Definition. Causes: Debility—general and local, and its causes,
fermentescible food, legumes, new grain, paralyzing seeds, musty
fodder, defective teeth, jaws and salivary glands, iced water after
grain, verminous embolism, chill. Symptoms: Anamnesis, colic, gaseous
distension, stupor, death, diagnosis from spasmodic colic. Course:
Fatal in two hours, or more. Recovery. Lesions: Distension of bowels
with carburetted hydrogen, carbon dioxide, and nitrogen, redness of
intestinal mucosa, anæmia of abdominal organs, congestion of cutaneous
and surface vessels. Treatment: Stimulants, antiseptics, enemata,
chloral hydrate, puncture, eserine, pilocarpin, friction, massage,
exercise, dieting, bitters.
_Definition._ A gaseous overdistension of the intestines, from
fermentations in the ingesta, but also in part from air that has been
swallowed, and from carbon dioxide exhaled from the blood circulating in
the intestinal mucosa.
_Causes._ These are to a large extent the same as those of gastric
tympany. General and digestive debility resulting from former disease,
from spare diet, from unsuitable or indigestible food, from anæmia, from
parasites, from hemorrhages, is a potent predisposing cause.
Weakness of the alimentary canal from catarrh, or other persistent
disease, from impaired innervation, from embolism of the vessels and
imperfect circulation also predisposes, or again the lack of vermicular
movement and of the mingling of the digestive fluids with the food,
leaving the latter in a specially fermentescible condition. As direct
_exciting causes_ may be named:
Very _fermentescible food in excess_, such as the leguminous products
(beans, peas, vetches, cowpea, alfalfa, sainfoin, clover) in their green
condition. These contain an excess of protein compounds, which should be
mainly digested in the stomach, and if passed rapidly in large quantity
into the intestines, they fail to be sufficiently acted on by the
trypsin, and are specially liable to fermentation. Very rapidly grown
and aqueous grasses are similarly liable to decomposition.
_New grain_ is specially liable to fermentation the more so that it
sometimes contains a paralyzing agent, which acts like intoxicating
ryegrass. The ripening seeds of many forage plants often act in this
way, (annual and perennial ryegrass, millet, Hungarian grass, chick
vetch, vetches generally). The same has been observed of the leaves of
growing maize, grapevine leaves, and potato plants.
_Musty and spoiled fodders_ of all kinds are very dangerous, the toxic
principles of the fungi and bacterial ferments paralyzing the
sympathetic nervous filaments.
_Fodders_ that are _imperfectly masticated and insalivated_ owing to
defective teeth or diseased jaws or glands are liable to prove hurtful
in a similar way.
_A full drink of water_ and especially of ice cold water _after a feed
of grain_ is one of the most potent factors. The stomach and intestines
are both roused to violent peristaltic action, the undigested food is
washed on into the bowels, and too often the action of the cold induces
congestion and partial paresis, and exposes the undigested mass to the
uncontrolled action of ferments.
_Circulatory troubles_ caused by verminous embolism (see intestinal
congestion) is another very prolific factor. _A sudden chill_ in an
animal that is perspiring and fatigued may precipitate an attack, by
causing a retrocession of blood from the skin to the intestines, with
resulting paresis of their coats.
_Symptoms._ The condition is usually complicated with gastric tympany,
so that we have a complication of symptoms. The history of the case is
often diagnostic, showing one of the above mentioned causes, and above
all a full drink after a feed of grain, speedily followed by abdominal
pain, gaseous distension of the abdomen, causing death in two hours or
upward. The distension of the abdomen usually shows more on the right
than the left, and the resonance on percussion is greater. Colics are
usually less violent than in intestinal congestion, and the actions of
the animal are less precipitate or disorderly. He may lie down, roll and
rise, but the constant restless movement, the sitting on the haunches,
and the frequent agonized turning of the nose toward the flank are
rarely shown. The animal is rather dull and prostrate, passing finally
into a stupor, the face is pinched and anxious, the back arched, the
head pendent, the walk slow and unsteady, and respiration and pulse
accelerated. There is no complete intermission of pain, though it is
more acute at one time than another, for some time there is rumbling in
the bowels followed by complete silence, as they are fully paralyzed,
fæces may be passed at first, but this ceases as the floating colon is
emptied and the gaseous distension becomes extreme, and urination which
may take place in the early stages is no longer effected in the advanced
ones. The compression of the thorax causes severe dyspnœa, accompanied,
when the patient is down, by a slight groan.
_Course_. In the advanced stages the animal may sink to the ground
oppressed by the shock, poisoned by the carbon dioxide which can no
longer be exhaled through the lungs, and by hydrogen sulphide and other
toxic products of intestinal fermentation. Death may follow two hours
after a hearty meal and is rarely long delayed in fatal cases.
Improvement may be recognized by the termination of the paresis, the
lessening of the abdominal tension, the return of the rumbling in the
abdomen, the passage of fæces and flatus, and of urine and by general
relief.
_Lesions_. In case of death the overdistension of the intestines and
abdomen is the most marked lesion, the composition of the gas varying
with the nature of the ingesta and the duration of the illness.
Carburetted hydrogen compounds abound as a rule in the early stages,
while carbon dioxide predominates later. Pinner found 49 per cent. of
carburetted hydrogen, 8 per cent. of carbon dioxide, and 42 per cent. of
nitrogen.
The contents of the large intestines are usually in considerable amount
and in an undigested condition. The walls of the distended bowels are
greatly attenuated and may show congestion, petechiæ, or rupture.
Rupture of the diaphragm is not uncommon. Congestion of the lungs, but
especially of the skin and superficial structures of the body, and of
the brain are natural results of the expulsion of blood from the
abdominal cavity.
_Treatment_. The desiderata are: relief from existing gaseous tension;
arrest of further fermentation; and the restoration of the vermicular
movement of the intestine.
The two first indications may sometimes be successfully met by
stimulants and antiseptics. Formerly, mild cases were successfully
treated by oil of peppermint and oil of turpentine in oil, and a free
use of enemata. A more modern resort is a large (virtually soporific)
dose of chloral hydrate (1 oz.) given in solution. This is at once a
powerful antiferment and an antispasmodic. It is moreover highly
volatile and in the heat of the stomach is readily passed on into the
duodenum and absorbed. Employed early it not only checks the production
of gas, but it relaxes the whole intestinal tract and allows the free
passage of accumulated gas which passes off rapidly per anum.
But in severe cases the gaseous distension is too great to hope for
relief by such measures and puncture of the cæcum or double colon is the
only hopeful resort. This is made with a small trochar and cannula not
more than ¼ inch in bore, which is inserted at the point of greatest
resonance. The point usually advised, as in the ox, is the centre of the
space circumscribed by the last rib, the ilium and the transverse
processes of the lumbar vertebræ. A better plan is to percuss and
puncture the point where the drumlike resonance is greatest. The higher
the puncture the more promising as the cannula is less likely to be
blocked by the ingesta which accumulates in the lower part of each
viscus. The cannula may be left in place for some time to keep the bowel
flaccid and allow time for the restoration of its contractile functions.
The cannula may be utilized to inject antiferments (chloral) and
peristaltic stimulants (eserine, pilocarpin, barium chloride). In cases
in which puncture is not imperative these agents may be used
hypodermically, eserine 1½ gr., pilocarpin 2 grs. or barium chloride 7
grs.
Enemata of soapsuds, with or without stimulants prove effective in
emptying the floating colon and soliciting the action of the large
intestines generally and the passage of flatus. Friction of the abdomen
and walking exercise are desirable. After recovery a restricted diet,
laxatives and bitters serve to restore the lost tone of the alimentary
canal.
ACUTE INTESTINAL INDIGESTION WITH IMPACTION OF THE LARGE INTESTINES IN
THE HORSE.
Definition. Causes: dessication of ingesta in colon, sacculation,
constriction at pelvic flexure, debility, ill health, local
peristalsis, diseased teeth, jaws or salivary apparatus, excess of
food, heating grain, hard fibrous indigestible fodder, green
leguminosæ, privation of water, inactivity, verminous aneurisms,
tumors, strictures, obstructions. Symptoms: colics after meals,
becoming more severe, tension and firmness of right side, sitting on
haunches, stretching, small, hard, dry coated stools, obstruction felt
on rectal exploration, frequent attempts to urinate, tympany. Course:
six hours to six days or more, signs of aggravation and improvement.
Lesions: large intestines tympanitic, impaction often at pelvic
flexure, or other constriction, adherent mucosa has thick mucus or
blood, is discolored, friable, necrosis, perforation, liquid contents
of distended bowel in front, rupture, invagination, volvulus.
Treatment: laxative diet, injections, aloes, pilocarpin, eserine,
barium chloride, chloral hydrate, morphia, henbane, belladonna,
puncture, cold or oleaginous enemata, empty or knead rectum and colon,
cold compress, electricity, friction, laparotomy.
_Definition._ This is an impaction and obstruction of the colon, and
usually of the pelvic flexure with dried and badly digested alimentary
matters.
_Causes._ Certain anatomical and physiological conditions contribute to
this disease in the horse. The ingesta as it leaves the stomach is
liquid or pultaceous and throughout the small intestines it remains so,
so that they are little liable to impaction. But by the time the cæcum
is reached much of the liquid has been absorbed, and as the contents
pass into the double colon they are usually a soft solid, which
gradually becomes dried as it advances through the double and floating
colon. The sacculation of cæcum and colon tends to delay the masses and
favors absorption. The pelvic flexure, the narrowest part of the double
colon, is formed by an acute bend of the viscus on itself so that the
dried masses advancing from in front are especially liable to become
arrested and impacted at this point. Impaction may, however, occur at
any part of the large intestine.
Any debility or atony of the intestines predisposes to the condition.
The ingesta accumulates in the portion which does not contract
sufficiently to pass it onward, and this soon becomes distended to a
state of absolute paresis. All conditions of debility, and all prolonged
ill health tend to operate in this way by lessening vermicular movement.
Again in cases of nausea or intestinal disorder the supervention of
antiperistaltic movements, will tend to accumulate the ingesta at one
point and favor impaction (Ernst).
As in the case of other indigestions the imperfect preparation of the
food is an active factor. Diseased teeth, jaws or salivary glands, act
in this way and a functionally weak stomach contributes to this as to
other intestinal disorders.
An excess of food and especially indigestible food will contribute to
impaction. Heating grain, like corn, wheat, buckwheat, passed rapidly
through the stomach in an imperfectly digested condition, tends to
accumulate in the larger intestines. Hard, fibrous fodders like hay and
straw that have run to seed, or which have been washed out by rains,
bleached or heated, rye-straw, the stalks of beans, peas, vetches, which
have been similarly spoiled, and clover hay affected with cryptogams or
other ferments act in the same way. Even clover eaten green, produces in
foals impactions to which the hairs of the leaves and chalices
materially contribute (Verrier). The allied plants alfalfa and sainfoin
when passed rapidly through the stomach tend to impaction of the large
intestines. But any fibrous, indigestible and innutritious fodder, taken
in excess to make up the deficiency of nutriment is liable to act in
this way.
Other conditions that contribute to impaction are lack of water,
especially at night when much hay is consumed, and lack of exercise
which tends to torpor of both liver and bowels.
Finally verminous aneurisms and embolism of the intestinal arteries
induce congestion, paresis, spasms, and other disorders which tend to
aggregation and impaction. Also tumors, strictures and obstructions of
all kinds tend to impaction.
_Symptoms._ A certain amount of impaction is not incompatible with
ordinary health, but as this increases all grades of colic may be met
with from the most simple and transient to the most persistent and
severe.
In the milder forms slight and transient colics come on after meals, for
days in succession, before any serious attack is sustained. These are
especially marked under dry bulky fodder (hay), less so on grain, and
less on green food or roots. The animal paws, moves the hind limbs
uneasily, looks at the flanks, he may even kick at the abdomen, lie down
and roll, rise, pass a little manure or flatus, and seeming relieved may
resume feeding, until the next attack. The intermissions may last a few
minutes, a quarter of an hour or longer, and they gradually become more
prolonged until they disappear for the time. Sooner or later, however,
the obstruction becomes more complete and the colic more severe and
persistent. To the ordinary symptoms of violent abdominal pain there are
added symptoms which point to bowel impaction or obstruction. There is a
special tension of the right side of the abdomen, with flatness on
percussion. When down there is a tendency to sit on the haunches to
relieve pressure on the diaphragm and lungs. When standing there is a
disposition to stretch the fore limbs out forward and the hind ones
backward. Fæces may be passed at first in a few small round balls at a
time, but this soon ceases, and very little or none can be obtained even
by the use of enemas. The straining is usually so violent as to expel
the enemata as soon as introduced. The hand introduced into the rectum
can easily detect the solid impacted pelvic flexure of the colon
pressing backward into the pelvis or impinging on the right pubis.
Another common symptom is the frequent passage of urine in dribblets,
due to the irritation of the bladder by the pressure upon it of the
impacted colon during straining. In cases of this kind the colon and
cæcum become tympanitic as first shown by a resonant distension of the
right flank obliterating the hollow in front of the ilium, and later by
a similar condition of the left flank.
The abdominal pain is usually less acute than in simple spasmodic colic
or intestinal congestion. The face is less pinched and anxious, the eye
less frightened, the kicking at the belly less violent, and the lying
down more deliberate and careful. Very commonly the patient merely rests
on his belly or side without attempting to roll.
_Course._ The disease may last six to twelve hours, or even as many days
before it ends in recovery or death. The colicy symptoms usually
increase, with the complication of dyspnœa when tympany becomes well
marked, hyperthermia in case of the supervention of enteritis, and signs
of general peritonitis and collapse in case of rupture of the bowel. A
sudden increase of the pain may otherwise indicate the occurrence of
invagination.
As indicating a favorable termination there may be restoration of the
rumbling, the passage of fæces at first perhaps in the form of solid
cylindroid masses, and later as a mixture of broken up ingesta, liquid
and gas, the tension of the abdomen disappears, the pains lessen and
cease, and there is a gradual restoration to health.
_Lesions._ The abdominal walls are tense and more or less drumlike, and
when these are cut through the large intestines protrude strongly. When
punctured there is a free discharge of gas. The most common seat of
obstruction is the pelvic flexure, but it may occur in the floating
colon, or rectum, in the double colon even at other parts than its
pelvic flexure, in the cæcum or in the ilio-cæcal opening. The impacted
mass is firm, rather dry, covered with mucus and sometimes blood, and
manifestly only partially digested. Its size and form vary greatly as it
is moulded into the affected viscus. The mucosa in contact with the
impacted mass is covered with a thick layer of viscid mucus sometimes
streaked with blood. The mucosa itself is congested, thickened, friable,
and marked with spots or patches of various colors (white, gray, green,)
indicating commencing necrosis. In old standing cases this may extend to
the other coats of the bowel determining perforation or laceration.
The portion of the bowel immediately in front of the obstruction is
filled with liquid which has been forced down upon the barrier by the
active peristaltic movements, and the distension by liquid and gas may
have increased until rupture has ensued with the escape of the contents
into the peritoneal cavity. Invagination, volvulus and peritonitis are
common.
_Treatment._ This will vary according to the stage and degree of the
illness. In slight cases with transient colics only after meals, a more
laxative diet may suffice. Boiled flaxseed, roots, potatoes, apples,
green cornstalks, silage, or even sloppy bran mashes, with an abundance
of good water and active exercise may prove efficient. Copious
injections of warm water, soapsuds, or linseed oil emulsion may be
added.
