense elastic bladder may often be distinctly felt through the abdominal walls. The inflamed bladder is liable to paresis and paralysis with great overdistension, and aggravation of the general symptoms, the eyes sunken, and dullness, stupor and coma betraying uræmic poisoning. Some claim rupture of the bladder as is so common in the ox.

In the main, _treatment_ is as for the horse. Rest, warm bath, or fomentations, catheterism with aseptic catheter, draw urine through hypodermic nozzle in prepubian region. Antiseptics: boric or salicylic acid by the mouth and bladder. Laxatives, and plenty of water are important. Free access to open air where the animal can urinate, is very essential. In chronic cases, buchu, copaiba, balsams, or piperazine may be employed. Mustard blister. Electricity. Small doses of belladonna to give tone to the bladder.

ATONY AND PARALYSIS OF THE BLADDER.

_Causes._ This comes usually from troubles of innervation. Paraplegia, dorsal and lumbar fractures with injury to the spinal cord, brain lesions, hæmoglobinuria with effusion pressing on the cystic plexus, overdistension of the viscus, from cervical spasm, urethral stricture or calculus or parasite (strongylus gigas), acute or chronic cystitis. In dogs it may come from obstruction by enlarged prostate. Polypus blocking the cervix and chronic disease of the walls of the organ are additional causes.

_Symptoms._ More or less complete retention of the urine. The bladder cannot be completely emptied except by powerful contractions of the abdominal muscles. Habitually it may escape in drops, or in jets at intervals during exercise. Palpation will show overdistended bladder as a tense, elastic mass. But as overdistension may occur without paralysis, no case can be certainly diagnosed without catheterization to show that the urethra is free.

When the paralysis affects the cervix, the urine escapes continually and trickles down the insides of the hips in mares, or from the sheath in males.

_Diagnosis_ demands catheterism and rectal examination.

Complication. Cystitis by retention. Infection by catheter.

_Treatment._ Corresponds to causes. These corrected, use aseptic catheter often. After extreme distension empty partially, or inject a few ounces of borax or boric acid solution. Thus avoid collapse and inflammation, and secure antisepsis. Give tone by a course of strychnia, (ergot, belladonna), mustard blister; turpentine in small doses. Better electricity, 1 pole in bladder, 1 on pubic symphysis. Apply for 5 minutes.

TUMORS OF THE BLADDER.

Recorded cases of sarcoma (Mauri), carcinoma (Cadeac, Hink, Friedberger), and tuberculosis can be adduced. Papilloma is perhaps as frequent as any of the above. The author has treated two cases of papilloma in mares complicated with multiple small calculi and gravel. _Treatment_ is exclusively surgical and in the mare with the widely dilatable urethra this is sometimes possible through that channel. In the same animals _diagnosis_ may be accomplished by introducing the finger into the urethra and bladder. In other females and males, vaginal or rectal palpation must be resorted to.

VESICAL PARASITES.

Eustrongylus gigas. Dog, horse, man.
Trichosoma plicata. Dog.
Œstrus Hemorrhoidalis. Mare.

SPASM OF NECK OF BLADDER.

Spasm of the cervix vesicæ has been doubted, save as the result of local inflammation, yet it not uncommonly takes place in horses and other animals in connection with irritation attendant on the retention of urine during work, or in dogs during a period passed indoors. Trouble and suffering continues, with ineffectual efforts to micturate, but practically complete relief is secured by catheterization or by a spontaneous abundant discharge. The neurosis which leads to it is produced or aggravated at times by enlarged prostate, or lesions in the urethra. Intense fear may cause it.

_Treatment._ Remove cause. Give antispasmodics, valerian, musk, bromides, chloral hydrate, opium, stramonium, hyoscyamus, codeine, etc., may be given as injections or suppositories. For the horse spread the litter and soothe by whistle or song. Or use the catheter and correct any local irritation.

RUPTURE AND LACERATION OF THE BLADDER.

