Part 59

The symptoms are those of violent colic suddenly appearing in connection with some manifest cause of injury, and going on to septic peritonitis and gradual sinking.

Treatment is manifestly useless excepting in the case of some such fortunate condition as in the case of abscess of the rectum in which the free use of injections and the antisepsis of the abscess cavity proved successful.

LACERATION OF THE INTESTINE IN SWINE.

This is rare and appears to have been observed only in connection with scrotal and ventral hernias, with adhesion. It may lead to an artificial anus which in its turn may cicatrise and close, or to the discharge of fæces into the peritoneal cavity with fatal effect. If seen early enough, laparotomy with suture of the bowel and careful antisepsis will be indicated.

LACERATION OF THE INTESTINE IN CARNIVORA.

Obstruction and overdistension, necrosis, ulceration, feculent impaction, kicks, parasites, caustics, abscess, tubercle, cancer. Symptoms: peritonitis following accident, vomiting, no defecation. Treatment: laparotomy.

The most common cause of intestinal rupture is obstruction by foreign bodies, with overdistension of the bowel immediately in front, or necrosis and ulceration of the portion of the bowel pressed upon. Feculent impaction acts in a similar way. Kicks and other external injuries sustained on a full intestine will lead to rupture. Perforation by parasites, by caustic agents swallowed, by abscesses, and by tubercle or cancer is also to be met with.

The symptoms are those of sudden peritonitis, with marked abdominal tenderness, tucking up of the abdomen, bringing the legs together under the body, vomiting, suspension of defecation and peristalsis. Rabiform symptoms have been noted.

Treatment. As in swine there is every hope of success by suture of the intestinal wound if done early. The same general method may be followed as in closing the wound after extraction of a foreign body.

ABSCESS OF THE BOWEL IN SOLIPEDS.

In strangles, from puncture, kicks, blows, foreign bodies in food, larva, cysts, large or small, creamy or cheesy, open into bowel or peritoneum, infective peritonitis. Symptoms: rigor, ill health, unthrift, colics, tender abdomen, tympany, painful movements, lying, rising, turning, going downhill, rectal exploration, phlegmonous swelling, pus passed by anus. Treatment: open when it points on abdominal wall, or when near rectum, antiseptics, support strength, careful dieting, antipuruleut agents.

This is most common as an irregular form of strangles, the abscess forming in connection with the mesenteric glands or on the walls of the intestine. Small abscesses may also implicate the mucous glands or Peyer’s patches as a result of catarrhal enteritis. Less frequently an abscess forms in the seat of the puncture of the colon for tympany, or in connection with blows, kicks, punctures with stable forks, nails and other pointed objects. Foreign bodies entering with the food and the cysts of the larvæ of the sclerostomata will also give rise to suppuration.

These abscesses may attain a large size, especially in strangles, and involve adhesions between the bowel and other viscera, or the walls of the abdomen. Or they may be small like peas or beans scattered along the coats of the intestine or between the folds of the mesentery. They may be inspissated to the consistency of thick cream or rich cheese, and they may rupture into the intestine, through the abdominal walls or into the peritoneum. In the last case infective peritonitis sets in usually with fatal results.

Symptoms. These are generally obscure. There may have been noticed a rigor, and there are always marked indications of ill health, dullness, lack of spirit or appetite, dryness and erection of the hair, hide bound, insensibility of the loins to pinching, colics after meals, tenderness of the abdomen, tympany, groaning when lying down or rising, when turned around short, or when walked down hill. Sometimes the abscess can be distinctly felt by the hand in the rectum. When it implicates the abdominal walls there is usually a diffuse phlegmonous swelling, at first soft and pasty, then firm and solid, and finally softening and fluctuating in the center. Sometimes there is the evacuation of pus by the anus or of the investing membrane of the abscess, and this may be expected to herald recovery. In case of infective peritonitis there are the usual symptoms of stiff movement, the bringing of the feet together under the belly, abdominal tenderness, trembling, hyperthermia, cold ears and limbs, cold perspirations, great dullness and prostration, small, weak or imperceptible pulse, hurried breathing and gradual sinking.

Treatment. This is most favorable when the abscess approaches the surface so as to be punctured through the abdominal walls. In other cases it is so situated that it can be punctured with trochar and cannula through the rectum. In such a case it may be evacuated and injected with a nontoxic antiseptic, the puncture and injection being repeated as wanted. In the internal and deeply seated abscesses we must seek to support the general health, give pure air, easily digestible and nourishing food, and agents that may be hoped to retard suppuration. Hyposulphite of soda in ½ oz. doses, or sulphide of calcium in scruple doses, may be repeated two or three times a day.

ULCERATION OF THE INTESTINES.

Symptom or sequel of other disease, or from traumas, caustics, neoplasms, peptic ulcers, verminous thrombosis, tubercle. Catarrhal erosion, peptic, deep, round ulcer, calculi with irregular ulcers, cord ulcer at mesenteric attachment, small, follicular, grouped ulcers, sloughing ulcers of infectious diseases, circular projecting, button like ulcers of hog cholera, microbes. Symptoms: diarrhœa, black, or red, sloughs, fever, blood stained vomit, manipulation. Treatment: for foreign body, poison, or infectious disease, careful diet, antiseptics.

