CHAPTER VI.. Enteritis.

ENTERITIS.

Enteritis consists in inflammation of the intestine, or, more precisely, in inflammation of the intestinal mucous membrane. All the constituent portions of the intestinal tube may be affected (duodenum, jejeunum, ileum, colon, cæcum); but clinical distinctions and localisation of inflammation in the various parts are very difficult in the domesticated animals, and at present it is impossible to describe with any accuracy the differences between duodenitis, enteritis of the jejeunum and ileum, colitis or typhlitis. Without doubt certain symptoms suggest that some regions are more affected than others; but clinically we are only able to distinguish between acute and chronic enteritis. Acute enteritis may assume different forms, according to its intensity, rapidity of development, and lesions, so that it is possible to distinguish between such conditions as simple acute enteritis and hæmorrhagic enteritis.

Chronic enteritis, an abstraction founded on our knowledge of such specific forms of enteritis as are due to tuberculosis, distomatosis, helminthiasis, etc., usually assumes the diarrhœic form.

ACUTE ENTERITIS.

As acute enteritis, whether localised in one portion of the intestine or involving the whole intestinal tube, is produced by varying causes, and assumes very varying degrees of intensity, its clinical symptoms are equally diverse.

=Causation.= The various forms of enteritis result from two great series of causes: infections and intoxications. Normally the intestine contains an extremely large number of different microbes, which may prove of service so long as circulation, secretion, and peristalsis continue normal; but as soon as any perturbation occurs, either in the blood supply or in the movement of the bowel, normal secretion is impeded; abnormal organic fermentation commences, producing irritant principles or toxins which at once set up local irritation, or, being absorbed, produce that complex of symptoms which we recognise as enteritis, intoxication of intestinal origin, or even infection.

Bearing in mind these facts, we are better able to understand the part played by cold, by damaged fodder, by intense, stimulating feeding, or sudden changes in the food, as well as by the action of drastic purgatives, which modify beyond physiological limits the condition of the glands, or even cause local desquamation of epithelium.

Toxic substances or plants act similarly by modifying either the circulatory, secretory, or motor systems.

=Symptoms.= The first appreciable external symptoms appear to result from fever—loss of appetite, suspension of rumination, dryness of the muzzle and of the mouth, earthy-red colour of the conjunctival mucous membrane, etc.

On manipulating the left flank one notes neither tympanites nor sensitiveness—in a word, there is no indication of functional disturbance of the rumen.

On the right side, on the contrary, palpation causes the animal to resist and to show signs of pain. According as this sensitiveness is more marked in the middle or upper region or towards the hypochondriac circle, we infer that the inflammation is most acute in the large or small intestine, either in the middle portions or, again, in the most anterior portion. The temperature always rises at the commencement, attaining 103° to 104° Fahr. (39·5° or 40° C.), but rarely a higher point, a fact which negatives the idea of a rapidly progressive infectious disease. Slight colic appears, and is accompanied by constipation; the fæces are covered with mucus, or false membranes, or are completely enclosed in fibrinous tubes. After four or five days the fæces change in character. Constipation gives place to a liquid, blackish, very fœtid diarrhœa. Finally the mouth exhales a stercoraceous odour, resulting from fœtid eructation.

The passage of flat or tubular false membranes continues for a certain time.

When false membranes constitute the chief symptom, the condition is termed “pseudo-membranous, croupal, or diphtheritic enteritis.” This form is only a variety of acute enteritis, but is grave, because complications due to hæmorrhage or infection are very liable to occur.

In certain cases movement causes groaning. In the slighter forms the patient may recover spontaneously. If fed with easily digested materials, the symptoms diminish in intensity. Towards the eighth day the fæces become normal, appetite and rumination reappear, and the secretion of milk which had fallen off rises to its normal amount. Resolution has occurred.

