Special Report on Diseases of the Horse Part 17

It remains to be noted that similar symptoms may be determined by a stone or sebaceous ma.s.s, 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 r.e.c.t.u.m. In obstruction, the hard, impacted body can usually be felt by tracing the urethra along the lower and posterior surface of the p.e.n.i.s 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 r.e.c.t.u.m 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 p.e.n.i.s and pushed on carefully until it has entered the bladder. To effect this the p.e.n.i.s must first be withdrawn from its sheath, and when the advancing end of the catheter has reached the bend of the urethra beneath the a.n.u.s it must be guided forward by pressure with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 r.e.c.t.u.m 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 teta.n.u.s, acute rheumatism, paraplegia, and hemiplegia, in which the animal can not stretch himself to urinate, and in cyst.i.tis, 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 a.s.sociated 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 r.e.c.t.u.m 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 cyst.i.tis. 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 a.n.u.s 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 (CYSt.i.tIS, OR UROCYSt.i.tIS).

Cyst.i.tis 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 cyst.i.tis, as they may nephritis. Finally, inflammation may extend from a diseased v.a.g.i.n.a 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 p.e.n.i.s hangs from the sheath, or in the mare the v.u.l.v.a 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 r.e.c.t.u.m or v.a.g.i.n.a. 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 r.e.c.t.u.m or v.a.g.i.n.a.

_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 gra.s.s), 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 r.e.c.t.u.m, 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 a.n.u.s 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.

Some horses, and especially mares, show an irritability of the bladder and nerve centers presiding over it by frequent urination in small quant.i.ties, though the urine is not manifestly changed in character and no more than the natural quant.i.ty is pa.s.sed in the twenty-four hours.

The disorder appears to have its source quite as frequently in the generative or nervous system as in the urinary. A troublesome and dangerous form is seen in mares, which dash off and refuse all control by the rein if driven with a full bladder, but usually prove docile if the bladder has been emptied before hitching. In other cases the excitement connected with getting the tail over the reins is a powerful determining cause. The condition is marked in many mares during the period of heat.

An oleaginous laxative (castor oil 1 pint) will serve to remove any cause of irritation in the digestive organs, and a careful dieting will avoid continued irritation by acrid vegetable agents. The bladder should be examined to see that there is no stone or other cause of irritation, and the sheath and p.e.n.i.s should be washed with soapsuds, any sebaceous matter removed from the bilocular cavity at the end of the p.e.n.i.s, and the whole lubricated with sweet oil. Irritable mares should be induced to urinate before they are harnessed, and those that clutch the lines under the tail may have the tail set high by cutting the cords on its lower surface, or it may be prevented from getting over the reins by having a strap carried from its free end to the breeching. Those proving troublesome when "in heat" may have 4-dram doses of bromid of pota.s.sium, or they may be served by the male or castrated. Sometimes irritability may be lessened by daily doses of belladonna extract (1 dram), or a better tone may be given to the parts by balsam copaiba (1 dram).

DISEASED GROWTHS IN THE BLADDER.

These may be of various kinds, malignant or simple. In the horse I have found villous growths from the mucous membrane especially troublesome.

They may be attached to the mucous membrane by a narrow neck or by a broad base covering a great part of the organ.

_Symptoms._--The symptoms are frequent straining, pa.s.sing of urine and blood with occasionally gravel. An examination of the bladder with the hand in the r.e.c.t.u.m will detect the new growth, which may be distinguished from a hard, resistant stone. In mares, in which the finger can be inserted into the bladder, the recognition is still more satisfactory. The polypi attached by narrow necks may be removed by surgical operation, but for those with broad attachments treatment is eminently unsatisfactory.

DISCHARGE OF URINE BY THE NAVEL, OR PERSISTENT URACHUS.

This occurs only in the newborn, and consists in the nonclosure of the natural channel (urachus), through which the urine is discharged into the outer water bag (allantois) in fetal life. At that early stage of the animal existence the bladder resembles a long tube, which is prolonged through the navel string and opens into the outermost of the two water bags in which the fetus floats. In this way the urine is prevented from entering the inner water bag (amnion), where it would mingle with the liquids, bathing the skin of the fetus and cause irritation. At birth this channel closes up, and the urine takes the course normal to extra-uterine life. Imperfect closure is more frequent in males than in females, because of the great length and small caliber of the male urethra and its consequent tendency to obstruction. In the female there may be a discharge of a few drops only at a time, while in the male the urine will be expelled in strong jets coincidently with the contractions of the bladder and walls of the abdomen.

The first care is to ascertain whether the urethra is pervious by pa.s.sing a human catheter. This determined, the open urachus may be firmly closed by a stout, waxed thread, carried with a needle through the tissues back of the opening and tied in front of it so as to inclose as little skin as possible. If a portion of the naval string remains, the tying of that may be all sufficient. It is important to tie as early as possible so as to avoid inflammation of the navel from contact with the urine. In summer a little carbolic-acid water or tar water may be applied to keep the flies off.

EVERSION OF THE BLADDER.