This occurs most commonly in oxen from obstruction of the urethra by a calculus. Similar obstruction in the horse causes most acute symptoms, calling for immediate relief, and rupture is a comparatively rare occurrence. Pench mentions a case resulting from a fall during an attack of colic, and with a full bladder. It has happened during lithotrity, or lithotomy, and even during parturition. Perforation by parasites has been noted and in one case by an osseous tumor of the pubic symphysis. In horses a fatal result is prompt, in cattle from 6 to 48 days.

Treatment surgical.

EVERSION OF THE BLADDER.

This is really invagination into the female urethra and bladder. It has only been seen in mares, and then by reason of the extreme dilatability of the urethra. A pyriform, red, perhaps rugose tumor shows between the lips of the vulva, during straining. It is covered by mucosa, and on its upper surface near to its neck are two small orifices from which urine oozes or comes in jets during active expulsive efforts. It soon becomes muco-purulent on the surface, and even excoriated. Urine escaping continuously trickles down the thighs with much fœtor. It occurs especially during violent expulsive efforts as in parturition or constipation.

_Treatment_ essentially surgical consists in uniform compression to expel blood and exudate followed by the pushing of the fundus through the bladder and urethra. The more recent the case, the easier is the process. Pressecq claims to have cured an obstinately recurring case, by cauterizing the urethra up to the cervix vesicæ with a round iron rod an inch in diameter. The resulting loss of substance, with the neoplasia and constriction effectually prevented renewed eversion even during parturition. Other veterinarians have successfully excised the bladder, but this entailed incontinence and constant offensive soaking of the thighs with urine.

HERNIA OF THE BLADDER.

This is commonly seen in the mammalian female in connection with rupture of the floor of the vagina during dystokia. It has also been observed without such lesion in both male and female dogs and horses, the bladder forming a cystocele of the vagina, or bulging between the anus and the ischium.

_Diagnosis_ is confirmed by careful palpation through the rectum. The folding of the bladder backward obstructs the exit of urine.

_Treatment_, essentially surgical, might include replacing of the organ and suturing of the wound, or, in the absence of a wound, evacuation of the bladder by a hypodermic needle, and replacing by palpation through the vagina or rectum. Sometimes suture of the vulva is desirable.

ANOMALIES OF THE BLADDER.

=Persistent urachus.= Seen in the new born and mainly in males. Antiseptic closure is essential after having ascertained that the urethra is pervious.

=Imperforate cervix vesicæ.= A case reported by Lapotre, in a calf, had no cervix, and the ureters were blocked by pea-shaped nodules.

=Recto-vesical fistula.= In a calf 13 days old the rectum opened into the bladder and the fæces and urine escaped by a pervious urachus. (Kaufmann and Blanc).

URETHRAL ANOMALIES.

_Imperforations._ In the new born male, foal, lamb, etc. Usually at the outer end, and it may be for some distance back. In one case the sheath was firmly adherent on the wall of the abdomen, thus shutting off all exit of urine. If the canal is absent only at the orifice or for a short distance, the urethra beyond this can be felt full of liquid and fluctuating. The patient being properly fixed a fine trochar is pushed from the end of the penis into the blind end of the urethra, which will be ascertained by the overcoming of resistance. The trochar is now withdrawn and the urine flows through the cannula. A catheter or sound is now tied in the passage to maintain it pervious until cicatrization shall have taken place.

_Hypospadias._ Short urethra opening backward on the lower surface of the penis. Considered irremediable.

_Epispadias._ Urethra opening on the upper surface of the penis. Much more rare.

ACUTE URETHRITIS. CATARRH OF THE URETHRA.

This occurs in all genera of domestic animals, and may be either acute or chronic. It is most common in the entire males, not only because of infections sustained in copulation, but because frequent erection exposes the opening of the urethra to injury and inflammation, and to the entrance of pathogenic germs.

_Symptoms._ Pruritus of the penis, and difficulty and pain in urination and straining are frequent, but a single small jet may be all that is passed at a time. The papilla on the end of the penis is red and angry and somewhat swollen. Later a few drops of muco-purulent fluid may be pressed from the orifice. In the bull, dog and boar this oozes from the retracted penis into the sheath, so that a collection is found in that canal, and the mucosa becomes infected causing a balanitis.

