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A Case of Renal Calculus with Complications
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57 1
and ulna and the upper row of carpal bones had been completely removed at the first operation, and a septic periostitis was found extending as far as th e upper third of the forearm. The fibrous tissue of the origi na l swelling was so thick as to render the limb quite rigid, so that excessive mobility-one of the diag nostic symptoms of complete fracture --was entirely absent. The flaps over the stump which were brought together with silk sutures, united by first int ention, and the iJitch immediately afterwards began to recover her norm al health and spirits. A silk ligature was a pplied to tli e radial artery.
VII. SI NU S IN
A
H ORSE 's FOOT.
Subject. -A bay m are , aged 7, the property of a hawker. H istory.- The mare became lame and was taken to a farrier, who ex amined the foot and could find nothin g in it to acco unt for the lamen ess. The foot was then put in a linseed meal poultice, and a few days aiter wa rds the owner found part of a lady's hatpin protruding from th e foot, about I in. behind the point of the fro g, and withdrew it. Symptollls. -Ten days after the accident th e ma re was seen standing on three legs, and a si nus was found a t the place where the pin had been. Ex plorati on wi th a probe re vealed the sinus to be of grea t depth. Treatmeut.-Had the animal brought to th e College in the ambulance, cast, a nd an oes theti zed generally with chloroform and locall y wi th cocaine over th e plantar nerves; put on a tourniquet just below th e knee, thoroughly scraped and washed the affected foot, cut away the horn r ound the ori fi ce of the sinus, and scraped out the latter with a curette to its bottom, going through the plantar aponeurosis on to th e pos terior aspect of the navic ular bone, whi ch was superfi cially affected, and con sequen tly on ly very gently scraped; sy rin ged out the cav ity with ly sol soluti on, then irrigated with tincture of iodin e, dusted with pure iodofor m, plugged with sterili zed gauze saturated with tincture of iodine, appli ed a pad and bandage a nd leather boot, and put th e patient in slings. Dressed daily afterwards w ith 2 per cent. lysol in boiled water, with tincture of iodine, I to 2 of boiled water, pure iodoform, iodin e gauze, a nd protec ti ve dressing. Th ere was prac tically no discha rge fro m the operation wound, a nd the deep cavity gradually filled up wi th g ranul ation s. The mare recovered the use of the limb by degrees, and after six weeks had elapsed a shoe with a leath er sole and tar and tow dressing were applied, a nd the mare was practically sound . For controlling th e a nim als which were difficult to dress we found Howard' s side- fe tter a grea t boon.
A CASE OF REN AL C ALC U L U S WITH COMPLICATIONS. llY ARTH U R PAYNE, F. R.C . V.S., WEYBRIDG E .
TH E patient was a St. Bernard, male, bred by the owner in May, 1906. He had good health until a ttaining the age of 10 months, whe n he was noticed to lose condition . I was consulted early in 1907 , and found the dog presenting a very unthrifty appearance. Th e visible mucous membranes denoted an
57 2
The Veterina ry
J ourllal.
ischre mic condition; the coa t was dry and harsh. The animal had a languid gait, and a fter taking a few steps would "flop " down. The pulse was s mall, the cardiac sounds were weak but other wise normal, and the te mperature wa s normal. With a good libera l di et and pills of arsenic, iron, and q uinine, he rapidly gain ed in fle sh a n d~ made an uneventful recovery. On A ug ust 26 of this year (1 909) I was requested t o call and see the d og as soon a s possible. Upon my arrival I found him in a pitiable conditiDn ; he was crouching and ap parently with diffi culty passing blood-s tained urine. The floor of the kennel-run wa s liberally sprinkled with blood -stained urine, and I found a "cast " a bout 2 in. long. I co uld not de tect a calculus either in the urethra or bladder, but the wa lls of the latter were thick ened, and I wa s a ble to diag nose an enlarged prostate. The te m perature was 102' 3 0 F., a nd the pul se fast and small. I could not obta in a very lucid history from the m an in cha rge of the dog , a s the owner and his cha uffeur- the la tter bein g the on e who k new mos t about the dog-were away from home. All I could ascertain was that the patien t had had a diffi cul ty in passin g his urine d uring th e last few d ays , and had rather a poor appetite. I prescribed urotropine g r. x. three times da ily, and a diet of milk , fi sh, and boiled tripe. The following day there was a n appreciable improve ment ; the urine was a better c.ol our, and passed a t interv a ls with a fairly steady stream. The appetite returned and th e patient did not present such a woebegon e appearan ce. On the 28th th ere was a marked improveme nt , a nd on the 30th the urine passed freely, was of a normal colour, and the a ppetite was good. I must here pa y a tri b ute to th e va lue of urotropine and to its cheaper c hemica l s ubstitute , hexam e th y lene·t e tra mine. In so many cases of urin a ry trouble I have found its action simply miraculous. On Sep te mber 2 I received a n urgent message from th e owner, who had just returned home , a nd on my arri va l I found th e orig in al alarming symptom s, but now only a few drops of al most pure blood escaped frolll the urethra. A metal sound was passed, a nd a calc ulus could be detected in the usual position in the urethra. As the animal was so distressed th e owner in sisted on having him destroyed . Post 1II0rtem.- Th e body was fairly w ell nouri shed , th e penis swollen and blue. A urethral calCuJu s was di scovered jll st behind t he os penis. The wall s of the bladder were thic kened, and th e inner coat eroded and infl a med throug hout, and contain ed n ine calcll li , varying in si ze from a pea do wn ward s. In the pelvis of left kidney was a cdlculus in three pieces; the pieces could be piec ed together, and the surfaces which came in apposition had the appearance of th e articular surface of bones, but were broken a way in place s. \ \lith the pieces placed in position the calculus meas ured 5 c m . in leng th, 3 cm. in height, and about 2 cm. throug h . Wh ere it was n ot blood-s tained the ca lculu s was almost whit e , and had bright g listenin g spots in its substance, and appeared of a uniform character throughout. I should judge that the urethra l calculus wa s in its position on S eptember I, and that the ma n in charge had not observed the poor beast's condition. The particular points to which especial attention may be
Carcinoma
0./ the
Clitoris, Vulva, and Vagina.
573
drawn are the comparatively young age of th e patient, the a mount of mischief which had taken pl ace, and the absence of sym ptom s of urin ary trouble up to the time when we were consulted. The owner had frequently rem a rked that the dog exhibited extraordinary sex ual excitem ent under the slightest provocation.
CARCINOMA OF THE CLITORIS, VU L VA, AND VAGINA. FROM THE REPORT OF THE VETERI N ARY CO LLEG E OF DRESDE N.
A RATH E R well-nourished ma re, aged about 9, was brought to the clinic to be operated on for a swelIing on the vulva. The vulva was completely deformed; the left vagi nal lip was almost entirely destroyed whilst the right protrud ed over to the left and was considerably enlarged . The urine was often passed in a wide stream to the left . The right vaginal lip showed at its ed ge, especialIyat its upper commissure, pronounced dest ruction of tissue. Th e deeper
portions of the labium felt hard. In place of th e clitoris, ex tending and going over to the rig ht labium was a hard, tu berous swelling, showing necrosis here and there on its surface. The vagi nal wall on the tight si de was hard and infiltrated, and on the left side tb e hardness began about 6 cm. inside, and the left labi um ,vas almost completely destroyed , and in its place was an ulcerous surface which was covered over by the right labium. In the region of tbe vulva on e could easily see the course of swollen lymphatic vessels. Microscopic examination of a small portion of the neoplasm led to the diagnosis of epithel ial
57 1
and ulna and the upper row of carpal bones had been completely removed at the first operation, and a septic periostitis was found extending as far as th e upper third of the forearm. The fibrous tissue of the origi na l swelling was so thick as to render the limb quite rigid, so that excessive mobility-one of the diag nostic symptoms of complete fracture --was entirely absent. The flaps over the stump which were brought together with silk sutures, united by first int ention, and the iJitch immediately afterwards began to recover her norm al health and spirits. A silk ligature was a pplied to tli e radial artery.
VII. SI NU S IN
A
H ORSE 's FOOT.
Subject. -A bay m are , aged 7, the property of a hawker. H istory.- The mare became lame and was taken to a farrier, who ex amined the foot and could find nothin g in it to acco unt for the lamen ess. The foot was then put in a linseed meal poultice, and a few days aiter wa rds the owner found part of a lady's hatpin protruding from th e foot, about I in. behind the point of the fro g, and withdrew it. Symptollls. -Ten days after the accident th e ma re was seen standing on three legs, and a si nus was found a t the place where the pin had been. Ex plorati on wi th a probe re vealed the sinus to be of grea t depth. Treatmeut.-Had the animal brought to th e College in the ambulance, cast, a nd an oes theti zed generally with chloroform and locall y wi th cocaine over th e plantar nerves; put on a tourniquet just below th e knee, thoroughly scraped and washed the affected foot, cut away the horn r ound the ori fi ce of the sinus, and scraped out the latter with a curette to its bottom, going through the plantar aponeurosis on to th e pos terior aspect of the navic ular bone, whi ch was superfi cially affected, and con sequen tly on ly very gently scraped; sy rin ged out the cav ity with ly sol soluti on, then irrigated with tincture of iodin e, dusted with pure iodofor m, plugged with sterili zed gauze saturated with tincture of iodine, appli ed a pad and bandage a nd leather boot, and put th e patient in slings. Dressed daily afterwards w ith 2 per cent. lysol in boiled water, with tincture of iodine, I to 2 of boiled water, pure iodoform, iodin e gauze, a nd protec ti ve dressing. Th ere was prac tically no discha rge fro m the operation wound, a nd the deep cavity gradually filled up wi th g ranul ation s. The mare recovered the use of the limb by degrees, and after six weeks had elapsed a shoe with a leath er sole and tar and tow dressing were applied, a nd the mare was practically sound . For controlling th e a nim als which were difficult to dress we found Howard' s side- fe tter a grea t boon.
A CASE OF REN AL C ALC U L U S WITH COMPLICATIONS. llY ARTH U R PAYNE, F. R.C . V.S., WEYBRIDG E .
TH E patient was a St. Bernard, male, bred by the owner in May, 1906. He had good health until a ttaining the age of 10 months, whe n he was noticed to lose condition . I was consulted early in 1907 , and found the dog presenting a very unthrifty appearance. Th e visible mucous membranes denoted an
57 2
The Veterina ry
J ourllal.
ischre mic condition; the coa t was dry and harsh. The animal had a languid gait, and a fter taking a few steps would "flop " down. The pulse was s mall, the cardiac sounds were weak but other wise normal, and the te mperature wa s normal. With a good libera l di et and pills of arsenic, iron, and q uinine, he rapidly gain ed in fle sh a n d~ made an uneventful recovery. On A ug ust 26 of this year (1 909) I was requested t o call and see the d og as soon a s possible. Upon my arrival I found him in a pitiable conditiDn ; he was crouching and ap parently with diffi culty passing blood-s tained urine. The floor of the kennel-run wa s liberally sprinkled with blood -stained urine, and I found a "cast " a bout 2 in. long. I co uld not de tect a calculus either in the urethra or bladder, but the wa lls of the latter were thick ened, and I wa s a ble to diag nose an enlarged prostate. The te m perature was 102' 3 0 F., a nd the pul se fast and small. I could not obta in a very lucid history from the m an in cha rge of the dog , a s the owner and his cha uffeur- the la tter bein g the on e who k new mos t about the dog-were away from home. All I could ascertain was that the patien t had had a diffi cul ty in passin g his urine d uring th e last few d ays , and had rather a poor appetite. I prescribed urotropine g r. x. three times da ily, and a diet of milk , fi sh, and boiled tripe. The following day there was a n appreciable improve ment ; the urine was a better c.ol our, and passed a t interv a ls with a fairly steady stream. The appetite returned and th e patient did not present such a woebegon e appearan ce. On the 28th th ere was a marked improveme nt , a nd on the 30th the urine passed freely, was of a normal colour, and the a ppetite was good. I must here pa y a tri b ute to th e va lue of urotropine and to its cheaper c hemica l s ubstitute , hexam e th y lene·t e tra mine. In so many cases of urin a ry trouble I have found its action simply miraculous. On Sep te mber 2 I received a n urgent message from th e owner, who had just returned home , a nd on my arri va l I found th e orig in al alarming symptom s, but now only a few drops of al most pure blood escaped frolll the urethra. A metal sound was passed, a nd a calc ulus could be detected in the usual position in the urethra. As the animal was so distressed th e owner in sisted on having him destroyed . Post 1II0rtem.- Th e body was fairly w ell nouri shed , th e penis swollen and blue. A urethral calCuJu s was di scovered jll st behind t he os penis. The wall s of the bladder were thic kened, and th e inner coat eroded and infl a med throug hout, and contain ed n ine calcll li , varying in si ze from a pea do wn ward s. In the pelvis of left kidney was a cdlculus in three pieces; the pieces could be piec ed together, and the surfaces which came in apposition had the appearance of th e articular surface of bones, but were broken a way in place s. \ \lith the pieces placed in position the calculus meas ured 5 c m . in leng th, 3 cm. in height, and about 2 cm. throug h . Wh ere it was n ot blood-s tained the ca lculu s was almost whit e , and had bright g listenin g spots in its substance, and appeared of a uniform character throughout. I should judge that the urethra l calculus wa s in its position on S eptember I, and that the ma n in charge had not observed the poor beast's condition. The particular points to which especial attention may be
Carcinoma
0./ the
Clitoris, Vulva, and Vagina.
573
drawn are the comparatively young age of th e patient, the a mount of mischief which had taken pl ace, and the absence of sym ptom s of urin ary trouble up to the time when we were consulted. The owner had frequently rem a rked that the dog exhibited extraordinary sex ual excitem ent under the slightest provocation.
CARCINOMA OF THE CLITORIS, VU L VA, AND VAGINA. FROM THE REPORT OF THE VETERI N ARY CO LLEG E OF DRESDE N.
A RATH E R well-nourished ma re, aged about 9, was brought to the clinic to be operated on for a swelIing on the vulva. The vulva was completely deformed; the left vagi nal lip was almost entirely destroyed whilst the right protrud ed over to the left and was considerably enlarged . The urine was often passed in a wide stream to the left . The right vaginal lip showed at its ed ge, especialIyat its upper commissure, pronounced dest ruction of tissue. Th e deeper
portions of the labium felt hard. In place of th e clitoris, ex tending and going over to the rig ht labium was a hard, tu berous swelling, showing necrosis here and there on its surface. The vagi nal wall on the tight si de was hard and infiltrated, and on the left side tb e hardness began about 6 cm. inside, and the left labi um ,vas almost completely destroyed , and in its place was an ulcerous surface which was covered over by the right labium. In the region of tbe vulva on e could easily see the course of swollen lymphatic vessels. Microscopic examination of a small portion of the neoplasm led to the diagnosis of epithel ial