Part 31

Treatment.--Treatment is only successful when the cause of the trouble can be remedied. After these (sprains of the back, etc.) have recovered, blisters (mustard) on the loins, the lower part of the abdomen, or between the thighs may be resorted to with success. Two drams of copaiba or of solid extract of belladonna or 2 grains Spanish flies daily may serve to restore the lost tone. These failing, the use of electric currents may still prove successful.

URINARY CALCULI (STONE OR GRAVEL).

Stone or gravel consists of hard bodies mainly made up of the solid earthy constituents of the urine which have crystallized out of that liquid at some part of the urinary passage, and have remained as small particles (gravel), or have concreted into large masses (stone, calculus). (See Pl. XI, figs. 1, 2, 3.) In cattle it is no uncommon thing to find them distending the practically microscopic tubes in the red substance of the kidney, having been deposited from the urine in the solid form almost as soon as that liquid has been separated from the blood. These stones appear as white objects on the red ground formed by cutting sections of the kidney, and are essentially products of the dry feed of winter, and are most common in working oxen, which are called upon to exhale more water from the lungs and skin than are the slop-fed and inactive cows. Little water being introduced into the body with the feed and considerable being expelled with the breath and perspiration in connection with the active life, the urine becomes small in amount, but having to carry out all waste material from the tissues and the tissue-forming feed it becomes so charged with solids that it is ready to deposit them on the slightest disturbance. If, therefore, a little of the water of such concentrated urine is reabsorbed at any point of the urinary passages the remainder is no longer able to hold the solids in solution, and they are at once precipitated in the solid form as gravel or commencing stone. In cattle, on the other hand, which are kept at pasture in summer, or which are fed liberally on roots, potatoes, pumpkins, apples, or ensilage in winter, this concentrated condition of the urine is not induced, and under such circumstances, therefore, the formation of stone is practically unknown. Nothing more need be said to show the controlling influence of dry feeding in producing gravel and of a watery ration in preventing it. Calculus in cattle is essentially a disease of winter and of such cattle as are denied succulent feed and are confined to dry fodder as their exclusive ration. While there are exceptions, they are so rare that they do not invalidate this general rule. It is true that stone in the kidney or bladder is often found in the summer or in animals feeding at the time on a more or less succulent ration, yet such masses usually date back to a former period when the animals were restricted to a dry ration.

In this connection is should be noted that a great drain of water from the system by any other channel than the kidneys predisposes to the production of gravel or stone. In case of profuse diarrhea, for example, or of excessive secretion of milk, there is a corresponding diminution of the water of the blood, and as the whole quantity of the blood is thus decreased and as the urine secreted is largely influenced by the fullness of the blood vessels and the pressure exerted upon their walls from within, it follows that with this decrease of the mass of the blood and the lessening of its pressure outward there will be a corresponding decrease of urine. The waste of the tissues, however, goes on as before, and if the waste matter is passed out through the kidneys it must be in a more concentrated solution, and the more concentrated the urine the greater the danger that the solids will be deposited as small crystals or calculi.

Again, the concentrated condition of the urine which predisposes to such deposits is favored by the quantity of lime salts that may be present in the water drunk by the animal. Water that contains 20 or 30 grains of carbonate or sulphate of lime to the gallon must contribute a large addition of solids to the blood and urine as compared with soft waters from which lime is absent. In this connection it is a remarkable fact that stone and gravel in the domesticated herbivora are notoriously prevalent on many limestone soils, as on the limestone formations of central and western New York, Pennsylvania, Ohio, and Michigan; on the calcareous formations of Norfolk, Suffolk, Derbyshire, Shropshire, and Gloucestershire, in England; in Landes in France, and around Munich in Bavaria. It does not follow that the abundance of lime in the water and fodder is the main cause of the calculi, as other poisons which are operative in the same districts in causing goiter in both man and animal probably contribute to the trouble, yet the excess of earthy salts in the drinking water can hardly fail to add to the saturation of both blood and urine, and thereby to favor the precipitation of the urinary solids from their state of solution.