The infection may be conveyed from male to female and _vice versa_. Dr. Horand of Lyons even found that the muco-purulent discharge of gonorrhœa in man caused an urethral catarrh in the dog, which however did not persist for any great length of time.

_Diagnosis_ is based on frequent and painful urination in jets, tenderness of the urethra under palpation or catheterization, redness and swelling round the urethral orifice, and the oozing of pus. In the absence of any external injury one should always ascertain if cystitis is present.

_Prognosis_ is favorable under appropriate treatment. Spontaneous recovery will usually occur early.

_Treatment._ Dilute the urine. Give pure water to drink at will, or flaxseed gruel, or gum or barley water. Alkaline carbonates. In the early stage foment and use injection of potassium permanganate (2 grs. to 1 oz.). Later may be used more astringent agents (boric acid 1:100, zinc sulphate 1:100, lead acetate 1:100, potass. chlorate 3:100. In the presence of great pain cocaine muriate 2:100). There is danger of stricture from the stronger astringents or caustics in the early stages before suppuration. To complete the cure give copiaba, buchu, resin, or essence of turpentine.

WOUNDS OF THE URETHRA.

Actual wounds occur in surgical operations, or accidentally as by shafts, poles, forks, hooks, bites, etc., or from calculus or a catheter forced into a false route. An arrested or slowly moving calculus has been known to induce several perforating ulcers causing infiltration of urine and infecting germs into the connective tissue. This determines rapidly increasing œdematous fluctuating tumors. Gangrene and septic intoxication are common results, especially in cattle.

Longitudinal wounds keep more open and heal more readily than transverse wounds, probably because the circular muscular fibres in contracting, pull the edges apart and counteract stricture, the breach being filled up by granulations. The perineal wound in lithotomy will heal thus in 20 days, while that made in amputation of the penis is exceedingly liable to circular contraction and stricture or occlusion.

Contusions of the perineum, may cause lacerations of the urethra and hæmorrhages, with bloody discharge or sanguineous swelling.

_Treatment._ Will vary. Calculi must be diagnosed and removed. Breach of the walls of the urethra may necessitate frequent catheterization or, better, the wearing of a catheter. Escape of urine into the connective tissue should be met by a counter opening in the skin to drain the part and allow free antisepsis. Similar resorts are required for urinary infiltration, accompanied by antiseptic injection subcutem. Abscesses must be located, punctured with trochar and cannula, evacuated and injected antiseptically.

FOREIGN BODIES IN THE URETHRA.

Apart from calculi, may be found straws, glumes, chaff and catheters and even stones and small bodies which must have been introduced deliberately. An irritation corresponding to the offending mass and its seat, ensues, and must be treated by soothing and antiphlogistic measures while the offending body must be found and completely extracted.

STRICTURE OF THE URETHRA.

This may be suspected when in spite of much straining the urine is habitually passed in a very fine stream, which has become finer and finer for a length of time, without complete arrest as in calculus. The introduction of a catheter will confirm the diagnosis and show the exact seat of the stricture.

It is determined by irritation caused by calculus, urethritis, ulcer, wounds, etc., which tend to the formation of a cicatrix encircling and narrowing the canal. One efficient cause is the injection of strong astringent or slight caustic solutions in the early stages of urethritis.

_Treatment_ is by dilation, by bougies pointed and gradually thickening, or simply by an elastic staff which at first passes with some force and is replaced by a larger one as the urethra stretches under daily use.

=Catheterization.= In connection with diseases of the bladder and urethra the passing of the catheter is a most important operation which requires considerable skill on the part of the operator. A short statement of the method to be adopted for each of the domestic animals will therefore be in place.

=Catheterization in the male Soliped.= The catheter, a hollow, gum elastic tube, must be proportioned to the size of the animal, but for the average adult horse about 3½ feet in length and ⅓ inch in thickness. To give it the requisite solidity and resistance it is usually furnished with a stilet of whalebone or cane.

The operation is performed with the animal standing, in quiet animals without any restraint, but in the more sensitive or restive, with one fore foot held up; or with both hind feet in hobbles furnished with ropes passing between the fore limbs and tied over the neck in front of the withers; or finally with a twitch on the nose.

