Chapter IX: Part 9

=White, chylous urine= occurs with a hæmatozöon (=Bilharzia Crassa=) in the blood of cattle.

=Translucency.= Urine may be passed clear and become turbid by standing. The presence of colloids hinders precipitation and prevents clearing.

=Horse=: Urine is generally turbid, especially what has been long in the bladder, and that which is last passed. The turbidity is largely due to precipitation of calcium carbonate and bicarbonate, and increases on green food, or if the liquid stands exposed to the air and is cooled. Not unfrequently the salts are thrown down as fine spherical granules, or there may be a white pultaceous mass. They are sometimes entangled in extremely mobile cylindroid masses coming from the uriniferous tubes during convalescence from fevers or during fasting. A fine pellicle on the surface is normal in horse’s urine left in the air.

=Ox, Sheep and Goat=: Urine is passed clear. May become turbid through the change of lime carbonate into bicarbonate in cattle but always more slowly than in the horse.

=Carnivora=: Urine is passed clear but becomes turbid on decomposition, or if concentrated. With excess of fat in the food it may become opaque from floating oil globules, apart from the classic chyluria.

=Pig=: Fed on raw fresh vegetables the urine is clear, but if on cooked or dried vegetables, and especially if nitrogenous, it may show opacity.

=Pathological=: The =horse’s= urine is limpid and acid in polyuria; limpid and alkaline or neutral with modified phosphates. It may be morbidly turbid from excess of lime phosphate or sulphate, urea or other acid salts, exudates, leucocytes or pus. These usually indicate nephritis. Mucus and muco-purulent exudate suggest pyelitis or pelvic nephritis. Blood elements indicate nephritis, cystitis or urethritis. Debris of kidney tissue may indicate tuberculosis; tumors, etc.

Turbidity in =other animals= than solipeds is abnormal: examine the urine.

=Consistency of Urine.= Morbid urine may be gluey, sizy, syrupy, mucous, oily. If a =horse’s= urine is scanty a =slight siziness= may be normal and due to tenacious mucus from the pelvis of the kidney, and from the solution of mucin and epithelium in the alkaline fluid. =Viscous=, =sizy=, =stringy=, and =tarry= (=pitchy=) urine is found in pyelitis, pyelo-nephritis, or cystic catarrh, but not in polyuria owing to the presence of the solvent acid.

=Odor of Urine.= This is somewhat =aromatic= in =horse= and =ox=, =disagreeable= in the =dog=, and =repulsively heavy= in the =cat=. With polyuria the odor is less. If the urine has been =retained= and =fermented= it is =ammoniacal=, if there are =ulcers= or =tumors= it is =fœtid=, in =diabetes= it smells of =acetone=, after taking =turpentine= it has a =violet odor=, and after phenic acid, camphor, ether and other drugs it is variously modified.

=Specific Gravity of Urine= in ratio to water 1000:

Horse, 1020 to 1050 (1040)
Ox, 1025 „ 1045 (1030)
Sheep; Goat, 1015 „ 1065 (1040)
Dog, 1020 „ 1060 (1040)
Pig, 1005 „ 1015 (1010)
Cat, 1020 „ 1040 (1030)

In the horse the urine may be 1001 to 1010 in polyuria, in chronic interstitial nephritis, and in a crisis of fever attended by diuresis. It may be 1050 to 1060 in glycosuria. Undissolved solids that are merely suspended in the urine do not affect its density.

A rough estimate of solids may be made by multiplying the last two figures of a specific gravity expressed in four figures by 2.33. The result approximates to the number of grammes of solids in 1000 cc.

=Chemical Reaction of Urine.= The liquid is tested by litmus paper, red and blue, weakly impregnated. The normal reaction is determined by the food: the urine of =carnivora= and =sucking herbivora= is =acid= turning blue litmus red: the urine of =vegetable feeders= is _alkaline_ turning reds blue. In the =horse= the =alkalinity= is mainly due to excess of lime bicarbonate, passing, with standing, into lime carbonate, the carbon dioxide being derived from organic acids (lactic, malic, citric, etc.), by oxidation. The hippurates are also alkaline in reaction. In =dogs= the acidity is due to lime and soda phosphates, sulphates, urates and oxalates.

=Pathologically= we find the urine strongly =alkaline= from the evolution of ammonia from urea, in fermentations occurring with prolonged retention in the bladder or in cystitis. The urine is =acid= even in herbivora in all fevers in which appetite is lost or seriously impaired, and in which the metabolism is excessive.

=Chemical Changes in the Urine in Disease.= =Sodium Chloride=, is present in large amount in health (horse 25 to 35 grammes, dog 0.25 to 5 grammes daily) is =diminished= in fever, anæmia, visceral and exudative inflammations. It is =increased= during the absorption of false membranes and exudates. It is thrown down by adding solution of nitrate of silver, the curdy white precipitate being insoluble in nitric acid.

=Phosphates of lime, soda, potash and, scantily, of magnesia= are normally present (horse 0.08 to 0.60 gramme phosphoric acid daily) and are present in excess in digestive disorders and in malnutrition of bones (rachitis, osteoporosis and rheumatoid arthritis). The =alkaline phosphates= are very soluble and never precipitated. =Earthy phosphates= dissolve in acid urine, but are precipitated from alkaline. To a little of the urine add a few drops of acetic acid, followed by a few drops of uranium acetate. A yellow precipitate of uranium and ammonium double phosphate is thrown down.

=Indican= (C_{8}H_{7}NSO_{4}) is formed from indol which passes successively through the forms of indoxyle and indoxylid potassio-sulphate. This is normally present in the urine, the horse excreting 1 to 2 grammes daily, the dog 0.15 gramme. It is present in excess in intestinal indigestions, constituting indicanuria. It is tested by adding a drop of muriatic acid and one of a solution of chloride of lime to the urine, when it will show a blue ring, the depth of which indicates the relative amount.