This can occur only in the female. It consists in the turning of the organ outside in through the channel of the urethra, so that it appears as a red, pear-shaped ma.s.s hanging from the floor of the v.u.l.v.a and protruding externally between its lips. It may be a ma.s.s like the fist, or it may swell up to the size of an infant's head. On examining its upper surface the orifices of the urethra maybe seen, one on each side, a short distance behind the neck, with the urine oozing from them drop by drop.

This displacement usually supervenes on a flaccid condition of the bladder, the result of paralysis, overdistention, or severe compression during a difficult parturition.

The protruding organ may be washed with a solution of 1 ounce of laudanum and a teaspoonful of carbolic acid in a quart of water, and returned by pressing a smooth, rounded object into the fundus and directing it into the urethra, while careful pressure is made on the surrounding parts with the other hand. If too large and resistant it may be wound tightly in a strip of bandage about 2 inches broad to express the great ma.s.s of blood and exudate and diminish the bulk of the protruded organ so that it can be easily pushed back. This method has the additional advantage of protecting the organ against bruises and lacerations in the effort made to return it. After the return, straining may be kept in check by giving laudanum (1 to 2 ounces) and by applying a truss to press upon the lips of the v.u.l.v.a. (See Eversion of the womb.) The patient should be kept in a stall a few inches lower in front than behind, so that the action of gravity will favor retention.

[Ill.u.s.tration: PLATE XI.

CALCULI AND INSTRUMENT FOR REMOVAL.]

INFLAMMATION OF THE URETHRA (URETHRITIS, OR GLEET).

This affection belongs quite as much to the generative organs, yet it can not be entirely overlooked in a treatise on urinary disorders. It may be induced by the same causes as cyst.i.tis (which see); by the pa.s.sage and temporary arrest of small stones, or gravel; by the irritation caused by foreign bodies introduced from without; by blows on the p.e.n.i.s by sticks, stones, or by the feet of a mare that kicks while being served; by an infecting inflammation contracted from a mare served in the first few days after parturition or one suffering from leucorrhea; by infecting matter introduced on a dirty catheter, or by the extension of inflammation from an irritated, bilocular cavity filled with hardened sebaceous matter, or from an uncleansed sheath.

_Symptoms._--The symptoms are swelling, heat, and tenderness of the sheath and p.e.n.i.s; difficulty, pain, and groaning in pa.s.sing urine, which is liable to sudden temporary arrests in the course of micturition, and later a whitish, mucopurulent oozing from the papilla on the end of the p.e.n.i.s. There is a tendency to erection of the p.e.n.i.s, and in cases contracted from a mare the outer surface of that organ will show more or less extensive sores and ulcers. Stallions suffering in this way will refuse to mount or, having mounted, will fail to complete the act of coition. If an entrance is effected, infection of the mare is liable to follow.

_Treatment_ in the early stages consists in a dose of physic (aloes 6 drams) and fomentations of warm water to the sheath and p.e.n.i.s. If there is reason to suspect the presence of infection, inject the urethra twice daily with borax 1 dram, tepid water 1 quart. When the mucopurulent discharge indicates the supervention of the second stage a more astringent injection may be used (nitrate of silver 20 grains, water 1 quart), and the same may be applied to the surface of the p.e.n.i.s and inside the sheath. Balsam of copaiba (1 dram daily) may also be given with advantage after the purulent discharge has appeared.

Every stallion suffering from urethritis should be withheld from service, as should mares with leucorrhea.

STRICTURE OF THE URETHRA.

This is a permanent narrowing of the urethra at a given point, the result of previous inflammation, caused by the pa.s.sage or arrest of a stone, or gravel, by strong astringent injections in the early nonsecreting stage of urethritis, or by contraction of the lining membrane occurring during the healing of ulcers in neglected inflammations of that ca.n.a.l. The trouble is shown by the pa.s.sage of urine in a fine stream, with straining, pain, and groaning, and by frequent painful erections. It must be remedied by mechanical dilatation, with catheters just large enough to pa.s.s with gentle force, to be inserted once a day, and to be used of larger size as the pa.s.sage will admit them. The catheter should be kept perfectly clean and washed in a borax solution and well oiled before it is introduced.

URINARY CALCULI (STONE, OR GRAVEL).

These consist in some of the solids of the urine that have been precipitated from the urine in the form of crystals, which remain apart as a fine, powdery ma.s.s, or magma, or aggregate into calculi, or stones, of varying size. (See Pl. XI.) Their composition is therefore determined in different animals by the salts or other const.i.tuents found dissolved in the healthy urine, and by the additional const.i.tuents which may be thrown off in solution in the urine in disease. In this connection it is important to observe the following a.n.a.lysis of the horse's urine in health:

Water 918.5 Urea 13.4 Uric acid and urates .1 Hippuric acid 26.4 Lactic acid and lactates 1.2 Mucus and organic matter 22.0 Sulphates (alkaline) 1.2 Phosphates (lime and soda) .2 Chlorids (sodium) 1.0 Carbonates (potash, magnesia, lime) 16.0 ----- 1000.0

The carbonate of lime, which is present in large quant.i.ty in the urine of horses fed on green fodder, is practically insoluble, and therefore forms in the pa.s.sages after secretion, and its microscopic rounded crystals give the urine of such horses a milky whiteness. It is this material which const.i.tutes the soft, white, pultaceous ma.s.s that sometimes fills the bladder to repletion and requires to be washed out.