More frequently, either because the animals have less power of resistance or because decomposition is taking place more actively in the intestine, or, again, because intoxication is setting in, the disease becomes aggravated. Constipation is more marked, and the fæces passed are in small masses, covered with layers of epithelium, or sometimes streaked with blood. In other cases the diarrhœa becomes exaggerated and assumes a mucous or sero-mucous character; the temperature rises, and death results from exhaustion and infection, microorganisms passing from the lumen of the intestine through its walls and invading the general circulation.

=Lesions.= To study the lesions to advantage the autopsy must be performed as soon as possible after death.

In slight cases they consist of trifling generalised congestion of the intestinal mucous membrane. The points most affected show infiltration of the submucous coat, and sometimes of the muscular coat; the wall of the intestine is double its normal thickness, but the thickening never equals that seen in cases of rapidly fatal intestinal congestion.

At a more advanced stage the mucous membrane clearly is inflamed, its surface is covered with a fibrous exudate, and the glandular and epithelial cells proliferate, assume the embryonic form, and produce the new tissue which one recognises under the form of false membranes.

The false membranes are generally but slightly adherent, and are readily expelled.

In other cases, however, they adhere firmly, and when detached by the friction caused by movement of semi-digested food through the bowel, produce rupture of capillary vessels; this explains the presence of blood streaks in the fæces.

=The diagnosis= is relatively easy, especially at the onset, on account of the special character of the fæces and the sensitiveness of the right flank.

=The prognosis= is seldom grave. If the enteritis is taken at the beginning, recovery is usual; but if the animal has been ill for eight or ten days and is exhausted, and if fever and diarrhœa are intense, the prognosis should be guarded.

=The treatment= is that of all acute inflammatory diseases. Mustard plasters may be applied to the chest and abdomen and left in position for some hours, or may be repeated. Some practitioners prefer hot blankets or dry friction, or, again, rubbing with essence of turpentine, but this substance should be spread over large surfaces, in order to prevent injury to the skin. Bleeding is only justifiable in plethoric animals, and should never be exhaustive.

To relieve the digestive symptoms purgatives are at first given, even though diarrhœa is marked from the onset; for purgatives still constitute the best intestinal antiseptics, because they get rid of the intestinal contents and microbes. The diet should be carefully selected, and may consist of gruel, mucilaginous materials, linseed tea, cooked roots, etc.

Of drugs, sulphate of sodium in doses of 10 to 15 ounces is probably the best. It can gradually be replaced by 2 to 3 drachm doses of bicarbonate of soda or of ordinary salt per day. Laudanum, camphor, and bismuth relieve persistent colic and diarrhœa. Pilocarpine, veratrine and eserine, though recommended by some authors, present no advantage in our opinion. The first two of these substances certainly cause purgation, but the action is quite temporary. The last induces violent contraction of the striped muscular tissue, and may produce grave lesions or invagination when the bowel is diseased, thickened or infiltrated.

HÆMORRHAGIC ENTERITIS.

This form of enteritis derives its name from the dominant symptom, which consists in the passage of unaltered or clotted blood in the fæces. In the former case the blood is bright in colour, as if it came directly from an open vessel. In the second it is coagulated, and assumes the form of fibrinous clots, which seem to result from the superposition, in the intestinal tract of their constituent elements, viz., serum, blood corpuscles, and fibrin.

=Causation.= Hæmorrhagic enteritis is rarely seen except during the hottest days of summer, and in young animals which have previously shown nothing abnormal. The high temperature seems to favour its appearance, but is always supplemented by another cause, viz., the ingestion of irritant food, particularly of weeds and toxic plants or herbage of bad quality; amongst such may be mentioned dog’s mercury, and plants of the order Papaveraceæ, Euphorbiaceæ, etc. Otherwise the often rapid manner in which the disease develops indicates toxic enteritis.

In other cases, more benign in appearance, but quite as grave in reality, blood is passed continually, and the disease assumes a chronic form. It is then of parasitic origin, and is due to intestinal psorospermosis.

