CHAPTER I.. Polypi of the Glans Penis and Sheath.

POLYPI OF THE GLANS PENIS AND SHEATH.

In young animals the extremity of the glans penis and the margins of the sheath are not infrequently studded with polypi, soft swellings of papillomatous or verrucous appearance, sometimes of considerable size, which interfere with micturition, and deform the glans. The existence of these growths is shown by very well marked signs—viz., difficulty in micturition, deformity of the sheath, deviation of the jet of urine, obstruction in the passage of the penis, and more or less marked deformity of the penis itself.

These polypi are of the same nature as those so common in dogs, viz., papillomata.

=The diagnosis= is very easy. On digital examination the growths are almost always found at the base of the sheath.

At an early stage the =prognosis= is benign, provided intervention is promptly undertaken. If the disease is of old standing, or is not treated, the animals may become somewhat thin. They suffer pain, caused by retention of urine and inflammation of the sheath; urethritis may even be set up.

=The treatment= is fairly easy, and is exclusively surgical; but as it necessitates casting the animals the bladder should first be examined per rectum, and operation should never be attempted until the bladder has been emptied so as to avoid possible rupture. The animal being fixed on its back, the penis is withdrawn from the sheath, and the polypi can then be snipped off with scissors, the wounds being slightly cauterised to arrest hæmorrhage: in the case of the sheath, rather extensive wounds must sometimes be produced; these may be sutured.

To prevent the wounds afterwards becoming infected and suppurating, the sheath should be regularly washed out with an antiseptic solution and the animal kept on a very clean bed.

INFLAMMATION OF THE SHEATH.

This condition is much more common in the ox than in the horse on account of the different anatomical structure of the parts, and the methods of keeping and using oxen.

=Causation.= Several predisposing causes undoubtedly exist. The sheath is prolonged beneath the abdomen to a considerable distance beyond the glans. It is narrow, deeply seated, and, during micturition, not even the point of the penis passes beyond it. The urine, therefore, soils the interior, or a certain quantity may be retained, according to whether the orifice is more or less obstructed by urinary sediment, sebaceous material, manure, or other material. Moreover, experience shows that of all the large ruminants, those used for outdoor work are the most affected.

Of the occasional causes, if we except sebaceous and urinary products, the most important is mechanical violence, such as the lacerations or wounds produced by the bed-piece of the trevis when the animal is being shod. The working ox throws its whole weight on this bed-piece, on which it lies on one side or the other, according to the foot which is being lifted. The sheath is compressed, and if the animal is heavy and struggles, the parts may be abraded and torn, or the sheath and even the glans may be crushed. In less dangerous cases the connective tissue may be lacerated by the edge of the bed-piece. Any injury so inflicted is aggravated by dirt in the neighbourhood.

=Symptoms.= The first signs which attract attention are of a general character, and seldom very strongly marked. The animal shows slight fever, dryness of the muzzle, is restless and continually moves about, as though to get rid of the pain it feels. The hind limbs are frequently lifted. In this attitude it makes efforts to urinate, but urine is passed very slowly, and the act seems painful; then, later on, the appetite diminishes, rumination is suspended, and, as in all intense forms of cellulitis, complications may occur.

The local symptoms are more suggestive. The slowness and difficulty with which urine is passed at once attracts attention to the diseased parts. Examination immediately reveals extreme sensitiveness of the sheath, although as yet there is only slight engorgement. At a later stage a large swelling develops and extends along the abdominal wall on either side, sometimes upwards into the groin. In certain cases the sheath may be totally obstructed by sebaceous and inflammatory material, and in the absence of surgical assistance the bladder may become ruptured.

Inflammation most frequently ends in the tardy formation of an abscess, which shows little tendency to open spontaneously. It is usually accompanied by gangrene and by mortification of a mass of skin and subcutaneous tissue, sometimes of portions of the abdominal tunic. Such grave complications may even lead to the opening of an artery, and to fatal hæmorrhage.

All these symptoms develop comparatively slowly. Abscesses scarcely ever appear before the twelfth or fifteenth day, but when the disease is not treated it may continue as long as five or six months. On the other hand, resolution is the ordinary termination under suitable treatment.

=Diagnosis.= The diagnosis is easy when the exact facts can be ascertained. The difficulty in micturition is the chief indication. At a later stage, local swelling and acute sensitiveness are characteristic.

=Prognosis.= The prognosis is grave, having regard to possible complications and the chronic character which the inflammation tends to assume.