The known results of feeding cattle a generous or forcing ration in which phosphate of lime is present to excess adds additional force to the view just advanced. In the writer's experience, the Second Duke of Oneida, a magnificent product of his world-famed family, died as the result of a too liberal allowance of wheat bran, fed with the view of still further improving the bone and general form of the Duchess strain of Shorthorns. Lithotomy was performed and a number of stones removed from the bladder and urethra, but the patient succumbed to an inflammation of the bowels, induced by the violent purgatives given before the writer arrived, under the mistaken idea that the straining had been caused by intestinal impaction. In this case not only the Second Duke of Oneida, but the other males of the herd as well, had the tufts of hairs at the outlet of the sheath encased in hard, cylindroid sheaths of urinary salts, precipitated from the liquid as it ran over them. The tufts were in reality resolved into a series of hard, rollerlike bodies, more or less constricted at intervals, as if beaded.

When it is stated that the ash of the whole grain of wheat is but 3 per cent, while the ash of wheat bran is 7.3 per cent, and that in the case of the former 46.38 per cent of the ash is phosphoric acid, and in that of the latter 50 per cent, it can easily be understood how a too liberal use of wheat bran should prove dangerous if fed dry. The following table shows the relative proportion of ash and phosphoric acid in wheat bran and in some common farm seeds:

Ash and phosphoric acid in bran and some common farm seeds.

--------------------+----------+-------------+--------------- Kind of grain. | Ash. | Phosphoric | Phosphoric | |acid in ash. | acid in the | | | entire feed. --------------------+----------+-------------+--------------- |Per cent| Per cent | Per cent Wheat bran | 7.3 | 50 | 3.65 Wheat, grain | 3 | 46.38 | 1.3914 Oats, grain | 2.50 | 26.5 | .6625 Barley, grain | 3.10 | 39.6 | 1.2276 Bean, grain | 3.10 | 31.9 | .9864 Peas, grain | 2.75 | 34.8 | .957 Tare, grain | 3 | 36.2 | 1.086 Indian corn, grain. | 1.5 | -- | -- Rye, grain | 1.6 | 39.9 | .6384 --------------------+----------+-------------+---------------

Wheat bran, it will be observed, contains three times as much phosphoric acid as is found in any of the other grains, and four times as much as oats, beans, peas, or rye; so that if fed in excess it will readily overcharge the urine with phosphates.

There is another point to be considered, however, in estimating this danger. Wheat bran contains a far greater quantity of albuminoids and other nitrogen-containing constituents than the common grains (these being made up mainly of starch, which contains no nitrogen); and, all nitrogen-bearing products contained in the blood and tissues being expelled from the body mainly through the kidneys in the form of urea and (in cattle) hippuric acid, it follows that the excess of urea formed when such feed is consumed must load the urine with solids and bring it constantly nearer to the point of saturation, when such solids (or the least soluble of them) must be deposited.

The following table will show the relative amounts of the nitrogen-bearing products in wheat bran and some of our common grains:

Nitrogenous matter in wheat bran and some common farm grains.

-----------------+---------------+----------------+---------------------- Kind of grain. | Albuminoids | Woody fiber | Total nitrogenous- | (nitrogenous).| (nitrogenous.) | bearing constituents. -----------------+---------------+----------------+---------------------- | Per cent | Per cent | Per cent Wheat bran. | 16.1 | 8 | 24.1 Wheat, grain | 12.5 | 1.8 | 14.3 Barley, grain | 12.4 | 2.7 | 15.1 Oats, grain | 11.8 | 9.5 | 21.3 Rye, grain | 10.6 | 1.7 | 12.3 Indian corn | 10.1 | 1.7 | 11.8 -----------------+---------------+----------------+----------------------

It will be observed that, with the exception of oats, none of the grains contain more than two-thirds of the nitrogenous material present in the wheat bran, while in the case of rye and maize there is practically but one-half. Even in the case of oats the albuminoids, which are the more digestible principles, and therefore those that are the most easily and speedily converted into urea, are present only to the amount of two-thirds of that which exists in the wheat bran. With such an excess of ash, of phosphates, and of nitrogenous (urea-forming) constituents in wheat bran, its tendency to favor the formation of calculi is fully explained. It must not, however, be inferred that wheat bran is not a valuable feedstuff. The inference is only that it should be fed with an abundance of water, as a sloppy mash, or in combination with an abundance of roots, potatoes, pumpkins, or other succulent aliment.

