Albuminous urine in the horse is usually glairy, so that it may be drawn out in threads, but its presence can always be tested as follows: If the liquid is opaque, it may be first passed through filter paper; if very dense and already precipitating its salts, it may be diluted with distilled water; add to the suspected liquid acetic acid drop by drop until it reddens the blue litmus paper; then boil gently in a test tube; if a precipitate is thrown down, set the tube aside to cool and then add strong nitric acid. If the precipitate is not dissolved, it is albumen; if dissolved it is probably urate or hippurate of ammonia. Albumen is normally present in advanced gestation; abnormally it is seen in diseases in which there occurs destruction of blood globules (anthrax, low fevers, watery states of the blood, dropsies), in diseases of the heart and liver which prevent the free escape of blood from the veins and throw back venous pressure on the kidneys, in inflammation of the lungs and pleuræ, and even tympany (bloating), doubtless from the same cause, and in all congestive or inflammatory diseases of the kidneys, acute or chronic.
Casts of the uriniferous tubes can be seen only by placing the suspected urine under the microscope. They are usually very elastic and mobile, waving about in the liquid when the cover glass is touched, and showing a uniform, clear transparency (waxy) or entangled circular epithelial cells or opaque granules or flattened, red-blood globules or clear, refrangent oil globules. They may be even densely opaque from crystals of earthy salts.
Pus cells may be found in the urine associated with albumen, and are recognized by clearing up, when treated with acetic acid, so that each cell shows two or three nuclei.
This consists in an excessive secretion of a clear, watery urine of a low specific gravity (1.007) with a correspondingly ardent thirst, a rapidly advancing emaciation, and great loss of strength and spirit.
Causes.—Its causes may be any agent—medicinal, alimentary, or poisonous—which unduly stimulates the kidneys; the reckless administration of diuretics, which form such a common constituent of quack horse powders; acrid diuretic plants in grass or hay; new oats still imperfectly cured; an excess of roots or other very watery feed; a full allowance of salt to animals that have become inordinately fond of it; but, above all, feeding on hay, grain, or bran which has not been properly dried and has become musty and permeated by fungi. Thus hay, straw, or oats obtained in wet seasons and heating in the rick or stack is especially injurious. Hence this malady, like coma somnolentum (sleepy staggers), is widespread in wet seasons, and especially in rainy districts.
Symptoms.—The horse drinks deep at every opportunity and passes urine on every occasion when stopped, the discharge being pale, watery, of a low density, and inodorous; in short, it contains a great excess of water and a deficiency of the solid excretions. So great is the quantity passed, however, that the small amount of solids in any given specimen amounts in 24 hours to far more than the normal—a fact in keeping with the rapid wasting of the tissues and extreme emaciation. The flanks become tucked up, the fat disappears, the bones and muscles stand out prominently, the skin becomes tense and hidebound, and the hair erect, scurfy, and deficient in luster. The eye becomes dull and sunken, the spirits are depressed, the animal is weak and sluggish, sweats on the slightest exertion, and can endure little. The subject may survive for months, or may die early of exhaustion. In the slighter cases, or when the cause ceases to operate, a somewhat tardy recovery may be made.
Treatment consists in stopping the ingestion of the faulty drugs, poisons, or feed, and supplying sound hay and grain free from all taint of heating or mustiness. A liberal supply of boiled flaxseed in the drinking water at once serves to eliminate the poison and to sheathe and protect the irritated kidneys. Tonics like sulphate or phosphate of iron (2 drams morning and evening) and powdered gentian or Peruvian bark (4 drams) help greatly by bracing the system and hastening repair. To these may be added agents calculated to destroy the fungus and eliminate its poisonous products. In that form which depends on musty food nothing acts better than large doses of iodid of potassium (2 drams), while in other cases creosote, carbolic acid (1 dram), or oil of turpentine (4 drams), properly diluted, may be resorted to.
This is primarily a disease of the nervous system or liver rather than of the kidneys, yet, as the most prominent symptom is the sweet urine, it may be treated here.
