Special Report on Diseases of the Horse Part 16

_Treatment_ consists in stopping the ingestion of the faulty drugs, poisons, or feed, and supplying sound hay and grain free from all taint of heating or mustiness. A liberal supply of boiled flaxseed in the drinking water at once serves to eliminate the poison and to sheathe and protect the irritated kidneys. Tonics like sulphate or phosphate of iron (2 drams morning and evening) and powdered gentian or Peruvian bark (4 drams) help greatly by bracing the system and hastening repair. To these may be added agents calculated to destroy the fungus and eliminate its poisonous products. In that form which depends on musty food nothing acts better than large doses of iodid of pota.s.sium (2 drams), while in other cases creosote, carbolic acid (1 dram), or oil of turpentine (4 drams), properly diluted, may be resorted to.

SACCHARINE DIABETES (DIABETES MELLITUS, GLYCOSURIA, OR INOSURIA).

This is primarily a disease of the nervous system or liver rather than of the kidneys, yet, as the most prominent symptom is the sweet urine, it may be treated here.

_Causes._--Its causes are varied, but resolve themselves largely into disorder of the liver or disorder of the brain. One of the most prominent functions of the liver is the formation of glycogen, a principle allied to grape sugar, and pa.s.sing into it by further oxidation in the blood. This is a constant function of the liver, but in health the resulting sugar is burned up in the circulation and does not appear in the urine. On the contrary, when the supply of oxygen is defective, as in certain diseases of the lungs, the whole of the sugar does not undergo combustion and the excess is excreted by the kidneys.

Also in certain forms of enlarged liver the quant.i.ty of sugar produced is more than can be disposed of in the natural way, and it appears in the urine. A temporary sweetness of the urine often occurs after a hearty meal on starchy feed, but this is due altogether to the super-abundant supply of the sugar-forming feed, lasts for a few hours only, and has no pathological significance. In many cases of fatal glycosuria the liver is found to be enlarged, or at least congested, and it is found that the disorder can be produced experimentally by agencies which produce an increased circulation through the liver. Thus Bernard produced glycosuria by p.r.i.c.king the oblong medulla at the base of the brain close to the roots of the pneumogastric nerve, which happens to be also the nerve center (vasomotor) which presides over the contractions of the minute blood vessels. The p.r.i.c.king and irritation of this center leads to congestion of the liver and the excessive production of sugar.

Irritation carried to this point through the pneumogastric nerve causes saccharine urine, and, in keeping with this, disease of the pancreas has been found in this malady. The complete removal of the pancreas, however, determines glycosuria, the organ having in health an inhibitive action on sugar production by the liver. The same result follows the reflection of irritation from other sources, as from different ganglia (corpora striata, optic thalami, pons, cerebellum, cerebrum) of the brain. Similarly it is induced by interruption of the nervous control along the vasomotor tracts, as in destruction of the upper or lower cervical sympathetic ganglion, by cutting the nervous branch connecting these two, in injury to the spinal marrow in the interval between the brain and the second or fourth dorsal vertebra, or in disease of the celiac plexus, which directly presides over the liver. Certain chemical poisons also cause saccharine urine, notably woorara, strychnia, morphia, phosphoric acid, alcohol, ether, quinia, chloroform, ammonia, a.r.s.enic, and phlorizin.

_Symptoms._--The symptoms are ardent thirst and profuse secretion of a pale urine of a high density (1.060 and upward), rapid loss of condition, scurfy, unthrifty skin, costiveness or irregularity of the bowels, indigestion, and the presence, in the urine, of a sweet principle--grape sugar or inosite, or both. This may be most promptly detected by touching the tip of the tongue with a drop. Sugar may be detected simply by adding a teaspoonful of liquid yeast to 4 ounces of the urine and keeping it lightly stopped at a temperature of 70 to 80 F. for 12 hours, when the sugar will be found to have been changed into alcohol and carbon dioxid. The loss of density will give indication of the quant.i.ty of sugar transformed; thus a density of 1.035 in a urine which was formerly 1.060 would indicate about 15 grains of sugar to the fluid ounce.