=Urea= (CON_{2}H_{4}) the principal waste product of nitrogenous matter, is always present in considerable amount. The sound horse may eliminate 100 to 200 grammes daily, the dog 5 to 180 grammes. It is present in excess in all fevers and inflammations unless urination is suspended or impaired, in cryptogamic diuresis, in mellituria, uræmia, nephritis and cystitis. Test: The addition to a filtered solution of urine, freed from phosphates, of solution of acid nitrate of mercury, precipitates it as nitrate of urea. A simpler test is to add to a drop or two of urine on a glass slide a drop of nitric acid and heat gently. The nitrate of urea is precipitated in the characteristic rhombic or hexagonal crystals as seen under the microscope. Heat urea crystals in a test tube: biuret is formed and ammonia escapes. Add a trace of a copper sulphate solution and a few drops of a 20 per cent. solution of caustic potash: a rose-red color is produced—the biuret reaction.

=Uric Acid= (C_{5}H_{4}N_{4}O_{3}). Traces only of this are found in the normal herbivorous urine, yet it is more abundant when on a full dry grain diet, on milk (suckling) or on animal food. The dog kept on animal food has a large amount.

=Pathologically= it is produced in the dog and even in the horse in fever, overwork and starvation, the animal living on his own tissues. Interference with oxidation in the lungs seems to produce it as an arrest in the transformation of albuminoids to urea. The neutral urate of soda remains in solution: the acid urate of soda is precipitated. _Test_: To the urine add one-fourth its volume of muriatic acid and set aside for 24 hours in a cool place. On the bottom and sides of the glass and on the surface of the liquid will be found the yellowish red acicular crystals of uric acid.

=Hippuric Acid= (C_{9}H_{9}NO_{3}) is normally present in all urine, but is especially abundant in that of herbivora. The horse eliminates 60 to 160 grammes daily. It has been found to be increased by feeding on dandelion, carrots, clover, asparagus, apples, plums, benzoic acid, oil of bitter almonds, toluol, cinnamic or kinic acid. It is absent in sucking calves, and horses fed on grain devoid of husk. =Pathologically= it is increased in hyperthermia, icterus, some liver diseases and diseased kidneys. Test: Precipitate any albumen by nitric acid and boiling, then add hydrochloric acid which precipitates the hippuric acid in long needle-like crystals. Heated in a small glass tube it forms an oily liquid, and heated to redness gives off an odor of hydrocyanic acid (nitro-benzol) and carbon is left. This distinguishes alike from uric acid and benzoic.

=Phenol= is produced by intestinal fermentation. The horse normally excretes about 3 grammes daily. Pathologically it appears in excess in indigestions, abscesses, softened discharging tubercle, pyæmia, and septicæmia. Test: Dilute solutions of ferric salts give a blue coloration.

=Creatinin=, a product of metabolism of albuminoids, is found especially in the urine of carnivora and omnivora in health. It is pathologically increased when oxidation is interfered with, as in diseases of the lungs. Test: Add to the urine a very dilute solution of sodium nitro-prusside and then drop by drop some solution of caustic soda, when a ruby red color is shown and disappears again on boiling. Acetic acid changes to blue.

=Acetone= (C_{3} H_{6} O) is found in the urine of healthy omnivora and carnivora and increased by excess of nitrogenous food. Pathologically it has been found in fevers with much blood change, in inanition, in cancer, in indigestions, and auto-intoxications. Test: To several c c. of urine add a few drops of iodo-potassic iodide solution and caustic potash when iodoform will be abundantly precipitated with its characteristic color and odor.

=Oxalic Acid= (C_{2} H_{2} O_{4}) appears to be secreted in small amount by healthy kidneys and it may also come from the splitting up of uric acid after secretion. It is augmented by feeding agents rich in oxalic acid (beets, fresh beans, asparagus, tomatoes). Pathologically it abounds in certain indigestions, and is associated with lameness and emaciation. Test: Add lime water to the urine, and the white oxalate of lime is precipitated.

=Allantoin= (C_{4}H_{6}N_{4}O_{3}) is found in the urine of sucklings (calves) during the first few weeks of life, in pregnancy and when on a meat diet. It diminishes with the increase of vegetable food.

=Xanthin= (C_{5}H_{4}N_{4}O_{2}) is found in urine as a result of imperfect oxidation of nitrogenous matters especially, which would otherwise pass into uric or hippuric acid. Its immediate antecedents in such transformation are guanin and hypoxanthin or sarkin. It is a rare constituent of urinary calculus.

=Hypoxanthin= (C_{5}H_{4}N_{4}O) is produced from fibrine in gastric and pancreatic digestion and in putrefaction, and is especially abundant in leucæmic subjects.

=Cyanuric Acid= (C_{20}H_{14}N_{2}O_{6}) occurs in dog’s urine.

=Leucin= (C_{6}H_{13}NO_{2}) and =Tyrosin= (C_{9}H_{11}NO_{3}) are products of pancreatic digestion of proteids, and the former occurs normally in the spleen, thymus, thyroid, liver, salivary glands, and urine. Both are present in large amount, in the urine, in acute atrophy of the liver. Test for leucin: Evaporate carefully to dryness with nitric acid: the residue, if leucin, will be almost transparent and turn yellow or brown on the addition of caustic soda. If now heated with the soda it forms an oily drop. Test for tyrosin: treated with strong sulphuric acid, gently warmed and chloride of iron added, it gives a violet color.

=Albumen= is an important morbid constituent of urine, which appears in a great variety of diseases (nephritis, pneumonia, epilepsy, anæmia, leucæmia, diabetes, hæmaturia, hæmoglobinuria, hydræmia, infectious lung diseases, cardiac obstruction, venous stasis in the kidney, dermatitis, burns, lesions of the crura cerebri, floor of the fourth ventricle, spinal cord, or renal vaso-motor nerves). It also occurs after violent exertion, in poisoning by strong acid, phosphorus, arsenic, lead, mercury, opium or alcohol, and when an excess of albumen is injected into the blood. All forms of albumen may enter the urine, but the most common are serum albumen, globulin of serum, propeptone and peptone. A simple test is to acidulate the urine with acetic acid and boil: if the precipitate does not dissolve on addition of nitric acid, it is albumen. Sulphosalicylic acid added to the urine will cause a precipitate in urine containing only ¹⁄₅₀₀₀₀ of albumen.

