Part 50

=Catheterization in the male Soliped.= The catheter, a hollow, gum elastic tube, must be proportioned to the size of the animal, but for the average adult horse about 3½ feet in length and ⅓ inch in thickness. To give it the requisite solidity and resistance it is usually furnished with a stilet of whalebone or cane.

The operation is performed with the animal standing, in quiet animals without any restraint, but in the more sensitive or restive, with one fore foot held up; or with both hind feet in hobbles furnished with ropes passing between the fore limbs and tied over the neck in front of the withers; or finally with a twitch on the nose.

The rectum is emptied, and with the oiled or soapy hand the penis is found and slowly withdrawn from the sheath by steady traction. This is usually easy, though in certain cases, with a short penis and specially strong retractors, it will seriously tax the operator’s skill and address. In a specially obstinate case a hypodermic injection of morphine may be resorted to.

If the horse is down, as in paraplegia or hæmoglobinæmia, he may lie on his right side while the operator stoops over him from the loins; or his feet may be drawn together by hobbles, and the subject turned on his back, the operator placing himself as before on the left side.

The catheter must have been previously cleansed and disinfected outside and in. A mercuric chloride solution 1:2000, or boric acid 1:50 or permanganate of potash 1:50 may be employed. Then it must be smeared, preferably with vaseline but, in case of necessity, with sweet oil, glycerine, borated lard, or even castile soap.

The penis being withdrawn from the sheath, the catheter containing its stilet is introduced into the urethra and pushed on slowly and carefully until its point can be felt over the ischiatic arch. The stilet is now drawn out a few inches and the point of the catheter is bent forward over the ischium by the finger. The stilet is further drawn out and the catheter can easily be pressed on into the bladder. If any difficulty is experienced it may be guided by the hand introduced into the rectum.

In one extraordinary case, I found that the catheter entered a dilated seminal vesicle and failed to evacuate the bladder. This untoward occurrence must be rectified by the aid of the hand in the rectum. Usually the penetration of the bladder is signalized by the overcoming of resistance, and when the stilet is withdrawn the urine flows in a steady stream. If it fails to flow, a slight compression of the fundus of the bladder by the hand engaged in the rectum will start the stream.

The catheter should be withdrawn slowly and carefully.

=Catheterization in the Bovine Male.= Most veterinarians suppose that this is impossible, owing to the narrowness of the sheath interfering with the extraction of the penis, and the S shaped curve in the penis preventing the introduction of the catheter. Both obstacles can, however, be overcome in many cases. The bull may be tempted to protrude the penis by the presentation of a cow in heat, or in bull or ox the bulging anterior part of the organ may be protruded by careful manipulation through the sheath. Then the free extension of the penis can be made to efface the S shaped curve. The catheter must be small, not much over a line in caliber, and a metal stilet is employed. The animal may have to be placed under restraint, and the same antiseptic precautions are demanded as in the horse.

=Catheterization in the Ram and Wether.= These must be dealt with like the bull, the only additional difficulty being in the vermiform appendix. This is small and sinuous but the longitudinal opening on its lower surface is favorable to the introduction of the catheter.

=Catheterization in the Dog.= The fact that the urethra traverses the groove on the lower aspect of the bone of the penis, is held to prove an obstacle to the catheter, yet the introduction of the latter is in no sense difficult. Small or moderately sized dogs, may be held upright, the body resting on the rump and the pelvis inclined forward, which will favor the spontaneous protrusion of the penis. Or it may be pressed out by manipulation through the sheath. The catheter ⅔ ds. to 1 line in diameter may be 1¼ to 2 feet in length according to the size of the animal. It should be used aseptic.

=Catheterization of the Mare.= Nothing can be easier than this operation in the mare. The shortness and dilatability of the urethra, and the accessibility of its external orifice in the center of the floor of the vulva, 4 or 5 inches in front of the lower commissure, favors the introduction of the catheter. The latter may be a foot in length, perfectly straight and it may be constructed of silver or some other metal, which may be readily boiled and rendered aseptic. In the absence of a catheter the germ free nozzle of a rectal syringe may be used, or two fingers may be passed through the urethra and parted from each other so as to allow the exit of the urine.

=Catheterization of the Cow and Heifer.= The operation is often very difficult in the cow, by reason of the small size and undilatability of the urethra, and by the presence of two blind ducts (canals of Goërtner) above and to the two sides of the urethral opening. The thin rigid upper margin of the orifice projects down over it in a valvular manner so that the catheter will almost always find its way into one of the blind sacs. By introducing the tip of the index finger beneath the valvular fold and into the opening of the canal, the catheter may be directed beneath it and into the bladder. An apparatus consisting of a series of ribs of spring wire arranged in the form of a funnel and converging at one end to a point has been devised to insert into the urethral orifice, and guide the catheter which is passed through it.

