CHAPTER II.. Diseases of the Bladder.

DISEASES OF THE BLADDER.

ACUTE CYSTITIS.

Cystitis, or inflammation of the bladder, may be divided into two varieties: simple (acute or chronic) cystitis, and chronic cystitis due to the presence of calculi.

Simple acute cystitis occurs most commonly in the cow, less frequently in the ox, and rarely in the pig or sheep. Female animals are more subject to it than males.

It consists of more or less acute inflammation of the vesical mucous membrane. The inflammation sometimes extends to the muscular coat and the peri-vesical tissues, setting up local or general peritonitis.

=Causation.= The internal causes to which Cruzel attributes the disease are rather open to question. Retention of urine in particular is common in working oxen, which only pass urine when resting, and this would be more likely to produce distention, paralysis, or rupture of the bladder than true inflammation; it is doubtful whether inflammation would even follow the chronic irritation resulting from frequently repeated over-distention.

The ingestion of irritant plants certainly has a more marked action. Irritant principles eliminated by the kidneys might not injure them, although they would bring about changes in the vesical mucous membrane, with which they would remain in contact for some time.

More frequently cystitis is the result of inflammation due to continuity of tissue, and forms a complication of urethritis, vaginitis, and the conditions set up by retention of the after-birth. It may also result from ascending infection causing pyelo-nephritis, or ascending infection of any kind which eventually attacks the bladder. It is a very common consequence of the use of unclean catheters, but only in equines and females, as the catheter is not passed in the ox or bull until after urethrotomy.

In by far the majority of cases it is of infectious, and not of toxic, origin.

=Symptoms.= At first the symptoms are obscure. They commence with slight colic, and are afterwards characterised by frequent, difficult and painful micturition and by the small quantity of urine passed on each occasion.

The urine, moreover, is modified in appearance. At first it contains a small quantity of blood, and is reddish, or at least of a darker tint than is usual. Later it becomes thick and whitish, and contains greyish films of epithelium, and the débris of fibrinous coagula. The microscope reveals in it the presence of pus corpuscles, flat polygonal cells with large nuclei, and sometimes red blood corpuscles.

Locally almost all that can be detected in male animals is a little tenderness of the neck of the bladder on rectal examination, and in females on examination of the meatus urinarius by means of a speculum.

The vaginal mucous membrane then appears inflamed around the meatus, which itself is exceedingly sensitive.

In cases of very marked inflammation, accompanied by partial necrosis of the mucous membrane or the production of false membranes, the temperature rises as high as 104° Fahr. (40° C.), appetite disappears, colic is extremely acute, and violent efforts to pass urine are continually made until the animal is completely exhausted. The patient then refuses to walk about, but frequently lies down, arches its back, and constantly makes efforts to urinate, which are abortive or end only in the passage of little jets of fluid.

The urine passed contains little greyish necrotic fragments or débris of false membranes, suggestive of diphtheria. In female animals the canal of the urethra may also become obstructed, and rupture of the bladder, though rare, occasionally occurs.

In the ordinary forms inflammation persists for two to three weeks, then diminishes in intensity, and either ends in recovery or becomes chronic.

In the grave forms, where inflammation and infection extend to the peri-vesical tissues and the peritoneum, death by peritonitis is the rule.

On post-mortem examination, the mucous membrane is seen to be of a greyish colour, and sloughing or gangrenous over surfaces of varying size, whilst the surroundings are infiltrated, blackish and greatly thickened. The whole of the connective tissue layer which supports the peritoneum near the base of the bladder, and also the adipose tissue around the bladder, are markedly inflamed. At this stage pelvi-peritonitis or generalised peritonitis may occur as complications.

In the simple forms the mucous membrane is desquamating, infiltrated, and covered with granulations of apparent healthy appearance.

=Diagnosis.= The diagnosis is comparatively easy, the external symptoms being so clearly defined. There is a difficulty, however, in distinguishing this disease from cystitis caused by a calculus. In male animals this latter form of cystitis is characterised by frequent spasmodic contractions of the accelerator urinæ. In acute cystitis, on the contrary, the contractions are temporary only and of no importance. Lastly, in female animals cystitis due to calculus formation is quite exceptional, owing to the large diameter and shortness of the urethra.

