Chapter 15

In certain cases the _symptoms_ of nephritis are very manifest, and in others so hidden that the existence of the affection can be certainly recognized only by a microscopic examination of the urine. In violent cases there is high fever, increase of the body temperature to 103∞ F. and upward; hurried breathing, with a catching inspiration; accelerated pulse; dry, hot muzzle; burning of the roots of the horns and ears; loss of appetite; suspended rumination; and indications of extreme sensitiveness in the loins. The patient stands with back arched and hind legs extended backward and outward, and passes water frequently, in driblets, of a high color and specific gravity, containing albumin and microscopic casts. (Pl. XI, fig. 5.) When made to move, the patient does so with hesitation and groaning, especially if turned in a narrow circle; when pinched on the flank just beneath the lateral bony processes of the loins, especially on that side on which the disease predominates, it flinches and groans. If the examination is made with oiled hand introduced through the last gut (rectum), the pressure upward on the kidneys gives rise to great pain and to efforts to escape by moving away and by active contractions of the rectum for the expulsion of the hand. Sometimes there is a distinct swelling over the loins or quarter on one or both sides. In uncastrated males the testicle on the affected side is drawn up, or is alternately raised and dropped. In all there is a liability to tremors of the thigh on the side affected.

In some severe cases colicky pains are as violent as in the worst forms of indigestion and spasms of the bowels. The animal frequently shifts from one hind foot to the other, stamps, kicks at the belly, frequently looks anxiously at its flank, moans plaintively, lies down and quickly gets up again, grinds its teeth, twists its tail, and keeps the back habitually arched and rigid and the hind feet advanced under the belly. The bowels may be costive and the feces glistening with a coat of mucus, or they may be loose and irritable, and the paunch or even the bowels may become distended with gas (bloating) as the result of indigestion and fermentation. In some animals, male and female alike, the rigid, arched condition of the back will give way to such undulating movements as are sometimes seen in the act of coition.

The disease does not always appear in its full severity; for a day, or even two, however, there may be merely loss of appetite, impaired rumination, a disposition to remain lying down, yet when the patient is raised it manifests suffering by anxiously looking at the flanks, shifting or stamping of the hind feet, shaking of the tail, and attempts to urinate, which are either fruitless or lead to the discharge of a small quantity of high-colored or perhaps bloody urine.

In some recent slight cases, and in many chronic ones, these symptoms may be absent or unobserved, and an examination of the urine is necessary to reach a safe conclusion. The urine may contain blood, or it may be cloudy from contained albumin, which coagulates on heating with nitric acid (see "Albuminuria," p. 121); it may be slightly glairy from pus, or gritty particles may be detected in it. In seeking for casts of the uriniferous tubes, a drop may be taken with a fine tube from the bottom of the liquid after standing, and examined under a power magnifying 50 diameters. If the fine, cylindroid filaments are seen they may then be examined with a power of 200 or 250 diameters. (Pl. XI, fig. 5.) The appearance of the casts gives some clue to the condition of the kidneys. If made up of large, rounded or slightly columnar cells, with a single nucleus in each cell (epithelial), they imply comparatively slight and recent disease of the kidney tubes, the detachment of the epithelium being like what is seen in any inflamed mucous surface. If made up largely of the small, disk-shaped and nonnucleated red blood globules, they imply escape of blood, and usually a recent injury or congestion of the kidney--it may be from sprains, blows, or the ingestion of acrid or diuretic poisons. If the casts are made of a clear, waxy, homogeneous substance (hyaline), without any admixture of opaque particles, they imply an inflammation of longer standing, in which the inflamed kidney tubules have been already stripped of their cellular (epithelial) lining. If the casts are rendered opaque by the presence of minute, spherical granular cells, like white blood globules, it betokens active suppuration of the kidney tubes. In other cases the casts are rendered opaque by entangled earthy granules (carbonate of lime), or crystals of some other urinary salts. In still other cases the casts entangle clear, refrangent globules of oil or fat, which may imply fatty degeneration of the kidneys or injury to the spinal cord. The presence of free pus giving a glairy, flocculent appearance to the urine is suggestive of inflammation of the urinary pouch at the commencement of the excretory duct (pelvis of kidney) (Pl. IX, fig. 1), especially if complicated with gritty particles of earthy salts. This condition is known as pyelitis. In the chronic cases swelling of the legs or along the lower surface of chest or abdomen, or within these respective cavities, is a common symptom. So, also, stupor or coma, or even convulsions, may supervene from the poisonous action of urea and other waste or morbid products retained in the blood.

