Chapter 19

In looking, therefore, for the immediate causes of calculi we must consider especially all those conditions which determine the presence of albumen, blood, and excess of mucus, pus, etc., in the urine. Thus diseases of distant organs leading to albuminuria, diseases of the kidneys and urinary passages causing the escape of blood or the formation of mucus or pus, become direct causes of calculi. Foreign bodies of all kinds in the bladder or kidney have long been known as determining causes of calculi and as forming the central nucleus. This is now explained by the fact that these bodies are liable to carry bacteria into the passages and thus determine decomposition, and they are further liable to irritate the mucous membrane and become enveloped in a coating of mucus, pus, and perhaps blood.

The fact that horses, especially on the magnesian limestones, the same districts in which they suffer from goiter, appear to suffer from calculi may be similarly explained. The unknown poison which produces goiter presumably leads to such changes in the blood and urine as will furnish the colloid necessary for precipitation of the urinary salts in the form of calculi.

CLASSIFICATION OF URINARY CALCULI.

These have been named according to the place where they are found, renal (kidney), ureteric (ureter), vesical (bladder), urethral (urethra), and preputial (sheath, or prepuce). They have been otherwise named according to their most abundant chemical constituent, carbonate of lime, oxalate of lime, and phosphate of lime calculi. The stones formed of carbonates or phosphates are usually smooth on the surface, though they may be molded into the shape of the cavity in which they have been formed; thus those in the pelvis of the kidney may have two or three short branchlike prolongations, while those in the bladder are round, oval, or slightly flattened upon each other. Calculi containing oxalate of lime, on the other hand, have a rough, open, crystalline surface, which has gained for them the name of mulberry calculi, from a supposed resemblance to that fruit. These are usually covered with more or less mucus or blood, produced by the irritation of the mucous membrane by their rough surfaces. The color of calculi varies from white to yellow and deep brown, the shades depending mainly on the amount of the coloring matter of blood, bile, or urine which they may contain.

_Renal calculi._--These may consist of minute, almost microscopic, deposits in the uriniferous tubes in the substance of the kidney, but more commonly they are large masses and lodged in the pelvis. The larger calculi, sometimes weighing 12 to 24 ounces, are molded in the pelvis of the kidney into a cylindroid mass, with irregular rounded swellings at intervals. Some have a deep brown, rough, crystalline surface of oxalate of lime, while others have a smooth, pearly white aspect from carbonate of lime. A smaller calculus, which has been called coralline, is also cylindroid, with a number of brown, rough, crystalline oxalate of lime branches and whitish depressions of carbonate. These vary in size from 15 grains to nearly 2 ounces. Less frequently are found masses of very hard, brownish white, rounded, pealike calculi. These are smoother, but on the surface crystals of oxalate of lime may be detected with a lens. Some renal calculi are formed of more distinct layers, more loosely adherent to one another, and contain an excess of mucus, but no oxalate of lime. Finally, a loose aggregation of small masses, forming a very friable calculus, is found of all sizes within the limits of the pelvis of the kidney. These, too, are in the main carbonate of lime (84 to 88 per cent) and without oxalate.

Symptoms of renal calculi are violent, colicky, pains, appearing suddenly, very often in connection with exhausting work or the drawing of specially heavy loads, and in certain cases disappearing with equal suddenness. The nature of the colic becomes more manifest if it is associated with stiffness of the back and hind limbs, frequent passage of urine, and, above all, the passage of gravel with the urine, especially at the time of the access of relief. The passage of blood and pus in the urine is equally significant. If the irritation of the kidney goes on to active inflammation, then the symptoms of nephritis are added.