Causes.—Its causes are varied, but resolve themselves largely into disorder of the liver or disorder of the brain. One of the most prominent functions of the liver is the formation of glycogen, a principle allied to grape sugar, and passing into it by further oxidation in the blood. This is a constant function of the liver, but in health the resulting sugar is burned up in the circulation and does not appear in the urine. On the contrary, when the supply of oxygen is defective, as in certain diseases of the lungs, the whole of the sugar does not undergo combustion and the excess is excreted by the kidneys. Also in certain forms of enlarged liver the quantity of sugar produced is more than can be disposed of in the natural way, and it appears in the urine. A temporary sweetness of the urine often occurs after a hearty meal on starchy feed, but this is due altogether to the super-abundant supply of the sugar-forming feed, lasts for a few hours only, and has no pathological significance. In many cases of fatal glycosuria the liver is found to be enlarged, or at least congested, and it is found that the disorder can be produced experimentally by agencies which produce an increased circulation through the liver. Thus Bernard produced glycosuria by pricking the oblong medulla at the base of the brain close to the roots of the pneumogastric nerve, which happens to be also the nerve center (vasomotor) which presides over the contractions of the minute blood vessels. The pricking and irritation of this center leads to congestion of the liver and the excessive production of sugar. Irritation carried to this point through the pneumogastric nerve causes saccharine urine, and, in keeping with this, disease of the pancreas has been found in this malady. The complete removal of the pancreas, however, determines glycosuria, the organ having in health an inhibitive action on sugar production by the liver. The same result follows the reflection of irritation from other sources, as from different ganglia (corpora striata, optic thalami, pons, cerebellum, cerebrum) of the brain. Similarly it is induced by interruption of the nervous control along the vasomotor tracts, as in destruction of the upper or lower cervical sympathetic ganglion, by cutting the nervous branch connecting these two, in injury to the spinal marrow in the interval between the brain and the second or fourth dorsal vertebra, or in disease of the celiac plexus, which directly presides over the liver. Certain chemical poisons also cause saccharine urine, notably woorara, strychnia, morphia, phosphoric acid, alcohol, ether, quinia, chloroform, ammonia, arsenic, and phlorizin.
Symptoms.—The symptoms are ardent thirst and profuse secretion of a pale urine of a high density (1.060 and upward), rapid loss of condition, scurfy, unthrifty skin, costiveness or irregularity of the bowels, indigestion, and the presence, in the urine, of a sweet principle—grape sugar or inosite, or both. This may be most promptly detected by touching the tip of the tongue with a drop. Sugar may be detected simply by adding a teaspoonful of liquid yeast to 4 ounces of the urine and keeping it lightly stopped at a temperature of 70° to 80° F. for 12 hours, when the sugar will be found to have been changed into alcohol and carbon dioxid. The loss of density will give indication of the quantity of sugar transformed; thus a density of 1.035 in a urine which was formerly 1.060 would indicate about 15 grains of sugar to the fluid ounce.
Inosite, or muscle sugar, frequently present in the horse's urine, and even replacing the glucose, is not fermentable. Its presence may be indicated by its sweetness and the absence of fermentation or by Gallois's test. Evaporate the suspected urine at a gentle heat almost to dryness, then add a drop of a solution of mercuric nitrate and evaporate carefully to dryness, when a yellowish residue is left that is changed on further cautious heating to a deep rose color, which disappears on cooling and reappears on heating.
In advanced diabetes, dropsies in the limbs and under the chest and belly, puffy, swollen eyelids, cataracts, catarrhal inflammation of the lungs, weak, uncertain gait, and drowsiness may be noted.
Treatment is most satisfactory in cases dependent on some curable disease of liver, pancreas, lungs, or brain. Thus, in liver diseases, a run at pasture in warm weather, or in winter a warm, sunny, well-aired stable, with sufficient clothing and laxatives (sulphate of soda, 1 ounce daily) and alkalies (carbonate of potassium, one-fourth ounce) may benefit. To this may be added mild blistering, cupping, or even leeching over the last ribs. Diseases of the brain or pancreas may be treated according to their indications. The diet should be mainly albuminous, such as wheat bran or middlings, peas, beans, vetches, and milk. Indeed, an exclusive milk diet is one of the very best remedial agencies. It may be given as skimmed milk or butter-milk, and in the last case combines an antidiabetic remedy in the lactic acid. Under such an exclusive diet recent and mild cases are often entirely restored, though at the expense of an attack of rheumatism. Codeia, one of the alkaloids of opium, is strongly recommended by Tyson. The dose for the horse would be 10 to 15 grains thrice daily. In cases in which there is manifest irritation of the brain, bromid of potassium, 4 drams, or ergot one-half ounce, may be resorted to. Salicylic acid and salicylate of sodium have proved useful in certain cases; also phosphate of sodium. Bitter tonics (especially nux vomica one-half dram) are useful in improving the digestion and general health.
Cause.—As seen in the horse, bloody urine is usually the direct result of mechanical injuries, as sprains and fractures of the loins, lacerations of the sublumbar muscles (psoas), irritation caused by stone in the kidney, ureter, bladder, or urethra. It may, however, occur with acute congestion of the kidney, with tumors in its substance, or with papilloma or other diseased growth in the bladder. Acrid diuretic plants present in the feed may also lead to the escape of blood from the kidney. The predisposition to this affection is, however, incomparably less than in the case of the ox or the sheep, the difference being attributed to the greater plasticity of the horse's blood in connection with the larger quantity of fibrin.
