The horse may be operated upon in the standing position

The horse may be operated upon in the standing position

The horse may be operated upon in the standing position

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.

The removal of the stone in the horse

The removal of the stone in the horse

The removal of the stone in the horse

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.

In the mare the hard stone may be

In the mare the hard stone may be

In the mare the hard stone may be

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.

Symptoms of stone in the bladder

Symptoms of stone in the bladder

Symptoms of stone in the bladder

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.

Stone in the bladder vesical calculus

Stone in the bladder vesical calculus

Stone in the bladder vesical calculus

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.

Treatment of renal and ureteric calculi

Treatment of renal and ureteric calculi

Treatment of renal and ureteric calculi

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.

Caused by the obstruction of the ureter by the impacted calculus

Caused by the obstruction of the ureter by the impacted calculus

Caused by the obstruction of the ureter by the impacted calculus

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.

Symptoms of renal calculi are violent

Symptoms of renal calculi are violent

Symptoms of renal calculi are violent

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.

Deposits in the uriniferous tubes in the substance of the kidney

Deposits in the uriniferous tubes in the substance of the kidney

Deposits in the uriniferous tubes in the substance of the kidney

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.

Classification of Urinary 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.

Especially on the magnesian limestones

Especially on the magnesian limestones

Especially on the magnesian limestones

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.

Thus diseases of distant organs leading to albuminuria

Thus diseases of distant organs leading to albuminuria

Thus diseases of distant organs leading to albuminuria

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.