When nephritis and cystitis co-exist certain signs indicate the fact.

=Prognosis.= The prognosis varies, according to the acuteness of the disease and the character of the urine and epithelial débris, which afford valuable information.

=Treatment.= The treatment should be directed towards relieving the vesical and pelvic pain and modifying the local conditions.

Hot fomentations to the loins and flanks relieve pain. The administration of bicarbonate of soda and of cold drinks, such as barley-water, decoctions of couch grass and pellitory, mucilage, etc., are of service. These materials are readily taken by the patients, and have a soothing effect. Camphor also produces good results, but benzoate of soda is most useful on account of the disinfectant action produced within the bladder, as a consequence of the benzoic acid being separately eliminated by the kidney. Repeated washing out of the bladder with antiseptic solutions has been recommended, but is open to criticism. Such treatment is difficult in male animals, owing to the special formation of the glans penis and urethra, and in female animals it is by no means easy. In all cases of acute cystitis, in fact, the passage of the catheter is painful, and as a metal, gutta-percha or hard rubber sound is used, the mere contact of the tip of the instrument injures the diseased mucous membrane, makes it bleed, and gives rise to danger of autoinoculation, with the possibility of serious results.

Those who recommend this method of treatment can never have followed closely the development of a grave case of acute cystitis, and if the practice is at all permissible, only a soft catheter should be used.

In chronic cystitis, on the other hand, washing out the bladder might be useful.

CHRONIC CYSTITIS.

Chronic inflammation of the bladder is still rarer than acute cystitis. It usually attacks females as a consequence of acute inflammation, though the condition may be chronic from the first, in which case the early stages are commonly overlooked.

=Symptoms.= The chief functions of the body do not appear to be disturbed, although the urine seems abnormal. Micturition is difficult, slow, and somewhat painful, and is followed by long-continued tenesmus.

The urine appears whitish, purulent, slimy, or of a deeper tint, rapidly becoming blackish. It is of ammoniacal or fœtid odour, and decomposes quickly.

The period of development may be prolonged, and recovery rarely occurs spontaneously. The condition often leads to ascending infection, inflammation of the ureters, pyelitis, and nephritis.

On post-mortem examination of animals slaughtered before complete wasting has occurred the vesical mucous membrane is found to be thickened, granulating, or suppurating. The muscular tissue shows infiltration and localised sclerosis, and is very irregularly thickened, inelastic, and wanting in contractile power. The peri-vesical tissues may be chronically inflamed.

=Diagnosis.= The diagnosis is easy, provided the peculiar characteristics of the urine are noted, and an examination is made through the vagina of the condition of the walls of the bladder, of the ureters and of the kidneys.

=Prognosis.= The prognosis is grave, because treatment would occupy too much of the practitioner’s time to allow it to be rigorously carried out, and therefore animals are usually slaughtered.

=Treatment.= Treatment comprises the use of many of the drugs used in acute cystitis, particularly benzoate of soda, benzoic acid, and bicarbonate of soda. The medicines comprised in the balsamic group are also valuable, viz., turpentine, tar, and terpine.

In this chronic form the bladder should be irrigated, but this must be done with strict aseptic precautions, the fluids used being cooled boiled water, boric acid or borax solution of 3 per cent, strength, or solution of fluoride of soda of a strength of 15 grains to the quart.

We need not point out the difficulties of pursuing this treatment in ordinary practice. As a rule, treatment is confined to internal medication whilst the animals are fattened.

URINARY LITHIASIS. CALCULUS FORMATION.

Normally the urine contains in solution certain salts, such as urates, hippurates and phosphates of lime, magnesia or ammonia. Under certain circumstances, in animals predisposed to the condition, these salts are precipitated in the kidneys, ureters or bladder, and form powdery or sandy deposits known as sediments; or, on the other hand, calculi, produced by the adhesion of the powdery masses. This constitutes urinary lithiasis.

The sediments are of a greyish-yellow colour.

