Chapter XIII: Part 13

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.

In =pleurisy= the hyperthermia, the transient duration of the colic, and the tenderness on manipulating the intercostal spaces will usually differentiate.

=Ruminants.= In cattle, as in the horse, the symptoms of spasmodic colic are restlessness, constant movement, looking round at the flanks, wriggling of the tail, uneasy lifting of the hind feet, kicking at the abdomen, and abruptly lying down and rising again. The animal does not roll on the back nor sit on the haunches. Fæces may be passed in small quantity or entirely suppressed, and there may be a slight tympany of the paunch.

=Swine.= The animal is attacked abruptly, starts with a grunt or scream, moves around uneasily, lies down, rolls, gets up, and repeats the motions. Vomiting is not uncommon, and the belly may be tense, tympanitic and even tender. The bowels may be confined or relaxed.

=Carnivora.= The colicy dog is very restless, changing from place to place, sitting on his haunches, lying down curled up, starting up suddenly with a yelp, and repeating the restless movements. He looks anxiously at his flank, sometimes bites at it, and cries plaintively. The bowels are usually torpid, and defecation effected with straining.

There are distinct intermissions but these are cut short by a new accession of pain.

The attack is usually transient and ends in recovery.

_Treatment._ =Solipeds.= For nervous colic the hypodermic injection of sulphate of morphia (2 grs.) is very effective. This will commonly bring relief in less than five minutes. Should there be no effect at the end of this time it may be repeated with advantage, but should a second dose fail, it is well to resort to other measures. Eserine and barium chloride are contraindicated as being liable to increase the spasm, and if there is no irritant to expel there is no object in their exhibition. The old prescriptions of laudanum and turpentine; laudanum and ether; sweet spirits of nitre with belladonna, or hyoscyamus, and other stimulants and narcotics are of little avail as they are not absorbed from the horse’s stomach and cannot operate until they have reached the duodenum. If given at all, their action may often be hastened by injecting them into the rectum.

When the morphia fails it is the safest treatment to give a moderate dose of aloes or other laxative, in combination with extract of hyoscyamus or chloral hydrate. This takes time to pass into the duodenum, and be absorbed and secreted anew in order to have its full effect, and therefore it may be necessary to keep up a moderate action of the morphia as a palliative. In four hours, however, at the latest, the aloes can be counted on to bring permanent relief. This appears to come as soon as the active principles have been absorbed, the nauseating effect operating at once on the overexcited nerve centres. The action is more perfect still when a free secretion has been started from the intestinal mucosa, and the circulation and innervation in the intestinal walls are essentially changed. This measure which was long successfully practiced and advocated by the late Joseph Gamgee, is even more perfectly adapted to the colics of indigestion and irritation, of impaction and fermentation. There are of course cases of complete obstruction in which it must fail, but it is probably the most successful method for colicy affections in general.

In addition to the above, other methods of correcting the disordered innervation are available. Active friction of the abdomen with straw wisps is often effective, also fomenting the abdomen with hot water. Simply leading the animal around acts as a nervous derivative, and may be employed to prevent his dashing himself down so suddenly as to injure himself. Then copious injections of warm water soothe the rectum, solicit its peristalsis and by sympathy affect the other intestines in the same way. They may often be made more effective by the addition of antispasmodics (extracts of belladonna or hyoscyamus or chloral hydrate).

In all cases a soft bed should be provided to secure the animal against injury in his sudden reckless movements.

=Ruminants.= Simple spasmodic colic is usually transient and may be successfully treated by driving around, giving copious warm water injections, and using morphia subcutem. Frictions to the abdomen with straw wisps, or with oil of turpentine should be tried. Should these fail there is a presumption of further trouble and no time should be lost in giving a laxative (Glauber salts) 1 to 2 pounds, or castor oil 1 quart, with antispasmodics and stimulants as for the horse.