_Treatment._--In the treatment of acute nephritis the first consideration is the removal of the cause. Acrid or diuretic plants in the feed must be removed, and what of this kind is present in the stomach or bowels may be cleared away by a moderate dose of castor or olive oil; extensive surfaces of inflammation that have been blistered by Spanish flies must be washed clean with soapsuds; sprains of the back or loins must be treated by soothing fomentations or poultices or by a fresh sheepskin with its fleshy side applied on the loins, and the patient must be kept in a narrow stall in which it can not turn even its head. The patient must be kept in a warm, dry building, so that the skin may be kept active rather than the kidneys. Warm blanketing is equally important, or even mustard poultices over the loins will be useful. Blisters of Spanish flies, turpentine, or other agent which may be absorbed and irritate the kidneys must be avoided. The active fever may be checked by 15 drops tincture of aconite every four hours or by one-third ounce of acetanilid. If pain is very acute, 1 ounce of laudanum or 2 drams of solid extract of belladonna will serve to relieve. When the severity of the disease has passed, a course of tonics (quinin, 2 drams, or gentian powder, 4 drams, daily) may be given. Diuretics, too, may be given cautiously at this advanced stage to relieve dropsy and give tone to the kidneys and general system (oil of turpentine, 2 teaspoonfuls; bicarbonate of soda, 1 teaspoonful, repeated twice a day). Pure water is essential, and it should not be given chilled; warm drinks are preferable.

In the chronic forms of kidney inflammation the same protection against cold and similar general treatment are demanded. Tonics, however, are important to improve the general health (phosphate of iron, 2 drams; powdered nux vomica, 20 grains; powdered gentian root, 4 drams, daily). In some instances the mineral acids (nitric acid, 60 drops, or nitrohydrochloric acid, 60 drops, daily) may be used with the bitters. Mustard applied to the loins in the form of a thin pulp made with water and covered for an hour with paper or other impervious envelope, or water hotter than the hand can bear, or cupping, may be resorted to as a counterirritant. In cupping, shave the loins, smear them with lard, then take a narrow-mouthed glass, expand the air within by smearing its interior with a few drops of alcohol, setting it on fire and instantly pressing the mouth of the vessel to the oiled portion of the skin. As the air within the vessel cools it contracts, tending to form a partial vacuum, and the skin, charged with blood, is strongly drawn up within it. Several of these being applied at once, a strong derivation from the affected kidneys is obtained. In no case of inflamed or irritable kidney should Spanish flies or oil of turpentine be used upon the skin.

PARASITES OF THE KIDNEY.

As the kidney is the visual channel by which the bacteria leave the system, this organ is liable to be implicated when microphytes exist in the blood, and congestions and blood extravasions are produced. In anthrax, southern cattle fever (Texas fever), and other such affections bloody urine is the consequence. Of the larger parasites attacking the kidney may be specially named the cystic form of the echinococcus tapeworm of the dog, the cystic form of the unarmed or beef tapeworm of man, the diving bladderworm--the cystic form of the marginate tapeworm of the dog, and the giant strongyle-- the largest of the roundworms. These give rise to general symptoms of kidney disease, but the true source of the trouble is likely to be detected only if the heads or hooklets of the tapeworm or the eggs of the roundworm are found on microscopical examination of the urine.

TUMORS OF THE KIDNEY (HYPERTROPHY OR ATROPHY).

The kidney may be the seat of cancerous or simple tumors, and it may be unnaturally enlarged or reduced in size, but though there may be signs of urinary disorder the true nature of the disease is seldom manifest until after death. The passing of blood and of large multi-nucleated cells in the urine (to be detected under the microscope) may betray the existence of an ulcerated cancer of the kidney. The presence of cancerous enlargement of (superficial) lymphatic glands may further assist and confirm the decision.

RETENTION OF URINE.

Inability to pass urine may come from any one of three conditions--first, spasm of the neck of the bladder; second, paralysis of the body of the bladder; third, obstruction of the channel of outlet by a stone (calculus) (see Pl. XI) or other obstacle.

In _spasm of the neck of the bladder_ the male animal may stand with the tail slightly raised and making rhythmical contractions of the muscle beneath the anus (accelerator urinÊ) (see Pl. IX, fig. 2), but without passing a drop of liquid. In the female the hind legs are extended, widely parted, and the back is arched as if to urinate, but the effort is vain. If the oiled hand is introduced into the rectum or vagina in the early stages of the affection, the bladder may be felt beneath partially filled, but not overdistended with liquid, and its neck or mouth firm and rigid. In the more advanced stages of the affection the organ is felt as a great, tense, elastic bag, extending forward into the abdomen. In this condition the overdistended muscular coat of the bladder has lost its power of contraction, so that true paralysis has set in, the muscle closing the mouth of the sac alone retaining its contractile power.