The rectum is emptied, and with the oiled or soapy hand the penis is found and slowly withdrawn from the sheath by steady traction. This is usually easy, though in certain cases, with a short penis and specially strong retractors, it will seriously tax the operator’s skill and address. In a specially obstinate case a hypodermic injection of morphine may be resorted to.

If the horse is down, as in paraplegia or hæmoglobinæmia, he may lie on his right side while the operator stoops over him from the loins; or his feet may be drawn together by hobbles, and the subject turned on his back, the operator placing himself as before on the left side.

The catheter must have been previously cleansed and disinfected outside and in. A mercuric chloride solution 1:2000, or boric acid 1:50 or permanganate of potash 1:50 may be employed. Then it must be smeared, preferably with vaseline but, in case of necessity, with sweet oil, glycerine, borated lard, or even castile soap.

The penis being withdrawn from the sheath, the catheter containing its stilet is introduced into the urethra and pushed on slowly and carefully until its point can be felt over the ischiatic arch. The stilet is now drawn out a few inches and the point of the catheter is bent forward over the ischium by the finger. The stilet is further drawn out and the catheter can easily be pressed on into the bladder. If any difficulty is experienced it may be guided by the hand introduced into the rectum.

In one extraordinary case, I found that the catheter entered a dilated seminal vesicle and failed to evacuate the bladder. This untoward occurrence must be rectified by the aid of the hand in the rectum. Usually the penetration of the bladder is signalized by the overcoming of resistance, and when the stilet is withdrawn the urine flows in a steady stream. If it fails to flow, a slight compression of the fundus of the bladder by the hand engaged in the rectum will start the stream.

The catheter should be withdrawn slowly and carefully.

=Catheterization in the Bovine Male.= Most veterinarians suppose that this is impossible, owing to the narrowness of the sheath interfering with the extraction of the penis, and the S shaped curve in the penis preventing the introduction of the catheter. Both obstacles can, however, be overcome in many cases. The bull may be tempted to protrude the penis by the presentation of a cow in heat, or in bull or ox the bulging anterior part of the organ may be protruded by careful manipulation through the sheath. Then the free extension of the penis can be made to efface the S shaped curve. The catheter must be small, not much over a line in caliber, and a metal stilet is employed. The animal may have to be placed under restraint, and the same antiseptic precautions are demanded as in the horse.

=Catheterization in the Ram and Wether.= These must be dealt with like the bull, the only additional difficulty being in the vermiform appendix. This is small and sinuous but the longitudinal opening on its lower surface is favorable to the introduction of the catheter.

=Catheterization in the Dog.= The fact that the urethra traverses the groove on the lower aspect of the bone of the penis, is held to prove an obstacle to the catheter, yet the introduction of the latter is in no sense difficult. Small or moderately sized dogs, may be held upright, the body resting on the rump and the pelvis inclined forward, which will favor the spontaneous protrusion of the penis. Or it may be pressed out by manipulation through the sheath. The catheter ⅔ ds. to 1 line in diameter may be 1¼ to 2 feet in length according to the size of the animal. It should be used aseptic.

=Catheterization of the Mare.= Nothing can be easier than this operation in the mare. The shortness and dilatability of the urethra, and the accessibility of its external orifice in the center of the floor of the vulva, 4 or 5 inches in front of the lower commissure, favors the introduction of the catheter. The latter may be a foot in length, perfectly straight and it may be constructed of silver or some other metal, which may be readily boiled and rendered aseptic. In the absence of a catheter the germ free nozzle of a rectal syringe may be used, or two fingers may be passed through the urethra and parted from each other so as to allow the exit of the urine.

=Catheterization of the Cow and Heifer.= The operation is often very difficult in the cow, by reason of the small size and undilatability of the urethra, and by the presence of two blind ducts (canals of Goërtner) above and to the two sides of the urethral opening. The thin rigid upper margin of the orifice projects down over it in a valvular manner so that the catheter will almost always find its way into one of the blind sacs. By introducing the tip of the index finger beneath the valvular fold and into the opening of the canal, the catheter may be directed beneath it and into the bladder. An apparatus consisting of a series of ribs of spring wire arranged in the form of a funnel and converging at one end to a point has been devised to insert into the urethral orifice, and guide the catheter which is passed through it.