The blood may be present in small clots or in more or less intimate admixture with the urine. Its condition may furnish some indication as to its source; thus, if from the kidneys it is more liable to be uniformly diffused through the urine, while as furnished by the bladder or passages clots are more liable to be present. Again, in bleeding from the kidney, minute, cylindrical clots inclosing blood globules and formed in the uriniferous tubes can be detected under the microscope. Precision also may be approximated by observing whether there is coexisting fracture, sprain of the loins, or stone or tumor in the bladder or urethra.
Treatment.—The disease being mainly due to direct injury, treatment will consist, first, in removing such cause whenever possible, and then in applying general and local styptics. Irritants in feed must be avoided, sprains appropriately treated, and stone in bladder or urethra removed. Then give mucilaginous drinks (slippery elm, linseed tea) freely, and styptics (tincture of chlorid of iron 3 drams, acetate of lead one-half dram, tannic acid one-half dram, or oil of turpentine 1 ounce). If the discharge is abundant, apply cold water to the loins and keep the animal perfectly still.
Like diabetes, this is rather a disease of the liver and blood-forming functions than of the kidney, but as prominent symptoms are loss of control over the hind limbs and the passage of ropy and dark-colored urine, the vulgar idea is that it is a disorder of the urinary organs. It is a complex affection directly connected with a plethora in the blood of nitrogenized constituents, with extreme nervous and muscular disorder and the excretion of a dense reddish or brownish urine. It is directly connected with high feeding, especially on highly nitrogenized feed (oats, beans, peas, vetches, cottonseed meal), and with a period of idleness in the stall under full rations. The disease is never seen at pasture, rarely under constant daily work, even though the feeding is high, and the attack is usually precipitated by taking the horse from the stable and subjecting it to exercise or work. The poisoning is not present when taken from the stable, as the horse is likely to be noticeably lively and spirited, but he will usually succumb under the first hundred yards or half mile of exercise. It seems as if the aspiratory power of the chest under the sudden exertion and accelerated breathing speedily drew from the gorged liver and abdominal veins (portal) the accumulated store of nitrogenous matter in an imperfectly oxidized or elaborated condition, and as if the blood, surcharged with these materials, were unable to maintain the healthy functions of the nerve centers and muscles. It has been noticed rather more frequently in mares than horses, attributable, perhaps, to the nervous excitement attendant on heat, and to the fact that the unmutilated mare is naturally more excitable than the docile gelding.
Lignières has found in hemoglobinuria a streptococcus which produced nephritis, bloody urine, and paraplegia in experimental animals, including horses.
Symptoms.—In the milder forms this affection may appear as a lameness in one limb, from indefinite cause, succeeding to some sudden exertion and attended by a dusky-brown color of the membranes of the eye and nose and some wincing when the last ribs are struck. The severe forms come on after one or two days of rest on a full ration, when the animal has been taken out and driven one hundred paces or more: The fire and life with which he had left the stable suddenly give place to dullness and oppression, as shown in heaving flanks, dilated nostrils, pinched face, perspiring skin, and trembling body. The muscles of the loins or haunch become swelled and rigid, the subject moves stiffly or unsteadily, crouches behind, the limbs being carried semiflexed, and he soon drops, unable to support himself. When down, the body and limbs are moved convulsively, but there is no power of coordination of movement in the muscles. The pulse and breathing are accelerated, the eyes red with a tinge of brown, and the urine, if passed, is seen to be highly colored, dark brown, red, or black, but it contains neither blood clots nor globules. The color is mainly due to hemoglobin and other imperfectly elaborated constituents of the blood.
It may end fatally in a few hours or days, or a recovery may ensue, which is usually more speedy and perfect if it has set in at an early stage. In the late and tardy recoveries a partial paralysis of the hind limbs may last for months. A frequent sequel of these tardy cases is an extensive wasting of the muscles leading up from the front of the stifle (those supplied by the crural nerve) and a complete inability to stand.
Prevention.—The prevention of this serious affection lies in restricting the diet and giving daily exercise when the animal is not at work. A horse that has had one attack should never be left idle for a single day in the stall or barnyard. When a horse has been condemned to absolute repose on good feeding he may have a laxative (one-half to 1 pound Glauber's salt), and have graduated exercise, beginning with a short walk and increasing day by day.