=Symptoms.= The primary symptoms are similar to those of acute enteritis, and consist of fever, dryness of the muzzle and of the mouth, colic and constipation. This is soon followed by loose motions containing blood or blood clots, according as the hæmorrhage occurs at a greater or less distance from the rectum. The fæces are then ejected violently to a considerable distance, on account of the exaggerated intestinal peristalsis.

The disease may produce death in twenty-four hours, though usually the end is deferred for several days, or, in cases due to sporozoa, for a considerably longer time. In these cases there is some chance of recovery, provided that treatment be prompt.

=The diagnosis= is very easy.

=The prognosis= is in all cases grave.

=The lesions= are ill-recognised. The animals die rapidly, and if not immediately examined show no characteristic lesions. The changes to be looked for consist in intense congestion or ulceration of the intestine, or even in ulceration of arterioles and of arteries of considerable size.

In parasitic enteritis one finds localised inflammation and, in the epithelial interstices, sporozoa, which cause the rupture of blood-vessels.

=Treatment.= It is necessary to act energetically from the outset, and to arrest hæmorrhage by acting on the intestine, on the vascular system, and on the skin. Mustard plasters or other external stimulant applications are therefore indicated. Internally, small doses of astringents like tannin, preparations of opium, 25 per cent. solution of sulphuric acid in alcohol, etc., are given to produce constriction of the vessels, though they seldom arrest the discharge of blood for long. In most cases it is necessary to have recourse to subcutaneous injections of ergotine, in doses of 5 to 10 grains in young animals, and 15 to 45 grains in adults. The dose may be given in two parts to prevent an unduly severe action. The smooth fibres of the small vessels are thus directly excited, and hæmorrhage ceases in consequence of clotting in the contracted vessels.

One may give for the same purpose injections of arseniate of strychnine, which has the advantage of sustaining the tone of the heart and preventing syncope. The dose should not exceed 1·5 grains in large animals.

Finally, a stimulating diet containing milk, alcohol, soup, cooked vegetables, and small quantities of vegetable pulp is useful.

With early treatment animals sometimes recover in a few hours.

Intravenous or subcutaneous injections of physiological salt solution (2 drachms of sodium chloride in one quart of water) may prove of value when hæmorrhage has been abundant and vascular pressure is low.

CHRONIC ENTERITIS (CHRONIC DIARRHŒA).

Chronic diarrhœa is common in byres. It appears suddenly, often fails to attract attention, and assumes the form of simple diarrhœa, a fact which accounts for it frequently being described as chronic diarrhœa, dysentery, etc.

=Causation= and =pathogeny=. This form of diarrhœa occurs sporadically throughout France, and under exceptional circumstances may permanently attack a number of animals in a given place.

The immediate cause is not known, but without doubt the disease is of microbic origin. Like Lignières, Moussu at one time believed that this disease was very probably identical with that known in Argentina under the names of diarrhœa, entéqué, or bovine pasteurellosis. The hypothesis has not been verified, and Lignières’ treatment, said by him to have succeeded in Argentina, always failed in Moussu’s hand.

The only point which seems admissible is that this disease, which Moussu considered to have analogies with chronic sporadic dysentery in man, is due to one or several organisms, which develop in the intestine and produce toxins, causing diarrhœa, without, however, marked inflammation of the intestinal mucous membrane.

=Symptoms.= The onset is often overlooked. The diarrhœa gradually increases without appearing to be very serious; but it persists in varying degrees of intensity. The patients do not appear to suffer, and do not lose their appetite or spirits, but in time the diarrhœa becomes exhausting; they waste, and after some months become excessively thin and poor.

Intestinal peristalsis becomes exaggerated without the existence of colic or tympanites. The evacuations are frequent, and little by little the abdomen retracts, until, in horseman’s parlance, “the belly is up to the back,” even in cows of four, seven, and eight years’ bearing.

The diarrhœa is serous, always fœtid, and without tenesmus.

The fæces may either be very soft or be passed in veritable jets. They are always a little discoloured, and frequently contain grain or undigested forage. They always contain numerous bubbles of gas.

The wasting during later periods of the disease is absolutely characteristic, and different from that of other wasting diseases, such as chronic broncho-pneumonia, tuberculosis, etc. The patients finally become walking skeletons. The red corpuscles of the blood progressively decrease, until the number may fall as low as 800,000 or even 500,000 red corpuscles instead of six millions, the normal figure. The œdema common to wasting conditions appears, and the animals die without suffering, in a condition of absolute exhaustion.

Complications are rare, though occasionally intestinal hæmorrhage or broncho-pneumonia occurs. The temperature, which remains normal or shows very slight changes throughout the course of the disease, may then oscillate between 101° and 103° Fahr. (38° and 39·5° C.).

=Lesions.= At the first glance no lesions can be detected on post-mortem examination except those of generalised wasting, but when the autopsy is carried out immediately after death all the interior of the intestine appears affected. The mucous membrane of the abomasum and the mucous folds appear infiltrated, thickened, and with moderate sub-epithelial congestion. The intestine seems friable, and tears with the slightest traction. The sub-epithelial portions of the mucous folds are infiltrated and congested, while the more prominent parts of the folds, which are exposed to the friction of semi-digested food, become eroded.

Throughout the length of the jejeunum and ileum the mucous membrane exhibits multitudes of small ulcerations.

Histologically, the epithelium and the glands seem atrophied, without any inflammatory change having occurred in the mucous or submucous coats.

The colon and the cæcum show similar lesions, and in addition brown deposits of pigment under the mucous membrane and along the course of the small blood-vessels. This lesion resembles that found in chronic dysentery in man, and suggested to Moussu a possible connection between the two diseases.

The liver is less than the normal size. In the heart Moussu has seen one case of sclerosis of the auricles and calcareous infiltration of the sub-endothelial lining of the aorta.

In several instances he has noted calcareous infiltration of the mesenteric lymphatic gland.

=Diagnosis.= It is easy to diagnose this condition, and quite possible to distinguish it from the diarrhœa of tuberculous enteritis, infectious hepatitis, and other conditions.

=Prognosis.= The prognosis is very grave, and the disease almost always proves fatal.

=Treatment.= At the present moment no curative treatment is known. Lignières’ treatment—viz., the injection of physiological salt solution and serum from healthy oxen, and saline solution or defibrinated blood—has never given permanently successful results.

All the drugs usually employed against diarrhœa, the antiseptics, astringents, etc., fail, or confer merely momentary benefit. Economically, nothing is to be gained by keeping the patients alive. With great care existence may be prolonged for months, or even for several years, but the animals never regain condition, and are never of any use.

The most rapid and lasting good effects follow the administration of 2½ to 8 fluid drachms of hydrochloric acid per day, given in two portions and very freely diluted.

DYSENTERY IN CALVES.

This disease sometimes appears on the first day after birth, frequently on the second or third. It may be mistaken for septicæmia of umbilical origin.

=Symptoms.= The young animal may be born vigorous and in good condition, though this is exceptional. More frequently it is puny and below normal weight. The first evacuation (of meconium) may exhibit the diarrhœic character; in other cases this peculiarity only appears on the second or third day, when half-digested milk is passed. The fluid is greyish, extremely fœtid, and rapidly becomes brownish and blood-stained. Evacuation is frequent and accompanied by tenesmus.

The patients at once become very dull, refuse to suck, and resist efforts to feed them by hand. The temperature rises, and the diarrhœa, which at first was of an alimentary character, becomes mucous, serous and blood-stained. The little patients appear “tucked up,” the flanks sink in, the strength diminishes, and in twenty-four hours, or two or three days at most, they die of exhaustion.

Recovery is exceptional, and when the disease assumes this character it usually attacks a considerable proportion of the other animals in the byre.

=Causation.= The exact cause of this form of dysentery in new-born calves has not yet been identified, but the disease is undoubtedly a microbic enteritis, and may even be a primary septicæmia of puerperal origin.

For a very long time this dysentery was mistaken for simple diarrhœa, though it exhibits neither the characteristics, course, nor termination of the latter disease.

The co-existence of epizootic abortion and dysentery in certain byres has led some authors to believe that a connection exists between the two diseases, and that the young are infected with dysentery at birth. Evidently, intra-uterine infection is not exceptional, and it seems quite natural that the new-born calf may equally suffer when the fœtal envelopes and fluids are infected before parturition. Epizootic abortion is probably not the only disease which may produce this condition.

=The diagnosis= is very simple. The course of the disease and its rapid development prevent it from being mistaken for ordinary diarrhœa. It is more difficult to distinguish from septicæmia of umbilical origin, although this disease also has well-marked characteristics.

=The prognosis= is not hopeful. Statistics show that almost all the affected animals die, and that those exceptional cases which survive remain puny and sickly. There is no economic advantage in attempting to save them.

The mothers of affected calves seldom show any sign of illness, though the after-birth is often retained.

=Lesions.= The macroscopic lesions are of very trifling importance compared with the gravity of the disease. The digestive tract appears congested throughout. The intestinal mucous membrane is moderately swollen, but without gross lesions. The intestinal contents exhale a sickly, fœtid odour. The smaller vessels and capillaries forming the peripheral vascular network appear distended, as in septicæmia. The carcases putrefy with extreme rapidity.

Curative =treatment= is very uncertain. Varying results have been obtained with doses of 4 to 5 drams of slight purgatives like borotartrate of potassium, sodium sulphate, and magnesium sulphate; small doses of intestinal antiseptics like salicylic acid, 15–grain doses of salicylate of soda, 45 to 75 grains of carbolic acid, 2 per cent. carbolic solution in doses of 7 to 12 drams; 1 per cent. Lysol solution in doses of 2 to 4 ounces; benzo-naphthol, lactic acid 45 to 75 grains, tar water, lime water, etc. Although all these preparations, when carefully used, generally give good results in the early stages of simple diarrhœa, they appear to fail in dysentery of new-born calves.

Prophylactic measures are more reliable. They consist:

(1.) In scrupulous disinfection of the byres when the first case of abortion occurs;

(2.) In successively isolating cows which are about to calve in a small specially detached stable;

(3.) In carefully disinfecting the genital organs of cows which have aborted, firstly with boiled water at a temperature of 100° Fahr., and then with 1 per cent. iodine solution.

Calves which are infected when born cannot be saved, but abortion can be prevented and dysentery so stamped out.

DIARRHŒIC ENTERITIS IN CALVES.

This disease is usually called “simple sporadic diarrhœa.” It may appear at any time before weaning, and can usually be cured if treated early before the patients show bodily wasting.

=Causation.= Indigestion from failure of the abomasum to deal with the milk usually precedes diarrhœic enteritis; it may terminate without complications, but very often is followed by diarrhœa. Anything which produces milk indigestion, therefore, favours the occurrence of enteritis. Such predisposing influences include over-distension of the abomasum, milk of bad chemical composition, milk tainted by keeping or by storage in dirty and infected pails, etc. The addition to the milk of nutritive substances which the abomasum and intestine are not yet capable of digesting, such as wheat, rye, barley, or maize meals, very often produces diarrhœa even when the meal is well cooked.

Chills, privations, irregular feeding, and badly-managed weaning may facilitate its development, but none of these causes, however important they may be, seem to play any other part than that of favouring the multiplication of the numerous varieties of microbes to be found in the intestinal tract. Vascular disturbance occurs, either as a result of direct irritation of the intestinal mucous membrane or of the action of toxic products contained in milk which has served as a culture medium for these microbes; this is followed by secretory disturbance, and the intestinal contents being modified in character, the microbes normally present undergo changes in number and quality. Inoffensive organisms assume pathogenic qualities and secrete toxic principles, normal digestion is disturbed, the intestinal defence becomes less perfect, toxic principles which the liver is incapable of destroying are absorbed, and diarrhœic enteritis is set up.

