Part 42

=Resolution= is marked by general improvement of pulse, breathing and expression, clearing of the urine, and return of appetite. The urine may remain albuminous for eight days longer.

=Complete suppression of urine= has persisted five days in cattle (Funk), and seven days in horses (Friedberger), accompanied by intense fever, dullness, stupor and coma ending in death from uræmia.

=Purulent urine= is white, milky, albuminous, granular, with epithelial cells and casts and pus cells, showing their double nuclei with acetic acid. There are usually rigor, hyperthermia (106° F.), thirst, intermittent colics, diarrhœa, perspiration, uncertain walk, and stocked legs. Convulsions have been noticed in the horse (Didie), cow (Pflug) and bitch (Trasbot). The horse may turn in a circle (Friedberger) or have amaurosis (Didie). Death usually occurs in two weeks.

=Gangrene= is likely to prove fatal. Berger has seen death occur in three days in the horse, and Trasbot in four days in a cow, after a large cantharides blister.

Pathological Anatomy. The kidney is enlarged, soft, friable, dark red, yellow with red spots, or having areas of hemorrhage. When fatty it is marbled, pale yellow or white and red. The capsule is easily detached. On section it is bloody, oozing or even dropping blood, or a pale creamy fluid. The pelvis contains urine, thick, gelatinoid, bloody or purulent. The latter condition must not be confounded with the thick pus-like mucus which normally occupies the renal pelvis in the horse.

The lesions of the secreting portions of the kidney will vary with the concentration of the inflammation in one or other of the separate tissues.

In =glomerulitis= from toxic irritants, the capsules enclose an albuminous liquid exudate, the capillaries are overdistended, their walls thickened and cloudy, and thrombi with an excess of red globules and leucocytes block them at intervals. This capillary obstruction extends to the plexus surrounding the convoluted tubules.

In =tubular nephritis= there is congestion of the plexus covering the convoluted tubes, and the epithelium shows cloudy swelling, with fatty granules and hyalin droplets in the desquamating cells.

With =interstitial nephritis= there is an exudate into the interstitial connective tissue between the tubules, and into the tubules, forming hyalin casts. The epithelium of the tubules are swollen, granular, opaque and desquamating.

In =suppurative nephritis= may be found all stages of abcedation from minute points, gray or yellow, and only just visible to the naked eye, in the midst of the deep red congested tissues, through the larger white suppurative areas, to the extensive abscess formed by a coalescence of the many, the intervening tissue having broken down by a necrotic disintegration. In the earlier stages the pus infiltrates the parenchyma so that it may be comparable to a sponge filled with this liquid.

Treatment. The first consideration is rest, with a warm building or clothing to solicit the action of the skin and lessen the work of the kidneys. Warm summer weather is favorable, or we should secure a sunny, comfortable, loose box, or a building heated by a stove. In default of this, warm woolen blankets, hood and leg bandages should be secured. If the case is mild enough to allow of appetite, the food for herbivora may be green food in summer and carrots, beet, turnip, potato or ensilage in winter. The dog may have buttermilk or sweet milk or mush and milk. Meat is objectionable because of the amount of urea and other urinary products which it produces.

Trasbot strongly recommends general bleeding in strong, vigorous horses and cattle, attacked by the disease in an acute form, but deprecates it in the lymphatic, fat, or debilitated.

Omitting the general bleeding, one can always find a good and safe alternative in bleeding the animal into his own tissues. Shaving the loins and cupping has often an excellent effect. An approach to this may be had by vigorous rubbing by several men at once, of the limbs and the whole surface of the body, by warm fomentations over the loins by means of spongio-piline or surgeon’s cotton covered with dry blankets, or by winding a hose round the body through which warm water is forced, or finally by a bath of steam or hot air, or in small animals of warm water. The dog may be placed in a bath of 80° or 90° F., which is allowed to gradually cool to 65° or 70°. In all these cases the greatest care must be taken to avoid chill when the animal is taken out. He should be quickly rubbed dry in a warm room and blanketed.