Treatment.—The treatment of the mild cases may consist in a laxative, graduated daily exercise, and a daily dose of saltpeter (1 ounce). Sudden attacks will sometimes promptly subside if taken on the instant and the subject kept still and calmed by a dose of bromid of potassium (4 drams) and sweet spirits of niter (1 ounce). The latter has the advantage of increasing the secretion of the kidneys. Iodid of potassium in one-half ounce doses every four hours has succeeded well in some hands. In severe cases, as a rule, it is desirable to begin treatment by a dose of aloes (4 to 6 drams) with the above-named dose of bromid of potassium, and this latter may be continued at intervals of four or six hours, as may be requisite to calm the nervous excitement. Fomentations with warm water over the loins are always useful in calming the excitable conditions of the spinal cord, muscles, liver, and kidneys, and also in favoring secretion from the two latter. On the second day diuretics may be resorted to, such as saltpeter one-half ounce, and powdered colchicum, one-half dram, to be repeated twice daily. A laxative may be repeated in three or four days should the bowels seem to demand it, and as the nervous excitement disappears any remaining muscular weakness or paralysis may be treated by one-half dram doses of nux vomica twice a day and a stimulating liniment (aqua ammonia and sweet oil in equal proportions) rubbed on the torpid muscles.
During the course of the disease friction to the limbs is useful, and in the advanced paralytic stage the application of electricity along the line of the affected muscles. When the patient can not stand he must have a thick, soft bed, and should be turned from side to side at least every twelve hours. As soon as he can be made to stand he may be helped up and even supported in a sling.
Inflammations of the kidneys have been differentiated widely, according as they were acute or chronic, parenchymatous or tubal, suppurative or not, with increased or shrunken kidney, etc. In a work like the present, however, utility will be consulted by classing all under acute or chronic inflammation.
Causes.—The causes of inflammation of the kidneys are extremely varied. Congestion occurs from the altered and irritant products passed through these organs during recovery from inflammations of other organs and during fevers. This may last only during the existence of its cause, or may persist and become aggravated. Heart disease, throwing the blood pressure back on the veins and kidneys, is another cause. Disease of the ureter or bladder, preventing the escape of urine from the kidney and causing increased fullness and tension in its pelvis and tubes, will determine inflammation. Decomposition of the detained urine in such cases and the production of ammonia and other irritants must also be named. In elimination of bacteria through the kidney, the latter is liable to infection with consequent inflammation. The advance of bacteria upward from the bladder to the kidneys is another cause. The consumption in hay or other fodder of acrid or irritant plants, including fungi, the absorption of cantharidine from a surface blistered by Spanish flies, the reckless administration of diuretics, the presence of stones in the kidney, exposure of the surface to cold and wet, and the infliction of blows or sprains on the loins, may contribute to its production. Liver disorders which throw on the kidneys the work of excreting irritant products, diseases of the lungs and heart from which clots are carried, to be arrested in the small blood vessels of the kidney, and injuries and paralysis of the spinal cord, are additional causes.
Symptoms.—The symptoms are more or less fever, manifest stiffness of the back and straddling gait with the hind limbs, difficulty in lying down and rising, or in walking in a circle, the animal sometimes groaning under the effort, arching of the loins and tucking up of the flank, looking back at the abdomen as if from colicky pain, and tenderness of the loins to pinching, especially just beneath the bony processes 6 inches to one side of the median line. Urine is passed frequently, a small quantity at a time, of a high color, and sometimes mixed with blood or even pus. Under the microscope it shows the microscopic casts referred to under general symptoms. If treated by acetic acid, boiling and subsequent addition of strong nitric acid, the resulting and persistent precipitate indicates the amount of albumen. The legs tend to swell from the foot up, also the dependent parts beneath the belly and chest, and effusions of liquid may occur within the chest or abdomen. In the male the alternate drawing up and relaxation of the testicles in the scrotum are suggestive, and in small horses the oiled hand introduced into the rectum may reach the kidney and ascertain its sensitiveness.
Treatment demands, first, the removal of any recognized cause. Then, if the suffering and fever are high, 2 to 4 quarts of blood may be abstracted from the jugular vein; in weak subjects or unless in high fever this should be omitted. Next relieve the kidneys so far as possible by throwing their work on the bowels and skin. A pint of castor oil is less likely than either aloes or salts to act on the kidneys. To affect the skin a warm stall and heavy clothing may be supplemented by dram doses of Dover's powder. Pain may be soothed by dram doses of bromid of potassium. Boiled flaxseed may be added to the drinking water, also thrown into the rectum as an injection, and blankets saturated with hot water should be persistently applied to the loins. This may be followed by a very thin pulp of the best ground mustard made with tepid water, rubbed in against the direction of the hair and covered with paper and a blanket. This may be kept on for an hour, or until the skin thickens and the hair stands erect. It may then be rubbed or sponged off and the blanket reapplied. When the action of the bowels has been started it may be kept up by a daily dose of 2 or 3 ounces of Glauber's salt.
During recovery a course of bitter tonics (nux vomica 1 scruple, ground gentian root 4 drams) should be given. The patient should also be guarded against cold, wet, and any active exertion for some time after all active symptoms have subsided.
