Part 47

In rupture of the ureter in dystokia the walls of the womb or vagina have usually suffered, and a recovery with a ureterouterine or uretero-vaginal fistula is not unknown.

ACUTE CATARRHAL CYSTITIS.

Acrid diuretics, by mouth or skin, microbian infection, retention of urine, urethral calculus, parasites, spasm, enforced suspension of micturition, unclean catheter, adjacent infection, chill. Lesions: hyperæmia of mucosa, thickening, vascular distention, clouding of epithelium, muco-purulent secretion, alkaline fermentation, ammonia, liquefaction of cells, erosion. Symptoms: Slight fever, stiff, straddling gait, urine scanty, cloudy, alkaline, penis or clitoris semi-erect, smearing of tail or prepuce. Crystals of triple phosphate. Treatment: Antiseptics, boric or salicylic acid, gum arabic, astringent antiseptics, laxatives, flax seed, slippery elm, anodynes, diluents, piperazine, drainage, rest, restricted laxative diet, warmth, avoid stimulants.

Causes. Cystitis is caused in all animals by irritant diuretics like cantharides, copaiba, or oil of turpentine given by the mouth or applied to an extensive cutaneous surface. It is an error, however, to conclude with Williams that this is the sole cause. The very existence of calculi virtually implies bacterial infection, and fermentation. The presence of free ammonia in the urine usually implies fermentation, and fermentation must be looked upon as practically synonymous with microbian invasion. That bacteria may be present without serious injury is undoubted. The protective power of the healthy mucosa is very great. But when the mucosa is weakened, microbes that would otherwise be harmless, find a ready infection atrium, and triumph over the weakened tissues. Hence retention of urine and overdistension of the bladder as in urethral calculus, blocking of the urethra by a parasite, spasm of the sphincter vesicæ, compulsory retention as in the mare in harness, the dog kept indoors, or in railway car on a long journey, or in mares so travelling, may become the occasion of cystitis. Even in cases in which no microbe is present at first, this reaches the bladder by the introduction of an unclean catheter, or by extension from an uretheritis, vaginitis or metritis, or even from a peritonitis, or infected urachus. Or the infection may descend from a suppurating kidney. Another occasion of microbian invasion is the congestion which attends on exposure to cold.

Lesions. Hyperæmia of the cystic mucosa, with dilation and tortuous deviations of the larger vessels, thickening of the membrane, and distension and clouding of the epithelial cells, with a thick covering of tenacious mucus containing epithelial, pus, or white blood cells. As the disease advances epithelium is desquamated abundantly, and degenerates with production of free nuclei and pus. Along with these are microbes, usually the bacillus coli communis, and various cocci. In the fully established disease there is liable to be alkaline fermentation, and the liberated ammonia dissolves the epithelial cells, leading to extensive desquamation and raw granulating surfaces, so that the disease tends to run in a vitiating circle, the alkali dissolving the epithelium and increasing the microbian development and fermentation, which in its turn produces an increasing quantity of ammonia.

Symptoms. There is slight hyperthermia or none, stiff or straddling gait, frequent passage of urine in small quantities and cloudy, or straining without passage, the penis or clitoris is semi-erect, eversion of the lips of the vulva is frequent, and the bladder is tender (through prepubian wall, vagina or rectum). If a finger is inserted into the bladder in the mare the thickening of the walls can often be recognized. The urine often contains precipitated crystals of ammonio-magnesian phosphate, and even clots of blood. It has an alkaline reaction even in herbivora.

Treatment. The danger centres around the bacteridian fermentations, and a main object must be to disinfect the bladder. This will be all the more effectual if the lotions used are of an acid reaction. Thus boric acid or salicylic acid in 3 per cent. solution, injected after evacuation of the bladder and repeated a number of times a day may soon establish a healthy action. If the bladder is especially irritable a boiled weak solution of gum arabic will form a suitable medium. Other antiseptics are often used as creosote (0.5:100), carbolic acid (3:100), chloride of zinc (3:100), chlorate of potash (3:100), mercuric chloride (1:5000), silver nitrate (0.5:100), or astringents are often better: PbA, ZnSO_{4} tannic acid, ferri chloridi in dilute solution so as not to cause pain.