=Catheterization of the Bitch.= The operation is rendered difficult by the narrowness of the passage, and the puckers and folds of the vaginal mucosa which serve to hide the urethral orifice. A small catheter like that used on the male is used or a short metallic catheter may be substituted. By directing this forward exactly in the median line of the floor of the vulva, with gentle pressure downward it may be made to enter the urethra. In case of special difficulty a bivalve speculum may be resorted to, to efface the mucous folds and reveal the orifice.

ACUTE PROSTATITIS AND HYPERÆMIA OF THE PROSTATE.

Causes: In dogs, house life, overfeeding, compulsory retention of urine, and fæces, constipation, proctitis (rectitis), piles, calculi, strangury, uric acid, urethral ulceration or stricture, rude catheterization, chill, generative excitement to excess, secondary abscess or infection. Forms. Lesions: follicular, interstitial, circumscribed and diffuse suppuration. Symptoms: frequent straining urination, rectal palpation, incontinence of urine, costiveness, tender perineum, dullness, recumbency, fever, pus in urine, collapse of swelling, fistula. Diagnosis. Prognosis: grave. Treatment: laxatives, mercurials, salines, leeches, acid laxative, non-stimulating, camphor, bromides, ergot, witch hazel, opium, belladonna, enemata of cold water, or ice suppository, catheterization, perineal incision, antiseptics.

Causes. This is most commonly seen in dogs, in which it may depend on house life with overfeeding on stimulating, spiced, albuminous food, compulsory restraint of urination and defecation in obedience to the demands of cleanliness, distended bladder, and rectum, constipation, proctitis, piles, and other sources of local irritation. In all animals its origin is favored by the formation or arrest of calculi in the prostate, the pelvic urethra or even the bladder; by drug strangury from cantharides or other irritant diuretic; by excess of urea, uric acid or other irritant in the urine; by infection extending from the urethra or bladder; by ulceration or stricture of the urethra; by rude or incautious catheterization, or injection; by exposure to cold; and by local infection in pyæmia and other general zymotic disorders. Most of these conditions conduce to local excitement and hyperæmia, which from adjacent organs, are sympathetically transferred to the prostate. The same is true of frequent, and intense generative excitement which according to Lafosse and Cadiot is a common cause of prostatitis in stud horses. Again the abscess of strangles may become localized in the prostate, or the nodule of glanders, or the tubercle of tuberculosis (cattle, pigs, dogs). Cadiot suggests that in animals, divested of the tail, external injuries to the perineum may extend by continuity to the prostate, as happens to man from horseback or bicycle riding. He adduces no cases however. The habit of masturbation acquired by certain males may also be adduced theoretically as both cause and consequence of prostatitis but future observation must show how frequently this really operates.

Forms. Lesions. According to the nature of the lesions the affection has been divided into different forms 1st, =Follicular= or =Parenchymatous=; 2d, =Diffuse= or =Interstitial=; 3d, =Circumscribed Prostatic Abscess=; 4th, =Multiple Miliary Abscesses=.

=Follicular Prostatitis= implicates primarily the follicles and gland ducts and finally the entire gland tissue. It is usually associated with and doubtless often proves an extension from an adjacent infective urethritis, and tends, in persistent cases, to go on to interstitial inflammation and abscess, or hypertrophy. This is characterized by more or less swelling of the prostate, with increased vascularity of its mucosa and the oozing from its openings and gland ducts under pressure, of a thick, yellow, gelatinoid fluid containing pus and granular epithelial cells and sometimes striæ of blood.

=Diffuse= (=Interstitial=) =Prostatitis= shows, in addition to the general swelling and muco-purulent discharge, a considerable exudate into the interstitial tissue, with increased tension and resistance of its substance. It is associated during life with more fever and constitutional disturbance than the simple catarrhal or follicular form.

In =Circumscribed Prostatic Abscess= we find, in addition to the general hyperæmia and swelling, a much more prominent local swelling, the seat of intense inflammation, at first firm and resistant and later softer and fluctuating in the centre, which is filled with pus. This may have its origin in the follicular form, the pus becoming shut up in a follicle and gradually increasing until it bursts into the urethra, the bladder, the rectum, the peritoneum, or pelvic fascia and perineum. In other cases it becomes complicated by pyæmia and secondary abscesses.