The calculi are generally rose-coloured, white or somewhat grey. They contain oxalates and carbonates of lime and magnesia, earthy phosphates, etc. In appearance and shape they vary greatly. They may resemble coral or may form growths of a rounded, polyhedric or raspberry appearance. Some are hard and resistant; others friable. They vary in size between that of a grain of sand and a hen’s egg or more. A large calculus is usually solitary; the smaller sizes are often multiple.

Calculi occur in oxen and sheep, but more particularly in the latter species. They develop slowly without producing any marked external signs, and often it is only when the urethra becomes obstructed and urine is retained that the diagnosis is established. Calculi are rare in females in consequence of the dilatability of the urethra.

CALCULI IN BOVINE ANIMALS.

=Causation.= The older writers believed that calculi developed through winter feeding and a stinted supply of water. Nowadays this would not apply to well-managed establishments, water being provided regularly, and winter feeding comprising roots, etc., rich in water. Experience and observation have shown that the chief cause is excessive feeding, calculus formation occurring most frequently in animals which are most richly fed.

Nevertheless, it would be a mistake to overlook the effects of temperament and constitution. In human medicine the importance of hereditary predisposition and of the special diathesis is undeniable (uric or gouty diathesis). In veterinary medicine the same thing applies, for, apart from rich feeding, it is not uncommon to meet with cases of gravel in animals living under the most diverse conditions, although the issue of the same parents.

Certain infections of the urinary passages, though trifling at first, or at least of slow development, are also capable of causing mineral deposits in the urinary passages, a fact which Moussu considers to be proved by his success in experimentally reproducing given forms of pyelo-nephritis.

=Symptoms.= The symptoms are often overlooked, as long as the calculus deposits affect only the kidneys, their increase in that part not giving rise to alarming symptoms. It is certain that the eventual passage of the calculus through the ureter towards the bladder causes nephritic colic, but this form of colic is little understood, and has never been well described. Writers have simply mentioned cases of colic accompanied by great tenderness in the lumbar region, temporary suspension of the secretion of urine, and more or less marked dysuria.

Nothing resembling the extremely grave symptoms of nephritic colic in mankind has been described, though probably there is little difference in the complaint as it affects the bovine species.

When the sediment or the calculus reaches the bladder there is a tendency for it to be passed during micturition. The signs then become more strongly marked, because they point to obstruction of the urethra. If the deposit is simply of the nature of sediment, there is merely a little difficulty in urination, accompanied by some moderate amount of pain, and sediment is afterwards found within the sheath or adhering to the groups of hair at its extremity.

If, however, the deposit is in the form of small calculi, these are pushed towards the neck of the bladder and the urethra, which then appears to be obstructed.

The obstruction may occur at the origin, at the ischial curve, or at the =S=-shaped curve of the penis (Fig. 226). Henceforth strongly marked and unmistakable symptoms rapidly develop. Vesical colic appears, owing to retention of urine, and rapidly acquires extreme intensity, though it instantly ceases with rupture of the bladder in cases where no treatment is attempted. This form of vesical colic is accompanied by continual but unsuccessful efforts to urinate and by spasmodic contractions of the accelerator urinæ.

Appetite and rumination cease, and the animal shows extreme anxiety. Palpation along the course of the penis reveals unusual tenderness, and the calculus can sometimes be felt near the =S= curve, though more frequently in the ischial arch. The litter is not soiled with urine.

Cautious rectal examination proves the bladder to be extremely distended, or, in the case of rupture having occurred, entirely collapsed. In the latter case the spasmodic contraction of the accelerator urinæ completely ceases soon after rupture, and the animal appears to be recovering. This deceptive calm is due to the disappearance of the vesical colic, but the animal’s condition is still graver in consequence, and it must of necessity die. Rupture of the bladder is followed by inundation of the peritoneal cavity with urine, which is partly reabsorbed by the peritoneum, producing a kind of urinary intoxication, so that despite the elimination of certain volatile principles through the lungs (the breath has an odour suggestive of urine), the animal very soon dies.

In many cases, also, the urine is not aseptic, and after rupture of the bladder acute peritonitis supervenes and carries off the patient in from six to ten days.

Even when the urine appears to be aseptic, chronic exudative peritonitis is produced by the irritant action of the urine on the peritoneal endothelium. The exuded liquid mixes with the urine, and the animal soon shows marked ascites. Despite this condition, some animals have been known to survive as long as from three to six weeks without showing very marked disturbance.