Counter-irritants act in the same way, and mustard or hot water hotter than the hands can bear may be applied. Turpentine, cantharides and other diuretic counter-irritants must be carefully avoided. An old practice of laying a freshly removed sheep skin over the loins, with the flesh side inward, often causes a distinct exudation, thickening of the skin and derivation.

A damp cloth, laid across the loins and thoroughly covered with dry to prevent any evaporation and chill, will usually give great relief and may be kept on for days.

Internal medication must at first be mainly anodyne, laxative and diaphoretic. The two latter classes are at once derivative and eliminating, carrying out through other channels, waste products that would otherwise have taxed the kidneys.

Among anodynes, the bromide of camphor (horse, 1–2 drs., dog, 2 to 5 grs.), bromide of potassium (horse, 1 dr., dog, 1 to 3 grs.), or hyoscyamus may be used, and repeated twice daily.

Purgatives must be restricted to such as have no tendency to act on or irritate the kidneys. Castor oil, or sweet oil for the larger animals, or for the dog senna or jalap, may be given every morning to secure free movement.

As diaphoretics, ipecacuanha, Dover’s powder, tartar emetic, and even pilocarpin may be used. The last named agent is especially useful when dropsy sets in, or uræmic stupor or coma threatens (horse 3 grs., ox 7 grs., dog ½ to ⅓ gr. according to size). If the heart shows weakness it must be sustained by digitalis, strophanthus, caffein or nitro-glycerine, and the pilocarpin withheld.

In a sufficiently strong subject the stupor or coma may be met by the abstraction of blood, which benefits by the dilution of that which is left.

Eclampsia may be further met by the inhalation of ether or chloroform, or the rectal injection of chloral or bromide solution.

As the inflammation abates, if the action of the kidney is still insufficient in spite of the free drinking of pure water, alkaline diuretics may be given in small doses (tartrate, acetate or citrate of potash, bicarbonate of soda, saltpeter).

In excessive dropsy avoid sloughing by lancing the most tensely swollen parts to allow drainage, and keep the parts disinfected with carbolic or other antiseptic lotion. For ascites or hydrothorax, aspirate, and apply a compressory bandage.

During convalescence a course of bitters (cinchona, salicin, gentian, nux vomica) and iron (phospho-tartar, iodide or phosphate) will often be called for. Anæmia may be met by doses of peroxide of hydrogen or the inhalation of oxygen.

In the advanced stages benefit may accrue from the use of small doses of cubebs, copiaba, oil of turpentine or buchu, which have a tonic action on the renal mucosa.

PURULENT NEPHRITIS.

Causes: general, traumatic, metastatic, infective, wounds, shocks, strains, blows, falls, crowding, heavy loads, calculi, infective embolism. Lesions: miliary or large abscesses, diffuse suppuration, softening, disintegration, fistula. Symptoms: obscure, nephritic symptoms following distant abscess, chill, hyperthermia, general symptoms of nephritis, pus in urine, anæmia, emaciation. Treatment: to external wound, antiseptics, evacuate abscess, extirpate kidney with pyonephrosis, in dog or pig, calcium sulphide, sulphites, copiaba.

Causes. Aside from the main causes of nephritis, the suppurative form may be determined by traumatic or metastatic infective conditions. Under traumatic factors may be named punctured or gunshot wounds, shocks and strains connected with falls, blows, crowding, compression, too heavy weights on the back (pack, rider, two wheeled cart loaded too heavily forward and going down hill), and finally calculi in the uriniferous tubules. Under metastatic factors come all infections, pyæmia, omphalitis, any suppurative affection of the lungs, (abscess, pneumonia, broncho-pneumonia), pharyngitis, etc. Embolic renal abscess may start from endocarditis, arteritis, or pulmonary phlebitis.