In this connection the presence of magnesia in the feed or water must be named as favoring calculous formations in the urinary passages. The explanation is that while the phosphate of magnesia thrown out in the urine is soluble in water, the compound phosphate of ammonia and magnesia is insoluble, and, accordingly, if at any time ammonia is introduced into urine containing the phosphate of magnesia there is instantly formed the ammonio-magnesium phosphate, which is as promptly deposited in the solid form. The common source of ammonia in such cases is from decomposition of the urea in fermenting urine. In order to produce this a ferment is necessary, however, and therefore, as an additional prerequisite, the presence of bacteria, or fungi, in the urine is essential. These ferments may make their way from without along the urinary passage (urethra), and their propagation in the bladder is greatly favored by the prolonged retention of urine, as in case of spasm of the neck of the bladder or obstruction by an already existing stone. Another mode of entrance of the ferment is an unclean catheter used to draw the urine. Still another is the elimination through the kidneys of the bacteria of infectious diseases, or of such as, without producing a general infection, yet determine fermentation in the urine. The precipitation is favored not only by the production of ammonia, but also by the formation of viscid (colloid) products of fermentation. In this sense bacteria are most important factors in causing gritty deposits in the urine.

Another insoluble salt which enters largely into the composition of many urinary calculi of the ox is carbonate of lime. This is derived mainly from the lime in the feed and water and from the carbon dioxid formed by the oxidation of the organic acids in the fodder. These organic acids, being composed of carbon, hydrogen, and oxygen (without nitrogen), are resolved by the addition of oxygen into carbon dioxid (CO{2}) and water (H{2}O). The carbon dioxid unites with the lime in the blood to form carbonate of lime, and in this state passes into the urine. Now, carbonate of lime is soluble in water containing free or uncombined carbon dioxid, but is precipitated whenever the latter is withdrawn. It is only necessary, therefore, to have in the urine sufficient lime or other available base to unite with all the free carbon dioxid in order to bring about the precipitation of the dissolved carbonate of lime in the solid, crystallized form; hence it is that, of all sediments in the urine of herbivora, this is the most frequent and usually the most abundant.

A less common constituent of urinary calculi is the insoluble oxalate of lime. In this case the lime is derived as before from the feed or water, or both, while the oxalic acid is a product of the oxidation of organic acids of the feed, less oxygen having been used than in the formation of carbon dioxid. The final product of the complete oxidation of these acids is carbon dioxid, but when less oxygen is furnished, owing to some disease of the lungs or a disease of the nerve centers, which lessens the activity of the breathing, then oxalic acid may be produced. If this oxalic acid comes into contact with lime, it is instantly precipitated as crystals of oxalate of lime.

Another inorganic substance at times found in urinary calculi is silica (SiO{2}). This contributes largely to giving stiffness to the stems of growing plants, and in most of our cereals and grasses makes up a large proportion of the ashes of the burned plant. It is found in the soluble form in combination as silicate of potash, but at times is displaced by oxalic or other acid and then appears as gritty, sandy particles in the stem. This gritty, insoluble silica is especially noticeable among the horsetails (EquisetacÊceÊ_), bamboos, and sedges. The per cent of silica in the ash of several common fodder plants is given below:

Silica in ash of various fodder plants.

Ash of-- Silica. Per cent.

Wheat straw 67.6 Oats and husk 38.6 Oat straw 35.4 Barley straw 73.1 Rye straw 64.4 Rye-grass hay 64.57 Wheat chaff 81.2 Oat chaff 59.9 Barley awn 70.7

It is only soluble silica that is taken up into the system, and it is in this form (usually as silicate of potash or soda) that it enters the urine, but all that is wanted to precipitate it in crystalline form as a gritty sand is the presence of oxalic or other acid having a stronger affinity for its base (potash or soda).