Causes.—Chronic inflammation of the kidneys is more commonly associated with albumen and casts in the urine than the acute form, find in some instances these conditions of the urine may be the only prominent symptoms of the disease. Though it may supervene on blow, injuries, and exposures, it is much more commonly connected with faulty conditions of the system—as indigestion, heart disease, lung or liver disease, imperfect blood formation, or assimilation; in short, it is rather the attendant on a constitutional infirmity than on a simple local injury.
It may be associated with various forms of diseased kidneys, as shrinkage (atrophy), increase (hypertrophy), softening, red congestion, white enlargement, etc., so that it forms a group of diseases rather than a disease by itself.
Symptoms.—The symptoms may include stiffness, weakness, and increased sensibility of the loins, and modified secretion of urine (increase or suppression), or the flow may be natural. Usually it contains albumen, the quantity furnishing a fair criterion of the gravity of the affection, and microscopic casts, also most abundant in bad cases. Dropsy, manifested in swelled legs, is a significant symptom, and if the effusion takes place along the lower line of the body or in chest or abdomen, the significance is increased. A scurfy, unthrifty skin, lack-luster hair, inability to sustain severe or continued exertion, poor or irregular appetite, loss of fat and flesh, softness of the muscles, and pallor of the eyes and nose are equally suggestive. So are skin eruptions of various kinds. Any one or more of these symptoms would warrant an examination of the urine for albumen and casts, the finding of which signifies renal inflammation.
Treatment of these cases is not always satisfactory, as the cause is liable to be maintained in the disorders of important organs elsewhere. If any such coincident disease of another organ or function can be detected, that should be treated first or simultaneously with this affection of the kidneys. In all cases the building up of the general health is important. Hence a course of tonics may be given (phosphate of iron 2 drams, nux vomica 20 grains, powdered gentian root 4 drams, daily) or 60 drops of sulphuric acid or nitrohydrochloric acid may be given daily in the drinking water. If there is any elevated temperature of the body and tenderness of the loins, fomentations may be applied, followed by a mustard pulp, as for acute inflammation, and even in the absence of these indications the mustard may be resorted to with advantage at intervals of a few days. In suppression of urine, fomentations with warm water or with infusion of digitalis leaves is a safer resort than diuretics, and cupping over the loins may also benefit. To apply a cup, shave the skin and oil it; then take a narrow-mouthed glass, rarify the air within it by introducing a taper in full flame for a second, withdraw the taper and instantly apply the mouth of the glass to the skin and hold it closely applied till the cooling tends to form a vacuum in the glass and to draw up the skin, like a sucker.
As in the acute inflammation, every attention must be given to secure warm clothing, a warm stall, and pure air.
Tumors, whether malignant or simple, would give rise to symptoms resembling some form of inflammation, and are not liable to be recognized during life.
To parasites of the kidney belong the echinococcus, the larval, or bladder worm, stage of the small echinococcus tapeworm of the dog. Dioctophyme renale, the largest of roundworms, has been found in the kidney of the horse. Its presence can be certified only by the passage of its microscopic eggs or of the entire worm. Immature stages of roundworms, either Strongylus equinus or a related species, may be found in the renal artery or in the kidney itself.
This affection consists in spasmodic closure of the outlet from the bladder by tonic contraction of the circular muscular fibers. It may be accompanied with a painful contraction of the muscles on the body of the bladder; or, if the organ is already unduly distended, these will be affected with temporary paralysis. It is most frequent in the horse, but by no means unknown in the mare.
Causes.—The causes are usually hard and continuous driving without opportunity for passing urine, cold rainstorms, drafts of cold air when perspiring and fatigued, the administration of Spanish fly or the application of extensive blisters of the same, abuse of diuretics, the presence of acrid, diuretic plants in the fodder, and the presence of stone in the bladder. As most mares refuse to urinate while in harness, they should be unhitched at suitable times for urination. Spasms of the bowels are always attended by spasm of the bladder, hence the free passage of water is usually a symptom of relief.
Symptoms.—The symptoms are frequent stretching and straining to urinate, with no result or a slight dribbling only. These vain efforts are attended by pain and groaning. On resuming his natural position the animal is not freed from the pain, but moves uneasily, paws, shakes the tail, kicks at the abdomen with his hind feet, looks back to the flank, lies down and rises, arches the back, and attempts to urinate as before. If the oiled hand is introduced into the rectum the greatly distended bladder may be felt beneath, and the patient will often shrink when it is handled.
It is important to notice that irritation of the urinary organs is often present in impaction of the colon with solid matters, because the impacted intestine under the straining of the patient is forced backward into the pelvis and presses upon and irritates the bladder. In such cases the horse stands with his fore limbs advanced and the hind ones stretched back beyond the natural posture and makes frequent efforts to urinate, with varying success. Unpracticed observers naturally conclude that the secondary urinary trouble is the main and only one, and the intestinal impaction and obstruction is too often neglected until it is irremediable. In cases in which the irritation has caused spasm of the neck of the bladder and overdistention of that organ, the mistake is still more easily made; hence it is important in all cases to examine for the impacted bowel, forming a bend or loop at the entrance of the pelvis and usually toward the left side. The impacted intestine feels soft and doughy and is easily indented with the knuckles, forming a marked contrast with the tense, elastic, resilient, overdistended bladder.
