Part 68

When pus forms in the peritoneum or when extensive effusion has taken place, it should certainly be evacuated, as it is but a centre for the development of the deadly bacteria. It can be drawn off through the already existing traumatic orifice, or, if necessary, a new opening can be made by cannula and trochar, or by direct incision under suitable antiseptic precautions. The opening having been made, and the liquid having escaped, the peritoneum may be profitably washed out with a normal salt solution which has been recently boiled and which is used at near the body temperature (80° to 90°).

Blisters are sometimes of use in the advanced stages of the disease, in stimulating resolution and reabsorption, but hot or cold applications are preferable in the early acute stages.

Laparotomy in cases due to rupture of stomach or bowel, or of extensive perforation, has not been attempted in solipeds, and it could hardly be expected to succeed, yet in such cases, which are otherwise inevitably fatal, any measure giving even a remote hope of success is allowable.

When tympany sets in it may be met by using a fine cannula and trochar, and as soon as the gas has escaped, antiseptics like chloral hydrate, salicylate of soda, salicylic acid, or glycerine, can be injected into the fermenting mass by attaching a caouchouc tube and funnel to the cannula.

CHRONIC PERITONITIS IN SOLIPEDS.

Secondary: after acute, or with disease of liver, spleen, kidney, rheumatism, melanosis, lymphadenoma, epithelioma, carcinoma, or sarcoma. Gastric ulcer, infected punctures. Symptoms: poor health, tender abdomen, irregular bowels, slight colic, tense, fluctuating belly, pallid mucosæ, dropsy of sheath, limbs, etc., slight fever. Treatment: remove primary disease: saline laxatives, diuretics, drainage, antiseptic irrigation (boric acid, etc.), abdominal bandage, tonics, derivatives.

Causes. Chronic peritonitis is always a secondary disease, succeeding the acute, or dependent on some other affection of the abdominal organs, as chronic congestion of the liver, or spleen, Bright’s disease, rheumatism, melanosis, lymphadenoma, epithelioma, carcinoma, or sarcoma. Tuberculosis and actinomycosis, so common in cattle, are rare in solipeds. Chronic ulcers of stomach or bowels and injuries and infections from punctures are exceptional causes.

Symptoms. The manifestations of the disease are indefinite, the acute form may have subsided so that the patient is supposed to have completely recovered, a moderate appetite and a certain capacity for work may be present, yet he is easily fatigued, there is some tenderness of the abdomen to pressure, some irregularity of the bowels—constipation and diarrhœa alternating—and occasional slight colics. Some weeks later may be noticed abdominal tension and tympany, with perhaps fluctuation in the lower parts, increasing pallor of the mucosæ, and œdematous swelling of the sheath, mammæ, abdominal walls or hind limbs. To detect fluctuation it is sometimes necessary to introduce one hand into the rectum. When present hyperthermia is slight, but assists in diagnosis from ascites.

Treatment should be directed to the primary disease. As that is too often irremediable the peritonitis will resist all other treatment.

In cases that supervene on the acute form, paracentesis, saline laxatives and diuretics with antiseptics, tonics, and counter-irritants will sometimes succeed. As in the acute form of the disease the removal of the effusion is the removal of the culture fluid, and may be followed by irrigation of the peritoneum with a normal salt solution, or with an antiseptic solution (boric acid or potassium permanganate), 1:20 warm water; Aluminum acetate, 1:2000. Sulphate of soda given to keep up a moderately laxative action, tends to counteract the contraction of the intestine by false membranes, and operates with diuretics in reducing the tendency to exudation or in causing its reabsorption. After removal of the liquid, support by a close (or elastic) abdominal bandage is often of value in preventing further effusion. As tonics, gentian, nux vomica and the iron salts may be profitably employed, and as antiseptics salicylate of soda and iodide of potassium. As counter-irritants mustard and cantharides may be named.

PERITONITIS IN RUMINANTS.