=Glucose= (C_{6}H_{12}O_{6}) is often normally present for a short period in small amount after a full meal of farinaceous material. It is permanently present in excess in glycosuria, which may result, among other conditions, from diseased liver, punctured medulla, suppression of milk secretion on weaning the calf, oil of turpentine, nitrobenzole, nitrotoluol or amyle nitrate. Test: Add yeast to the urine and keep at 15° to 20° C. when if glucose is present, it becomes cloudy and gives off carbon dioxide, or add a little caustic potash solution, and a few drops of cupric sulphate solution until it is blue: then heat and a red precipitate of cupreous oxide is thrown down. The amount gives the ratio of glucose. Uric acid, hypoxanthin or mucus causes brown precipitate in the absence of glucose: peptone, creatin, creatinine, pepsine and urinary pigment prevent its formation though glucose be present.

=Bile Salts and Pigments= are present in excess in cases of icterus, where these characters may be studied. See Icterus.

=Blood and Hæmoglobin in Urine.= In a variety of diseases (anthrax, hæmaturia, nephritis, Texas fever, hæmoglobinuria, etc.) blood or blood coloring matter escapes in the urine. When blood escapes one finds the reddish color, and under the microscope red globules, normal or crenated (especially in alkaline urine), free, aggregated in masses, in small clots, or embedded in casts of the uriniferous tubes. Under the spectroscope the spectrum shows two dark absorption bands, one in the yellow and one in the green. When the color is due to hæmoglobin the urine shows under the microscope numerous masses of amorphous brown pigment, and the spectrum shows one dark line in the yellow, and three others less deep, (but one of them very broad) on the limit of the green and blue. Urine which contains the elements of blood is usually turbid and thick or glairy, by reason of the presence of salts, albumen and fibrine. There may also be crystals of urinary salts (calculi), fragments of broken down tissue (tumors) or the ova of worms.

=Epithelium in Urine.= The slight cloud seen in healthy urine contains epithelial cells. The source of these may be often determined under the microscope. The _bladder epithelium_ are the most numerous, the largest, and are squamous. Those from the _ureters_ and _renal pelvis_ are also squamous, but neither so large nor so numerous. The _epithelium from the uriniferous tubules_ are polyhedral with large nucleus or columnar. The cells from the _male urethra_ are also largely columnar. In cases, however, in which these cells are passed in large amount because of catarrh of the mucosa all alike tend to assume the globular form with large nucleus so that their true source cannot be certainly stated. It is only from such cells as have become detached without change of form that the seat of desquamation can be determined. If an excess of cells approximating to the kidney type are associated with albuminuria and cylindroid casts they become diagnostically significant. Polygonal cells darkly granular with large oval nucleus and nucleolus suggest kidney inflammation. If the granules are freely soluble in ether there is probably fatty degeneration. If hard, tough and glossy they suggest (but don’t prove) amyloid degeneration.

=Pus Cells in Urine.= Pus cells, with multiple nuclei revealed by adding dilute acetic acid, may be found in small numbers in apparently healthy urine. When present in large numbers, they usually indicate a catarrhal affection of the mucosa, and especially pyelitis, cystitis, or urethritis. There is always cloudiness, excess of mucin, and, in the alkaline herbivorous urine, the liquid may be glairy or stringy.

=Casts of the Uriniferous Tubes.= These usually indicate the existence of nephritis, yet they may be present in small numbers in the urine of healthy individuals under a slight toxic action such as alcohol.

_Unorganized casts_ of urinary salts or hæmatoidin found in sucklings appear to have no pathological significance. _Organized_ casts, on the other hand, usually imply renal troubles, and especially inflammation. As these will be fully described under Bright’s disease, it need only be noted here that they may be composed in great part of _red globules_, _leucocytes_, _epithelium_, _bacteria_, _granules_, a _homogeneous wax-like matter_, _fat globules_, _hyaline matter_, or _urinary salts_. The predominance of one or other of these determines the nature of the cast.

The observations of Mayer, Knoll, Bovida, Von Jaksch and others seem to show that the basis substance of urinary casts differs from all our familiar proteids and must be considered as a distinct nitrogenous compound, a derivative of one of the common proteids.

GENERAL SYMPTOMS OF URINARY DISEASE.

External symptoms, arched back, stiff gait, straining, tender loins,
backing, turning, dropping under weight, urine checked, dribbled; in
dogs and cats, palpation of kidney; bladder, urethra, pains in
different animals. Internal symptoms, rectal exploration, vaginal,
urethral, straining, ureters, bladder, calculi, neoplasms, prostate,
urethritis.

=External Symptoms.= With inflammatory or painful affections of the urinary organs the animal tends to roach the back or loins, tuck up the abdomen, move the hind limbs stiffly and with a straddling gait, protract and withdraw the penis which may be semi-erect, retract and drop the testicles alternately, and stretch himself and strain to pass urine without success. Lying down and rising may be accomplished with marked effort and groaning. The loins along the spines or beneath the outer ends of the transverse processes may prove tender to tapping or pinching, the animal drooping to excess. Backing or turning in a narrow circle may be accomplished awkwardly and stiffly though usually more easily than with lumbar sprain. The animal drops when mounted but less than with sprained back. Urine may be passed in excess or in diminished amount, or it may be entirely suppressed. It may be abruptly interrupted when in full stream, suggesting calculus or polypus, or it may be passed often in mere dribblets, or finally it may ooze away constantly partly lodging in the sheath and partly trickling down the thighs.

In dogs or cats with flaccid walls of the abdomen external manipulation may detect in the kidneys, differences in size, position, and tenderness as well as the presence of tumors. The distended bladder also may be distinctly felt, and the pyriform area of flatness on percussion will serve to map out its size and outline.

In the horse the urethra is superficial and easily traced over the ischiatic arch and for some distance downward, when it becomes deeper and is less easily felt. In the bull the urethra is deep over the ischiatic arch but becomes more superficial lower down and can be easily felt at the sigmoid flexure and below. In sheep and dog it is easily followed from the ischium to the end of the penis.

As a rule the penis is easily drawn from its sheath in the horse and dog; this is more difficult in the sheep and goat and still more so in the bull and boar. In the small animal protrusion is favored by setting him on his rump, with his back between the operator’s legs, and the pelvis doubled forward toward the sternum. The penis of the bull may be extended in presence of a cow in heat, and promptly seized, or it may be seized through the sheath back of its first bulging part and skillfully worked out. In the ruminant, calculi may be felt at the sigmoid curve, and in the ram, in the vermiform appendix at the fore end of the penis.