=Catheterization of the Bitch.= The operation is rendered difficult by the narrowness of the passage, and the puckers and folds of the vaginal mucosa which serve to hide the urethral orifice. A small catheter like that used on the male is used or a short metallic catheter may be substituted. By directing this forward exactly in the median line of the floor of the vulva, with gentle pressure downward it may be made to enter the urethra. In case of special difficulty a bivalve speculum may be resorted to, to efface the mucous folds and reveal the orifice.

ACUTE PROSTATITIS AND HYPERÆMIA OF THE PROSTATE.

Causes: In dogs, house life, overfeeding, compulsory retention of
urine, and fæces, constipation, proctitis (rectitis), piles, calculi,
strangury, uric acid, urethral ulceration or stricture, rude
catheterization, chill, generative excitement to excess, secondary
abscess or infection. Forms. Lesions: follicular, interstitial,
circumscribed and diffuse suppuration. Symptoms: frequent straining
urination, rectal palpation, incontinence of urine, costiveness,
tender perineum, dullness, recumbency, fever, pus in urine, collapse
of swelling, fistula. Diagnosis. Prognosis: grave. Treatment:
laxatives, mercurials, salines, leeches, acid laxative,
non-stimulating, camphor, bromides, ergot, witch hazel, opium,
belladonna, enemata of cold water, or ice suppository,
catheterization, perineal incision, antiseptics.

_Causes._ This is most commonly seen in dogs, in which it may depend on house life with overfeeding on stimulating, spiced, albuminous food, compulsory restraint of urination and defecation in obedience to the demands of cleanliness, distended bladder, and rectum, constipation, proctitis, piles, and other sources of local irritation. In all animals its origin is favored by the formation or arrest of calculi in the prostate, the pelvic urethra or even the bladder; by drug strangury from cantharides or other irritant diuretic; by excess of urea, uric acid or other irritant in the urine; by infection extending from the urethra or bladder; by ulceration or stricture of the urethra; by rude or incautious catheterization, or injection; by exposure to cold; and by local infection in pyæmia and other general zymotic disorders. Most of these conditions conduce to local excitement and hyperæmia, which from adjacent organs, are sympathetically transferred to the prostate. The same is true of frequent, and intense generative excitement which according to Lafosse and Cadiot is a common cause of prostatitis in stud horses. Again the abscess of strangles may become localized in the prostate, or the nodule of glanders, or the tubercle of tuberculosis (cattle, pigs, dogs). Cadiot suggests that in animals, divested of the tail, external injuries to the perineum may extend by continuity to the prostate, as happens to man from horseback or bicycle riding. He adduces no cases however. The habit of masturbation acquired by certain males may also be adduced theoretically as both cause and consequence of prostatitis but future observation must show how frequently this really operates.

_Forms. Lesions._ According to the nature of the lesions the affection has been divided into different forms 1st, =Follicular= or =Parenchymatous=; 2d, =Diffuse= or =Interstitial=; 3d, =Circumscribed Prostatic Abscess=; 4th, =Multiple Miliary Abscesses=.

=Follicular Prostatitis= implicates primarily the follicles and gland ducts and finally the entire gland tissue. It is usually associated with and doubtless often proves an extension from an adjacent infective urethritis, and tends, in persistent cases, to go on to interstitial inflammation and abscess, or hypertrophy. This is characterized by more or less swelling of the prostate, with increased vascularity of its mucosa and the oozing from its openings and gland ducts under pressure, of a thick, yellow, gelatinoid fluid containing pus and granular epithelial cells and sometimes striæ of blood.

=Diffuse= (=Interstitial=) =Prostatitis= shows, in addition to the general swelling and muco-purulent discharge, a considerable exudate into the interstitial tissue, with increased tension and resistance of its substance. It is associated during life with more fever and constitutional disturbance than the simple catarrhal or follicular form.