=Treatment.= When the sheath is filled with sebaceous material or foreign substances it may be necessary to cleanse it daily with mild antiseptic injections. Some practitioners recommend laying open the external orifice, an operation which may be performed in the standing position. This, however, is not without danger, and infection may easily occur.

When the subcutaneous connective tissue surrounding the sheath and the glans penis is infiltrated and inflamed, the inflammatory swelling must be examined every day, so as to detect the abscesses as early as possible, and open them without delay. Under some circumstances deep firing in points produces very favourable results.

When an abscess has caused partial necrosis of the sheath, it is well to pass a drain and wash out the parts frequently with antiseptic solutions. For this purpose a counter-opening is made through the skin opposite the fluctuating point. The mucous membrane of the sheath is then cautiously punctured, and a seton or strip of gauze is passed by means of a seton needle, so as to allow of constant drainage.

PERSISTENCE OF THE URACHUS.

This condition is an infirmity or congenital anomaly, rather than a morbid condition. Persistence of the urachus after birth and after separation of the cord is due to the fact that the canal which communicates with the bladder fails to close up. The urine, instead of escaping through the urethra, passes along the urachus, and the animal urinates through its umbilicus.

=Causation.= The causes are simple. Certain practitioners have suggested that sex has some influence, this being an anomaly occurring more frequently in males than in females. From investigations which have been carried out, it would appear that, in some cases, persistence of the urachus is due to an imperforate condition of the urethra; in other cases, to its obstruction by accumulations of mucus of a caseous appearance, which enter the urethra and completely block the passage. Finally, in other cases the urachus simply persists while no lesion exists on the side of the urethra.

Whatever the original cause, escape of urine by the umbilicus produces irritation, which may end in complications, infection of the unhealed umbilical wound, infection of the canal of the urachus itself and the bladder, or even infection of the peritoneum.

=Symptoms.= At first, persistence of the urachus is shown by permanent or intermittent discharge of urine through the umbilicus. Usually this discharge is only seen from five to eight days after birth, when the necrosed cord is detached; in most cases it is continuous, for the opening is abnormal and has no sphincter.

Contact with the air and the wound causes the urine to undergo a kind of ammoniacal fermentation and to irritate neighbouring tissues, such as the stumps of the umbilical vessels, the interstitial connective tissue, and even the skin. The wound constitutes an excellent culture medium for microbes. The umbilicus becomes swollen and œdematous, and soon exhibits a saccular swelling, 2 to 4 inches in diameter, which, on palpation, proves to be hot and painful; its centre is occupied by the opening of the urinary fistula. A probe passed into this fistula travels upwards and backwards (see Fig. 183).

At a later stage other complications, including omphalitis and omphalo-phlebitis, may set in. The most frequent of the delayed complications is purulent cystitis, with the formation of purulent concretions in the bladder, which may occur even after the fistula of the urachus has healed. In other cases the canal of the urachus contracts and becomes obliterated towards the bladder. A blind fistula then persists, with an opening at the umbilicus, or, the parts having healed externally, all that remains is a phlegmonous swelling with the characteristic symptoms.

=Diagnosis.= A thorough examination will invariably allow of urinary fistulæ being distinguished from other diseases of the umbilicus, the escape of urine at this point being so suggestive.

=Prognosis.= The prognosis is rather grave, on account of the complications, which are possible, and, in fact, usual, unless the disease is promptly diagnosed.

=Treatment.= Formerly as a preventive measure a ligature was applied to the whole mass of the cord at birth, but this ligature in no way prevents the canal of the urachus persisting after the atrophied portion separates. Cauterisation of the urinary fistula with Rabel’s fluid or tincture of iodine can have no good result, unless the urethra is permeable.

If the urethra is obstructed it is evidently from that side that treatment should be attempted, either by displacing the mucoalbuminous plugs with a catheter or in some other way. Such intervention is very delicate and difficult in the case of young animals. Sometimes it is better to allow the discharge of urine from the umbilicus to continue, and to recommend that the animal should be rapidly fattened for the butcher.

In practice, pervious urachus may be treated by suturing, by firing across the fistula, and sometimes by blistering. The first step in all cases is to see that the urethral passage is free. English veterinary surgeons claim to have had a fair measure of success from these methods.

If a radical cure were thought desirable, the abdomen would have to be opened, and the operator would proceed to isolate the urachus, resect it, and suture the base of the bladder by bringing together its external surfaces. The operation, though not perhaps impossible, is of no practical value.