=Internal Exploration.= This is accomplished in the larger animals with the oiled hand in the rectum, the nails having been pared short and even to avoid injury to the mucosa. In ponies and yearlings the kidney may be felt, and this may be true also of mature animals of larger species in cases of hypertrophy or floating kidney. The ureters, bladder and intrapelvic urethra are easily felt in the male. The empty bladder lies on the anterior border of the pelvis; when full, it projects forward into the abdomen but retains its pyriform or, in the very young animal, its fusiform shape. In the female the sensation is somewhat modified by the presence on its upper surface of the uterus dividing into its two horns anteriorly. The single enlarged horn of pregnancy is especially misleading.

The female urethra, cervix and bladder may be explored through the vagina. To explore the cervix vesicæ and urethra the fingers are slowly drawn back from the bladder along the median line of the floor of the vagina. In the _mare_ the cervix and adjacent portion of the bladder can be further explored with the index finger introduced through the opening of the urethra in the floor of the pelvis and at the junction of the vagina and vulva. In the cow the urethra is too small to be readily explored from within, and the orifice is still further guarded by the two lateral blind canals of Gærtner, into which the unskilled fingers more readily pass. Success only attends the careful search for the small central lower orifice. In the _smaller animals_ the finger only can be introduced into vagina or rectum and the urethra, cervix and bladder only can be felt. _The result of such exploration_ is straining even in healthy conditions but which becomes excessive in nephritis, pyelitis, renal, urethral, vesical or urethral calculus, cystitis, rectitis or enteritis.

The _ureters_ are tender when inflamed, and they are swollen in calculus obstruction with an elastic feeling in front of the stone.

The _bladder_ is very sensitive when overdistended, inflamed or pendent on the abdominal floor, or when the seat of calculus. In the absence of any liquid contents a calculus is felt as a hard solid mass firmly clasped by the contracted vesical walls. If liquid is present the solid hard calculus is felt movable in the fluid. An empty contracted bladder is firm and pyriform. An empty flaccid bladder, resulting from rupture or exhaustion, is flabby, with indefinite form and, if the seat of a lesion, tender. It varies in consistency with neoplasms (papilloma, sarcoma, carcinoma, or epithelioma). These have not the free mobility of the calculus floating in urine, and their point of connection with the wall may often be made out. When a solid body is felt, or suspected to be in the contracted bladder, an injection of sterilized water will usually facilitate diagnosis, and a differentiation of calculus and neoplasm.

_Hypertrophy_ of the prostate is felt as a swelling of uneven outline over the cervix vesicæ. It is to be looked for especially in old dogs.

_Urethritis_ is indicated by swelling and tenderness along the median line of the pelvic floor, back of the cervix. With a _calculus_ in the urethra the swelling is more strictly localized and the canal in front of it may be full and elastic.

HEMATURIA.

Symptoms of different lesions of kidneys and constitutional states, of
poisoning by irritant plants, common on moors and in woods. In
puerperal cow fed on turnips raised on mucky, unreclaimed, sour lands.
Bacteria. Toxins. Anæmia. Poor wintering. Limed new soils. _Symptoms_:
in plethoric, congested mucosæ, vascular tension, hurried breathing,
colics, straining, red urine; in vegetable irritants, depression,
weakness, coldness, trembling, stiffness behind, scanty red or black
urine, diarrhœa, constipation; in anæmia, poverty, debility, red
urine, pink tinge in milk, emaciation, hidebound, anorexia, colics.
Chronic or intermittent. Lesions: in plethoric, congested enlarged
kidney, without softening; in irritant poisons, congestion also of
throat, stomachs, intestines, liver with hæmorrhagic extravasations;
in anæmia, kidneys pale, flaccid, hydroæmia, liver enlarged, softened,
reddish liquids in serous cavities. Treatment: avoid the injurious
soils, drain, cultivate, feed products of such soils with other food,
oleaginous or saline laxatives, antiferments, tonics, astringents,
flax seed, farinas.

The passage of blood or blood elements in the urine.

_Causes._ A symptom of a variety of diseases, producing lesions of the secreting structures of the kidneys; acute congestion, tumors, calculi, parasitism. Also as a manifestation of diseases of distant organs—hæmoglobinuria, southern cattle fever, anthrax, poisoning by irritant diuretics, wounds of the bladder, pelvic fracture with injury to bladder or urethra, cystitis with varicose cystic veins, etc.

Among the irritant plants charged with producing the affection are the young shoots of oak, ash, privet, hornbeam, alder, hazel, dogberry, pine, fir, and coniferæ, generally. Also ranunculus, hellebore, colchicum, mercuriales annuus, asclepias vincetoxicum, broom, etc. The disease is common in spring in cattle turned out too early to get good pasturage and which, it is alleged, take to eating the swelling buds and young shoots of irritant plants.

The disease has occurred mostly in woods and wild lands and has accordingly been vulgarly named the wood evil, (maladie de bois, holzkrankheit), and moor ill.

In England, as occurring in the puerperal cow, Cuming, of Ellon, attributes it to a too exclusive diet of turnips. His analysis showed that turnips contained 10% sugar and 1 to 1½% vegetable albumen. The sugar is held to stimulate unduly the milk secretion, but fails to supply the nitrogenous materials needful to form it, and the cow is speedily rendered anæmic, with solution of the blood globules or of the hæmatin and its excretion by the urine. No attempt was made to produce hæmaturia by an exclusive or excessive diet of sugar, and cows fed on turnips grown on well drained lands never suffered from the disease.

Williams says that urine in such cases had a strong odor of rotten turnips. This argues not an anæmia determined by sugar, but rather an intestinal fermentation, perhaps superinduced by ferments introduced along with the turnips. Add to this the notorious fact that the offending turnips are usually such as are grown on wild, damp, undrained, swampy, or mucky lands, and we have the suggestion of a bacteridian poison, or a toxic product of bacteria. Williams and Reynal practically agree on the point that the common hæmaturia is the result of anæmia. It has long been noticed that the herds which suffer from the affection are those which have come out of the winter in low condition, the victim is the poor man’s cow, and the symptoms are most likely to appear when turned into the fields in spring before the pastures have come up. The anæmic condition of the carcasses is quoted in support of this view, but perhaps without making sufficient account of the extraordinary destruction of blood globules during the progress of the malady.

Pichon and Sinoir see in the liming of soils and the production of larger crops, a cause of anæmia in the rank and aqueous growth of the meadows, and their overstocking in order to eat them down, or to consume their products. They found that an abundant artificial feeding was the most efficacious mode of treatment.

Reynal, who endorses this view, tells us that in the anæmic and liquid blood the globules become smaller and can pass more readily through the walls of the vessels. But this is exactly the opposite effect from what we see when the blood is diluted with water. The globules in such a case are distended and enlarged, and may finally have their protoplasm and hæmatin dissolved and diffused through the liquid. If the blood globules are shrunken, then we must look for a cause very different from anæmia.

Reynal further assures us that plethora is a common cause of hæmaturia in cattle. “Under the prolonged influence of a very assimilable diet, the blood becomes more plastic, circulates with difficulty in the capillaries, and may even rupture them, with a resulting capillary renal hæmorrhage, and bloody urine.” He further intimates that this occurs especially in spring after the animals have been turned out on very rich pastures, and that in Normandy certain pastures of unusual richness are notorious for producing hæmaturia.

Apart from the fact that the rich grasses of spring produce at first intestinal congestion, and diarrhœa, with consequent disorder of the liver and kidneys, this spring affection on particular pastures suggests some special poison in the pasture as the unknown cause of the disease.

In all forms alike of this affection the nature of the soil appears to have a preponderating influence. It is the disease of the woods, and waste lands, of damp and undrained lands, of dense clays, of lands underlaid by clay or hard pan, of lands rich in vegetable humus, or vegetable moulds the decomposition of which has been hastened by the application of quicklime.

Pottier, Salomé, Wiener, and Reynal especially testify to the prevalence of hæmaturia on soils that are either dense and impermeable, or that have a subsoil of clay or hardpan.

The disease has not been traced to any definite microbe nor toxin, but there is much to suggest the necessity for inquiry in that line. The special susceptibility of animals that may be plethoric on the one hand, or in low condition on the other, would be entirely in keeping with such a view, as the debility or derangement of health would lay the system open to attack.

_Symptoms._ In the plethoric animal there are congested mucosæ, full, strong pulse, forcible heartbeats, full veins, accelerated breathing, colicy pains, dullness, straining frequently and the discharge of thick, red or bloody urine.

If from irritant buds and shoots, or plants, there is more depression, weakness, fever, dry skin, staring coat, coldness of the surface, tremblings, stiffness or weakness of the hind limbs, diarrhœa, followed by constipation, frequent straining and the passage of colored urine with pain. In violent cases the expulsion of bloody urine may be excessive, and the cow may die in 24 hours. From irritant plants however the quantity of urine is liable to be small, but frequently passed.

As occurring irrespective of plethora or irritants there may be at first only poor condition and debility with the passage of blood. A pink tinge may show on the froth in the milk pail, and a red precipitate on its bottom. If not anæmic at the outset they soon become so, and the pulse which was at first bounding becomes small and weak, the heart palpitates, the red mucosæ become pale. The subjects become tucked up, emaciated, weak, rough coated, the skin adherent to the bones, and the appetite and rumination impaired or lost. Sometimes colics are present.

In the milder anæmic forms it may continue for months before it causes death. In such cases it may prove intermittent.

_Morbid Anatomy._ In the hæmaturia of plethora the kidneys are large, congested and of a dark red, but, preserve their normal consistency and texture.

In the form associated with ingestion of irritant plants, there is congestion of the pharynx, stomachs, and intestines with hæmorrhagic spots, congestion of the liver, violent congestion of the kidneys which are of a blackish red color, and enlarged to perhaps twice the normal size, with hæmorrhagic exudations, the convoluted tubes filled with fibrinous exudate and blood globules, the pelvis red and like the bladder containing some reddish urine. The vesical mucosa may be black.

In anæmic cases the kidneys are pale, flaccid and colorless, with a reddish liquid in the pelvis and bladder. The vascular system is comparatively empty, and the blood, thin, and watery, and often coagulates loosely or not at all. As noted by Herland globules are greatly reduced in numbers and size, and often crenated or partially broken down. Slight serous effusions in the serous membranes are common. The liver is softened and enlarged, the lacteals have reddish contents, and the ingesta are dark colored.

_Treatment. Preventive._ Avoid hæmaturia pastures and the fodder grown on such lands. Drain and cultivate such soils. When animals must feed on the products of such soils supplement the food by grain, oil cake, cotton seed meal, etc. Avoid stagnant waters draining from such soils.

_Therapeutic Treatment._ Give oleaginous or saline laxative to clear out poisons and ferments from the bowels and may add an antiferment (salol, salicylic acid, carbolic acid, turpentine oil, chlorate of potash, sulphites or hyposulphites), no matter if diarrhœa is present. Follow with tonics (copperas, chloride of iron) and stimulant antiseptics (ol. terebinth, potass. chlorate), and sound food. Flax seed, linseed meal, farinas. Bitters may be added (gentian, quinine, quassia). As a calmative, camphor (2 to 4 drs.) 2 or 3 times a day has proved useful.

In case of nephritis treat as for that affection.

Weiner lauds empyreumatic oil and oil of turpentine with camphor.

In chronic cases, nourishing food with change of locality and water are very important.

A course of iron tonics should wind up the treatment.

ACUTE CONGESTION OF THE KIDNEYS IN SOLIPEDS.

Definition. Causes: bacteria, toxins, irritant diuretics, musty oats
or fodder, foul water, cantharides, turpentine, aqueous grasses,
onions, moulting, cold, chills, injuries to loins, over-driving.
Lesions: kidney enlarged, red, black, softened, capsule loose, cut
surface drops blood, brown, softened necrosed areas, gorged
capillaries of glomeruli and convoluted tubes, granular or fatty
changes in epithelium, may be ruptures. Symptoms: sudden; weak tender
loins, slow dragging straddling gait, accelerated pulse and breathing,
anxious countenance, colics, sweating, urine from limpid to black,
with red globules, and casts. Prompt recovery or nephritis. Diagnosis:
from nephritis, hæmoglobinuria, laminitis, indigestion. Prevention:
Treatment: bleeding, laxatives, diffusible stimulant diuretics,
bromides, diluents, mucilaginous agents, fomentations, sinapisms,
rectal injections, clothing, friction to the skin, restricted laxative
diet.