Causes: infection, chill, blows, wounds, debility, ill health, Chauveau’s experiment with castration, dystokia, abdominal congestion and inflammation, bile or urine in absence of sepsis, gastric or intestinal ulcer or perforation, foreign bodies, abscesses, surgical wounds. Spoilt marc of beet sugar factories. Symptoms: fever, stiffness, dragging hind limbs, knuckling, arched back, shifting feet, moving tail, tense belly, pendent, fluctuating below, friction sounds, diarrhœa, later constipation, weakness, emaciation, death fourth to twentieth day. Recovery, often partial. After dystokia putrid vaginal discharge, and nervous depression, resembling parturition fever. Infection in ewes through shepherd’s hands, œdematous swellings of vulva, perineum and abdomen. Lesions: as in solipeds, with abundant false membranes, fœtid pus metritis, with putrid contents of womb. Treatment: saline laxatives, diuretics, demulcents, enemata, morphia, antiseptics, cold to abdomen. After dystokia, antiseptic irrigation of womb, elevation of head, with ice, strychnia, acetanilid. Tubercular peritonitis.

Causes. As in solipeds infection of the peritoneum and the increase of susceptibility by exposure to cold, blows, wounds, poor feeding or stabling, disease and other causes of ill health, operate together in inducing peritonitis.

The effect of debility or predisposition of the tissues is well shown in Chauveau’s experiments with bistournage in rams. Healthy rams subjected to bistournage showed no infection, and rams subjected to intravenous injection of pus microbes without bistournage showed no infection, whereas if the rams were first subjected to injection of pus microbes, and then to bistournage, peritonitis set in. In the same way chills occurring after dystokia, when the womb is charged with microbes and more or less congested, may determine peritonitis, and congestions, impactions, tympanies, and other injuries of the gastro-intestinal viscera coöperate with cold to the same end. Rupture of the gall or urinary bladder does not usually cause prompt peritonitis, yet it irritates the serosa and lays it open to infection if the germs should reach it through the circulation. Otherwise the animal suffers only from uræmia or biliary poisoning and may survive one or two weeks. Ruptures of stomach or intestine, or ulceration or the perforation of their walls by hard, pointed or other metallic bodies are causes of peritonitis. The rupture of abscesses into the peritoneum and the escape of germs from the womb in case of rupture of the womb in difficult parturition, or in metritis, are additional causes. Surgical wounds as in castration of the male or female, and punctures and incisions of the rumen are occasional causes, but there is by no means the tendency to extension of such peritonitis that we see in solipeds. The self-protective power of the tissues is incomparably greater in the ruminant.

Nocard, Butel and others have recorded a gastro-entero-peritonitis of septic nature, occurring in cattle and above all in sheep, fed on the fermented refuse of beet sugar factories, which had been kept in silos through the winter. On the third and fourth days of this feeding many were attacked.

Symptoms. Beside the general systemic disorder and a very variable amount of hyperthermia (102° to 107°), there are the special indications of abdominal inflammation, stiff movement and dragging of the hind limbs, or if standing the back is arched, the head drooping and the legs drawn together and slightly bent, with uneasy shifting of the hind feet, and lateral movements of the tail. The walls of the abdomen are usually tense, often bulging laterally below, though fallen in beneath the lumbar transverse processes (pot-bellied); they are tender to pressure, and may be drum like to percussion above, while flat, dull, and fluctuating below. The tenderness is slightest below, where liquid effusion has settled, but is quite marked in the upper and resonant parts, where pressure will cause wincing and trembling. In this upper part on the left side may be heard friction sounds after the fourth or sixth day. This is especially observable in tuberculous peritonitis over the parts covered by tubercular growths. There may be at first diarrhœa which usually soon gives place to constipation, and weakness and emaciation advances rapidly, and death may take place from the fourth to eighth day, or may be deferred for some weeks.

In favorable cases the acute symptoms subside, the liquid effusion is absorbed, appetite and rumination are in great part restored, and a partial recovery is made. It is, however, very liable to merge into the chronic form, and inevitably so in tuberculous cases.

In cases following on difficult parturition there are redness of the vaginal mucosa, with mucopurulent or putrid discharges, and swelling of the lower part of the abdomen, with liquid effusion and fluctuation, and tenderness of the right flank. The further symptoms are largely nervous, approximating somewhat to those of parturition fever. Temperature may rise to 104° or 106°, blindness, stupor, incoördination of muscular movement, staggering gait, if down she may lie on the side or sternum unable to rise, has frequent afterpains, tympany, sour eructations, and grinding of the teeth. The case may culminate in loss of vision, in stupor and coma, or improvement may set in and go on to a rapid recovery. This is a more common affection in ewes than in cows and is very destructive, the infection being carried by the hands of the shepherd. The most fatal cases are those in which the infection becomes generalized, and œdematous swellings appear round the vulva, between the thighs and beneath the abdomen.

