Part 32

(1) Coralline calculi.--These are of a dull-white color and irregular surface, like coral. They are made up of hard and resistant layers evenly deposited around a central nucleus. (Pl. XI, fig. 3.) Their specific gravity is 1,760, water being 1,000, and they contain 74 per cent of carbonate of lime with some carbonate of magnesia, organic matter, and a trace of carbonate of iron. Yellowish-white, smooth, round calculi of the same chemical composition are met with.

(2) Pearly calculi.--These are more frequent than the first-named variety. They are very hard and smooth on the surface, reflecting a play of various colors after the fashion of a pearl. This peculiarity appears to be caused by the thinness and semitransparency of the supposed layers. They have a specific gravity of 2,109 to 2,351, and nearly the same chemical composition as the coralline variety. Golding Bird found a specimen of this kind formed of carbonate of lime and organic matter only.

(3) Green calculi (metalloid calculi).--These are usually small and numerous, as they are exceedingly common. They are of a very hard consistency, and have a clear-polished, greenish surface of almost metallic brilliancy. They have a specific gravity of 2.301 and a composition almost identical with the second variety.

(4) White calculi.--Pure white, smooth, lustrous calculi are rare. They have a specific gravity of 2.307, and contain as much as 92 per cent of carbonate of lime with carbonate of magnesia and organic matter.

(5) Ammonio-magnesium calculi.--These are of a grayish color and a very rough, crystalline surface, which proves very irritating to the mucous membrane. They have a specific gravity of 1.109 to 1.637, and are composed chiefly of ammonio-magnesium phosphate, oxalate of lime, and organic matter, with a little carbonate of lime and magnesia.

(6) Siliceous calculi.--These are clear, smooth, and hard, and usually spherical. They have a specific gravity of 1.265 to 1.376, and contain 57 per cent of silica with carbonates of iron and magnesia, organic matter, and traces of iron. In other specimens of siliceous calculi there was a specific gravity of 3.122, and there was 79 to 85 per cent of carbonate of lime together with carbonate of magnesia, and iron, silica, and organic matter. Others are almost exclusively made of silica.

(7) Oxalate of lime calculi (mulberry calculi) (Pl. XI, fig. 2).-- These are characterized by their extremely rough, angular surface, formed by the octahedral crystals of oxalate of lime. Their specific gravity may be 3.441, and they contain oxalate of lime to the extent of 81 per cent, together with carbonates of lime and magnesia and organic matter.

(8) Gravel (pultaceous deposits).--Simple crystals may be met with at any point from the kidneys to the external opening at the end of the prepuce (sheath), and they may appear singly, as crystals, or they may accumulate in masses of fine spherical crystals almost like dirty powdered chalk suspended in water. In the ox this is especially common as a collection in the sheath, distending that into a soft, doughy swelling.

FORMS OF CALCULI IN DIFFERENT SITUATIONS.

Apart from the rough crystalline surfaces of the calculi of oxalate of lime and ammonio-magnesium phosphate, the general tendency is to a smooth, round outline. At times, however, they show more or less flattening with rounded angular edges, caused by the contact and mutual friction of two calculi. Sometimes two or more stones lying together become united into one by a new external deposit, and the resulting mass then shows rounded swellings on opposite sides. The large calculi occupying the pelvis of the kidneys usually show a central part having the outline of the main cavity of the pelvis and two or more projections that have been molded into the corresponding branches or channels which lead to corresponding lobes of the kidney. In winter and spring small concretions in the form of plates are often met with in the branches of the pelvis, having been formed and molded in the confined space between the projecting papilla and the surrounding cuplike branch of the pelvis. Finally, the pulplike deposits in the sheath and elsewhere are made up of globular masses, individually so small as to be often practically microscopic.

STONE IN THE KIDNEY (RENAL CALCULI).

In an animal leading the quiet, uneventful life of the ox, stones of large size may be present in the kidney without producing any disorder appreciable to the people about him. In cattle fattened on dry feed in winter, on the magnesian limestone of New York, it is exceptional to find the substance of the kidney free from calculi about the size of a grain of wheat or less, and standing out as white objects in the general red of the cut surface of the organ. Similarly around the papillÊ in the cuplike arms of the pelvis we find minute, flattened or more or less rounded, yellowish-white concretions. Even the large concretions may prove apparently harmless. I have a calculus several ounces in weight which filled the entire pelvis of the kidney, that was found by accident in a fat carcass while being dressed. In work oxen, however, such concretions may give rise to symptoms of kidney disease, such as stiffness of the loins, shown especially in the acts of rising or turning, weakness of the hind parts when set to pull a heavy load, an irritability of the kidneys, shown by the frequent passage of urine in small quantity, tenderness of the loins, shown when they are pinched or lightly struck, and it may be the passage of blood or minute gritty masses with the urine. If the attack is severe, what is called "renal colic" (kidney colic) may be shown by frequent uneasy shifting of the hind limbs, shaking or twisting of the tail, looking around at the flanks, and lying down and rising again at short intervals without apparent cause. The frequent passage of urine, the blood or gritty masses contained in it, and perhaps the hard, stony cylinders around the tufts of hair of the sheath, show that the source of the suffering is the urinary organs. In bad cases active inflammation of the kidneys may set in. (See "Nephritis," p. 123.)

URETERAL CALCULI.

These are small stones which have passed from the pelvis of the kidney into the canal (ureter) leading from the kidney to the bladder, but, being too large to pass on easily, have blocked that canal and forced the urine back upon the kidney. The result is the production of symptoms more violent than in renal calculi, though not varying, save in intensity, from those of renal colic. In case of complete and unrelieved obstruction, the secretion of the kidney on that side is entirely abolished, and it becomes the seat of passive congestion, and it may even be absorbed in greater part or as a whole, leaving only a fibrous sac containing fluid with a urinous odor. In small cattle, in which the oiled hand introduced into the last gut may reach the affected part, the distended ureter may be felt as a tense, elastic cord, extending forward from the point of obstruction on the lateral wall of the pelvis and beneath the loins toward the kidney. If relief is obtained by the onward passage of the stone a free flow of urine usually follows, in the midst of which may often be found gritty masses. If the outlets from both kidneys are similarly blocked the animal becomes poisoned by the retention in the blood of the elements of the urine, and by their reabsorption after secretion.

Treatment of renal and ureteral calculi.--Treatment is not very successful, as only the smallest calculi can pass through the ureter and enter the bladder, and even if they should do so they are liable to a progressive increase there, so that later they may cause the symptoms of stone in the bladder. Fortunately, ordinary dairy, growing, or fattening cattle rarely show evident symptoms of illness, and even though they do so they can usually be fattened and slaughtered before the health is seriously impaired. In work oxen the case is different, and acute symptoms may develop, but even then the animal may often be fitted for the butcher. When treatment is demanded it is primarily soothing and antispasmodic. Fomentations with warm water over the loins should be persisted in without intermission until relief has been secured. The soothing effect on the kidney will often relieve inflammation and irritation, should the stone be in that situation, while if in the ureter the warm fomentations will at once soothe irritation, relax spasm of the muscular coat of the canal, and favor an abundant secretion from the kidney, which, pressing on the obstructing stone, may slowly push it on into the bladder. Large doses of laudanum (2 ounces) or of solid extract of belladonna (2 drams) will not only soothe the pain but relax the spasm and favor the onward passage of the calculus. The animal should be encouraged to drink large quantities of cool water to favor the free secretion of a very watery urine, which will not only serve to obviate irritation and continued deposit caused by a highly concentrated urine, but will press the stone onward toward the bladder, and even in certain cases will tend to disintegrate it by solution of some of its elements, and thus to favor its crumbling and expulsion. This is a principle which must never be lost sight of in the treatment of calculi. The immersion of the stone in a liquid of a lower specific gravity than that in which it has formed and grown tends to dissolve out the more soluble of its component parts, and thus to destroy its density and cohesion at all points, and thereby to favor its complete disintegration and expulsion. This explains why cattle taken from a herd on magnesian limestone in spring, after the long, dry feeding of winter, usually have renal calculi, while cattle from the same herd in the fall, after a summer's run on a succulent pasture, are almost always free from concretions. The abundance of liquid taken in the green feed and expelled through the kidneys and the low density or watery nature of the urine have so opened the texture and destroyed the density of the smaller stones and gravel that they have all been disintegrated and removed. This, too, is the main reason why benefit is derived from a prolonged stay at mineral springs by the human victims of gravel. If they had swallowed the same number of quarts of pure water at home and distributed it at suitable times each day, they would have benefited largely without a visit to the springs.