_Definition._ Active congestion of the renal capillaries, especially of those of the glomeruli and convoluted tubes, with colicy pains, and free discharge of urine, in some cases bloodstained.

_Causes._ It may be determined by local irritation caused by the passage of the bacteria and toxins of infectious diseases such as influenza or contagious pneumonia. In the same way irritant diuretics, medicinal, alimentary and toxic, operate. Diuretic balls and condition powders given recklessly by stablemen and grooms, saltpeter, resin, oleo resins, turpentine, rue, savin, colchicum, squill, anemone nemorosa, adonis, cynanchum vincetoxicum and other species of ascelepias, hellebore, mercurialis annua and bryony are examples. The young shoots of the coniferous plants, fir, balsam fir, pine, white and yellow, and hemlock, are at times injurious.

In the same way, damp moldy oats or fodder produce renal congestion and excessive polyuria, also corrupt, stagnant water and that of marshes which often contains complex toxic products of fermentation. Water of ponds in which cantharides or potato beetles have been drowned, is dangerous. The cantharides, euphorbium or oil of turpentine applied too extensively to the skin as a counter-irritant, is another factor.

Even the rich aqueous grasses of spring succeeding to the dry winter diet, stimulate the kidneys, determining an active congestion with polyuria and in bad cases hæmaturia. In many such cases there are superadded the acrid diuretic plants already referred to. In Denmark where onions are grown on a large scale, the tops fed to animals have produced renal congestion.

There appears to be an extra susceptibility in spring when the winter coat is being shed, and at this time especially, but also independently of this and at other seasons, exposure to cold and the occurrence of chills tend to induce an attack. Exposure to cold storms of rain or sleet when perspiring or fatigued, standing tied out of doors in zero weather without a blanket, wading or swimming deep rivers in cold weather and while fatigued, standing wet and unblanketed in a cold stable when returned from work, exposure to draughts between open windows or doors, the continuous falling of cold rain, from a leaking roof, on the loins, the cold of a damp stable newly finished in brick or stone, the cold and damp of an undrained floor in a wet retentive soil, all have a tendency to drive the blood from the surface, to increase the tension of the blood in the heart and internal organs, to stimulate the kidneys to extraordinary secretory activity, and at the same time to temporarily debilitate the whole system and lessen the power of resistance and recuperation. The factor is especially potent when it involves the nervous interdependent sympathy between the chilled loins or abdomen and the kidneys. Sprains and other injuries of the loins have long been charged with producing renal congestion and inflammation, and even Trasbot, who doubts the reality of this, acknowledges that the already diseased kidneys are seriously injured in this way. Cadeac and Schmid record cases of actual rupture of the horses’ kidney from violent movement, and other cases of congestion and bloody urine have been traced to kicks on the loins, falls, sprains and the carrying of unduly heavy loads. The overexertion which produces albuminuria, casts and sanguineous transfusion in athletes has a similar effect on the overdriven race horse, trotter or draught horse.

_Lesions._ The congested kidney is enlarged, sometimes to two or three times its natural size, softened, and red, especially in the cortical portion which may be so dark as to appear cyanotic. The capsule is also the seat of ramified redness, and is very loosely adherent to the cortex. Beneath it may be considerable yellowish exudate especially abundant in the vicinity of the hilus. On section the cut surface is very bloody, the cortex literally dropping blood, though brownish spots may appear at intervals representing areas of necrosis, which under pressure break down into a pulpy debris. Microscopically the glomeruli appear hæmorrhagic, the capillary vessels being gorged to excess, while blood globules and even minute blood clots are found in the intervascular spaces. The epithelium covering the glomeruli and lining the convoluted tubes show granular or fatty changes, and granular matter is found outside the vessels.

The congestion is less in the medullary portion and even in the convoluted tubes and the tubes of Henle, though these may be the seat both of hyperæmia and exudation.

In case of very violent congestion, extensive sanguineous extravasation may occur, leading even to rupture of the capsule and the escape of blood into the perirenal adipose tissue or into the abdominal cavity. Cases of this kind in the soliped are recorded by Caroni, Cadeac, Moussu, Kitt, Zundel, Mollereau and Porcher. Averons describes in the _Revue Veterinaire_ (1897) a case in which both kidneys were surrounded by an immense black clot, and weighed no less than 36 lbs. Leblanc records a similar case affecting the one kidney. The mass measured about 10 inches by 8.

_Symptoms._ These are liable to appear suddenly, often while the patient is at work, and are manifested by weakness in the loins, slow gait or sudden stopping, the hind limbs are held in abduction, and advanced with apparent stiffness and pain. There is much excitement and anxiety, the face is pinched and strained, the respiration accelerated, the pulse hard, tense and rapid, and the eyes or nose may be turned toward the flank or loins. There may be colicy pains, with uneasy movements of the tail and hind limbs, pawing, and even lying down and rolling. The visible mucosæ are strongly injected and in bad cases the skin may be drenched with sweat. There is at first little or no hyperthermia.

At first there may be no micturition but in an hour or more, urine may be discharged in excess, sometimes as much as 25 quarts, and of a low specific gravity (1001 to 1005). If there has been no blood extravasation it is usually clear and limpid but with extravasation it may be of all shades of pink or red to black. In the latter case the suffering is liable to be acute (Cadeac), and contrary to the condition in hæmoglobinuria, the urine contains blood globules and even tubular coagula representing the uriniferous tubes and entangling the blood cells. This is complicated by albuminuria.

_Course. Duration._ The congestion is short lived. It speedily undergoes resolution with the passage of normal, clear urine, and the recovery of appetite and spirit, or it becomes rapidly aggravated, with continuous suffering and colic, complete loss of appetite, dullness, constant decubitus, weakness, debility, small or imperceptible pulse, palpitations, darker color and perhaps complete suppression of urine, and stupor or other nervous disorder. Death may occur on the fourth to the sixth day. It may be delayed by a partial recovery followed by a relapse.

_Diagnosis._ Acute renal congestion is distinguished from _nephritis_ by the suddenness of the onset, the absence of fever and the comparative absence of tenderness of the loins, and of tubular casts.

From _hæmoglobinæmia_ it is distinguished by the absence of the conditions under which that affection appears:—the previous heavy work and full rich feeding, the day or more of complete rest on full ration, and the sudden exercise following. The hind parts in hæmoglobinæmia are benumbed, paretic, or paralytic and not unfrequently rigid and swollen, and the brownish or reddish urine contains hæmoglobin in amorphous particles, and not red blood globules and sanguineous tubular casts as in renal congestion.

From _laminitis_ it is distinguished by the absence of high fever, by the absence of the advance of the fore feet resting on the heels, of the heat and tenderness of the feet, by the ability to bear the lifting of one fore foot, or the tap of a hammer on the toe, by the lack of improvement after the first few steps as is seen in laminitis, and by the absence of the strong pulsations in the digital arteries.

From _indigestion_ it is distinguished by the absence of the history which leads up to that condition, of abdominal tympany, of rumbling, of impaction and of frequent attempts to defecate, and by the presence of the stiffness, straddling, and the blood globules and albumen in the urine of low density.

_Prevention._ This must be sought by the avoidance of all the factors of causation:—auto-intoxication in contagious diseases, excessive renal irritation from the injudicious use of diuretics, or the accidental ingestion of irritant or acrid diuretic plants or waters, or musty fodders, or the sudden change to the succulent, watery, first vegetation of spring, or of exposure to cold, wet, or damp, in all their forms, or of direct injury to the back or loins by blows, shocks, or violent exertions.

_Treatment._ Trasbot and Cadeac strongly recommend venesection, and at the very outset in specially acute cases the sudden lessening of the arterial and capillary tension, by this potent means, may furnish the opportunity for the capillaries of the glomeruli and tubes to regain their normal tone, and thus contribute to a speedy abortion of the affection. If resorted to at all it should be made in a full stream from the jugular, so as to secure the fullest and most prompt result with the least possible effusion of blood.

Much, however, must depend on the attendant conditions. In toxin poisoning following on an infectious fever, the already existing debility will sufficiently forbid a resort to the lancet, and we must seek elimination by the bowels, the skin or even the kidneys. Antiseptics, too, are in order if there appears any ground for suspicion of the action of infecting agents. Some cases will recover promptly under diffusible, stimulant diuretics such as spirits of nitrous ether, which by stimulating the circulation in other organs and especially the skin, appears to relieve the kidney and solicit normal secretion. But most veterinarians dread the stimulus and irritation and prefer small doses of refrigerant diuretics: bicarbonate of soda 4 drs., saltpeter 2 drs. or the tartrates, citrates or acetates of the alkaline bases. In case of irritation by acrid diuretics, but especially by cantharides, camphor 2 drs., has been found to be particularly soothing, and next to this, bromide of camphor or bromide of potassium 1 to 2 drs. may be resorted to. Zundel prescribes acidulated camphorated drinks. The free use of mucilaginous drinks, such as boiled flax seed; and the persistent application of fomentations or wet compresses to the loins are of equal value in soothing irritation. Sinapisms may advantageously follow the local emollients.

Laxatives act with less promptitude than diuretics, but on the whole constitute a safer treatment, since they secure elimination and derivation without risk of irritation to the kidneys. The oils: castor 1 to 2 pints, linseed 2 pints, or olive 2 pints, are especially to be recommended in this respect, but l’Homme advises manna, and calomel may also be used as a substitute. Injections of warm water are valuable in unloading the rectum and colon, soothing the kidneys and soliciting peristalsis.

A restricted amylaceous diet is essential, and a warm stall or abundant clothing. Grooming or active rubbing of the skin tends to active derivation and often materially relieves. The case should not be abandoned until a day or two after the urine has returned to the normal, and for some time special care should be taken of the diet, stabling and work.

ACUTE CONGESTION OF THE KIDNEYS IN CATTLE.

Causes: infection, toxins, etc., irritant diuretics, chills, moulting,
swill. Lesions: cortical kidney congestion, red to black, softening
friability; urine limpid to red, with blood globules, albumen, and
crystals. Symptoms: chill, tender loins, colic, straining, recovery in
four days. Diagnosis: from hæmoglobinuria, cystitis, calculus.
Prevention: diet, etc. Treatment: laxatives, flax seed, wet
compresses, bromides, camphor, disinfectants, bitters.

_Causes._ In cattle this malady is largely traceable to the same causes as in the horse, and is very often but a complication of some other affection. The renal congestion of infectious diseases is seen in the advanced stages of lung plague, in anthrax, in malignant catarrh, in hæmoglobinæmia, and implies an accumulation of irritant toxins in the system. The abuse of diuretics, the ingestion of acrid diuretic plants, including the early shoots of the coniferæ, the introduction through any channel of cantharides or potato beetles, the drinking of stagnant water charged with deleterious fermentation products, the consumption of musty or spoiled fodder, and the sudden change to the succulent grasses of spring, operate as in the horse. So it is with cutaneous chills, cold stone floors, cold wet storms, draughts and dropping from a leaky roof. The shedding of the coat in spring is an undoubted predisposing cause.

Cattle in the swill stables of breweries and distilleries are the subjects of a constant renal congestion and polyuria, which, however, does not prevent rapid fattening. This diet, however, unfits the animal for a future vigorous life, and any concurrent injurious influence may easily bring on active kidney disease.

_Lesions._ There is redness and swelling of the kidney, it may be to two or three times its normal size, the enlargement being especially referable to the cortical portion, which may be mottled in different shades of red up to black extravasations. The lack of firmness in its connection with its sheath, and the softening and friability of the parenchyma resemble the same conditions in the horse. The urine may be clear or more or less tinged with blood, and contains blood globules, albumen, and crystals of carbonate of lime and urate of ammonia, which seem to indicate the presence of a bacterial ferment.

_Symptoms._ The patient usually shows some indication of chill, with staring coat and arched back, which is very sensitive to pinching. There is impairment of rumination and appetite, decrease of milk in dairy cows, uneasy movements of the hind limbs and tail, frequent straining to urinate, and the passage of urine often in small amount and sometimes of a pink or reddish tinge. In bad cases this may become deep red, or black, and the pulse becomes weak, with palpitations, marked muscular weakness and a tendency to lie down most of the time.