_Ureteric calculi._--These are so called because they are found in the passage leading from the kidney to the bladder. They are simply small, renal calculi which have escaped from the pelvis of the kidney and have become arrested in the ureter. They give rise to symptoms almost identical with those of renal calculi, with this difference, that the colicky pains, caused by the obstruction of the ureter by the impacted calculus, are more violent, and if the calculus passes on into the bladder the relief is instantaneous and complete. If the ureter is completely blocked for a length of time, the retained urine may give rise to destructive inflammation in the kidney, which may end in the entire absorption of that organ, leaving only a fibrous capsule containing an urinous fluid. If both the ureters are similarly blocked, the animal will die of uremic poisoning.

_Treatment of renal and ureteric calculi._--Treatment is unsatisfactory, as it is only the small calculi that can pass through the ureters and escape into the bladder. This may be favored by agents which will relax the walls of the ureters by counteracting their spasm and even lessening their tone, and by a liberal use of water and watery fluids to increase the urine and the pressure upon the calculus from behind. One or two ounces of laudanum, or 2 drams of extract of belladonna, may be given and repeated as it may be necessary, the relief of the pain being a fair criterion of the abating of the spasm. To the same end use warm fomentations across the loins, and these should be kept up persistently until relief is obtained. These act not only by soothing and relieving the spasm and inflammation, but they also favor the freer secretion of a more watery urine, and thus tend to carry off the smaller calculi. To accomplish this object further give cool water freely, and let the feed be only such as contains a large proportion of liquid, gruels, mashes, turnips, beets, apples, pumpkins, ensilage, succulent grasses, etc. If the acute stage has passed and the presence of the calculus is manifested only by the frequent passage of urine with gritty particles, by stiffness of the loins and hind limbs, and by tenderness to pressure, the most promising resort is a long run at pasture where the grasses are fresh and succulent. The long-continued secretion of a watery urine will sometimes cause the breaking down of a calculus, as the imbibition of the less dense fluid by the organic, spongelike framework of the calculus causes it to swell and thus lessens its cohesion. The same end is sought by the long-continued use of alkalies (carbonate of potassium), and of acids (muriatic), each acting in a different way to alter the density and cohesion of the stone. It is only exceptionally, however, that any one of these methods is entirely satisfactory. If inflammation of the kidneys develops, treat as advised under that head.

_Stone in the bladder (vesical calculus, or cystic calculus)._--These may be of any size up to over a pound in weight. One variety is rough and crystalline and has a yellowish-white or deep-brown color. These contain about 87 per cent carbonate of lime, the remainder being carbonate of magnesia, oxalate of lime, and organic matter. The phosphatic calculi are smooth, white and formed of thin, concentric layers of great hardness extending from the nucleus outward. Besides the phosphate of lime they contain the carbonates of lime and magnesia and organic matter. In some cases the bladder contains and may be even distended by a soft, pultaceous mass made up of minute, round granules of carbonates of lime and magnesia. This, when removed and dried, makes a firm, white, and stony mass. Sometimes this magma is condensed into a solid mass in the bladder by reason of the binding action of the mucus and other organic matter, and then forms a conglomerate stone of nearly uniform consistency and without stratification.

_Symptoms of stone in the bladder._--The symptoms of stone in the bladder are more obvious than those of renal calculus. The rough, mulberry calculi especially lead to irritation of the mucous membrane and frequent passing of urine in small quantities and often mingled with mucus or blood or containing minute, gritty particles. At times the flow is suddenly arrested, though the animal continues to strain and the bladder is not quite emptied. In the smooth, phosphatic variety the irritation is much less marked and may even be altogether absent. With the pultaceous deposit in the bladder there is incontinence of urine, which dribbles away continually and keeps the hair on the inner side of the thighs matted with soft magma. In all cases alike the calculus may be felt by the examination of the bladder with the oiled hand in the rectum. The pear-shaped outline of the bladder can be felt beneath, and within it the solid, oval body. It is most easily recognized if the organ is half full of liquid, as then it is not grasped by the contracting walls of the bladder, but may be made to move from place to place in the liquid. If a pultaceous mass is present it has a soft, doughy feeling, and when pressed an indentation is left.

In the mare the hard stone may be touched by the finger introduced through the short urethra.

_Treatment of stone in the bladder._--The treatment of stone in the bladder consists in the removal of the offending body; in the mare this is easily effected with the lithotomy forceps. These are slightly warmed and oiled, and carried forward along the floor of the passage of the vulva for 4 inches, when the orifice of the urethra will be felt exactly in the median line. Through this the forceps are gradually pushed with gentle, oscillating movement until they enter the bladder and strike against the hard surface of the stone. The stone is now grasped between the blades, care being taken to include no loose fold of the mucous membrane, and it is gradually withdrawn with the same careful, oscillating motions as before. Facility and safety in seizing the stone will be greatly favored by having the bladder half full of liquid, and if necessary one oiled hand may be introduced into the rectum or vagina to assist. The resulting irritation may be treated by an injection of laudanum, 1 ounce in a pint of tepid water.

The removal of the stone in the horse is a much more difficult proceeding. It consists in cutting into the urethra just beneath the anus and introducing the lithotomy forceps from this forward into the bladder, as in the mare. It is needful to distend the urethra with tepid water or to insert a sound or catheter to furnish a guide upon which the incision may be made, and in case of a large stone it may be needful to enlarge the passage by cutting in a direction upward and outward with a probe-pointed knife, the back of which is slid along in the groove of a director until it enters the bladder.

The horse may be operated upon in the standing position, being simply pressed against the wall by a pole passed from before backward along the other side of the body. The tepid water is injected into the end of the penis until it is felt to fluctuate under the pressure of the finger, in the median line over the bone just beneath the anus. The incision is then made into the center of the fluctuating canal, and from above downward. When a sound or catheter is used as a guide it is inserted through the penis until it can be felt through the skin at the point where the incision is to be made beneath the anus. The skin is then rendered tense by the thumb and fingers of the left hand pressing on the two sides of the sound, while the right hand, armed with a scalpel, cuts downward onto the catheter. This vertical incision into the canal should escape wounding any important blood vessel. It is in making the obliquely lateral incision in the subsequent dilatation of the urethra and neck of the bladder that such danger is to be apprehended.

If the stone is too large to be extracted through the urethra, it may be broken down with the lithotrite and extracted piecemeal with the forceps. The lithotrite is an instrument composed of a straight stem bent for an inch or more to one side at its free end so as to form an obtuse angle, and having on the same side a sliding bar moving in a groove in the stem and operated by a screw so that the stone may be seized between the two blades at its free extremity and crushed again and again into pieces small enough to extract. Extra care is required to avoid injury to the urethra in the extraction of the angular fragments, and the gravel or powder that can not be removed in this way must be washed out, as advised below.

When a pultaceous magma of carbonate of lime accumulates in the bladder it must be washed out by injecting water through a catheter by means of a force pump or a funnel, shaking it up with the hand introduced through the rectum and allowing the muddy liquid to flow out through the tube. This is to be repeated until the bladder is empty and the water come away, clear. A catheter with a double tube is sometimes used, the injection passing in through the one tube and escaping through the other. The advantage is more apparent than real, however, as the retention of the water until the magma has been shaken up and mixed with it hastens greatly its complete evacuation.

To prevent the formation of a new deposit any fault in feeding (dry grain and hay with privation of water, excess of beans, peas, wheat bran, etc.) and disorders of stomach, liver, and lungs must be corrected. Give abundance of soft drinking water, encouraging the animal to drink by a handful of salt daily. Let the feed be laxative, consisting largely of roots, apples, pumpkins, ensilage, and give daily in the drinking water a dram of either carbonate of potash or soda. Powdered gentian root (3 drams daily) will also serve to restore the tone of the stomach and system at large.

_Urethral calculus (stone in the urethra)._--This is less frequent in horses than in cattle and sheep, owing to the larger size of the urethra in the horse and the absence of the S -shaped curve and vermiform appendix. The calculi arrested in the urethra are never formed there, but consist of cystic calculi which have been small enough to pass through the neck of the bladder, but are too large to pass through the whole length of the urethra and escape. Such calculi therefore are primarily formed either in the bladder or kidney, and have the chemical composition of the other calculi found in those organs. They may be arrested at any point of the urethra, from the neck of the bladder back to the bend of the tube beneath the anus, and from that point down to the extremity of the penis. I have found them most frequently in the papilla on the extreme end of the penis, and immediately behind this.

_Symptoms of urethral calculus._--The symptoms are violent straining to urinate, but without any discharge, or with the escape of water in drops only. Examination of the end of the penis will detect the swelling of the papilla or the urethra behind it, and the presence of a hard mass in the center. A probe inserted into the urethra will strike against the gritty calculus. If the stone has been arrested higher up, its position may be detected as a small, hard, sensitive knot on the line of the urethra, in the median line of the lower surface of the penis, or on the floor of pelvis in the median line from the neck of the bladder back to the bend of the urethra beneath the anus. In any case the urethra between the neck of the bladder and the point of obstruction is liable to be filled with fluid, and to feel like a distended tube, fluctuating on pressure.

_Treatment of urethral calculus_ may be begun by an attempt to extract the calculi by manipulation of the papilla on the end of the penis. This failing, the calculus may be seized with a pair of fine-pointed forceps and withdrawn from the urethra; or, if necessary, a probe-pointed knife may be inserted and the urethra slightly dilated, or even laid open, and the stone removed. If the stone has been arrested higher up it must be extracted by a direct incision through the walls of the urethra and down upon the nodule. If in the free (protractile) portion of the penis, that organ is to be withdrawn from its sheath until the nodule is exposed and can be incised. If behind the scrotum, the incision must be made in the median line between the thighs and directly over the nodule, the skin having been rendered tense by the fingers and thumb of the left hand. If the stone has been arrested in the intrapelvic portion of the urethra, the incision must be made beneath the anus and the calculus extracted with forceps, as in stone in the bladder. The wound in the urethra may be stitched up, and usually heals slowly but satisfactorily. Healing will be favored by washing two or three times daily with a solution of a teaspoonful of carbolic acid in a pint of water.

_Preputial calculus (calculus in the sheath, or bilocular cavity)._--These are concretions in the sheath, though the term has been also applied to the nodule of sebaceous matter which accumulates in the blind pouches (bilocular cavity) by the sides of the papilla on the end of the penis. Within the sheath the concretion may be a soft, cheesy-like sebaceous matter, or a genuine calculus of carbonate, oxalate, phosphate and sulphate of lime, carbonate of magnesia, and organic matter. These are easily removed with the fingers, after which the sheath should be washed out with castile soap and warm water and smeared with sweet oil.

DISEASES OF THE GENERATIVE ORGANS.

By JAMES LAW, F. R. C. V. S.,

Formerly Professor of Veterinary Science, etc., in Cornell University.

CONGESTION AND INFLAMMATION OF THE TESTICLES, OR ORCHITIS.

In the prime of life, in vigorous health, and on stimulating feed, stallions are subject to congestion of the testicles, which become swollen, hot, and tender, but without any active inflammation. A reduction of the grain in the feed, the administration of 1 or 2 ounces of Glauber's salt daily in the feed, and the bathing of the affected organs daily with tepid water or alum water will usually restore them to a healthy condition.

When the factors producing congestion are extraordinarily potent, when there has been frequent copulation and heavy grain feeding, when the weather is warm and the animal has had little exercise, and when the proximity of other horses or mares excites the generative instinct without gratification, this congestion may grow to actual inflammation. Among the other causes of orchitis are blows and penetrating wounds implicating the testicles, abrasions of the scrotum by a chain or rope passing inside the thigh, contusions and frictions on the gland under rapid paces or heavy draft, compression of the blood vessels of the spermatic cord by the inguinal ring under the same circumstances, and, finally, sympathetic disturbance in cases of disease of the kidneys, bladder, or urethra. Stimulants of the generative functions, like rue, savin, tansy, cantharides, and damiana, may also be accessory causes of congestion and inflammation. Finally, certain specific diseases, like dourine, glanders, and tuberculosis, localized in the testicles, will cause inflammation.

_Symptoms._--Apart from actual wounds of the parts, the symptoms of orchitis are swelling, heat, and tenderness of the testicles, straddling with the hind legs alike in standing and walking, stiffness and dragging of the hind limbs or of the limb on the affected side, arching of the loins, abdominal pain, manifested by glancing back at the flank, more or less fever, elevated body temperature, accelerated pulse and breathing, lack of appetite, and dullness. In bad cases the scanty urine may be reddish and the swelling may extend to the skin and envelopes of the testicle, which may become thickened and doughy, pitting on pressure. The swelling may be so much greater in the convoluted excretory duct along the upper border of the testicle as to suggest the presence of a second stone. Even in the more violent attacks the intense suffering abates somewhat on the second or third day. If it lasts longer, it is liable to give rise to the formation of matter (abscess). In exceptional cases the testicle is struck with gangrene, or death. Improvement may go on slowly to complete recovery, or the malady may subside into a subacute and chronic form with induration. Matter (abscess) may be recognized by the presence of a soft spot, where pressure with two fingers will detect fluctuation from one to the other. When there is liquid exudation into the scrotum, or sac, fluctuation may also be felt, but the liquid can be made out to be around the testicle and can be pressed up into the abdomen through the inguinal canal. When abscess occurs in the cord the matter may escape into the scrotal sac and cavity of the abdomen and pyemia may follow.

_Treatment_ consists in perfect rest and quietude, the administration of a purgative (1 to 1-1/2 pounds Glauber's salt), and the local application of an astringent lotion (acetate of lead 2 drams, extract of belladonna 2 drams, and water 1 quart) upon soft rags or cotton wool, kept in contact with the part by a suspensory bandage. This bandage, of great value for support, may be made nearly triangular and tied to a girth around the loins and to the upper part of the same surcingle by two bands carried backward and upward between the thighs. In severe cases scarifications one-fourth inch deep serve to relieve vascular tension. When abscess is threatened its formation may be favored by warm fomentations or poultices, and on the occurrence of fluctuation the knife may be used to give free escape to the pus. The resulting cavity may be injected daily with a weak carbolic-acid lotion, or salol may be introduced. The same agents may be used on a gland threatened with gangrene, but its prompt removal by castration is to be preferred, antiseptics being applied freely to the resulting cavity.

SARCOCELE.

This is an enlarged and indurated condition of the gland, resulting from chronic inflammation, though it is often associated with a specific deposit, like glanders. In this condition the natural structure of the gland has given place to embryonal tissue (small, round cells, with a few fibrous bundles), and its restoration to health is very improbable. Apart from active inflammation, it may increase very slowly. The diseased testicle is enlarged, firm, nonelastic, and comparatively insensible. The skin of the scrotum is tense, and it may be edematous (pitting on pressure), as are the deeper envelopes and spermatic cord. If liquid is present in the sac, the symptoms are masked somewhat. As it increases it causes awkward, straddling, dragging movement of the hind limbs, or lameness on the affected side. The spermatic cord often increases at the same time with the testicle, and the inguinal ring being thereby stretched and enlarged, a portion of intestine may escape into the sac, complicating the disease with hernia.

The only rational and effective treatment is castration, and when the disease is specific (glanders, tuberculosis), even this may not succeed.

HYDROCELE, OR DROPSY OF THE SCROTUM.

This may be merely an accompaniment of dropsy of the abdomen, the cavity of which is continuous with that of the scrotum in horses. It may be the result, however, of local disease in the testicle, spermatic cord, or walls of the sac.