It follows from what has been just said that a succulent diet, including a large quantity of water (gruels, sloppy mashes, turnips, beets, potatoes, apples, pumpkins, ensilage, succulent grasses), is an important factor in the relief of the milder forms of stone and gravel.

Prevention.--Prevention of calculus especially demands this supply of water and watery rations on all soils and in all conditions in which there is a predisposition to the disease. It must also be sought by attempts to obviate all those conditions mentioned above as causative of the malady. Sometimes good rain water can be furnished in limestone districts, but putrid or bad-smelling rain water is to be avoided as probably more injurious than that from the limestone. Unsuccessful attempts have been made to dissolve calculi by alkaline salts and mineral acids, respectively, but their failure as a remedy does not necessarily condemn them as preventives. One dram of caustic potash or of hydrochloric acid may be given daily in the drinking water. In diametrically opposite ways these attack and decompose the less soluble salts and form new ones which are more soluble and therefore little disposed to precipitate in the solid form. Both are beneficial as increasing the secretion of urine. In cases in which the diet has been too highly charged with phosphates (wheat bran, etc.), these aliments must be restricted and water allowed ad libitum. If the crystals passed with the urine are the sharp angular (octahedral) ones of oxalate of lime, then the breathing should be made more active by exercise, and any disease of the lungs subjected to appropriate treatment. If the crystals are triangular prisms of ammonia-magnesium phosphate or starlike forms with feathery rays, the indications are to withhold the feed or water that abounds in magnesia and check the fermentation in the urine by attempts to destroy its bacteria. In the latter direction plenty of pure-water diuretics, and a daily dose of oil of turpentine in milk, or a dose thrice a day of a solution containing one-tenth grain each of biniodid of mercury and iodid of potassium would be indicated.

In considering the subject of prevention, it must never be forgotten that any disease of a distant organ which determines the passage from the blood into the urine of albumin or any other colloid (uncrystallizable) body is strongly provocative of calculus, and should, if possible, be corrected. Apart from cases from geological formation, faulty feeding, and other causes, the grand preventive of calculus is a long, summer's pasturage of succulent grasses, or in winter a diet of ensilage or other succulent feed.

The calculi formed in part of silica demand special notice. This agent is secreted in the urine in the form of silicate of potash and is thrown down as insoluble silica when a stronger acid displaces it by combining with the potash to its exclusion. In cases of siliceous calculi, accordingly, the appropriate chemical prevention is caustic potash, which being present in the free state would attract to itself any free acid and leave the silica in its soluble condition as silicate of potash.

STONE IN THE BLADDER (VESICAL CALCULUS, OR URETHRAL CALCULUS).

Stone in the bladder may be of any size, but in the ox does not usually exceed half an inch in diameter. There may, however, be a number of small calculi; indeed, they are sometimes so small and numerous as to form a small, pulpy magma by which the bladder is considerably distended.

Symptoms.--The symptoms of stone in the bladder may be absent until one of the masses escapes into the urethra, but when this occurs the escape of urine is prevented, or it is allowed to pass in drops or driblets only, and the effect of such obstruction becomes manifest. The point of obstruction is not always the same, but it is most frequently at the S-shaped curve of the penis, just above the testicles or scrotum. In cows and heifers the urethra is so short and becomes so widely dilated during the urination that the calculi easily escape in the flow of liquid and dangerous symptoms practically never appear.

