Part 26

In very urgent cases, 1 ounce to 2 ounces chloral hydrate is often effective. It acts as a powerful antiferment, checking further extrication of gas, and counteracts spasms of the bowels, so that gas passes more freely per anum, vermicular movements are resumed and recovery may be hoped for.

Puncture of the stomach through the external abdominal wall can only be effected by transfixing the transverse colon above which it lies and few have the hardihood to undertake this. It may, however, be punctured with comparative safety through the fourteenth to the seventeenth intercostal space in its upper half (Scammel). The overdistended stomach pressing forward on the left half of the diaphragm, applies that against the inner surface of the ribs, the lung being driven forward out of the way, and the liver and colon are also displaced, so that the trochar transfixes the skin, intercostal muscles, costal and phrenic pleura, diaphragm, peritoneum and stomach. The marked drumlike resonance on percussion indicates the best point for the puncture, and the trochar should be directed inward and slightly backward and pushed until solid resistance at its point ceases. As the intestines are usually tympanitic as well it may be requisite to puncture also the cæcum and colon, to restore the peristalsis of the alimentary tract generally. Antiseptics such as sulphurous acid, the sulphites, or hyposulphites, calcium chloride, bleaching powder, potassium permanganate or chloral hydrate, may be introduced through the cannula or by the mouth.

As far as the stomach is concerned, an effective relief can be had through the probang or stomach pump. A small one-half inch hollow probang may be safely passed through the nose and gullet into the stomach, and any gas or liquid allowed to escape. With proper attachments this may be fixed to a stomach pump and the viscus exhausted of all available liquid, after which an equal amount is pumped in and again withdrawn, until the contents are reduced to a normal amount. The water pumped in may be rendered antiseptic by sodium chloride, sodium bisulphite, or other antiferment, so that further extrication of gas will be prevented. If it is necessary to use the ordinary probang or stomach tube introduced through the mouth, great care must be taken in introducing it to see that the soft palate does not deflect it downward into the larynx. Its presence in the gullet above and beyond the larynx can be felt by manipulation from without, and until this is ascertained it should on no account be pushed onward.

The importance of a measure of mechanical relief such as this, is the greater that the stomach of the soliped is non-absorbing, and relief from undue pressure of contents can only be had by their passage upward or downward. Then again, the horse cannot vomit like the carnivora and omnivora, nor regurgitate like ruminants, and if left to himself with engorged stomach, his case is hopeless indeed.

The contingent weakness in cases of recovery may demand careful feeding and a course of bitter tonics.

GASTRIC INDIGESTION IN CARNIVORA.

Causes: too frequent feeding, indigestible food, epidermic products, bones, tendons, rubber, cords, marbles, pebbles, catarrh, inflammation, intestinal lesions, fever. Symptoms: dullness, restlessness, eating grass, vomiting, seeks seclusion, colics, giddiness, tense, tender abdomen. Treatment: emetic, diluents, dieting, tonics.

Causes. Unintermittent work of the organ wears out its tone and indigestion follows. The more indigestible the food, and the admixture with the food of indigestible materials the greater the tendency to this fatigue and atony. Thus epidermic materials, hair, horn, wool, bristles, feathers are often injurious; also bones, tendons, and above all pieces of rubber, caouchouc, cords, marbles, pebbles and other small objects. Fortunately such agents are usually rejected by vomiting, but if retained, the movements of the viscus become tardy and its secretions defective, and fermentation, indigestion and irritation ensue. The evil effects however mostly come of catarrhal and other inflammations of the stomach, and serious lesions of the intestines, (inflammation, obstruction, volvulus, intussusception, tumors, strangulated hernia,) or acute fever. In any such case the stomach ceases to act, and its contents become a center of active fermentation with more or less irritation.

Symptoms. In transient cases the dog will appear dull and restless, moving about, and, if opportunity affords, perhaps eating grass so as to hasten emesis and relief. With this relief the subject may remasticate and swallow the very materials he has vomited.

If relief is not secured by vomiting, the animal remains dull, anxious, retiring, seeking perhaps seclusion and darkness, is taciturn, moves continually, lying down first on one side and then on the other, or successively in different places, looks round at the belly, starts up suddenly with a piercing cry, and may appear giddy and uncertain in his gait. The abdomen is usually tense or even full and tender to touch.

Treatment. The first resort is the evacuation of the stomach by vomiting. Give tepid water and tickle the fauces with a feather or the finger. Or ½ to 1 gr. tartar emetic in a tablespoonful tepid water, or a teaspoonful of ipecacuan wine. Or ½ dr. of a ¹⁄₁₀₀ solution of apomorphia hypodermically. Beyond this, little is wanted except careful feeding as regards quantity and quality. Nux vomica ½ gr. twice a day will serve to restore tone. Further treatment will come naturally under catarrhal gastritis.

ACUTE GASTRIC INDIGESTION IN SWINE.

Causes: fermented or putrid swill, spoilt vegetables, frozen aliments, caustic alkalies (powdered soaps) from kitchen, indigestible materials, poisons. Symptoms: dullness, grunting, restlessness, seeking seclusion, colics, vomiting, rumbling, tense, tucked up abdomen, diarrhœa. Treatment: emetic, bland acids, laxative, dieting, bitters, iron.

Causes. Swine have such a varied dietary, are so constantly fed swill containing all manner of ingredients and often kept in barrels, etc., that are never emptied and cleansed, and therefore so often the seat of septic fermentation, that both gastritis and enteritis are often produced. Spoilt turnips, potatoes, apples and other succulent vegetables, or those that have been exposed to frost, or which are devoured while frozen are additional causes of irritation. The various caustic alkaline powders used in washing the table dishes and the product added to the swill is another cause of such outbreaks which, attacking a whole herd at once, is attributed to hog cholera. Then indigestible materials (hoofs, hair, bristles, tree bark, etc.) when they fail to be rejected by vomiting cause gastritis and indigestion. Finally a long list of medicinal and toxic substances act in this way.

Symptoms are like those seen in dogs, dullness, arching of the back, drawing the feet together, erection of the bristles, hiding under the litter, grunting, restlessness, frequent movement from place to place, lifting of the hind feet, grubbing in the litter with the snout, tension of the abdomen, and often abdominal rumbling followed by diarrhœa and recovery. More commonly, however, relief comes from early rejection of the irritant matters by vomiting.

Treatment. Induce emesis as in the dog. Give vinegar in case of alkaline poisoning. Follow this by a laxative if the irritants have gained the intestines, and finally a course of iron or bitters. Careful dieting is absolutely essential.

ACUTE CATARRHAL GASTRITIS IN THE HORSE.

Causes: wet fermented food, cryptogams, bacteria, sprouted green potatoes, sand, irritants, hot food, frosted food, ill health, starvation, anæmia, siliceous plants, diseased teeth or salivary apparatus, parasites, calculi, specific inflammations. Symptoms: depraved appetite, licking soils, walls, filth, etc., clammy mouth, red bordered tongue, eructations, colic, rumbling, tympany, icterus, costive, coated fæces, tender hypochondrium, anorexia, emaciation. Lesions: stomach full or nearly empty, pyloric sac congested, mucosa thickened, petechiated, with excess of mucus and desquamated epithelium, cells swollen opaque, congested duodenum, pale yellow liver, with excess of pigment in cells, also in urine, ruptured stomach, hemorrhagic infiltrations. Treatment: careful dieting, laxative, stomachics, pepsin, antiferments, bitters, ipecacuan.

Causes. This is a much less common affection in horses than dogs and is usually charged on some fault in diet. Fodders that have been badly harvested or wet from any other cause and are musty, dusty, rusty, or covered with any irritant or poisonous cryptogams or bacterial ferment, sprouted oats, or potatoes that have become green by exposure to the sun, sand and gravel in the grain, irritant plants like ranunculus, euphorbium, veratrum, etc.; cooked food given too hot, or vegetable food given frosted; putrid water, and indeed all the causes of indigestion tend to produce gastric catarrh. Weakness of the stomach and gastric functions from any cause is a concurrent factor. Thus extensive inflammations and violent fevers, prolonged abstinence, starvation, anæmic and parasitic affections, the action of frozen food on the viscus, are to be feared. A horse which has been for a week or more without food is extremely subject to such attacks unless fed with the greatest caution at first. Irritant plants like carex, equisetum, etc., which act mechanically by reason of the contained silica, food imperfectly masticated on account of disease of the jaws, teeth or salivary glands, parasites like spiroptera and bots and phosphatic and oat-hair calculi, act mechanically. Finally certain affections like petechial fever, influenza, pneumonia, pustulous stomatitis and horse pox may develop local foci of inflammation in the stomach. When once started, microbian infection tends to maintain and aggravate it.