In _paralysis of the body of the bladder_ attention is rarely drawn to the urinary disorder until the bladder has been distended to full repletion and is almost ready to give way by rupture and to allow the escape of the contained liquid into the abdomen. Overdistention is the most common cause of the paralysis, yet it may occur from inflammation of the muscular wall of the bladder, or even from injury to the terminal part of the spinal marrow. In this last condition, however, the tail is liable to be powerless, and the neck of the bladder may also be paralyzed, so that the urine dribbles away continuously.

_Causes._--Among the causes of spasm of the neck of the bladder may be named the lodgment of small stones or gravel, the feeding on irritant diuretics (see "Bloody urine," p. 119, or "Nephritis," p. 123), the enforced retention of urine while at work or during a painful or difficult parturition. The irritation attendant on inflammation of the mucous membrane of the bladder may be a further cause of spasms of the neck, as may also be inflammation of the channel (urethra) back of the neck. Extensive applications of Spanish flies to the skin, the abuse of diuretics, and the occurrence of indigestion and spasms of the bowels are further causes. So long as spasmodic colic is unrelieved, retention of water from spasm of the neck of the bladder usually persists.

_Treatment._--Treatment depends largely on the cause. In indigestion the irritant contents of the bowels must be got rid of by laxatives and injections of warm water; Spanish-fly blisters must be washed from the surface; a prolonged and too active exertion must be intermitted. The spasm may be relaxed by injecting one-half ounce of solid extract of belladonna in water into the rectum or by a solution of tobacco. Chloroform or ether may be given by inhalation, or chloral hydrate (1 ounce) may be given in water by the mouth. Fomentations of warm water may be made over the loins and between the thighs, and the oiled hand inserted into the rectum may press moderately on the anterior part of the bladder, which can be felt as an elastic fluctuating bag of an oval shape just beneath.

All other measures failing, the liquid must be drawn off through a tube (catheter). This is, however, exceedingly difficult, alike in male and female, and we can not expect an amateur to succeed in accomplishing it. In the cow the opening into the bladder is found in the median line of the floor of the generative entrance, about 4 inches in front of the external opening, but it is flanked on either side by a blind pouch, into which the catheter will pass, in ninety-nine cases out of a hundred, in the hands of any but the most skilled operator. In the bull or steer the penis, when retracted into its sheath, is bent upon itself like the letter S, just above the scrotum and testicles (see Pl. IX, fig. 2), and unless this bend is effaced by extending the organ forward out of its sheath it is quite impossible to pass a catheter beyond this point. When, however, by the presentation of a female, the animal can be tempted to protrude the penis, so that it can be seized and extended, or when it can be manipulated forward out of the sheath, it becomes possible to pass a catheter of small caliber (one-third inch or under) onward into the bladder. Youatt advised laying open the sheath so as to reach and extend the penis, and others have advocated opening the urethra in the space between the thighs or just beneath the anus, but such formidable operations are beyond the stock owner. The incision of the narrow urethra through the great thickness of muscular and erectile bleeding tissue just beneath the anus is especially an operation of extreme delicacy and difficulty. Drawing the liquid through the tube of an aspirator is another possible resort for the professional man. The delicate needle of the aspirator is inserted in such cases through the floor of the vagina and upper wall of the bladder in the female, or through the floor of the rectum (last gut) and roof of the bladder in the male, or finally through the lower and back part of the abdominal wall, just in front of the bones of the pelvis (pubic bones), thence through the lower and anterior part of the bladder near its blind anterior end. After relief has been obtained the administration of belladonna in 2-dram doses daily for several days will tend to prevent a recurrence of the retention.

When the body of the bladder has become benumbed or paralyzed by overdistention, we may seek to restore its tone by doses of one-half a dram of powdered nux vomica repeated daily, and by mustard plaster applied over the loins, on the back part of the belly inferiorly, or between the thighs. Small doses (2 drams) of balsam of copaiba are sometimes useful in imparting tone to the partly paralyzed organ.

INCONTINENCE OF URINE (PALSY OF THE NECK OF THE BLADDER).

This may occur from disease or injury to the posterior part of the spinal cord or from broken back, and in these cases the tail, and perhaps the hind limbs, are liable to be paralyzed. In this case the urine dribbles away constantly, and the oiled hand in the vagina or rectum will feel the half-filled and flaccid bladder beneath and may easily empty it by pressure.

_Treatment._--Treatment is only successful when the cause of the trouble can be remedied. After these (sprains of the back, etc.) have recovered, blisters (mustard) on the loins, the lower part of the abdomen, or between the thighs may be resorted to with success. Two drams of copaiba or of solid extract of belladonna or 2 grains Spanish flies daily may serve to restore the lost tone. These failing, the use of electric currents may still prove successful.

URINARY CALCULI (STONE OR GRAVEL).