In traumatic cases the external wounds can usually be found with active inflammation and surrounding tumefaction.

Lesions. The peritoneum, as in solipeds, shows the symptoms of congestion, exudation of a fine fibrinous network or shreds, of thicker and more extended false membranes in patches, of effusions more or less sanguineous, of formation of pus, usually fœtid, or the presence of decomposing ingesta which has escaped through a lesion of stomach or bowels. The peritoneal and subserous tissue are infiltrated with liquid, and the other gastric and intestinal organs are more or less tympanitic, and the mucosa of the latter is thickened, ecchymosed, or eroded, with black, fœtid bloodstained contents. In parturient cases, the uterine mucosa is congested, reddened and softened, the cotyledons swollen, perhaps gangrenous, and the membranes, if still present, float in a dark, putrid offensive liquid.

Treatment. As in the horse, morphia has been used to relieve pain and check peristalsis. The addition of saline laxatives, and diuretics, will assist in elimination and depletion, and in the removal of intestinal bacteria which become a source of danger. A laxative dose should be followed by frequent drinks of pure water or mucilaginous liquids, and sulphate of soda may also be given freely in enema. As diuretics, saltpeter or digitalis may be resorted to. Antiferments (salicylate of soda, bisulphite of soda) should not be forgotten nor cold applications to the abdomen. When effusion or suppuration has taken place evacuation by puncture may be followed by antiseptic irrigation.

If with septic metritis, antiseptic injections of the vagina and womb are the first consideration. With boiled water at a tepid heat the womb should be thoroughly washed out, followed by a solution of mercuric chloride (1:2000), or permanganate of potash (1:1000), or boric acid (1:25) until the liquid returns clear and odorless. This may be repeated several times a day. The symptoms of brain congestion, may be met by tying, or packing up the patient with straw so that the head will be somewhat elevated, and bags of ice or snow, or simple cold water may be kept applied to the upper part of the head and neck. When there is no great nervous excitement the nervous functions may be roused by nux vomica in enema, or strychnia subcutem. If on the other hand the temperature runs very high acetanilid may be tried with caution, or resort may be had to wet compresses.

In case of perforation or rupture, if the animal cannot be at once sacrificed for beef or mutton before inflammation has set in, the only hope lies in laparotomy, followed by the cleansing, disinfection and suturing of the wound.

In tubercular peritonitis which constitutes a very large proportion of bovine cases, treatment is undesirable, and the animal is unfit for consumption.

PERITONITIS IN CARNIVORA.

Causes: gastro-intestinal inflammations, metritis, trauma to walls of abdomen, pyæmia, septicæmia, tuberculosis, cancer, tumors, parasites. Symptoms: dullness, hiding away, movements tardy, painful, arched back, retracted abdomen, tense and tender, drags hind limbs, vomits, yawns, bloats, hopeless look, snappish, death in 2 to 8 days. Treatment: anodynes, saline laxatives by mouth and rectum, damp compress, warm bath, antiseptics, diuretics, in effusion, puncture, antiseptic irrigation, laparotomy.

Causes. All inflammatory and other serious affections of the stomach and bowels may be associated with peritonitis. Metritis and injuries to the womb, and all injuries to the walls of the abdomen (kicks, blows, penetrating and castration wounds), may have a similar complication. Pyæmia and septicæmia may also have localization in the peritoneum. It must be borne in mind, however, that purulent and septic infection are less likely to occur in the dog than in cattle, the leucocytes of the dog having much more resisting power. On the other hand the dog, and, still more so, the cat has a fair measure of susceptibility to tuberculosis, cancer and various forms of tumors, which show a strong tendency to localization in the abdomen. Parasites also penetrate and irritate the peritoneum.

Symptoms. The animal becomes dull, retiring, and inclined to lie in a quiet place, though his suffering may lead to frequent change of bed, he moves slowly, painfully, with arched back, retracted abdomen, and drooping head, and dragging his hind limbs stiffly. The abdomen is tense and firm, hot and very tender, drawing forth whines and yelps when it is handled. There are hyperthermia (104°), small, weak, accelerated pulse, hurried, catching breathing, vomiting, yawning, tympany and constipation. The face has a hopeless, stupid look and the eyes are sunken and at times glazed. Some patients become ill natured and snappish. The animal gradually sinks into a condition of prostration and finally of collapse and dies in two to eight days.