Death is the inevitable sequel after a longer or shorter time. When large calculi have been arrested, or rather developed, in the bladder the same symptoms occur should the calculus be thrust towards the neck of the bladder so as completely to obliterate the passage. This, however, is a very rare accident. As a rule the obstruction is merely temporary, and the resulting vesical colic and retention last but a short time. The displaced calculus falls back again into the lower part of the bladder, where it is retained, and the urinary passages again become free.

=Diagnosis.= The diagnosis is sometimes extremely easy, but it may present serious difficulty.

When the urethra is obstructed, the symptoms are so striking that there can scarcely be any doubt; but the diagnosis of renal calculus, nephritic colic, calculus in the bladder, and rupture of the bladder demands more attention. Examination of the urinary organs through the rectum then proves of great service.

=Prognosis.= The prognosis is grave in all cases, because of the possibility of the urinary passages being obstructed, so that surgical interference is necessary.

=Lesions.= The lesions caused by urinary calculi may vary greatly. Though insignificant and scarcely apparent in certain cases, they are often very marked, and comprise simple or suppurative pyelitis, inflammation of the ureters, hydro-nephrosis, cystitis of varying intensity, urethritis, and inflammation of the sheath.

=Treatment.= All farmers who fatten their animals know that the use of alkaline drugs, such as bicarbonate of soda, together with diuretics, linseed, barley and pellitory diminish the danger of urinary calculus formation. Bicarbonate of soda is often given with this object, and is excellent in cases where lithiasis does not extend beyond the production of sandy or muddy deposits. By rendering the urine more alkaline it prevents the growth of sabulous deposits, and may even cause slow but progressive solution of concretions already formed. When, on the other hand, the urethra is obstructed, and urine is retained, early surgical treatment (urethrotomy) alone offers any chance of preventing rupture of the bladder.

Certainly it is possible, as recommended by the older practitioners, to try massage of the glans penis and urethra opposite the obstruction, and, after withdrawing the penis, to attempt to loosen and eject the obstructing matter. But such attempts very frequently fail, because the material is too firmly fixed, and no time must be lost.

Urethrotomy is usually practised at one of two points, according to circumstances—firstly, opposite the ischial arch; and, secondly, opposite the =S=-shaped curve.

=Ischial urethrotomy= is the promptest method of affording relief, and should always be preferred whenever there is danger of rupture of the bladder.

It is performed in the standing position, but is only possible when the animal is not too fat.

In other cases urethrotomy is performed opposite the point where the calculus is fixed, and aims at removing the obstruction. It can only be practised after casting the animal; but, in this case also, it is indispensable that the animal should not be excessively fat, as in such cases a secondary urinary abscess is almost certain to form.

Should the animal be so fat as to render treatment difficult, it is best to slaughter it at once.

URINARY CALCULI IN SHEEP.

Urinary calculi are commoner in sheep than in oxen, and seem to depend more on the breed and on conditions of feeding. They are almost exclusively confined to animals which are richly fed, to show animals, and to males. In exceptional cases they are seen, under ordinary conditions of feeding, in aged subjects.

Calculus formation can moreover be induced experimentally, and in a relatively short time, by giving certain rations—e.g., 7 lbs. per day of maize, lentils and beans for adults, and 3 lbs. for lambs. The other favouring circumstances, viz., hereditary gouty diathesis and infection, are less well established than they are in the case of the ox.

In sheep the symptoms are still less characteristic than in oxen, for which reason gravel in sheep merits special description.

It shows itself in the passage of turbid urine, forming a deposit at the extremity of the sheath, which becomes somewhat inflamed. The colic resulting from retention of urine is shown by depression, want of appetite, dysuria, and generalised convulsive shivering fits.

The patients lie down in the sterno-abdominal or sterno-lateral position. They constantly suffer from attacks of general violent shivering, and die after twelve, twenty-four, or forty-eight hours.

On post-mortem examination the bladder is found to be ruptured, or the urethra obstructed.

=Diagnosis.= The diagnosis involves no difficulty, provided the method of feeding is understood. In many cases the shepherds themselves perfectly recognise the cause of the symptoms.

=Prognosis.= The prognosis is very grave, it being impossible to pass the catheter on account of the perineal valve in the urethra, while it is difficult to operate, the urethra being very small and deeply embedded in a thick layer of fat.

=Treatment.= The only resource is massage along the urethra, which may sometimes break up the mass of sediment or move the obstructing calculus. One remark may, however, be made, viz., that in the majority of cases the urethra is obstructed at its extremity by local accumulations of sediment behind the spiral filiform prolongation of the penis.

It is then sufficient, and experienced shepherds have no hesitation in performing the operation, to remove the spiral filament, thus facilitating the expulsion of the sediment and affording relief. If both methods, viz., massage and section of the filament, fail, the animal should be slaughtered, so as to avoid rupture of the bladder, which would render the flesh useless as food.

From a preventive standpoint, all sheep which are richly fed should receive an allowance of some slightly alkaline drink.

PARALYSIS OF THE BLADDER.

Paralysis of the bladder is somewhat frequent in female, but very rare in male, animals. In the majority of cases it is the consequence of difficult parturition, or is a post-partum complication.

It is characterised by incontinence of urine or retention with overflow. The continuous discharge soils the hind quarters, hocks, shanks, pasterns, etc., and the urine decomposes and causes irritation; it soon sets up urinary eczema in all the parts with which it comes in contact, a condition which can only be successfully treated by removing the cause.

=The prognosis= is grave, for methods of treatment are few, and of doubtful efficacy.

=Treatment.= If the condition results from post-partum infection, this must naturally first receive attention. Should the infection have disappeared whilst incontinence of urine still continues, the administration of tonics, e.g., tincture of nux vomica in daily doses of ¾ to 1 drachm for ten days or so in the case of a bovine animal, and a stimulating application to the lumbo-sacral region, may bring about recovery.

But if, in spite of such treatment, the incontinence persists, it is better, from an economic standpoint, to treat the urinary eczema with astringents, etc., and quickly to fatten the animal.

EVERSION OF THE BLADDER.

Eversion of the bladder only occurs in female animals after difficult parturition. The viscus is turned completely inside out, as occurs in eversion of the uterus, the base of the bladder becoming invaginated in the cavity of the bladder itself, and afterwards passing into the urethra and vagina. The bladder thus becomes totally displaced, and appears between the lips of the vulva, resting on the inferior commissure, and forming a mass the size of an orange.

Eversion cannot occur unless the ligaments of the bladder have become relaxed, stretched or ruptured. Expulsive efforts and the pressure of the intestinal mass complete the process, the peritoneum and peri-vasicular layers of connective tissue being torn.

=Diagnosis.= The diagnosis of eversion of the bladder presents no difficulty. The everted mass appears to have a narrow neck opposite the meatus, and is seen to form a reddish, unctuous mass. The mucous membrane now forms the external coat and appears covered with mucus so long as inflammation does not occur.

The urine continually escapes from the ureters (which open on the surface of the mucous membrane) as it is formed, and flows away by the lower commissure of the vulva. The vulva is half open, and the prominence formed by the bladder projects beyond it.

=Prognosis.= The prognosis is grave, because reduction is difficult, and may be accompanied by rupture of the organ; also because even in favourable cases it is invariably followed by acute cystitis.

=Treatment.= Treatment is confined to reduction. Before attempting this, measures must be adopted to prevent straining, either by passing a rope round the animal’s body, thus causing it to flex the vertebral column, or by puncturing the rumen or performing tracheotomy. The open hand is then applied to the surface of the swelling, which is gently compressed and thrust in turn through the meatus and urethra. The portions nearest to the urethra should first be returned. It is sometimes necessary to use both hands, and even to employ a catheter with a large round head, to reduce the eversion effectually. After reduction a truss or vulval clamp should be applied. Subsequent treatment consists in the administration of sedatives—e.g., laudanum, mucilaginous drinks, barley-water, pellitory, etc.

HÆMATURIA.

Hæmaturia, i.e., the passage of blood-stained urine, is in itself only a symptom, which may accompany very varying conditions, such as the congestion peculiar to the early stages of nephritis, traumatic lesions of the kidneys, ulceration of the uriniferous tubules, or of the pelvis of the kidney, lesions of the ureters, bladder, etc., etc. The term, therefore, does not indicate a disease, but nevertheless in bovine practice the term hæmaturia has acquired a special significance.

This hæmaturia of bovine animals is clinically indicated by the presence of blood in the urine; anatomically by lesions of the bladder, sometimes also of the ureters. It is probable that some forms at least of the condition will ultimately be proved to be due to the piroplasmata, but in the present state of our knowledge the disease can only be described from the clinical standpoint. The reader is recommended to refer to the article on “Bovine Piroplasmosis,” ante.

Pichon in 1863 and Sinoir in 1864 introduced the name “hæmaturia” in the course of their remarkable investigations concerning the disease. Vigney in 1845 and Gillet in 1862 had previously described it, and it has since formed the subject of constant researches.

Detroye in 1891 termed it “essential hæmaturia,” and Galtier in 1892 gave it the name of “hæmorrhagic cystitis.” Boudeaud in 1894 also used the term “hæmaturia of bovine animals.” In Germany the disease is known as “stallroth” (stable-red).

=Geographical distribution.= Hæmaturia is a perfect scourge in certain countries. It seems to have made its appearance in the departments of the West of France, the Mayenne and the Sarthe, afterwards spreading into the Maine-et-Loire and the Indre. At the present day, it inflicts great ravages in the Creuze, the Corrèze, Haut-Vienne, Cantal and Haute-Loire districts. It has been described in Germany, Belgium, and Italy. These forms are probably due to Piroplasma bigeminum.

=Causation.= The most varying opinions have been advanced regarding its cause. Pichon believed its appearance was due to changes in cultivation, which between 1830 and 1860 completely altered the general appearance of the country and the conditions of breeding in the old province of Maine. Land reclamations and the use of lime dressings have been mentioned, as well as the introduction of the Durham breed of cattle. Sinoir practically adopts the latter view, for he considers that the crossing with the Durham breed, while increasing the precocity, has diminished the powers of resistance of the indigenous cattle.

But in course of time these ideas have become modified, and investigation has taken a new direction. Detroye regarded the disease as a microbic and easily transmissible disorder, while Galtier in the following year described it as merely a chronic hæmorrhagic cystitis, produced by the consumption of irritant plants in animals previously suffering from distomatosis. In Germany, Arnold attributed “stallroth” to coccidia developing in the epithelium of the vesical mucous membrane.

Cruzel considered the disease to be due entirely to poor feeding. Boudeaud thought the same. He says that hæmaturia affected one-tenth of the whole of the oxen in the south of the Indre and the north of the Creuze, in parts where the arable soil is thin and poor in phosphoric acid. Furthermore, he suggests that dressings with lime and phosphates would result in the disappearance of hæmaturia.

We cannot admit that poor forage and feeding alone are sufficient to produce hæmaturia, for one frequently sees poorly nourished animals pass through all the stages of wasting and most profound cachexia without ever showing signs of this particular ailment. Besides, hæmaturia may attack animals in good condition.

Detroye’s early opinion as to the infectious or microbic nature of the disease seems scarcely more acceptable, for it now appears certain that the organism originally described is incapable of producing the disease.

Galtier’s theory is still less admissible. According to the Lyons professor, hæmaturia occurs only in animals suffering from distomatosis. The liver, he says, being affected by the growth of liver flukes, no longer performs its proper work of destroying toxins, and if under these conditions the animals eat improper food containing ranunculaceæ, sedges, rushes, etc., the toxic principles of these plants are absorbed. Then, he adds, these principles being no longer destroyed, are eliminated by the kidneys, their stay in the bladder causes irritation, and hæmorrhagic cystitis is set up, this being afterwards maintained by microbic agents in the bladder.

This very specious theory, all the points in which may readily be refuted, in our opinion falls to the ground before the simple fact that hæmaturia occurs in animals which present no trace of distomatosis on post-mortem examination, and that, furthermore, it is not seen in the lower regions of the departments of the Nord, the Pas-de-Calais and the Somme, where ranunculaceæ and other irritant plants are common and distomatosis rages.

Moussu states that he has proved that hæmaturia is very rare in young animals and is exceptional before the age of two and a half years or three years; that it attacks oxen as often as cows; that it is particularly common in low regions; and that it is scarcely ever seen above a height of 800 yards. Careful investigation, moreover, shows that the passage of blood occurs just as frequently in winter, when the animals are housed, as in spring, when at pasture.

=Lesions.= The lesions of hæmaturia are to be found in the bladder, though in exceptional cases they may also affect the ureters and kidneys. They have been described by Pichon and Sinoir, but as these observers regarded the condition as a disease of the blood due to poor feeding, etc., they did not attach much importance to them. Detroye has described the different appearances very well, though Moussu states that he has never met with the “blisters” which he mentions.

The first period is accompanied simply by abnormal vascularity of the bladder, which appears in the form of true varicosities of the submucous vessels and intra-mucous capillaries. But if this lesion is primary, it does not correspond to the period during which blood-stained urine is passed, and is not sufficient to explain it. It always appears in the form of a more or less abundant hæmorrhagic intra-mucous, sub-epithelial spotting.

Over the hæmorrhagic area, which may be of very varied dimensions, ranging from those of a small pin’s head to those of a lentil, the epithelium is swollen and loosened, and so separated from the surrounding parts as to have lost its vitality. This patch of separated epithelium soon falls away, leaving an epithelial ulceration of the mucous membrane. The subjacent clot rapidly breaks up in contact with the liquid in the bladder, and is replaced by a small ulceration which becomes the seat of continual capillary hæmorrhage. Nevertheless, the neighbouring tissues react, and the process of repair may end either in true cicatrisation, which appears to be rare, or more frequently in the formation of exuberant granulations, which are also of the nature of a soft, bleeding vegetation. This vegetation is either sessile or pedunculated, and is of very varying size.

The wall of the bladder also reacts, becoming sclerosed and thickened beneath the granulations, so that, in animals which have long suffered from hæmaturia, it may entirely have lost its dilatability.

When the disease has existed for a certain time, sub-epithelial hæmorrhages, ulcerations, vegetations and points of sclerosis may all co-exist, a fact which shows that the disease does not develop all at once, but that, on the contrary, every little lesion develops separately and continuously. This fact also explains the length of time for which blood may be passed, despite the presence of old or healed lesions.

Finally, in very old standing cases dating from several years back (Moussu saw an animal aged twenty-eight years which had suffered from this disease for more than twenty years, but in a very intermittent fashion), it is not exceptional to find numerous papilliform vegetations 1 or 2 inches in length, either with a fine pedicle or largely sessile, invading one-half or two-thirds of the internal surface of the bladder.

These vegetations sometimes, though rarely, invade the ureters. When they occur towards the point where these conduits enter the bladder, they obstruct the passage of urine, and lead to the development of hydro-nephrosis or pyelo-nephritis.

=Symptoms.= The early symptoms often escape notice, because general disturbance is rare. The first appreciable signs are cystitis and frequent urination.

The urine passed is turbid, particularly towards the end of the act of urination; then it is of a pink or red colour, and all intermediate shades between a pale pink and a bright arterial red colour may be observed.

The patients sometimes seem to pass unaltered blood in the urine, but on microscopic examination this blood is found to be extremely diluted. Provided the bladder is not gravely infected by the (secondary) penetration of germs into its cavity the blood corpuscles remain normal, or are scarcely changed. As soon as the bladder, however, becomes secondarily infected an almost immediate change takes place; the red blood corpuscles become crenated, broken up and dissociated; the hæmoglobin is also partly dissolved and modified, and at this stage the urine is red-brown or coffee-coloured, according to the length of time it has been retained in the bladder.

In other cases, chiefly when hæmaturia has existed for some time, the extravasated blood coagulates in the bladder, and the urine passed contains filamentous clots the size of a man’s thumb, a pigeon’s egg, or more. If the clots formed are too large to be passed, which is often the case in the ox, they may obstruct the urethra, causing retention of urine and all the accidents which accompany this condition, even including rupture of the bladder. This, in the ox, is a frequent termination. In the cow the dilatability and shortness of the urethra render retention of urine much rarer. It is certainly possible, however, and it is not exceptional, to find from 4 to 6 lbs. of clotted matter in the distended bladder. All these conditions can be detected by rectal exploration, and by attention to the symptoms of obstruction of the urethra.

Whenever there is retention of clots dysuria is extremely marked and, so to speak, permanent, the animals having continual tenesmus.

Hæmaturia observes a slow, progressive course, which, in time, ends in death by exhaustion, though this is not invariably the case. Hæmaturia is frequently intermittent, and, after having been very marked for weeks or months, may suddenly or gradually cease, and only reappear a long time afterwards. This fact is explained by a study of the development of the lesions. When ulceration occurs the sub-epithelial vessels of the mucous membrane, which have contributed to the formation of the hæmorrhagic spot, are widely open, and a capillary hæmorrhage results; but as soon as a small clot forms in this position, or local capillary thrombosis occurs, the hæmorrhage ceases, with the result that the hæmaturia disappears. Unfortunately, however, the obliterating clots are not permanent, any more than the local thrombosis—or, in the event of their proving permanent, another small lesion develops at a different point, and this lesion may at any time cause the reappearance of the hæmaturia; the process goes on until the animal succumbs. Should the lesions heal successively, spontaneous recovery may take place, but such recovery is exceptional.

The animals may not appear to suffer from the passage of blood for weeks or even months, but after a time they become less capable of replacing the loss. They become anæmic, the number of corpuscles falls from the normal figure of from six to seven millions of red corpuscles per cubic millimètre to three millions, two millions, one million, and even to five hundred or eight hundred thousand.

The richness in hæmoglobin simultaneously diminishes; wasting progresses to the point of cachexia, and the appetite diminishes while diarrhœa appears; swellings are noticeable about certain parts of the body; and the animals, continuing to pass blood, die in a state of absolute exhaustion, without apparent suffering.

This termination is the most common, unless slaughter is determined on, and is very different from the premature end which follows the formation of clots and obstruction of the urethra.

Externally the patients only show feebleness, pallor of the visible mucous membranes, and difficulty in urination. The bunch of hair at the lower commissure of the vulva is always soiled with blood-stained urine or little clots.

Hæmaturia may cause death by exhaustion in from six weeks to two months, but not infrequently it lasts for months or even years.

=Diagnosis.= The diagnosis presents no difficulty when the urine can be examined; but in the periods of intermittence no opinion can be advanced. These intermittences are so frequent that in parts of the country ravaged by this disease it is a usual custom, when selling, to grant or refuse guarantees for a longer or shorter term.

The condition can be distinguished from parasitic hæmoglobinuria (piroplasmosis) or from Brou’s disease (a febrile disease of rapid development) by simply examining the urine or blood.

=Prognosis.= The prognosis is extremely grave, for, up to the present, no really efficacious treatment has been discovered, and although some animals may live for years without their lives being in any way endangered, this cannot possibly be foreseen, and there is no economic advantage in keeping them.

=Treatment.= No curative treatment is known.

It is true that iron salts, tonics, Rabel’s liquid, decoctions of certain plants, such as plantain, have been recommended, but apart from the fact that they are of doubtful efficacy, they cannot be used over long periods. All these preparations also tend to increase the coagulability of the blood; but considering that the disease is beyond question of a parasitic character, good results cannot always be expected of them.

Preventive treatment appears more hopeful, although even in this connection, the best informed appear to have considerable doubts. All those who have studied the question agree in recommending drainage of the pasturages, and their improvement by the use of various manures, particularly superphosphates and lime. These improvements alter the character of the pasture, render the soil healthier, and may perhaps prove sufficient to diminish or prevent the local growth of the germs. Under such conditions, Boudeaud declares that he has seen hæmaturia disappear from farms where it had previously been in permanent possession. It has also been recommended that the affected cattle should be sent elsewhere to places where the disease does not exist, and experience shows that spontaneous recovery is more frequent under such conditions.

It is probable that, during attacks of hæmaturia in a contaminated country, successive parasitic infestations occur, which would explain the persistence with which blood is passed, a symptom which does not occur in a healthy country. This view, however, is still only an hypothesis.