Ulceration of the intestines is commonly a symptom or sequel of other intestinal disorder, such as intestinal catarrh, impaction, calculus, foreign body, parasites, petechial fever, influenza, glanders, rinderpest, Southern cattle fever, hog cholera, pneumoenteritis, rabies, canine distemper. Then there are ulcers, caused by sharp pointed bodies, by caustic agents ingested, and by obstructive changes in neoplasms. Peptic ulcers may occur in the duodenum as in the stomach. Finally local disturbances of the circulation and especially such as attend on verminous thrombosis, are at once predisposing and exciting causes of ulceration. Tuberculosis and other neoplasms are additional causes.

The ulcers may vary in different cases. In catarrh there is usually superficial desquamation of the epithelium, and erosions rather than deep ulcers. The peptic ulcer forms on the dependent wall of the gut, where the gastric secretions settle, and assumes a more or less perfectly circular outline (round ulcer). Those due to calculus or impaction, may be irregular patches mostly on the unattached side of the intestine and resulting from necrosis of the parts most exposed to pressure. The ulcers resulting from cords stretched along inside the bowel, are in the form of longitudinal sores on the attached or mesenteric side of the intestine, where the wall being shorter the cord continually presses. Follicular ulcerations are usually small, deep excavations, commonly arranged in groups. Ulcers connected with neoplasms have an irregular form determined by that of the morbid growth. In infectious diseases the ulcers are round or irregular, resulting from circumscribed sloughs. In most of the infectious diseases the tendency appears to be to attack the intervals between the folds of the mucosa, probably because the bacteria of ulceration find a safer lodgement in such places. In the hog cholera ulcers the older ulcers tend to the circular form with thick mass of necrotic tissue in the form of plates or scales imbedded in the bottom and projecting above the adjacent surface of the mucosa. As a rule the microbes which in the different cases preside over the necrobiosis are found in the depth and walls of the ulcers.

The symptoms are largely those of the diseases of which the ulcers are a concomitant or result. There is usually diarrhœa, which is generally black from extravasated blood, and may be marked by fresher red bloody striæ. Sloughs of variable size are not at all uncommon in the fæces. Hyperthermia is usually more intense than in ordinary chronic enteritis, indicating the action on the heat producing centres of the necrosing microbes and their toxins. In pigs and dogs there may be vomiting of dark blood stained material or of feculent matter. In the small animals it may be possible to feel through the walls of the abdomen the thickening of the intestine at and around the seat of any extensive ulcer.

Treatment. So far as this is not the treatment of the foreign bodies, poisons, or specific fevers which cause the ulcers, it consists mainly in careful dieting and the use of antiseptics such as subcarbonate of bismuth, salol, salicylic acid, sodium salicylate or naphthol.

DILATION OF THE INTESTINE.

Capacity adapted to ingesta, rich and nutritious food improves breeds, excessive filling renders paretic, dilates; obstructions, impactions, strangulations, hernias, invaginations, twisting, tumors, compressions, calculi, lowered innervation, impaired circulation, verminous aneurism, peritonitis, persistent umbilical vesicle in horse and ox, hernia of mucous through muscular coat, cæcal dilatation, colic, rectal, with atresia ani, diseased end of cord, retained fæces. Symptoms: colics after meals, abdominal and rectal exploration, softer than impaction. Treatment: empty mechanically or by laxatives, demulcents, kneading, stimulants, nux vomica, ergot, barium chloride, eserine, rich concentrated food, electricity, enemata, laxatives.

It is a physiological law that the intestine developes in ratio with the demands made upon it, provided these demands are not too sudden and extreme. Thus the domestic pig and rabbit have intestines at once longer and more capacious than those of the wild varieties. The same is true of cattle and even of horses, heavy, rich feeding, generation after generation, increases the capacity to take in and utilize more, and to attain to a larger size and earlier maturity. In such a case the walls of the intestinal canal retain their primary thickness and strength and the whole change is in the direction of physiological improvement for economical ends.

When, however, the retention or habitual accumulation of food in the alimentary canal exceeds the self-adapting powers of its walls a true pathological dilatation takes place, and attenuation or thickening and paresis or actual paralysis of the walls ensues.

Whatever interferes with the normal active movement of the ingesta predisposes to this. Thus partial obstructions of all kinds, strictures, impactions, strangulations, hernias, invaginations, twisting, tumors, compressions, calculi, contribute to the overfilling of the bowel in front of them and to its more or less speedy dilatation. Whatever weakens the muscular walls of the bowels or the nerves presiding over these has a similar effect. Thus pressure on the solar plexus or its branches from any cause, or degeneration of the same, a tardy and imperfect circulation resulting from verminous aneurism and thrombosis, and a circumscribed peritonitis extending from the serous to the muscular coat of the bowel act in this way.

The persistence of the canal of the umbilical vesicle has been repeatedly observed in solipeds, in the form of a pouch or dilatation connected with the ileum three or four inches in front of the ileo-cæcal valve. Rauscher records one of these of thirteen inches long and having a capacity of seven quarts. These have been noticed in cattle as well.

Another form of sacculation results from rupture of the muscular coat through which the mucous forms a hernial sac in the peritoneal cavity. On a small scale these sacs are not uncommon, the size of a pea, a bean, or a marble, and very often containing larval or mature worms. Degive records an enormous dilatation of the horse’s cæcum, Peuch, one of the pelvic flexure of the colon having a capacity of forty pounds, and Simonin one of the floating colon. Dilatations of the rectum always take place in the new born affected with atresia ani.