Part 29

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.

CHRONIC INFLAMMATION OF THE KIDNEYS.

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 OF THE KIDNEYS.

Tumors, whether malignant or simple, would give rise to symptoms resembling some form of inflammation, and are not liable to be recognized during life.

PARASITES.

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.

SPASM OF THE NECK OF THE BLADDER.

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 BLADDER.

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.

INFLAMMATION OF THE BLADDER (CYSTITIS, OR UROCYSTITIS).

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.

IRRITABLE BLADDER.