Even in the male the signs of illness are at first very slight. A close observer may notice the cylinders of hard, earthy materials encircling the tufts of hair at the opening of the prepuce. It may further be observed that the stall remains dry and that the animal has not been seen to pass water when out of doors. The tail may at times be gently raised and contractions of the muscle (accelerator urinÊ) beneath the anus (Pl. IX, fig. 2) may take place in a rhythmical or pulsating manner. As a rule, however, no symptom is noticed for two days, only the animal is lacking in his usual spirits. By this time the constantly accumulating urine has distended the bladder beyond its power of resistance and a rupture occurs, allowing the urine to escape into the cavity of the abdomen. Then dullness increases; the animal lies down most of his time; he becomes stupid and sometimes drowsy, with reddish-brown congestion of the lining membrane of the eyelids; pressure on the abdomen causes pain, flinching, and perhaps groaning, and the lowest part of the belly fluctuates more and more as the escaping urine accumulates in greater and greater amount. If at this stage the oiled hand is introduced into the rectum (last gut), the animal flinches when pressure is made downward on the floor of the pelvis, and no round, distended bladder is felt. If the same examination is made prior to the rupture, the rounded, tense, elastic bladder is felt extending forward into the abdomen, containing one or two gallons of liquid. There may be uneasy shifting of the hind limbs and twisting of the tail, also frequent lying down and rising, but these symptoms are exceptional.

When the obstruction is low down between the thighs (at the S-shaped flexure), the line of the pulsating urethra from the anus downward may be felt distended with liquid, and though, by the hard swelling of the urethra, it is seldom easy to distinguish the exact seat of the stone, yet there is usually tenderness at the point of obstruction, and from this it may be accurately located.

Treatment.--The treatment of stone in the bladder or urethra consists in the removal of the stone by incision and the use of forceps. (Pl. XI, fig. 4.) When the stone has been arrested at the S-shaped flexure just above the scrotum, the patient being lean, the thickened tender part of the penis may be seized between the fingers and thumb of the left hand, while the calculus is exposed by a free incision with the knife held in the right. If there is no other obstruction between this point and the bladder, and if the latter has not yet ruptured, a flow of urine should take place from the opening. If there is no escape of liquid, a catheter or sound, one-fourth of an inch in diameter, must be passed up through the canal (urethra) until it is arrested by the next stone, on which a similar incision should then be made to effect its extraction. In case the stone has been arrested in the portion of the urethra which is in front of the arch of the hip bone and inside the pelvis, it can be reached only by making an opening into the urethra beneath the anus and over the arch of the hip bone, and from this orifice exploring the urethra with fine forceps to the neck of the bladder or until the stone has been reached and extracted. Owing to the small size of the canal (urethra) to be opened and the great thickness of erectile tissue to be cut through, the operation requires a very accurate knowledge of the parts, while the free flow of blood is blinding to the operator. A staff should always be passed up through the urethra from the lower wound, if such has been made, or, in case of its absence, through the whole length of the penis, that organ having been drawn out of its sheath until the S-shaped curve has been effaced and the course of the canal rendered straight. Upon the end of this staff the incision can be made with far more confidence and certainty. The operation can be undertaken only by a skilled veterinary anatomist, but the hints given above may be valuable in showing the stock owner when he is being properly served in such a case.

In outlying districts, where no skilled operator can be had, a transverse incision may be made with a clean, sharp knife through the root of the penis, just over the arch of the hip bone, when the urine will flow out in a full stream. The attendant bleeding may be ignored, or if profuse it may be checked by packing the wound firmly with cotton wool for several hours. The urine will continue to escape by the wound, and the ox should be fattened for the butcher.

The immediate relief is not to be looked upon as a permanent cure, as the calculi in the affected ox are usually numerous, and later attacks are therefore to be looked for. Hence it is desirable to fatten and kill such cases after a successful operation. If a breeding animal is too valuable to be killed, he should be subjected to preventive measures, as laid down under "Stone in the kidney," page 139.

It should be added that when the bladder is filled with a soft magma a catheter may be introduced through the whole length of the urethra to be used in pumping water into the bladder. This water is extracted through the same channel when it has been charged with the suspended solids by manipulations of the bladder with the oiled hand introduced through the rectum.