It remains to be noted that similar symptoms may be determined by a stone or sebaceous mass, or stricture obstructing the urethra, or in the newborn by thickened mucus in that duct and by the pressure of hardened, impacted feces in the rectum. In obstruction, the hard, impacted body can usually be felt by tracing the urethra along the lower and posterior surface of the penis and forward to the median line of the floor of the pelvis to the neck of the bladder. That part of the urethra between the seat of obstruction and the bladder is usually distended with urine and feels enlarged, elastic, and fluctuating.
Treatment.—Treatment may be begun by taking the animal out of harness. This failing, spread clean litter beneath the belly or turn the patient out on the dung heap. Some seek to establish sympathetic action by pouring water from one vessel into another with dribbling noise. Others soothe and distract the attention by slow whistling. Friction of the abdomen with wisps of straw may succeed, or it may be rubbed with ammonia and oil. These failing, an injection of 2 ounces of laudanum or of an infusion of 1 ounce of tobacco in water may be tried. In the mare the neck of the bladder is easily dilated by inserting two oiled fingers and slightly parting them. In the horse the oiled hand introduced into the rectum may press from before backward on the anterior or blind end of the bladder. Finally, a well-oiled gum-elastic catheter may be entered into the urethra through the papilla at the end of the penis and pushed on carefully until it has entered the bladder. To effect this the penis must first be withdrawn from its sheath, and when the advancing end of the catheter has reached the bend of the urethra beneath the anus it must be guided forward by pressure with the hand, which guidance must be continued onward into the bladder, the oiled hand being introduced into the rectum for this purpose. The horse catheter, 3-1/2 feet long and one-third inch in diameter, may be bought of a surgical-instrument maker.
Paralysis of the body of the bladder with spasm of the neck has been described under the last heading, and may occur in the same way from overdistention in tetanus, acute rheumatism, paraplegia, and hemiplegia, in which the animal can not stretch himself to urinate, and in cystitis, affecting the body of the bladder but not the neck. In all these cases the urine is suppressed. It also occurs as a result of disease of the posterior end of the spinal marrow and with broken back, and is then associated with palsy of the tail, and, it may be, of the hind limbs.
Symptoms.—The symptoms are a constant dribbling of urine when the neck is involved, the liquid running down the inside of the thighs and irritating the skin. When the neck is unaffected the urine is retained until the bladder is greatly overdistended, when it may be expelled in a gush by the active contraction of the muscular walls of the abdomen; this never empties the bladder, however, and the oiled hand introduced through the rectum may feel the soft, flabby organ still half full of urine. This retained urine is liable to decompose and give off ammonia, which dissolves the epithelial cells, exposing the raw, mucous membrane and causing the worst type of cystitis. Suppression and incontinence of urine are common also to obstruction of the urethra by stone or otherwise; hence this source of fallacy should be excluded by manual examination along the whole course of that duct.
Treatment.—Treatment is only applicable in cases in which the determining cause can be abated. In remedial sprains of the back or disease of the spinal cord these must have appropriate treatment, and the urine must be drawn off frequently with a catheter to prevent overdistention and injury to the bladder. If the paralysis persists after recovery of the spinal cord, or if it continues after relief of spasm of the neck of the bladder, apply a pulp of mustard and water over the back part of the belly in front of the udder, and cover with a rug until the hair stands erect. In the male the mustard may be applied between the thighs from near the anus downward. Daily doses of 2 drams extract of belladonna or of 2 grains powdered Spanish fly may serve to rouse the lost tone. These failing, a mild current of electricity daily may succeed.
Cystitis may be slight or severe, acute or chronic, partial or general. It may be caused by abuse of diuretics, especially such as are irritating (cantharides, turpentine, copaiba, resin, etc.), by the presence of a stone or gravel in the bladder, the irritation of a catheter or other foreign body introduced from without, the septic ferment (bacterium) introduced on a filthy catheter, the overdistention of the bladder by retained urine, the extrication of ammonia from retained decomposing urine, resulting in destruction of the epithelial cells and irritation of the raw surface, and a too concentrated and irritating urine. The application of Spanish flies or turpentine over a too extensive surface, sudden exposure of a perspiring and tired horse to cold or wet, and the presence of acrid plants in the fodder may cause cystitis, as they may nephritis. Finally, inflammation may extend from a diseased vagina or urethra to the bladder.