Other conditions, however, enter largely into the causation of stone, or gravel. A high density of urine resulting from a highly saturated condition is often present for a length of time without any precipitation of solid materials. Urea and carbonates may be present in excess, the feed may be given dry, and drinking water may be deficient in quantity without any deposition of stone or gravel. In such cases, the presence of noncrystalline organic matter in the urine becomes an exciting cause. Rainey and Ord have shown experimentally that colloid (noncrystallizable) bodies like mucus, epithelial cells, albumin, pus, blood, hyaline casts of the kidney tubes, etc., not only determine the precipitation of crystallizable salts from a strong solution, but they determine the precipitation in the form of globular masses, or minute spheres, which, by further similar accessions, become stones, or calculi, of various sizes. The salts that are deposited by mere chemical reaction without the intervention of colloids appear in the form of sharply defined angular crystals, and hence the rough, jagged crystals of oxalate of lime or ammonia-magnesium phosphate. Heat intensifies the action of the colloids in causing precipitation of the dissolved salts, so that the temperatures of the kidneys and bladder constitute favorable conditions. Colloids that are undergoing decomposition are also specially powerful, so that the presence of bacteria or fungi causing fermentation is an important factor.

In looking, therefore, for the immediate causes of urinary calculi we must accord a high place to all those conditions which determine the presence of excess of mucus, albumin, pus, blood, kidney casts, blood-coloring matter, etc., in the urine. A catarrhal inflammation of the pelvis of the kidney, of the ureter, or of the bladder, generating excess of mucus or pus; inflammation of the kidneys, causing the discharge of blood, albumin, or hyaline casts into the urinary passages; inflammation of the liver, lungs, or other distant organ, resulting in the escape of albumin in the urine; disorders of the liver or of the blood-forming functions, resulting in hematuria or hemoglobinuria; sprains or other injuries to the back, or disease of the spinal marrow, which cause the escape of blood with the urine; the presence in the bladder of a bacterial ferment, which determines the decomposition of the mucus and urea, the evolution of ammonia and the consequent destruction of the protecting cellular (epithelia) lining of the bladder, or the irritation caused by the presence of an already formed calculus, may produce the colloid or uncrystallizable body that proves so effective in the precipitation of stone or gravel. It has long been known that calculi almost invariably form around any foreign body introduced into the kidney or bladder, and I have seen a large, calculous mass surrounding a splinter of an arrow that had penetrated and broken off in the body of a deer. The explanation is now satisfactory--the foreign body carries in with it bacteria, which act as ferments upon the urine and mucus in addition to the mechanical injury caused by its presence. If such a body has been introduced through the solid tissues, there is, in addition, the presence of the blood and lymph derived from the wounded structures.

CLASSIFICATION OF URINARY CALCULI.

Urinary calculi are most conveniently divided according to the locality in which they are found. Thus we find first renal calculi, formed in the kidney (Pl. XI, fig. 1), and which for cattle must be again divided into calculi of the uriniferous tubes and calculi of the pelvis. The second class are named ureteral calculi because they are found in the duct leading from the kidney to the bladder (ureter). The third class are the vesical calculi, from the bladder or vesicle in which they are found. The fourth class are the urethral calculi, and are found in the duct leading outward from the bladder through the penis (urethra). The fifth and last class are the preputial calculi, since they are found within the sheath of the penis (prepuce).

Calculi may also be classed according to their chemical composition and this has the advantage of suggesting the special cause of each as found in the feed, water, soil, or general conditions of health. This classification affords no guide to their location or symptoms, as calculi of the same chemical composition may be formed at any part of the urinary passages, as those formed in the kidney may pass on through all the various passages outward, unless it is found at any point of their progress that they have grown so large that the passage will not admit them. The following are among the concretions found in the various parts: