ACUTE CATARRHAL CYSTITIS.
Acrid diuretics, by mouth or skin, microbian infection, retention of urine, urethral calculus, parasites, spasm, enforced suspension of micturition, unclean catheter, adjacent infection, chill. Lesions: hyperæmia of mucosa, thickening, vascular distention, clouding of epithelium, muco-purulent secretion, alkaline fermentation, ammonia, liquefaction of cells, erosion. Symptoms: Slight fever, stiff, straddling gait, urine scanty, cloudy, alkaline, penis or clitoris semi-erect, smearing of tail or prepuce. Crystals of triple phosphate. Treatment: Antiseptics, boric or salicylic acid, gum arabic, astringent antiseptics, laxatives, flax seed, slippery elm, anodynes, diluents, piperazine, drainage, rest, restricted laxative diet, warmth, avoid stimulants.
Causes. Cystitis is caused in all animals by irritant diuretics like cantharides, copaiba, or oil of turpentine given by the mouth or applied to an extensive cutaneous surface. It is an error, however, to conclude with Williams that this is the sole cause. The very existence of calculi virtually implies bacterial infection, and fermentation. The presence of free ammonia in the urine usually implies fermentation, and fermentation must be looked upon as practically synonymous with microbian invasion. That bacteria may be present without serious injury is undoubted. The protective power of the healthy mucosa is very great. But when the mucosa is weakened, microbes that would otherwise be harmless, find a ready infection atrium, and triumph over the weakened tissues. Hence retention of urine and overdistension of the bladder as in urethral calculus, blocking of the urethra by a parasite, spasm of the sphincter vesicæ, compulsory retention as in the mare in harness, the dog kept indoors, or in railway car on a long journey, or in mares so travelling, may become the occasion of cystitis. Even in cases in which no microbe is present at first, this reaches the bladder by the introduction of an unclean catheter, or by extension from an uretheritis, vaginitis or metritis, or even from a peritonitis, or infected urachus. Or the infection may descend from a suppurating kidney. Another occasion of microbian invasion is the congestion which attends on exposure to cold.
Lesions. Hyperæmia of the cystic mucosa, with dilation and tortuous deviations of the larger vessels, thickening of the membrane, and distension and clouding of the epithelial cells, with a thick covering of tenacious mucus containing epithelial, pus, or white blood cells. As the disease advances epithelium is desquamated abundantly, and degenerates with production of free nuclei and pus. Along with these are microbes, usually the bacillus coli communis, and various cocci. In the fully established disease there is liable to be alkaline fermentation, and the liberated ammonia dissolves the epithelial cells, leading to extensive desquamation and raw granulating surfaces, so that the disease tends to run in a vitiating circle, the alkali dissolving the epithelium and increasing the microbian development and fermentation, which in its turn produces an increasing quantity of ammonia.
Symptoms. There is slight hyperthermia or none, stiff or straddling gait, frequent passage of urine in small quantities and cloudy, or straining without passage, the penis or clitoris is semi-erect, eversion of the lips of the vulva is frequent, and the bladder is tender (through prepubian wall, vagina or rectum). If a finger is inserted into the bladder in the mare the thickening of the walls can often be recognized. The urine often contains precipitated crystals of ammonio-magnesian phosphate, and even clots of blood. It has an alkaline reaction even in herbivora.
Treatment. The danger centres around the bacteridian fermentations, and a main object must be to disinfect the bladder. This will be all the more effectual if the lotions used are of an acid reaction. Thus boric acid or salicylic acid in 3 per cent. solution, injected after evacuation of the bladder and repeated a number of times a day may soon establish a healthy action. If the bladder is especially irritable a boiled weak solution of gum arabic will form a suitable medium. Other antiseptics are often used as creosote (0.5:100), carbolic acid (3:100), chloride of zinc (3:100), chlorate of potash (3:100), mercuric chloride (1:5000), silver nitrate (0.5:100), or astringents are often better: PbA, ZnSO4 tannic acid, ferri chloridi in dilute solution so as not to cause pain.
The bowels should be kept open by an occasional saline laxative, pain moderated by codeine, and abundance of pure water and a laxative diet enjoined. Linseed tea, and infusions of slippery elm or marsh mallow have long been employed, and by soothing and relaxing the bowels they act favorably on the urinary mucosa. Stimulants of the urinary track like buchu, uva ursi or copaiba in small doses, or antiseptics like creosote, boric acid, salicylic acid, piperazine, are available in slight cases or when the acute symptoms have subsided somewhat. With prior infection of the kidneys, the latter may be used. Constant drainage may be necessary to avoid distension.
Perfect rest is absolutely essential, a restricted laxative diet, and a careful avoidance of cold, and stimulants.
When urine is retained it should be removed with a thoroughly aseptic catheter.
In case of blood clots in the bladder, wash out with a boiled normal salt solution.