Symptoms.—The symptoms are slight or severe colicky pains; the animal moves his hind feet uneasily or even kicks at the abdomen, looks around at his flank, and may even lie down and rise frequently. More characteristic are frequently repeated efforts to urinate, resulting in the discharge of a little clear, or red, or more commonly flocculent urine, always in jets, and accompanied with signs of pain, which persist after the discharge, as shown in continued straining, groaning, and perhaps in movements of the feet and tail. The penis hangs from the sheath, or in the mare the vulva is frequently opened and closed, as after urination. The animal winces when the abdomen is pressed in the region of the sheath or udder, and the bladder is found to be sensitive and tender when pressed with the oiled hand introduced through the rectum or vagina. In the mare the thickening of the walls of the bladder may be felt by introducing one finger through the urethra. The discharged urine, which may be turbid or even oily, contains an excess of mucus, with flat shreds of membrane, with scaly epithelial cells, and pus corpuscles, each showing two or more nuclei when treated with acetic acid, but there are no microscopic tubular casts, as in nephritis. If due to stone in the bladder, that will be found on examination through rectum or vagina.
Treatment implies, first, the removal of the cause, whether poisons in feed or as medicine, the removal of Spanish flies or other blistering agents from the skin, or the extraction of stone or gravel. If the urine has been retained and decomposed it must be completely evacuated through a clean catheter, and the bladder thoroughly washed out with a solution of 1 dram of borax in a quart of water. This must be repeated twice daily until the urine no longer decomposes, because so long as ammonia is developed in the bladder the protecting layer of epithelial cells will be dissolved and the surface kept raw and irritable. The diet must be light (bran mashes, roots, fresh grass), and the drink impregnated with linseed tea, or solution of slippery elm or marsh mallow. The same agents may be used to inject into the rectum, or they may even be used along with borax and opium to inject into bladder (gum arabic 1 dram, opium 1 dram, tepid water 1 pint). Fomentations over the loins are often of great advantage, and these may be followed or alternated with the application of mustard, as in paralysis; or the mustard may be applied on the back part of the abdomen below or between the thighs from the anus downward. Finally, when the acute symptoms have subsided, a daily dose of buchu 1 dram and nux vomica one-half dram will serve to restore lost tone.
Some horses, and especially mares, show an irritability of the bladder and nerve centers presiding over it by frequent urination in small quantities, though the urine is not manifestly changed in character and no more than the natural quantity is passed in the twenty-four hours. The disorder appears to have its source quite as frequently in the generative or nervous system as in the urinary. A troublesome and dangerous form is seen in mares, which dash off and refuse all control by the rein if driven with a full bladder, but usually prove docile if the bladder has been emptied before hitching. In other cases the excitement connected with getting the tail over the reins is a powerful determining cause. The condition is marked in many mares during the period of heat.
An oleaginous laxative (castor oil 1 pint) will serve to remove any cause of irritation in the digestive organs, and a careful dieting will avoid continued irritation by acrid vegetable agents. The bladder should be examined to see that there is no stone or other cause of irritation, and the sheath and penis should be washed with soapsuds, any sebaceous matter removed from the bilocular cavity at the end of the penis, and the whole lubricated with sweet oil. Irritable mares should be induced to urinate before they are harnessed, and those that clutch the lines under the tail may have the tail set high by cutting the cords on its lower surface, or it may be prevented from getting over the reins by having a strap carried from its free end to the breeching. Those proving troublesome when "in heat" may have 4-dram doses of bromid of potassium, or they may be served by the male or castrated. Sometimes irritability may be lessened by daily doses of belladonna extract (1 dram), or a better tone may be given to the parts by balsam copaiba (1 dram).
These may be of various kinds, malignant or simple. In the horse I have found villous growths from the mucous membrane especially troublesome. They may be attached to the mucous membrane by a narrow neck or by a broad base covering a great part of the organ.
Symptoms.—The symptoms are frequent straining, passing of urine and blood with occasionally gravel. An examination of the bladder with the hand in the rectum will detect the new growth, which may be distinguished from a hard, resistant stone. In mares, in which the finger can be inserted into the bladder, the recognition is still more satisfactory. The polypi attached by narrow necks may be removed by surgical operation, but for those with broad attachments treatment is eminently unsatisfactory.
This occurs only in the newborn, and consists in the nonclosure of the natural channel (urachus), through which the urine is discharged into the outer water bag (allantois) in fetal life. At that early stage of the animal existence the bladder resembles a long tube, which is prolonged through the navel string and opens into the outermost of the two water bags in which the fetus floats. In this way the urine is prevented from entering the inner water bag (amnion), where it would mingle with the liquids, bathing the skin of the fetus and cause irritation. At birth this channel closes up, and the urine takes the course normal to extra-uterine life. Imperfect closure is more frequent in males than in females, because of the great length and small caliber of the male urethra and its consequent tendency to obstruction. In the female there may be a discharge of a few drops only at a time, while in the male the urine will be expelled in strong jets coincidently with the contractions of the bladder and walls of the abdomen.