In the more violent cases we must resort to more active measures and yet
drastic purgatives are full of danger. The free secretion from the
vascular small intestines and the active vermicular movements, lead to
the speedy overdistension of the bowel just in front of the obstruction,
the current being strong and active all around the contracting gut in
contact with the mucosa, while a weaker return current sets in in the
centre, but is effectually checked and arrested at no great distance in
front of the impaction by the strong backward peripheral stream. If
therefore the impaction is not broken up, it is inevitable that the gut
above must be more and more distended until a rupture ensues.
Yet in a certain number of cases a moderate dose of aloes or castor oil
supplemented by frequent enemata and other measures, succeeds in safely
overcoming the obstruction. The solid impacted mass is gradually
softened and removed, and finally after perhaps three or four days of
complete obstruction the fæces begin to pass and recovery ensues.
With or without the aloes, the hypodermic use of pilocarpin or eserine
or both will often succeed in obtaining successful peristalsis. Barium
chloride while inducing more active peristalsis is, on that account,
somewhat more dangerous.
Pain may be moderated and fermentation checked by chloral hydrate (½
oz.), or, an anodyne, morphia (2–4 grs.), may be given hypodermically.
In the absence of these, extract of hyoscyamus or belladonna (2 drs.)
may be given by the mouth, and repeated as may be necessary. If tympany
is dangerous use the trochar and cannula. Enemata and other accessory
measures must not be neglected.
W. Williams has resorted to rectal injections of 2 oz. aloes forced into
the rectum by a syringe furnished with a long elastic tube, and repeated
when expelled. Brusasco has used copious liquid injections poured into a
rectal tube the end of which is raised at least ten feet above the
croup, so as to gain the requisite force. Schadrin uses injections of
cold water to stimulate the bowels to contractions. Injections of oils
or mucilaginous matters when they can be carried far enough lubricate
the walls and favor the passage of solid matters. Castor oil which acts
to a large extent locally is especially applicable.
Mechanical applications are often valuable. If the obstruction is lodged
in the rectum or floating colon it can usually be reached by the oiled
hand and carefully extracted. If this is not successful, impactions in
the floating colon or pelvic flexure may still be to a large extent
broken up and loosened by the knuckles of the oiled hand in the rectum.
I have often resorted to this with excellent effect. Impactions in the
cæcum or elsewhere in the double colon are however inaccessible for such
treatment. For these, external measures are available. Wilhelm wraps the
abdomen in cold compresses. Causse and Lafosse recommend the electric
current. Friction to the skin of the abdomen is a common resort.
Rudofsky turns the animal on his side or his back, to remove the weight
of the small intestines from the impacted cæcum or colon, and favor the
exit by gravitation of the contents from the cæcum into the colon.
Kneading of the abdomen with the fists or knee when in this recumbent
position may also be resorted to.
As a _dernier resort_, Gaullet performed laparotomy but with no success
as the animal died the following day. The horse was, however, in
extremis at the time of the operation and a portion of the intestinal
wall was blackish and gangrenous. To be successful such an operation
should be practiced before there is any probability of gangrene, and
while the patient is still in good condition for recuperation. But these
are just the cases in which success is to be hoped for from less
dangerous measures. Again the conditions for its success are best in
case of obstruction of the pelvic flexure, as that could easily be drawn
out through a spacious abdominal wound, incised, emptied and sutured
with careful antiseptic precautions, and with little risk of infection
of the peritoneum. But this is just the point where an obstruction can
be efficiently dealt with in a less dangerous way, by kneading through
the rectum for example. The operation, however, is not one to be utterly
condemned, but in any case in which it is certain that the obstruction
is otherwise irremediable, it should be adopted at as early a stage as
possible, under anæsthesia, and with antiseptic precautions. The after
treatment would consist in a restricted diet of milk or gruel with
antiseptics to prevent fermentation and bloating.