=Symptoms.= Diarrhœic enteritis appears during the second week of life, towards the end of the first month, or even later. It is characterised by the passage of fæces consisting of mucus and containing little clots of milk.

This is the first stage of alimentary diarrhœa, also termed “white diarrhœa” or “white scour.” It may prove unimportant; it may last a day or two and then cease. Most commonly diarrhœa increases and assumes a mucous and then a serous character, whilst the dejecta exhale a very characteristic repulsive smell. The excrement becomes greenish brown, and after several days or a week or more may appear blood-stained. The number of evacuations varies enormously, depending on the gravity of the condition. The ejected material is irritant, and the parts soiled by it, like the perineum, hocks, and back of the cannon bones, become slightly inflamed as though blistered; later, the hair falls away.

The general health then begins to suffer. Fever remains moderate, but the mouth is pasty, the tongue coated, and the breath fœtid.

The patients become thin, and lose their appetite and spirits. Palpation of the abdomen, especially of the right flank, is slightly painful, and the pulse is accelerated.

The diarrhœa may spontaneously diminish if the animal’s constitution prove sufficiently strong; but if it follows its course, the little patient becomes weaker, eats less, the evacuations increase and are accompanied by tenesmus. In seven to eight days, in rare cases in four to five, the animal dies from toxi-intoxication of intestinal origin, or from infection resulting from intestinal germs, particularly the bacterium Coli communis, obtaining entrance into the circulation. On the other hand, the diarrhœa may continue for weeks.

=The diagnosis= is easy, and there should be no difficulty in distinguishing this disease from dysentery and from umbilical phlebitis, which are also accompanied by diarrhœa.

=The prognosis= is grave, unless treatment is early undertaken. In the latter case there is a good chance of recovery.

=Lesions.= The macroscopic lesions are not of much interest, being confined to congestion of the intestinal mucous membrane, superficial desquamation of the epithelium, small vascular erosions, and general wasting.

The mesenteric lymphatic glands are swollen and œdematous.

After death from general infection, it is not uncommon to find pleural, peritoneal, and pericardial exudation or even endocarditis.

Even in cases where no post-mortem change has had time to occur cultures from the blood yield varieties of the bacterium Coli communis.

=Treatment.= The meals should be given at fixed hours, and regulated both as regards quantity and quality. These precautions alone suffice to prevent the appearance of diarrhœic enteritis.

Curative treatment has every chance of succeeding when undertaken at the outset. Delafond and Trasbot recommend mild purgatives, which act more rapidly than intestinal antiseptics. These comprise borotartrate of potash in doses of 4 to 5 drachms, sodium sulphate in doses of 2½ to 4 drachms, sulphate of magnesia, etc. By evacuating the bowel and removing a large number of the germs which have multiplied there, they arrest intoxication and prevent infection. Nevertheless, they should not be administered for long, and after one or two doses should be followed by antiseptics like benzo-naphthol, in doses of 15 to 30 grains, salicylic acid in doses of 5 to 10 grains, or salicylate of soda 45 to 60 grains. Mucilaginous and sweetened drinks containing lactic acid in doses of 45 to 75 grains per day may be given between the meals, or at intervals if the calf is sucking.

Laudanum in doses of 6 to 10 drops per day administered in rice water, extract of opium, weak solutions of tannin, etc., are also of value. Filliàtre has successfully used tar water in the first stages. The solution consists of vegetable tar 6 drachms, boiling water 1 quart. This solution is used tepid in the proportion of 1 part to 3 parts of warm milk.

Decoctions of spiked purple loosestrife, willow bark, etc., are also of great value in certain districts.

The drug which appears least dangerous, however, is that so often successfully used in young children—viz., subnitrate of bismuth. It can be given in doses of 30 to 45 grains per day, with lactic acid in doses of 75 to 150 grains, according to the size of the patients. If the animals are greatly exhausted and have been ill for some time there is less chance of recovery, and under these circumstances Dr. Lesage’s anti-colic serum might be used.

It gives excellent results in infants, and it has proved successful in simple diarrhœa of calves.