The first care is to ascertain whether the urethra is pervious by passing a human catheter. This determined, the open urachus may be firmly closed by a stout, waxed thread, carried with a needle through the tissues back of the opening and tied in front of it so as to inclose as little skin as possible. If a portion of the naval string remains, the tying of that may be all sufficient. It is important to tie as early as possible so as to avoid inflammation of the navel from contact with the urine. In summer a little carbolic-acid water or tar water may be applied to keep the flies off.
This can occur only in the female. It consists in the turning of the organ outside in through the channel of the urethra, so that it appears as a red, pear-shaped mass hanging from the floor of the vulva and protruding externally between its lips. It may be a mass like the fist, or it may swell up to the size of an infant's head. On examining its upper surface the orifices of the urethra maybe seen, one on each side, a short distance behind the neck, with the urine oozing from them drop by drop.
This displacement usually supervenes on a flaccid condition of the bladder, the result of paralysis, overdistention, or severe compression during a difficult parturition.
The protruding organ may be washed with a solution of 1 ounce of laudanum and a teaspoonful of carbolic acid in a quart of water, and returned by pressing a smooth, rounded object into the fundus and directing it into the urethra, while careful pressure is made on the surrounding parts with the other hand. If too large and resistant it may be wound tightly in a strip of bandage about 2 inches broad to express the great mass of blood and exudate and diminish the bulk of the protruded organ so that it can be easily pushed back. This method has the additional advantage of protecting the organ against bruises and lacerations in the effort made to return it. After the return, straining may be kept in check by giving laudanum (1 to 2 ounces) and by applying a truss to press upon the lips of the vulva. (See Eversion of the womb.) The patient should be kept in a stall a few inches lower in front than behind, so that the action of gravity will favor retention.
This affection belongs quite as much to the generative organs, yet it can not be entirely overlooked in a treatise on urinary disorders. It may be induced by the same causes as cystitis (which see); by the passage and temporary arrest of small stones, or gravel; by the irritation caused by foreign bodies introduced from without; by blows on the penis by sticks, stones, or by the feet of a mare that kicks while being served; by an infecting inflammation contracted from a mare served in the first few days after parturition or one suffering from leucorrhea; by infecting matter introduced on a dirty catheter, or by the extension of inflammation from an irritated, bilocular cavity filled with hardened sebaceous matter, or from an uncleansed sheath.
Symptoms.—The symptoms are swelling, heat, and tenderness of the sheath and penis; difficulty, pain, and groaning in passing urine, which is liable to sudden temporary arrests in the course of micturition, and later a whitish, mucopurulent oozing from the papilla on the end of the penis. There is a tendency to erection of the penis, and in cases contracted from a mare the outer surface of that organ will show more or less extensive sores and ulcers. Stallions suffering in this way will refuse to mount or, having mounted, will fail to complete the act of coition. If an entrance is effected, infection of the mare is liable to follow.
Treatment in the early stages consists in a dose of physic (aloes 6 drams) and fomentations of warm water to the sheath and penis. If there is reason to suspect the presence of infection, inject the urethra twice daily with borax 1 dram, tepid water 1 quart. When the mucopurulent discharge indicates the supervention of the second stage a more astringent injection may be used (nitrate of silver 20 grains, water 1 quart), and the same may be applied to the surface of the penis and inside the sheath. Balsam of copaiba (1 dram daily) may also be given with advantage after the purulent discharge has appeared.
Every stallion suffering from urethritis should be withheld from service, as should mares with leucorrhea.
This is a permanent narrowing of the urethra at a given point, the result of previous inflammation, caused by the passage or arrest of a stone, or gravel, by strong astringent injections in the early nonsecreting stage of urethritis, or by contraction of the lining membrane occurring during the healing of ulcers in neglected inflammations of that canal. The trouble is shown by the passage of urine in a fine stream, with straining, pain, and groaning, and by frequent painful erections. It must be remedied by mechanical dilatation, with catheters just large enough to pass with gentle force, to be inserted once a day, and to be used of larger size as the passage will admit them. The catheter should be kept perfectly clean and washed in a borax solution and well oiled before it is introduced.
These consist in some of the solids of the urine that have been precipitated from the urine in the form of crystals, which remain apart as a fine, powdery mass, or magma, or aggregate into calculi, or stones, of varying size. (See Pl. XI.) Their composition is therefore determined in different animals by the salts or other constituents found dissolved in the healthy urine, and by the additional constituents which may be thrown off in solution in the urine in disease. In this connection it is important to observe the following analysis of the horse's urine in health: