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growing plants, and in most of our cereals and grasses makes up a large
proportion of the ashes of the burned plant. It is found in the soluble
form in combination as silicate of potash, but at times is displaced by
oxalic or other acid and then appears as gritty, sandy particles in the
stem. This gritty, insoluble silica is especially noticeable among the
horsetails (_EquisetacÊceÊ_), bamboos, and sedges. The per cent of silica
in the ash of several common fodder plants is given below:
_Silica in ash of various fodder plants._
Ash of-- Silica.
_Per cent._
Wheat straw 67.6
Oats and husk 38.6
Oat straw 35.4
Barley straw 73.1
Rye straw 64.4
Rye-grass hay 64.57
Wheat chaff 81.2
Oat chaff 59.9
Barley awn 70.7
It is only soluble silica that is taken up into the system, and it is in
this form (usually as silicate of potash or soda) that it enters the urine,
but all that is wanted to precipitate it in crystalline form as a gritty
sand is the presence of oxalic or other acid having a stronger affinity for
its base (potash or soda).
Other conditions, however, enter largely into the causation of stone, or
gravel. A high density of urine resulting from a highly saturated condition
is often present for a length of time without any precipitation of solid
materials. Urea and carbonates may be present in excess, the feed may be
given dry, and drinking water may be deficient in quantity without any
deposition of stone or gravel. In such cases, the presence of
noncrystalline organic matter in the urine becomes an exciting cause.
Rainey and Ord have shown experimentally that colloid (noncrystallizable)
bodies like mucus, epithelial cells, albumin, pus, blood, hyaline casts of
the kidney tubes, etc., not only determine the precipitation of
crystallizable salts from a strong solution, but they determine the
precipitation in the form of globular masses, or minute spheres, which, by
further similar accessions, become stones, or calculi, of various sizes.
The salts that are deposited by mere chemical reaction without the
intervention of colloids appear in the form of sharply defined angular
crystals, and hence the rough, jagged crystals of oxalate of lime or
ammonia-magnesium phosphate. Heat intensifies the action of the colloids in
causing precipitation of the dissolved salts, so that the temperatures of
the kidneys and bladder constitute favorable conditions. Colloids that are
undergoing decomposition are also specially powerful, so that the presence
of bacteria or fungi causing fermentation is an important factor.
In looking, therefore, for the immediate causes of urinary calculi we must
accord a high place to all those conditions which determine the presence of
excess of mucus, albumin, pus, blood, kidney casts, blood-coloring matter,
etc., in the urine. A catarrhal inflammation of the pelvis of the kidney,
of the ureter, or of the bladder, generating excess of mucus or pus;
inflammation of the kidneys, causing the discharge of blood, albumin, or
hyaline casts into the urinary passages; inflammation of the liver, lungs,
or other distant organ, resulting in the escape of albumin in the urine;
disorders of the liver or of the blood-forming functions, resulting in
hematuria or hemoglobinuria; sprains or other injuries to the back, or
disease of the spinal marrow, which cause the escape of blood with the
urine; the presence in the bladder of a bacterial ferment, which determines
the decomposition of the mucus and urea, the evolution of ammonia and the
consequent destruction of the protecting cellular (epithelia) lining of the
bladder, or the irritation caused by the presence of an already formed
calculus, may produce the colloid or uncrystallizable body that proves so
effective in the precipitation of stone or gravel. It has long been known
that calculi almost invariably form around any foreign body introduced into
the kidney or bladder, and I have seen a large, calculous mass surrounding
a splinter of an arrow that had penetrated and broken off in the body of a
deer. The explanation is now satisfactory--the foreign body carries in with
it bacteria, which act as ferments upon the urine and mucus in addition to
the mechanical injury caused by its presence. If such a body has been
introduced through the solid tissues, there is, in addition, the presence
of the blood and lymph derived from the wounded structures.
CLASSIFICATION OF URINARY CALCULI.
Urinary calculi are most conveniently divided according to the locality in
which they are found. Thus we find first renal calculi, formed in the
kidney (Pl. XI, fig. 1), and which for cattle must be again divided into
calculi of the uriniferous tubes and calculi of the pelvis. The second
class are named ureteral calculi because they are found in the duct leading
from the kidney to the bladder (ureter). The third class are the vesical
calculi, from the bladder or vesicle in which they are found. The fourth
class are the urethral calculi, and are found in the duct leading outward
from the bladder through the penis (urethra). The fifth and last class are
the preputial calculi, since they are found within the sheath of the penis
(prepuce).
Calculi may also be classed according to their chemical composition and
this has the advantage of suggesting the special cause of each as found in
the feed, water, soil, or general conditions of health. This classification
affords no guide to their location or symptoms, as calculi of the same
chemical composition may be formed at any part of the urinary passages, as
those formed in the kidney may pass on through all the various passages
outward, unless it is found at any point of their progress that they have
grown so large that the passage will not admit them. The following are
among the concretions found in the various parts:
(1) _Coralline calculi._--These are of a dull-white color and irregular
surface, like coral. They are made up of hard and resistant layers evenly
deposited around a central nucleus. (Pl. XI, fig. 3.) Their specific
gravity is 1,760, water being 1,000, and they contain 74 per cent of
carbonate of lime with some carbonate of magnesia, organic matter, and a
trace of carbonate of iron. Yellowish-white, smooth, round calculi of the
same chemical composition are met with.
(2) _Pearly calculi._--These are more frequent than the first-named
variety. They are very hard and smooth on the surface, reflecting a play of
various colors after the fashion of a pearl. This peculiarity appears to be
caused by the thinness and semitransparency of the supposed layers. They
have a specific gravity of 2,109 to 2,351, and nearly the same chemical
composition as the coralline variety. Golding Bird found a specimen of this
kind formed of carbonate of lime and organic matter only.
(3) _Green calculi_ (_metalloid calculi_).--These are usually small and
numerous, as they are exceedingly common. They are of a very hard
consistency, and have a clear-polished, greenish surface of almost metallic
brilliancy. They have a specific gravity of 2.301 and a composition almost
identical with the second variety.
(4) _White calculi._--Pure white, smooth, lustrous calculi are rare. They
have a specific gravity of 2.307, and contain as much as 92 per cent of
carbonate of lime with carbonate of magnesia and organic matter.
(5) _Ammonio-magnesium calculi._--These are of a grayish color and a very
rough, crystalline surface, which proves very irritating to the mucous
membrane. They have a specific gravity of 1.109 to 1.637, and are composed
chiefly of ammonio-magnesium phosphate, oxalate of lime, and organic
matter, with a little carbonate of lime and magnesia.
(6) _Siliceous calculi._--These are clear, smooth, and hard, and usually
spherical. They have a specific gravity of 1.265 to 1.376, and contain 57
per cent of silica with carbonates of iron and magnesia, organic matter,
and traces of iron. In other specimens of siliceous calculi there was a
specific gravity of 3.122, and there was 79 to 85 per cent of carbonate of
lime together with carbonate of magnesia, and iron, silica, and organic
matter. Others are almost exclusively made of silica.
(7) _Oxalate of lime calculi_ (_mulberry calculi_) (Pl. XI, fig. 2).--
These are characterized by their extremely rough, angular surface, formed
by the octahedral crystals of oxalate of lime. Their specific gravity may
be 3.441, and they contain oxalate of lime to the extent of 81 per cent,
together with carbonates of lime and magnesia and organic matter.
(8) _Gravel_ (_pultaceous deposits_).--Simple crystals may be met with at
any point from the kidneys to the external opening at the end of the
prepuce (sheath), and they may appear singly, as crystals, or they may
accumulate in masses of fine spherical crystals almost like dirty powdered
chalk suspended in water. In the ox this is especially common as a
collection in the sheath, distending that into a soft, doughy swelling.
FORMS OF CALCULI IN DIFFERENT SITUATIONS.
Apart from the rough crystalline surfaces of the calculi of oxalate of lime
and ammonio-magnesium phosphate, the general tendency is to a smooth, round
outline. At times, however, they show more or less flattening with rounded
angular edges, caused by the contact and mutual friction of two calculi.
Sometimes two or more stones lying together become united into one by a new
external deposit, and the resulting mass then shows rounded swellings on
opposite sides. The large calculi occupying the pelvis of the kidneys
usually show a central part having the outline of the main cavity of the
pelvis and two or more projections that have been molded into the
corresponding branches or channels which lead to corresponding lobes of the
kidney. In winter and spring small concretions in the form of plates are
often met with in the branches of the pelvis, having been formed and molded
in the confined space between the projecting papilla and the surrounding
cuplike branch of the pelvis. Finally, the pulplike deposits in the sheath
and elsewhere are made up of globular masses, individually so small as to
be often practically microscopic.
STONE IN THE KIDNEY (RENAL CALCULI).
[Pl. XI, fig. 1.]
In an animal leading the quiet, uneventful life of the ox, stones of
large size may be present in the kidney without producing any disorder
appreciable to the people about him. In cattle fattened on dry feed in
winter, on the magnesian limestone of New York, it is exceptional to find
the substance of the kidney free from calculi about the size of a grain of
wheat or less, and standing out as white objects in the general red of the
cut surface of the organ. Similarly around the papillÊ in the cuplike arms
of the pelvis we find minute, flattened or more or less rounded,
yellowish-white concretions. Even the large concretions may prove
apparently harmless. I have a calculus several ounces in weight which
filled the entire pelvis of the kidney, that was found by accident in a
fat carcass while being dressed. In work oxen, however, such concretions
may give rise to symptoms of kidney disease, such as stiffness of the
loins, shown especially in the acts of rising or turning, weakness of the
hind parts when set to pull a heavy load, an irritability of the kidneys,
shown by the frequent passage of urine in small quantity, tenderness of
the loins, shown when they are pinched or lightly struck, and it may be
the passage of blood or minute gritty masses with the urine. If the attack
is severe, what is called "renal colic" (kidney colic) may be shown by
frequent uneasy shifting of the hind limbs, shaking or twisting of the
tail, looking around at the flanks, and lying down and rising again at
short intervals without apparent cause. The frequent passage of urine,
the blood or gritty masses contained in it, and perhaps the hard, stony
cylinders around the tufts of hair of the sheath, show that the source
of the suffering is the urinary organs. In bad cases active inflammation
of the kidneys may set in. (See "Nephritis," p. 123.)
URETERAL CALCULI.
These are small stones which have passed from the pelvis of the kidney into
the canal (ureter) leading from the kidney to the bladder, but, being too
large to pass on easily, have blocked that canal and forced the urine back
upon the kidney. The result is the production of symptoms more violent than
in renal calculi, though not varying, save in intensity, from those of
renal colic. In case of complete and unrelieved obstruction, the secretion
of the kidney on that side is entirely abolished, and it becomes the seat
of passive congestion, and it may even be absorbed in greater part or as a
whole, leaving only a fibrous sac containing fluid with a urinous odor. In
small cattle, in which the oiled hand introduced into the last gut may
reach the affected part, the distended ureter may be felt as a tense,
elastic cord, extending forward from the point of obstruction on the
lateral wall of the pelvis and beneath the loins toward the kidney. If
relief is obtained by the onward passage of the stone a free flow of urine
usually follows, in the midst of which may often be found gritty masses. If
the outlets from both kidneys are similarly blocked the animal becomes
poisoned by the retention in the blood of the elements of the urine, and by
their reabsorption after secretion.
_Treatment of renal and ureteral calculi._--Treatment is not very
successful, as only the smallest calculi can pass through the ureter and
enter the bladder, and even if they should do so they are liable to a
progressive increase there, so that later they may cause the symptoms of
stone in the bladder. Fortunately, ordinary dairy, growing, or fattening
cattle rarely show evident symptoms of illness, and even though they do so
they can usually be fattened and slaughtered before the health is seriously
impaired. In work oxen the case is different, and acute symptoms may
develop, but even then the animal may often be fitted for the butcher. When
treatment is demanded it is primarily soothing and antispasmodic.
Fomentations with warm water over the loins should be persisted in without
intermission until relief has been secured. The soothing effect on the
kidney will often relieve inflammation and irritation, should the stone be
in that situation, while if in the ureter the warm fomentations will at
once soothe irritation, relax spasm of the muscular coat of the canal, and
favor an abundant secretion from the kidney, which, pressing on the
obstructing stone, may slowly push it on into the bladder. Large doses of
laudanum (2 ounces) or of solid extract of belladonna (2 drams) will not
only soothe the pain but relax the spasm and favor the onward passage of
the calculus. The animal should be encouraged to drink large quantities of
cool water to favor the free secretion of a very watery urine, which will
not only serve to obviate irritation and continued deposit caused by a
highly concentrated urine, but will press the stone onward toward the
bladder, and even in certain cases will tend to disintegrate it by solution
of some of its elements, and thus to favor its crumbling and expulsion.
This is a principle which must never be lost sight of in the treatment of
calculi. The immersion of the stone in a liquid of a lower specific gravity
than that in which it has formed and grown tends to dissolve out the more
soluble of its component parts, and thus to destroy its density and
cohesion at all points, and thereby to favor its complete disintegration
and expulsion. This explains why cattle taken from a herd on magnesian
limestone in spring, after the long, dry feeding of winter, usually have
renal calculi, while cattle from the same herd in the fall, after a
summer's run on a succulent pasture, are almost always free from
concretions. The abundance of liquid taken in the green feed and expelled
through the kidneys and the low density or watery nature of the urine have
so opened the texture and destroyed the density of the smaller stones and
gravel that they have all been disintegrated and removed. This, too, is the
main reason why benefit is derived from a prolonged stay at mineral springs
by the human victims of gravel. If they had swallowed the same number of
quarts of pure water at home and distributed it at suitable times each day,
they would have benefited largely without a visit to the springs.
It follows from what has been just said that a succulent diet, including a
large quantity of water (gruels, sloppy mashes, turnips, beets, potatoes,
apples, pumpkins, ensilage, succulent grasses), is an important factor in
the relief of the milder forms of stone and gravel.
_Prevention._--Prevention of calculus especially demands this supply of
water and watery rations on all soils and in all conditions in which there
is a predisposition to the disease. It must also be sought by attempts to
obviate all those conditions mentioned above as causative of the malady.
Sometimes good rain water can be furnished in limestone districts, but
putrid or bad-smelling rain water is to be avoided as probably more
injurious than that from the limestone. Unsuccessful attempts have been
made to dissolve calculi by alkaline salts and mineral acids, respectively,
but their failure as a remedy does not necessarily condemn them as
preventives. One dram of caustic potash or of hydrochloric acid may be
given daily in the drinking water. In diametrically opposite ways these
attack and decompose the less soluble salts and form new ones which are
more soluble and therefore little disposed to precipitate in the solid
form. Both are beneficial as increasing the secretion of urine. In cases in
which the diet has been too highly charged with phosphates (wheat bran,
etc.), these aliments must be restricted and water allowed ad libitum. If
the crystals passed with the urine are the sharp angular (octahedral) ones
of oxalate of lime, then the breathing should be made more active by
exercise, and any disease of the lungs subjected to appropriate treatment.
If the crystals are triangular prisms of ammonia-magnesium phosphate or
starlike forms with feathery rays, the indications are to withhold the feed
or water that abounds in magnesia and check the fermentation in the urine
by attempts to destroy its bacteria. In the latter direction plenty of
pure-water diuretics, and a daily dose of oil of turpentine in milk, or a
dose thrice a day of a solution containing one-tenth grain each of biniodid
of mercury and iodid of potassium would be indicated.
In considering the subject of prevention, it must never be forgotten that
any disease of a distant organ which determines the passage from the blood
into the urine of albumin or any other colloid (uncrystallizable) body is
strongly provocative of calculus, and should, if possible, be corrected.
Apart from cases from geological formation, faulty feeding, and other
causes, the grand preventive of calculus is a long, summer's pasturage of
succulent grasses, or in winter a diet of ensilage or other succulent feed.
The calculi formed in part of silica demand special notice. This agent is
secreted in the urine in the form of silicate of potash and is thrown down
as insoluble silica when a stronger acid displaces it by combining with the
potash to its exclusion. In cases of siliceous calculi, accordingly, the
appropriate chemical prevention is caustic potash, which being present in
the free state would attract to itself any free acid and leave the silica
in its soluble condition as silicate of potash.
STONE IN THE BLADDER (VESICAL CALCULUS, OR URETHRAL CALCULUS).
Stone in the bladder may be of any size, but in the ox does not usually
exceed half an inch in diameter. There may, however, be a number of small
calculi; indeed, they are sometimes so small and numerous as to form a
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