In hay-fed horses carbonates are still abundant, while in those mainly grain-fed they are replaced by hippurates and phosphates--the products of the wear of tissues--the carbonates being the result of oxidation of the vegetable acids in the feed. Carbonate of lime, therefore, is a very common const.i.tuent of urinary calculi in herbivora, and in many cases is the most abundant const.i.tuent.

Oxalate of lime, like carbonate of lime, is derived from the burning up of the carbonaceous matter of the feed in the system, one important factor being the less perfect oxidation of the carbon. Indeed, Fustenberg and Schmidt have demonstrated on man, horse, ox, and rabbit that under the full play of the breathing (oxidizing) forces oxalic acid, like other organic acids, is resolved into carbonic acid. In keeping with this is the observation of Lehmann, that in all cases in which man suffered from interference with the breathing oxalate of lime appeared in the urine. An excess of oxalate of lime in the urine may, however, claim a different origin. Uric and hippuric acids are found in the urine of carnivora and herbivora, respectively, as the result of the healthy wear (disa.s.similation) of nitrogenous tissues. If these products are fully oxidized, however, they are thrown out in the form of the more soluble urea rather than as these acids. When uric acid out of the body is treated with peroxid of lead it is resolved into urea, allantoin, and oxalic acid, and Woehler and Frerrichs found that the administration of uric acid not only increased the excretion of urea but also of oxalic acid. It may therefore be inferred that oxalic acid is not produced from the carbonaceous feed alone but also from the disintegration of the nitrogenous tissues of the body. An important element of its production is, however, the imperfect performance of the breathing functions, and hence it is liable to result from diseases of the chest (heaves, chronic bronchitis, etc.). This is, above all, liable to prove the case if the subject is fed to excess on highly carbonaceous feeds (gra.s.s and green feed generally, potatoes, etc.).

Carbonate of magnesia, another almost constant ingredient of the urinary calculi of the horse, is formed the same way as the carbonate of lime--from the excess of carbonaceous feed (organic acids) becoming oxidized into carbon dioxid, which unites with the magnesia derived from the feed.

The phosphates of lime and magnesia are not abundant in urinary calculi of the horse, the phosphates being present to excess in the urine in only two conditions--(a) when the ration is excessive and especially rich in phosphorus (wheat, bran, beans, peas, vetches, rape cake, oil cake, cottonseed cake); and (b) when, through the morbid, destructive changes in the living tissues, and especially of the bones, a great quant.i.ty of phosphorus is given off as a waste product. Under these conditions, however, the phosphates may contribute to the formation of calculi, and this, above all, is liable if the urine is retained in the bladder until it has undergone decomposition and given off ammonia. The ammonia at once unites with the phosphate of magnesia to form a double salt--phosphate of ammonia and magnesia--which, being insoluble, is at once precipitated. The precipitation of this salt is, however, rare in the urine of the horse, though much more frequent in that of man and sheep.

These are the chief mineral const.i.tuents of the urine which form ingredients in the horse's calculi, for though iron and manganese are usually present it is only in minute quant.i.ties.

The excess of mineral matter in a specimen of urine unquestionably contributes to the formation of calculi, just as a solution of such matters out of the body is increasingly disposed to throw them down in the form of crystals as it becomes more concentrated and approaches nearer to the condition of saturation. Hence, in considering the causes of calculi we can not ignore the factor of an excessive ration, rich in mineral matters and in carbonaceous matters (the source of carbonates and much of the oxalates), nor can we overlook the concentration of the urine that comes from dry feed and privation of water, or from the existence of fever which causes suspension of the secretion of water. In these cases, at least the usual quant.i.ty of solids is thrown off by the kidneys, and as the water is diminished there is danger of its approaching the point of supersaturation, when the dissolved solids must necessarily be thrown down. Hence, calculi are more common in stable horses fed on dry grain and hay, in those denied a sufficiency of water or that have water supplied irregularly, in those subjected to profuse perspiration (as in summer), and in those suffering from a watery diarrhea. On the whole, calculi are most commonly found in winter, because the horses are then on dry feeding, but such dry feeding is even more conducive to them in summer when the condition is aggravated by the abundant loss of water by the skin.

In the same way the extreme hardness of the water in certain districts must be looked upon as contributing to the concentration of the urine and correspondingly to the production of stone. The carbonates, sulphates, etc., of lime and magnesia taken in the water must be again thrown out, and just in proportion as these add to the solids of the urine they dispose it to precipitate its least soluble const.i.tuents.

Thus the horse is very subject to calculi on certain limestone soils, as over the calcareous formations of central and western New York, Pennsylvania, and Ohio, in America; of Norfolk, Suffolk, Derbys.h.i.+re, Shrops.h.i.+re, and Gloucesters.h.i.+re, in England; of Poitou and Landes, in France; and Munich, in Bavaria.