Symptoms. These are very indefinite, depending very much on the complications. Some loss or perversion of appetite, a licking of the soil or walls, eating litter, filth and even manure, a clammy mouth, a redness along the margin of the tongue, eructations or attempts to eructate, or actual vomiting, colicy pains which are usually dull until the bowels are implicated, more or less rumbling in the bowels, sometimes icterus, in other cases tympany, and nearly always tardy passage of hard and scanty mucus-covered fæces. The colics may be intermittent, appearing only just after food is taken, or they may be continuous, the animal pawing incessantly hour after hour. A slight hyperthermia and a distinct tenderness of the epigastrium and left hypochondrium to pressure are valuable symptoms. Percussion causes even keener suffering.

If the gastric contents are abundant and fermentation active, death may ensue from gastric tympany. In other cases, the persistence of colics at the time of feeding, of impaired appetite, constipation and loss of condition are the main symptoms. In the last named cases the patient may die of marasmus.

Lesions. In cases terminating in fermentation and fatal tympany the stomach is full; in other types it is empty of all but water, mucus, and perhaps some irritant contents, or decomposed food. The alveolar mucosa of the right sac and above all of the pylorus is red, congested, petechiated, macculated, thickened to double its normal thickness or more, thrown into rugæ, and covered with tenacious mucus. This mucus is highly charged with detached epithelial cells, and at different points the mucosa is abraded by their desquamation. The epithelium generally shows swollen, opaque cells. The red congested spots show active engorgement of the capillaries, and this is especially marked around the glandular follicles, with more or less formation of embryonic cells. The duodenum is often implicated with similar lesions of the mucosa and its epithelial layers, which may block the orifices of the pancreatic and especially of the biliary duct. In this case there is a yellowish discoloration of the liver, excess of pigment in the hepatic cells, and hemorrhagic spots in the liver and even in the kidneys. The urine may be yellow or reddish brown from the presence of bile or blood pigment. In ruptured stomach, spiroptera, bots, and other irritants, we find their characteristic lesions, and in petechial fever there is excessive and partly hemorrhagic infiltration of the mucosa and submucosa. In protracted cases ulcers may be present on both stomach and intestine. When it is a localization of some specific fever the characteristic lesions of that affection will be found.

Treatment. If appetite continues, diet should be restricted to a very moderate allowance of green food, pulped roots, bran mash, boiled flaxseed, boiled middlings, with pure water or whey. If there are irritants in the stomach they may be got rid of by a laxative (aloes 4 drachms, or sulphate of soda ½ pound). Sodium bicarbonate (½ drachm 2 or 3 times daily) is desirable to stimulate peptic secretion and check acid fermentations. Pepsin (2 drachms) should be given at equal intervals. Fermentations should be checked by the use of salol (1 to 2 drachms), naphthalin (1 to 2 drachms), benzo-naphthol (1 to 3 drachms), or calcium salicylate (2 drachms).

In this connection bitters are of value to improve the tone of the gastric mucosa, nux vomica, gentian, quinia and quassia in combination with ipecacuan giving good results.

PHLEGMONOUS (PURULENT) GASTRITIS IN THE HORSE.

Definition: deep inflammation tending to abscess. Causes: invasion by pus microbes, infectious diseases, parasitism, traumas. Symptoms: hyperthermia, colic, tenderness, icterus, coincident disease, hæmatemesis. Lesions: submucous or subperitoneal abscess, parasites, peritonitis, exudation, thickening, neoplasm of mucosa, catarrhal complications. Treatment: careful diet, antiseptics, bitters, laxatives.

Definition. This is a gastric inflammation affecting the membranous layers, and tending to submucous or subperitoneal abscess. It is much less frequent than the catarrhal form.

Causes. It may be attributed to invasion of the gastric walls by pus microbes, and appears as secondary abscess in pyæmia and above all in strangles. The microbes are introduced more directly through the wounds inflicted by the larvæ of œstrus, or by the burrowing of these (Argus, Schlieppe, Schortmann), or of spiroptera (Argus). Wounds by sharp pointed bodies taken in with the food, furnish other infection—atria, and in their turn ulcers connected with catarrhal or toxic inflammation may furnish a means of entrance.