The bowels should be kept open by an occasional saline laxative, pain moderated by codeine, and abundance of pure water and a laxative diet enjoined. Linseed tea, and infusions of slippery elm or marsh mallow have long been employed, and by soothing and relaxing the bowels they act favorably on the urinary mucosa. Stimulants of the urinary track like buchu, uva ursi or copaiba in small doses, or antiseptics like creosote, boric acid, salicylic acid, piperazine, are available in slight cases or when the acute symptoms have subsided somewhat. With prior infection of the kidneys, the latter may be used. Constant drainage may be necessary to avoid distension.

Perfect rest is absolutely essential, a restricted laxative diet, and a careful avoidance of cold, and stimulants.

When urine is retained it should be removed with a thoroughly aseptic catheter.

In case of blood clots in the bladder, wash out with a boiled normal salt solution.

ACUTE CROUPOUS CYSTITIS.

This has been found to follow the use of cantharides and other irritant diuretics, and to follow on certain specific diseases. Its nature is that of catarrhal inflammation, but with a fibrinous product or false membrane formed more or less extensively on the inflamed mucosa.

Symptoms are essentially those of catarrhal cystitis from which it is distinguished by the presence in the urine of flakes of the fibrinous membrane.

Treatment is essentially the same as in the catarrhal form, to which may be added the injection of a solution of 4 grains scale pepsin to the ounce of sterilized water. The boric acid solution may be of the strength of 20 per cent. Irrigate two or three times a day.

CHRONIC CATARRHAL CYSTITIS.

This may begin as such or it may continue after an acute attack. It has been noticed in horse, ox, and dog.

It may be associated with calculi, gravel, papilloma, and bacterial invasion especially by the colon bacillus.

Lesions. The mucosa and muscular coat are thickened, corrugated, puckered and contracted so that the bladder will not contain more than a few ounces of urine. The surface of the mucosa is discolored, mottled and variegated, slaty blue, brown, red, purple, or even black, with ulcers, encrustations of triple phosphate, and fungoid elevations. In dogs especially, the prostate is often enlarged.

Symptoms. Frequent urination accomplished with pain, groaning, or whining and it may be with sudden arrest. There may be incontinence, the urine dribbling almost continuously from the penis or vulva and in the latter case trickling down the thighs. The presence of pus and mucus tends to mat the hairs, and a strong urinous and ammoniacal odor is emitted.

Palpation of the prepubian region often, and of the vagina or rectum always causes pain and wincing. Temperature is normal.

Urine is albuminous in ratio to the amount of pus, or above that, and is then suggestive of kidney disease and likely to be complicated by casts.

Complicating lesions of the womb, vagina, prostate, and kidney are to be carefully looked for, also cystic papilloma.

Prognosis. Recovery though not uncommon is too often but partial and it is usually desirable to fatten the animal.

Treatment. Rest, moderate laxative diet, pure drinking water ad libitum, warmth, antiseptic irrigation.

CYSTITIS IN THE OX.

Special Symptoms. Beside general disorder there is a disposition to decubitus, but with frequent rising to urinate though the bladder is not filled to repletion. Then the urine is passed in a slow stream by abdominal contraction, and without pulsating contractions of the urethra at the ischium which are so marked in calculus. Cystitis is greatly aggravated by overdistension, and if the bladder is paralyzed is very liable to go on to rupture.

Galtier considers enzootic hæmaturia as essentially a hæmorrhagic cystitis, due to marshy soils, disordered liver, often distomatosis, and irritation of the urinary organs by the poisons which the liver was helpless to destroy or eliminate.