In =Circumscribed Prostatic Abscess= we find, in addition to the general hyperæmia and swelling, a much more prominent local swelling, the seat of intense inflammation, at first firm and resistant and later softer and fluctuating in the centre, which is filled with pus. This may have its origin in the follicular form, the pus becoming shut up in a follicle and gradually increasing until it bursts into the urethra, the bladder, the rectum, the peritoneum, or pelvic fascia and perineum. In other cases it becomes complicated by pyæmia and secondary abscesses.

=Miliary Abscesses= may be comparatively few in number or generally diffused through the prostate, and are often the result of a pre-existing general infection.

_Symptoms._ As the disease usually begins as a local infection the first symptoms are, as a rule, unattended by fever, which, however, appears in two or three days as the local lesions increase. The urine may be passed frequently in small amounts, or there may be frequent straining without passage of urine, the pressure of the swollen prostate, with or without spasm of the sphincter vescicæ, causing retention. It is no uncommon thing to find the last urine passed of a milky or glairy character and, coagula moulded in the prostatic canals may at times be found. The presence of spermatic crystals, fusiform, with very pointed extremities, and precipitated on the addition of ammonium phosphate, is characteristic of prostatic fluid, (Fürbringer). In other cases there is incontinence, the urine dribbling away involuntarily as the animal walks, and especially if anything occurs to excite him. Micturition may be painless or attended by acute suffering, which causes a sudden arrest of the flow. Defecation is attended with difficulty and more or less pain, and obstinate constipation is likely to set in. The animal is dull, spiritless and seeks to lie undisturbed. Pressure on the perineum is painful and exercise aggravates the symptoms. Rectal examination by the hand or finger according to the size of the animal, reveals the enlarged, tender prostate lying on the cervix vesicæ. This swelling may be unilateral but most commonly it is bilateral or general. When fever sets in with a temperature of 102°–104°, thirst, anorexia and weakness or stiffness in the hind parts may be noticed. In case of abscess, the urine may be perfectly clear until it bursts into the urethra or bladder when there is an abundant flow of pus, and rectal examination shows that the swelling and tension have notably diminished. Should it burst into the rectum, the pus shows in the fæces. Reinemann records a case in a bull with dysuria, œdema of the sheath and a swelling like the fist in the perineum, containing pus, and which communicated with the prostate and urethra. With the rupture of the abscess there is a marked amelioration of the symptoms.

Not infrequently the affection subsides into the chronic form and the abscess, having a restricted channel for evacuation, remains as a suppurating cavity.

_Diagnosis._ The enlargement and tenderness of the prostate as felt on rectal examination is pathognomonic. If the body of the urine is clear there is further corroboration, as in cystitis it is more or less turbid and flocculent or even bloodstained. Micturition is likely to be much more frequent in cystitis than in prostatitis. Catheterization is much more painful when the catheter passes the prostate in prostatitis than in cystitis.

_Prognosis_ is always grave. Some cases recover completely, while others run on to a fatal termination, and still others merge into the chronic form. Cases that are complicated by abscess are always to be dreaded, as chronic suppuration, or pelvic or peritoneal infection, or pyæmia, or septic poisoning is liable to supervene. As the disease is more common in the old so it is liable to prove more severe and redoubtable.

_Treatment._ In acute cases active derivation toward the bowels is desirable. A mercurial purge (calomel—horse or bull 1 to 2 drs.; dog, 2 to 5 grs.) may be followed a few hours later by salines (sodium sulphate—horse or bull 1 lb.; dog 1 oz.). Sodium sulphate or magnesium sulphate may also be given with glycerine as an enema. Great benefit may often be obtained from the application of leeches on the perineum or around the anus. The diet must be restricted and non-stimulating, mainly of amylaceous materials, and with the water, flaxseed tea may be liberally mixed. When the suffering is severe it may be met by camphor, camphor bromide, ergot, hamamelis, gelsemium or potassium bromide, given by the mouth or rectum. With violent strangury, opium, belladonna or hyoscyamus may be used. Some cases may be relieved by the use of enemata of cold water or pieces of ice in the rectum. In retention of urine, careful catheterization is imperative, the hand or finger in the rectum being employed to guide the point of the catheter under the prostate.