Stone or gravel consists of hard bodies mainly made up of the solid earthy constituents of the urine which have crystallized out of that liquid at some part of the urinary passage, and have remained as small particles (gravel), or have concreted into large masses (stone, calculus). (See Pl. XI, figs. 1, 2, 3.) In cattle it is no uncommon thing to find them distending the practically microscopic tubes in the red substance of the kidney, having been deposited from the urine in the solid form almost as soon as that liquid has been separated from the blood. These stones appear as white objects on the red ground formed by cutting sections of the kidney, and are essentially products of the dry feed of winter, and are most common in working oxen, which are called upon to exhale more water from the lungs and skin than are the slop-fed and inactive cows. Little water being introduced into the body with the feed and considerable being expelled with the breath and perspiration in connection with the active life, the urine becomes small in amount, but having to carry out all waste material from the tissues and the tissue-forming feed it becomes so charged with solids that it is ready to deposit them on the slightest disturbance. If, therefore, a little of the water of such concentrated urine is reabsorbed at any point of the urinary passages the remainder is no longer able to hold the solids in solution, and they are at once precipitated in the solid form as gravel or commencing stone. In cattle, on the other hand, which are kept at pasture in summer, or which are fed liberally on roots, potatoes, pumpkins, apples, or ensilage in winter, this concentrated condition of the urine is not induced, and under such circumstances, therefore, the formation of stone is practically unknown. Nothing more need be said to show the controlling influence of dry feeding in producing gravel and of a watery ration in preventing it. Calculus in cattle is essentially a disease of winter and of such cattle as are denied succulent feed and are confined to dry fodder as their exclusive ration. While there are exceptions, they are so rare that they do not invalidate this general rule. It is true that stone in the kidney or bladder is often found in the summer or in animals feeding at the time on a more or less succulent ration, yet such masses usually date back to a former period when the animals were restricted to a dry ration.

In this connection is should be noted that a great drain of water from the system by any other channel than the kidneys predisposes to the production of gravel or stone. In case of profuse diarrhea, for example, or of excessive secretion of milk, there is a corresponding diminution of the water of the blood, and as the whole quantity of the blood is thus decreased and as the urine secreted is largely influenced by the fullness of the blood vessels and the pressure exerted upon their walls from within, it follows that with this decrease of the mass of the blood and the lessening of its pressure outward there will be a corresponding decrease of urine. The waste of the tissues, however, goes on as before, and if the waste matter is passed out through the kidneys it must be in a more concentrated solution, and the more concentrated the urine the greater the danger that the solids will be deposited as small crystals or calculi.

Again, the concentrated condition of the urine which predisposes to such deposits is favored by the quantity of lime salts that may be present in the water drunk by the animal. Water that contains 20 or 30 grains of carbonate or sulphate of lime to the gallon must contribute a large addition of solids to the blood and urine as compared with soft waters from which lime is absent. In this connection it is a remarkable fact that stone and gravel in the domesticated herbivora are notoriously prevalent on many limestone soils, as on the limestone formations of central and western New York, Pennsylvania, Ohio, and Michigan; on the calcareous formations of Norfolk, Suffolk, Derbyshire, Shropshire, and Gloucestershire, in England; in Landes in France, and around Munich in Bavaria. It does not follow that the abundance of lime in the water and fodder is the main cause of the calculi, as other poisons which are operative in the same districts in causing goiter in both man and animal probably contribute to the trouble, yet the excess of earthy salts in the drinking water can hardly fail to add to the saturation of both blood and urine, and thereby to favor the precipitation of the urinary solids from their state of solution.

The known results of feeding cattle a generous or forcing ration in which phosphate of lime is present to excess adds additional force to the view just advanced. In the writer's experience, the Second Duke of Oneida, a magnificent product of his world-famed family, died as the result of a too liberal allowance of wheat bran, fed with the view of still further improving the bone and general form of the Duchess strain of Shorthorns. Lithotomy was performed and a number of stones removed from the bladder and urethra, but the patient succumbed to an inflammation of the bowels, induced by the violent purgatives given before the writer arrived, under the mistaken idea that the straining had been caused by intestinal impaction. In this case not only the Second Duke of Oneida, but the other males of the herd as well, had the tufts of hairs at the outlet of the sheath encased in hard, cylindroid sheaths of urinary salts, precipitated from the liquid as it ran over them. The tufts were in reality resolved into a series of hard, rollerlike bodies, more or less constricted at intervals, as if beaded.

When it is stated that the ash of the whole grain of wheat is but 3 per cent, while the ash of wheat bran is 7.3 per cent, and that in the case of the former 46.38 per cent of the ash is phosphoric acid, and in that of the latter 50 per cent, it can easily be understood how a too liberal use of wheat bran should prove dangerous if fed dry. The following table shows the relative proportion of ash and phosphoric acid in wheat bran and in some common farm seeds:

_Ash and phosphoric acid in bran and some common farm seeds._