Part 54

Of the various domestic animals horses are the most liable to superpurgation, from an undue dose of aloes acting on the very large colon and cæcum. Hence the importance of using such an agent carefully in the young, fat or debilitated especially, of the avoidance of cold drinks or exercise to excess after the aloes has been given, and of keeping from work during its operation or immediately after.

Symptoms. These are of all degrees of severity from the frequent pulpy evacuations of animals fed exclusively on roots, (beets, turnips, potatoes), to the excessive and almost constant discharge of a dark colored liquid mingled with more or less mucus. The discharge may be of a light color and fœtid, indicating deficiency of bile, or of a dark yellowish brown and odorless.

Slight diarrhœa does not affect the appetite nor general health, nor check improvement in condition. In the more severe and continued forms there is loud rumbling in the abdomen, loss of appetite and condition, a rapid small pulse, accelerated breathing, pallid mucous membranes, sunken glassy eye, and increasing debility even to an unsteady gait. Distension of the abdomen with pawing and other indications of abdominal pain may appear in bad cases. In the milder cases due to simple irritation and congestion there is no tenesmus, no excess of mucus, no formation of bubbles or froth in the stools, as occurs in active intestinal fermentation and dysentery. In symptomatic cases on the other hand there are superadded the marked symptoms of intestinal inflammation, or fermentation, and the fæces become putrid and offensive, which they do also in the different infectious diseases (influenza, contagious pneumonia, rinderpest, lung plague, hog cholera, swine plague, canine distemper, fowl cholera), when the toxins and waste matters of the food and decomposing tissues are being thrown off by the bowels.

Diarrhœa may be complicated with other diseases and especially in the horse with laminitis.

In mild cases it tends to a spontaneous recovery, and is followed by some slight costiveness, and if this should prove extreme there may be some danger of complicating sequelæ such as indigestion, enteritis, pneumonia or laminitis.

Treatment. The first consideration for the practitioner is to discover if possible the immediate cause of the diarrhœa. If this is found to reside in some infectious or other disease aside from the bowel, the attention must be directed to that even more than to the diarrhœa. If it depends on an overdose of some purgative agent or of acrid purgative plants taken with the food, any further laxative is to be avoided, and yet astringents and other agents which tend to lock up the offending material in the alimentary canal must be equally guarded against. An abundance of mucilaginous and demulcent liquids (mallow, flaxseed gruel, boiled starch, etc.) may be given both by the mouth and anus, to sheathe and protect the irritable mucous membrane and to dilute and carry off the irritant contents. Moderate doses of opium may be required to allay the violence of the spasms and peristalsis, but this should not be pushed to the extent of locking up the irritants. Sometimes antiseptics (naphthalin, salol) are useful to check fermentation, and pepsin may be given to assist digestion.

In ordinary cases due to the presence of an irritant the first object must be to relieve the bowels of this, and the second to soothe the irritated mucous membrane. A laxative is usually all that is required, but it must be a mild one so as not to add to already existing irritation. Olive or castor oil are to be preferred as a rule (horse and ox 1 pint; sheep and swine 4 ounces; dog ½ ounce), alone or with a moderate dose of laudanum. Or rhubarb or aloes may be substituted if desired. A dose of whisky or brandy, or oil of turpentine will often do much to allay the secretion and peristalsis. These should be followed by moderate doses of flaxseed gruel, or solution of slippery elm or mallow, or simple well boiled gruels.

If the discharge persists after the laxative has had time to operate, these mucilaginous agents may be replaced by solutions of boiled starch, or of gum arabic, and small doses of calmatives such as laudanum (horse or ox 1 ounce, sheep or pig 2 drachms, dog 20 drops), or prussic acid or cyanide of potassium (30 drops of the acid or grains of the salt for horse or cow). Sub-carbonate of bismuth, chalk, and carminatives and antiseptics may also be given. According to the indications the practitioner must combat persistent intestinal fermentation, or a relaxed adynamic condition of the intestinal mucosa, or general weakness and exhaustion, with such agents as seem best adapted to the individual case.

Chronic cases will demand the exercise of much judgment. After a gentle laxative, salts of iron (sulphate, chloride) and pure bitters may be given with antiseptics. Or vegetable astringents (catechu, kino) with freshly burned charcoal and essential oils (peppermint, cloves, cajeput) may be employed. In some instances calomel and chalk (1:12) will serve a good end. In others silver nitrate, or arsenite of copper succeeds. Quinine, nux vomica, pepsin, may be used to improve tone. The diet is usually all important. Well boiled gruels, boiled milk, arrowroot, pulped or scraped raw flesh may be demanded in different cases. The patient should be kept at perfect rest, and all excitement avoided.

COLIC, ENTERALGIA, INTESTINAL SPASM.

Definition. Colicy pains from spasm, enteralgia, tympanitic indigestion, overloading of bowels, impaction, calculi, concretions, sand, foreign bodies, intestinal and arterial parasites, irritants, enteritis, catarrhal, bacteridian, protozoan, chemicals, strangulation, adhesion, volvulus, invagination, hernia, trauma of stomach or intestine, peritonitis, pleuritis, metritis, ovaritis, hepatitis, biliary calculus, nephritis, urinary calculus, neoplasms, lead poisoning. Causes of enteralgia or spasm, idiosyncrasy, nervousness, cold, wet, high condition, debility, cold, rain, dew, perspiration, fatigue, indigestion, rheumatism. Symptoms: horse—sudden attack, paws, kicks, anxious look at flank, crouches, goes down, rolls, sits, rises, shakes himself, feeds, repeats at intervals, rumbling, defecations. Complications. Diagnosis, symptoms violent, transient, completely intermittent, no fever, no tenderness; from acute indigestion by absence of faulty feed, loaded or tympanitic abdomen, crepitation, continuous pain, and of careful decubitus; from constipation by complete intermissions and freer passages; from intestinal worms by absence of fur on anus, of rubbed rump, and of parasites in stools; from verminous thrombosis by complete intermissions and absence of prostration, cold sweats and of bloody stools; from enteritis and other inflammations by absence of fever; from intestinal anthrax by the intermissions, the absence of brownish mucosa, and perhaps of anthrax from the district; from hepatitis by absence of icterus, tender hypochondrium, and fever; from kidney affections by lack of stiff, straddling gait, tender loins, stretching; from pleurisy by absence of catching breathing, tender intercostals, and friction sound; ruminants—similar symptoms except sitting up or rolling; swine—sudden starting with grunt or scream, vomiting, etc.; Carnivora—frequent moving, yelps, snapping, straining, looking at flank. Treatment: solipeds, morphia subcutem, anodynes, laxative, friction, walking, enemata, chloral hydrate: ruminants, walking, enemata, morphia, laxative; swine, morphia, laxative, antispasmodics, injections, derivatives; dog,—purgative, injections, chloral hydrate, ether, olive oil.

The term colic is loosely applied to all abdominal pains from whatever cause they may arise. It is thus allowed to embrace all diseases of the abdomen. In its more restricted sense in which it will here be considered it may be held to indicate =abdominal pain without inflammation or any structural lesion=.

It may however be well to note the most common causes of abdominal pain so that the distinction may be more definitely reached by a process of exclusion.

1st. =Simple spasmodic colic.= 2d. =Enteralgia or neuralgia of the intestines.= 3d. =Colics from indigestion=, a =tympanitic=, b =from overloading with ingesta=, c =from impaction or constipation=, d =from calculi or concretions= or from =sand=, or =gravel= taken with the food or from =foreign bodies= swallowed, e from =worms in the intestines=, f from =worms in the mesenteric vessels= (thrombo-embolic), g from =irritants taken with the food or otherwise=. 4th. Colics from =structural lesions of the intestines=; a from =inflammation of intestine=, b from =bacteridian inflammation of the bowels=, c from =protozoan inflammation=, d from =chemical or other irritants=, e from =intestinal strangulations=, f from =adhesions=, g from =volvulus=, h from =invagination=, i from =mesenteric omental or phrenic hernia=, j from =strangulated inguinal, femoral ventral or umbilical hernia=, k from =wounds=, =ruptures or perforations of stomach or intestines=, l from =peritonitis or pleuritis=, m from =metritis or ovaritis=, n from =hepatitis or biliary calculus=, o from =pancreatitis or pancreatic calculus=, p from =nephritis=, =nephritic=, =uretral=, =cystic or urethral calculus=, q from =neoplasms affecting any of the abdominal organs=. 5th. Colic due to =lead poisoning=.

Causes of enteralgia and spasmodic colic. Enteralgia may be defined as a neuralgic pain of the bowel which may therefore be free from spasm or any other appreciable structural or functional change. Its existence in the lower animal is necessarily somewhat problematical, as it can only be inferred from the analogy of the animal with man, and of the enteron with the superficial parts that are more frequently attacked with neuralgia, and also from the absence of visible spasmodic contractions in the bowel which has been the seat of intense pain, yet shows no inflammatory lesion. But whether this is accepted or not, the occurrence of spasm is undeniable and as both are functional nervous disorders the same causative factors will apply to both.

In some nervous animals, especially high bred horses and dogs, there is undoubtedly an idiosyncrasy which shows itself in a special susceptibility of the nervous system. In such animals an exposure to cold or wet, or the presence of a local irritant which would have been without effect under other circumstances, lights up the nervous disorder and produces an explosion, it may be as spasm or it may be as nervous pain. Animals that are kept under the best care, that are least accustomed to exposure and neglect, that are highly fed, and maintained in high spirits and are impatient of control are more susceptible than those that become inured to change and exposure, yet are kept in moderately good condition. On the other hand the subject which has become debilitated by overwork, underfeeding, exhausting disease, or the generation in the system of some depressing poison is likely to show a similar nervous susceptibility, so that at the two extremes of plethora and nervous susceptibility, on the one hand, and anæmia and neurasthenia on the other, we find a corresponding tendency to nervous disorder under comparatively slight causes. Thus it happens that a drink of ice cold water, an exposure to a cold blast or a drenching rain or a heavy night dew may seem to be the one appreciable cause of the trouble. If the animal has been perspiring and fatigued the attack is more likely to occur. In other cases a slight indigestion unattended by impaction or tympany, or the ingestion of an irritant which on another occasion, or in another animal would have been perfectly harmless, will induce a violent nervous colic. In some instances the attack is supposed to be of a rheumatic nature the causative action of the cold giving color to the theory.

Symptoms. The attack usually comes on suddenly especially if it has followed on a drink of cold water or a cold exposure.

=Solipeds.= The horse leaves off feeding or whatever he may have been engaged in, paws with his fore feet, moves uneasily with his hind ones or kicks with them, one at a time against the abdomen or out backward, he looks back at the abdomen with pinched, drawn, anxious countenance, bright anxious eye, and dilated nostrils, he moves uneasily from side to side of the stall or box, crouches for a few seconds with semi-bent knees and hocks and then throws himself down violently with a prolonged groan. When down he may roll from side to side over the back, and struggle in various ways, he may start to rise, sit for a moment on his haunches, then go down and roll as before. Or he may get up, shake himself and resume feeding as if entirely well. Soon the spasms reappear, suddenly as at first, and after a time subside as before. Thus the disease proceeds, each succeeding paroxysm diminishing in violence until they permanently subside, or increasing until the animal dies worn out with shock, suffering and exhaustion. If the paroxysms are severe the skin is usually bathed more or less in perspiration. Usually the peristalsis continues more or less, a rumbling is heard in the bowels and more or less fæces are passed in small solid balls or semi-liquid.

The course of the disease is usually rapid and followed by recovery. When prolonged it may become complicated by volvulus, invagination, indigestion or even enteritis.

Diagnosis. The characteristic symptoms are the suddenness of the onset, the extreme suffering during the paroxysm, the reckless manner in which the animal throws himself down, the intermissions with complete absence of pain, the natural condition of the pulse and temperature in the intermissions, the comfort with which the patient shakes himself, and the absence of all abdominal tenderness, manipulation and friction seeming to give relief rather than discomfort.

In the colic of =acute indigestion= there is the previous excessive or unwholesome meal, or the full drink after feeding; there is tympany, or a loaded state of the abdomen proving flat on percussion, there may be crepitation on auscultation, there is continuous pain with exacerbations (not complete intermissions), and there is rather a careful mode of lying down.

In =intestinal constipation= or other =obstruction=, fæces may be passed at first in small pellets coated with mucus or they may be at first passed freely but in steadily lessening quantities until they stop altogether. The pain is constant but worse at one time than another and in case of external hernia the swelling will be visible.

In =helminthiasis= there is the general unthriftiness, irregular appetite, frizzled broken hair on the base of the tail, a fur of dried mucus around the anus and the presence of parasites in the droppings.

In =verminous thrombosis=, to the symptoms just named there are added the reckless method of throwing himself down, hyperthermia, constancy of the pain, rapidly running down pulse, cold sweats, and profound prostration. When blood is passed per anum it is all the more significant.

In =enteritis= or =peritonitis= the hyperthermia and the constancy of the pains are sufficiently pathognomonic.

In =intestinal anthrax= there are the dusky brownish yellow mucosæ, the marked prostration, the hyperthermia and the constancy of the suffering. There is also the fact that the region is subject to anthrax and bacilli may be present in the blood.

In =acute hepatic disease= there is hyperthermia, dusky or icteric mucous membranes, great tenderness when percussion is made over the short ribs, and sometimes lameness of one shoulder (usually the right).

In =disease of the urinary or generative organs= the stiff or straddling gait, tender loins, and the frequent stretching as if to urinate, are nearly pathognomonic.