=Miliary Abscesses= may be comparatively few in number or generally diffused through the prostate, and are often the result of a pre-existing general infection.

Symptoms. As the disease usually begins as a local infection the first symptoms are, as a rule, unattended by fever, which, however, appears in two or three days as the local lesions increase. The urine may be passed frequently in small amounts, or there may be frequent straining without passage of urine, the pressure of the swollen prostate, with or without spasm of the sphincter vescicæ, causing retention. It is no uncommon thing to find the last urine passed of a milky or glairy character and, coagula moulded in the prostatic canals may at times be found. The presence of spermatic crystals, fusiform, with very pointed extremities, and precipitated on the addition of ammonium phosphate, is characteristic of prostatic fluid, (Fürbringer). In other cases there is incontinence, the urine dribbling away involuntarily as the animal walks, and especially if anything occurs to excite him. Micturition may be painless or attended by acute suffering, which causes a sudden arrest of the flow. Defecation is attended with difficulty and more or less pain, and obstinate constipation is likely to set in. The animal is dull, spiritless and seeks to lie undisturbed. Pressure on the perineum is painful and exercise aggravates the symptoms. Rectal examination by the hand or finger according to the size of the animal, reveals the enlarged, tender prostate lying on the cervix vesicæ. This swelling may be unilateral but most commonly it is bilateral or general. When fever sets in with a temperature of 102°–104°, thirst, anorexia and weakness or stiffness in the hind parts may be noticed. In case of abscess, the urine may be perfectly clear until it bursts into the urethra or bladder when there is an abundant flow of pus, and rectal examination shows that the swelling and tension have notably diminished. Should it burst into the rectum, the pus shows in the fæces. Reinemann records a case in a bull with dysuria, œdema of the sheath and a swelling like the fist in the perineum, containing pus, and which communicated with the prostate and urethra. With the rupture of the abscess there is a marked amelioration of the symptoms.

Not infrequently the affection subsides into the chronic form and the abscess, having a restricted channel for evacuation, remains as a suppurating cavity.

Diagnosis. The enlargement and tenderness of the prostate as felt on rectal examination is pathognomonic. If the body of the urine is clear there is further corroboration, as in cystitis it is more or less turbid and flocculent or even bloodstained. Micturition is likely to be much more frequent in cystitis than in prostatitis. Catheterization is much more painful when the catheter passes the prostate in prostatitis than in cystitis.

Prognosis is always grave. Some cases recover completely, while others run on to a fatal termination, and still others merge into the chronic form. Cases that are complicated by abscess are always to be dreaded, as chronic suppuration, or pelvic or peritoneal infection, or pyæmia, or septic poisoning is liable to supervene. As the disease is more common in the old so it is liable to prove more severe and redoubtable.

Treatment. In acute cases active derivation toward the bowels is desirable. A mercurial purge (calomel—horse or bull 1 to 2 drs.; dog, 2 to 5 grs.) may be followed a few hours later by salines (sodium sulphate—horse or bull 1 lb.; dog 1 oz.). Sodium sulphate or magnesium sulphate may also be given with glycerine as an enema. Great benefit may often be obtained from the application of leeches on the perineum or around the anus. The diet must be restricted and non-stimulating, mainly of amylaceous materials, and with the water, flaxseed tea may be liberally mixed. When the suffering is severe it may be met by camphor, camphor bromide, ergot, hamamelis, gelsemium or potassium bromide, given by the mouth or rectum. With violent strangury, opium, belladonna or hyoscyamus may be used. Some cases may be relieved by the use of enemata of cold water or pieces of ice in the rectum. In retention of urine, careful catheterization is imperative, the hand or finger in the rectum being employed to guide the point of the catheter under the prostate.

In case of abscess an opening by the side of the anus is preferable to one by the urinary passages or rectum, and will obviate the danger of rupture into the peritoneum. A pasty or fluctuating swelling in the perineum should be incised until the pus flows. A tense elastic fluctuating prostate may be transfixed by a cannula and trochar from the side of the anus, guided by the hand or finger in the rectum. When the pus has been evacuated a drainage tube may be inserted through the cannula and left in place when the latter is removed so as to allow free drainage at all times and frequent antiseptic injections. Punctures and even incisions have been made from the rectum, but they make badly infected wounds, and a rupture into the urethra, determines infection on that side, without any possibility of any effective antiseptic injection or perfect drainage. As injections may be used permanganate of potash 1:10000, or boric acid, a saturated solution. Poisonous agents must be eschewed or used with the greatest circumspection.