Inosite, or muscle sugar, frequently present in the horse's urine, and even replacing the glucose, is not fermentable. Its presence may be indicated by its sweetness and the absence of fermentation or by Gallois's test. Evaporate the suspected urine at a gentle heat almost to dryness, then add a drop of a solution of mercuric nitrate and evaporate carefully to dryness, when a yellowish residue is left that is changed on further cautious heating to a deep rose color, which disappears on cooling and reappears on heating.

In advanced diabetes, dropsies in the limbs and under the chest and belly, puffy, swollen eyelids, cataracts, catarrhal inflammation of the lungs, weak, uncertain gait, and drowsiness may be noted.

_Treatment_ is most satisfactory in cases dependent on some curable disease of liver, pancreas, lungs, or brain. Thus, in liver diseases, a run at pasture in warm weather, or in winter a warm, sunny, well-aired stable, with sufficient clothing and laxatives (sulphate of soda, 1 ounce daily) and alkalies (carbonate of pota.s.sium, one-fourth ounce) may benefit. To this may be added mild blistering, cupping, or even leeching over the last ribs. Diseases of the brain or pancreas may be treated according to their indications. The diet should be mainly alb.u.minous, such as wheat bran or middlings, peas, beans, vetches, and milk. Indeed, an exclusive milk diet is one of the very best remedial agencies. It may be given as skimmed milk or b.u.t.ter-milk, and in the last case combines an antidiabetic remedy in the lactic acid. Under such an exclusive diet recent and mild cases are often entirely restored, though at the expense of an attack of rheumatism. Codeia, one of the alkaloids of opium, is strongly recommended by Tyson. The dose for the horse would be 10 to 15 grains thrice daily. In cases in which there is manifest irritation of the brain, bromid of pota.s.sium, 4 drams, or ergot one-half ounce, may be resorted to. Salicylic acid and salicylate of sodium have proved useful in certain cases; also phosphate of sodium. Bitter tonics (especially nux vomica one-half dram) are useful in improving the digestion and general health.

HEMATURIA (b.l.o.o.d.y URINE).

_Cause._--As seen in the horse, b.l.o.o.d.y urine is usually the direct result of mechanical injuries, as sprains and fractures of the loins, lacerations of the sublumbar muscles (psoas), irritation caused by stone in the kidney, ureter, bladder, or urethra. It may, however, occur with acute congestion of the kidney, with tumors in its substance, or with papilloma or other diseased growth in the bladder. Acrid diuretic plants present in the feed may also lead to the escape of blood from the kidney. The predisposition to this affection is, however, incomparably less than in the case of the ox or the sheep, the difference being attributed to the greater plasticity of the horse's blood in connection with the larger quant.i.ty of fibrin.

The blood may be present in small clots or in more or less intimate admixture with the urine. Its condition may furnish some indication as to its source; thus, if from the kidneys it is more liable to be uniformly diffused through the urine, while as furnished by the bladder or pa.s.sages clots are more liable to be present. Again, in bleeding from the kidney, minute, cylindrical clots inclosing blood globules and formed in the uriniferous tubes can be detected under the microscope.

Precision also may be approximated by observing whether there is coexisting fracture, sprain of the loins, or stone or tumor in the bladder or urethra.

_Treatment._--The disease being mainly due to direct injury, treatment will consist, first, in removing such cause whenever possible, and then in applying general and local styptics. Irritants in feed must be avoided, sprains appropriately treated, and stone in bladder or urethra removed. Then give mucilaginous drinks (slippery elm, linseed tea) freely, and styptics (tincture of chlorid of iron 3 drams, acetate of lead one-half dram, tannic acid one-half dram, or oil of turpentine 1 ounce). If the discharge is abundant, apply cold water to the loins and keep the animal perfectly still.

HEMOGLOBINURIA (AZOTURIA, AZOTEMIA, POISONING BY ALb.u.mINOIDS).

Like diabetes, this is rather a disease of the liver and blood-forming functions than of the kidney, but as prominent symptoms are loss of control over the hind limbs and the pa.s.sage of ropy and dark-colored urine, the vulgar idea is that it is a disorder of the urinary organs.

It is a complex affection directly connected with a plethora in the blood of nitrogenized const.i.tuents, with extreme nervous and muscular disorder and the excretion of a dense reddish or brownish urine. It is directly connected with high feeding, especially on highly nitrogenized feed (oats, beans, peas, vetches, cottonseed meal), and with a period of idleness in the stall under full rations. The disease is never seen at pasture, rarely under constant daily work, even though the feeding is high, and the attack is usually precipitated by taking the horse from the stable and subjecting it to exercise or work. The poisoning is not present when taken from the stable, as the horse is likely to be noticeably lively and spirited, but he will usually succ.u.mb under the first hundred yards or half mile of exercise. It seems as if the aspiratory power of the chest under the sudden exertion and accelerated breathing speedily drew from the gorged liver and abdominal veins (portal) the acc.u.mulated store of nitrogenous matter in an imperfectly oxidized or elaborated condition, and as if the blood, surcharged with these materials, were unable to maintain the healthy functions of the nerve centers and muscles. It has been noticed rather more frequently in mares than horses, attributable, perhaps, to the nervous excitement attendant on heat, and to the fact that the unmutilated mare is naturally more excitable than the docile gelding.

Lignieres has found in hemoglobinuria a streptococcus which produced nephritis, b.l.o.o.d.y urine, and paraplegia in experimental animals, including horses.

_Symptoms._--In the milder forms this affection may appear as a lameness in one limb, from indefinite cause, succeeding to some sudden exertion and attended by a dusky-brown color of the membranes of the eye and nose and some wincing when the last ribs are struck. The severe forms come on after one or two days of rest on a full ration, when the animal has been taken out and driven one hundred paces or more: The fire and life with which he had left the stable suddenly give place to dullness and oppression, as shown in heaving flanks, dilated nostrils, pinched face, perspiring skin, and trembling body. The muscles of the loins or haunch become swelled and rigid, the subject moves stiffly or unsteadily, crouches behind, the limbs being carried semiflexed, and he soon drops, unable to support himself. When down, the body and limbs are moved convulsively, but there is no power of coordination of movement in the muscles. The pulse and breathing are accelerated, the eyes red with a tinge of brown, and the urine, if pa.s.sed, is seen to be highly colored, dark brown, red, or black, but it contains neither blood clots nor globules. The color is mainly due to hemoglobin and other imperfectly elaborated const.i.tuents of the blood.

It may end fatally in a few hours or days, or a recovery may ensue, which is usually more speedy and perfect if it has set in at an early stage. In the late and tardy recoveries a partial paralysis of the hind limbs may last for months. A frequent sequel of these tardy cases is an extensive wasting of the muscles leading up from the front of the stifle (those supplied by the crural nerve) and a complete inability to stand.

_Prevention._--The prevention of this serious affection lies in restricting the diet and giving daily exercise when the animal is not at work. A horse that has had one attack should never be left idle for a single day in the stall or barnyard. When a horse has been condemned to absolute repose on good feeding he may have a laxative (one-half to 1 pound Glauber's salt), and have graduated exercise, beginning with a short walk and increasing day by day.

_Treatment._--The treatment of the mild cases may consist in a laxative, graduated daily exercise, and a daily dose of saltpeter (1 ounce).

Sudden attacks will sometimes promptly subside if taken on the instant and the subject kept still and calmed by a dose of bromid of pota.s.sium (4 drams) and sweet spirits of niter (1 ounce). The latter has the advantage of increasing the secretion of the kidneys. Iodid of pota.s.sium in one-half ounce doses every four hours has succeeded well in some hands. In severe cases, as a rule, it is desirable to begin treatment by a dose of aloes (4 to 6 drams) with the above-named dose of bromid of pota.s.sium, and this latter may be continued at intervals of four or six hours, as may be requisite to calm the nervous excitement. Fomentations with warm water over the loins are always useful in calming the excitable conditions of the spinal cord, muscles, liver, and kidneys, and also in favoring secretion from the two latter. On the second day diuretics may be resorted to, such as saltpeter one-half ounce, and powdered colchic.u.m, one-half dram, to be repeated twice daily. A laxative may be repeated in three or four days should the bowels seem to demand it, and as the nervous excitement disappears any remaining muscular weakness or paralysis may be treated by one-half dram doses of nux vomica twice a day and a stimulating liniment (aqua ammonia and sweet oil in equal proportions) rubbed on the torpid muscles.

During the course of the disease friction to the limbs is useful, and in the advanced paralytic stage the application of electricity along the line of the affected muscles. When the patient can not stand he must have a thick, soft bed, and should be turned from side to side at least every twelve hours. As soon as he can be made to stand he may be helped up and even supported in a sling.

ACUTE INFLAMMATION OF THE KIDNEYS, OR ACUTE NEPHRITIS.

Inflammations of the kidneys have been differentiated widely, according as they were acute or chronic, parenchymatous or tubal, suppurative or not, with increased or shrunken kidney, etc. In a work like the present, however, utility will be consulted by cla.s.sing all under acute or chronic inflammation.

_Causes._--The causes of inflammation of the kidneys are extremely varied. Congestion occurs from the altered and irritant products pa.s.sed through these organs during recovery from inflammations of other organs and during fevers. This may last only during the existence of its cause, or may persist and become aggravated. Heart disease, throwing the blood pressure back on the veins and kidneys, is another cause. Disease of the ureter or bladder, preventing the escape of urine from the kidney and causing increased fullness and tension in its pelvis and tubes, will determine inflammation. Decomposition of the detained urine in such cases and the production of ammonia and other irritants must also be named. In elimination of bacteria through the kidney, the latter is liable to infection with consequent inflammation. The advance of bacteria upward from the bladder to the kidneys is another cause. The consumption in hay or other fodder of acrid or irritant plants, including fungi, the absorption of cantharidine from a surface blistered by Spanish flies, the reckless administration of diuretics, the presence of stones in the kidney, exposure of the surface to cold and wet, and the infliction of blows or sprains on the loins, may contribute to its production. Liver disorders which throw on the kidneys the work of excreting irritant products, diseases of the lungs and heart from which clots are carried, to be arrested in the small blood vessels of the kidney, and injuries and paralysis of the spinal cord, are additional causes.

_Symptoms._--The symptoms are more or less fever, manifest stiffness of the back and straddling gait with the hind limbs, difficulty in lying down and rising, or in walking in a circle, the animal sometimes groaning under the effort, arching of the loins and tucking up of the flank, looking back at the abdomen as if from colicky pain, and tenderness of the loins to pinching, especially just beneath the bony processes 6 inches to one side of the median line. Urine is pa.s.sed frequently, a small quant.i.ty at a time, of a high color, and sometimes mixed with blood or even pus. Under the microscope it shows the microscopic casts referred to under general symptoms. If treated by acetic acid, boiling and subsequent addition of strong nitric acid, the resulting and persistent precipitate indicates the amount of alb.u.men.

The legs tend to swell from the foot up, also the dependent parts beneath the belly and chest, and effusions of liquid may occur within the chest or abdomen. In the male the alternate drawing up and relaxation of the t.e.s.t.i.c.l.es in the s.c.r.o.t.u.m are suggestive, and in small horses the oiled hand introduced into the r.e.c.t.u.m may reach the kidney and ascertain its sensitiveness.

_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 pota.s.sium. Boiled flaxseed may be added to the drinking water, also thrown into the r.e.c.t.u.m 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 a.s.sociated with alb.u.men 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 a.s.similation; in short, it is rather the attendant on a const.i.tutional infirmity than on a simple local injury.

It may be a.s.sociated 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 alb.u.men, the quant.i.ty furnis.h.i.+ng 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-l.u.s.ter hair, inability to sustain severe or continued exertion, poor or irregular appet.i.te, 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 alb.u.men 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 gla.s.s, 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 gla.s.s to the skin and hold it closely applied till the cooling tends to form a vacuum in the gla.s.s 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 pa.s.sage 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 pa.s.sing 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 pa.s.sage 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 r.e.c.t.u.m 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.