With early improvement recovery may be complete in from four to six days. In the more severe and fatal cases death may occur as early as the sixth day. Unless under the influence of violent irritants or a persistence of the original poison the prognosis is favorable.

_Diagnosis._ It is especially important to distinguish this from =hæmoglobinæmia=, which shows an uniform red or brown discoloration of the urine and an entire absence of blood globules as such. In congestion the reddish material tends to precipitate and is found to consist largely of blood globules. It is further associated with albuminuria.

=Hæmorrhagic cystitis= and =cystic calculi= are both chronic affections, and identified on rectal exploration by the tenderness of the bladder and the presence of the stone.

_Prevention_ consists in the avoidance of the various causative factors, and especially those that find access among alimentary matters. Cattle turned out in early spring should be fed before going and should be returned from the pasture in an hour or two. This repeated day by day, allows the digestive and urinary organs to accommodate themselves to the fresh spring grass and to any vegetation to which the animals have not been accustomed. Chills, draughts, injuries and other disturbing conditions must be guarded against.

_Treatment._ Bleeding is strongly recommended by Cruzel and Cadeac. In Germany, England and America derivation toward the digestive organs is more generally relied on. Laxatives should be, as in the horse, oleaginous (castor, olive, linseed) or manna, rather than agents that may perchance act on the kidneys. Free purgation should be secured. Flaxseed tea, and wet compresses over the loins are valuable adjuncts, and anodyne agents like camphor, bromide of camphor, or other bromides may be added, and when there is any suspicion of infection, salicylates, or iodide of potassium may be employed. Finally a course of bitters (salicin, quinine, nux,) may be employed to restore tone and iron carbonate with sodium carbonate as a reconstructive tonic. The diet must be changed to wholesome food, but not too stimulating, and the animal kept quiet.

ACUTE CONGESTION OF THE KIDNEYS IN SHEEP AND GOAT.

Causes: irritant food. Lesions: Symptoms: separates from its fellows,
arched back, stiff straddling gait, straining, muscular weakness,
recumbency, urine red, with blood globules and albumen. Prevention:
care in feeding and watering, change of pasture and treatment as in
the ox.

_Causes._ As in cattle, the smaller ruminants appear to suffer especially from an alimentary renal congestion, showing itself mainly in animals that are unaccustomed to the particular toxic aliment. Thus, Cornevin finds that the Pyrennean sheep thrives on the leaves of the Quercus tosa, while Southdown sheep taking it in any considerable quantity perish of renal congestion or nephritis. Similarly Weith fed four sheep on cynanchum vincetoxicum and developed renal congestion in the course of three days. Other causes doubtless contribute in individual cases but have not been specially traced to their effects.

_Lesions_ are in the main the same as in cattle, the kidneys being bluish red, soft, flaccid and friable.

_Symptoms._ The sheep lags behind the flock, frequently lies down and rises, strains to urinate, and passes often considerable quantities. The back is arched, the loins tender, the walk stiff and straddling, the pulse small and weak. If the disease advances, there come on extreme muscular weakness, a disposition to lie, an uncertain, gait, with frequent stumbling, dullness, stupor, and it may be coma. The urine is usually tinged with blood or of a deep red or black, and contains well-formed blood globules and more or less albumen.

_Prevention and treatment_ should proceed on the same lines as in the ox, but in dealing with a large herd it becomes difficult to treat each separate case with special care. The avoidance of sudden change of food as in turning out in spring, the feeding of grain before turning out, the return to the fold after a short freedom, and the gradual transition to the new food are important. When the disease has developed, an entire change of pasture or food, the use of roots, ensilage, or grain, or of freshly cut meadow grass, is indicated, and an oleaginous laxative (castor oil 2 to 3 ozs.) are indicated. Oilcake or flaxseed meal will often prove a most valuable article. Beyond this the same agents would be indicated as for the ox.

ACUTE CONGESTION OF THE KIDNEYS IN SWINE.

Causes: infection, toxins, fermented food, traumas, crowding, cold.
Symptoms: stiff loins and quarters, frequent micturition, urine limpid
or red. Treatment.

Renal congestion in pigs has been seen mainly as the result of toxin poisoning in swine erysipelas, hog cholera or caseous pneumonia. It is also liable to occur from putrid or overfermented food, and in fat, heavy animals from injuries sustained in shipping by rail by trampling on or squeezing each other. Kicks and other injuries may at times contribute to its occurrence. Exposure to cold storms, to which swine are especially sensitive, a wet, cold bed, or a leaky roof, are additional causes.

The _symptoms_ are more or less stiffness of the loins and hind parts, frequent urination, the secretion being often passed in excess, and though at times clear yet at others pink or bloody and precipitating blood clots or at least containing blood globules.

_Treatment_ is mainly prophylactic. If therapeutic measures are desirable for valuable animals, they should follow the same lines as for sheep: rest, fomentations, aqueous food, anodynes, weak alkaline diuretics, laxatives, and balsams.

CONGESTION OF THE KIDNEYS IN CARNIVORA.

Causes: acrid diuretics, loss of kidney, catheterization, dermatitis,
burns, traumas, overexertion. Lesions: enlarged, blood-gorged kidney,
red or black, petechiated. Symptoms: stiff, arched, tender loins,
tardy, dragging of hind limbs, urine passed often, clear to bloody,
albuminous, anorexia, nausea, vomiting, diarrhœa, dullness, stupor.
Treatment: stop cause, give emetic, laxative, in surgical cases
antiseptic, for cantharides, camphor, bromides, vegetable food. Warm
clothing or building.

_Causes._ This comes most commonly from the ingestion of acrid or diuretic agents, saltpeter, turpentine oil, cantharides and, according to Cadeac, various essential oils including oil of mustard. It takes place in the remaining kidney after the one has been extirpated, or had its functions abolished by disease or urethral obstruction. Again, surgical operations on the urinary organs, even the simple passing of a catheter, will cause sympathetic renal congestion. Extensive acute dermatitis, and burns of the skin may have a similar sequence.

Falls, kicks, blows, or crushing beneath a wheel or otherwise are additional causes.