=Swine.= The antispasmodic treatment may be tried on the pig, but usually it is well to give a purgative at once in combination with the narcotic. Castor oil 4 ounces, laudanum ½ drachm, or jalap 2 drachms, and extract of hyoscyamus 20 grains in electuary. Warm injections and embrocations to the abdomen are desirable.

=Dog.= It is usually well to give a purgative at once (jalap ½ drachm) with 10 to 20 drops laudanum according to size. Copious injections of warm water and a warm bath may follow. Chloral hydrate 20 to 60 grains, may be exhibited by the rectum; also ether 1 drachm, in olive oil.

CONSTIPATION FROM INTESTINAL ATONY.

Definition. Symptomatic. Causes: habit of retention in horse, dog and
cat, indigestible matters in colon, calculi, dry food, lack of water,
fever, diuresis, diaphoresis, milking, bleeding, hepatic torpor,
verminous thrombi, old age, debility, nervous disease, matting of
hairs, hæmorrhoids, abdominal suffering. Lesions: dilatation and
catarrh of bowel, disease of rectum. Symptoms: solipeds—small, dry,
coated, infrequent stools, straining, inappetence, tympany, colic,
stretching as if to urinate; dog, fruitless straining, or dry, earthy
looking fæces, coated, bloody, fœtid, anus swollen, tender, moist,
palpitation, colic, vomiting, diarrhœa may fruitlessly occur, male
urinates like bitch, foul, fœtid mouth; may last days or months;
complications, sequelæ. Treatment: solipeds—exercise, pasturage, cold
water before morning feed, regular regimen, bran, flaxseed, carrots,
turnips, ensilage, common salt, Glauber salts, nux, cold injection,
glycerine, barium chloride, purgative, enemata; dog:—mechanical
unloading of the rectum and colon, injections, exercise, water,
regular habits, laxative food, eserine, oil, calomel, jalap,
podophyllin, colocynth, belladonna, nux vomica, abdominal massage,
electricity.

_Definition._ Constipation consists in dryness, hardness, and undue retention of the fæces. It has of course many grades and may lay claim to many different causes, so that it might, like its antithesis diarrhœa, be held as merely a symptom of another disease. It has however such a definite character, that it is convenient to retain the name to designate those cases in which the torpor or atony is the most prominent and dominating feature, while other forms of obstruction will be treated under different heads.

_Causes._ Defecation is immediately due to the active peristaltic movements of the rectum overcoming the resistance of the sphincter. There is also the concurrent closure of the glottis and contraction of the diaphragm and abdominal walls, and it is usually the voluntary operation of these forces that rouses the rectum to effective peristalsis. The excitability of the rectum depends greatly on habit, hence the habitual retention of fæces, gradually dulls that organ and renders it less and less disposed to respond. In _horses_ this is seen largely in connection with abundant dry feeding and lack of exercise. In house _dogs_ and _cats_ on the other hand, inculcated habits of cleanliness, compels the suppression of the natural instinct, and the habitually overloaded bowel becomes less and less responsive. The retained excrements meanwhile give up more and more of their liquids until they become so dry, and incompressible as well as massive that they can be expelled only by violent efforts. Inflammation of the mucosa naturally follows the retention and this in its turn adds to the weakness and torpor.

Acting in a similar way the partial obstruction, by accumulations of bones and other undigested matters in the colon, and by calculi, tends to continued accessions of new material and to gradually increasing intestinal paresis. So with the other forms of obstruction which will not be further referred to here.

In all animals dry feeding and a lack of water are potent causes of inspissation of the ingesta and torpor of the bowels.

All or nearly all febrile affections, leading as they do to suppression of secretions, cause drying and tardy movement of the contents of the bowels.

The excessive loss of liquid through other channels,—by diuresis, by profuse perspirations, by excessive secretion of milk, or by bleeding—has a similar tendency.

The suppression of the biliary secretion through liver disease, or obstruction of the biliary duct, withholds from the intestine, the most important of the stimuli to peristalsis, and tends to constipation, unless the resulting irritation should cause excessive secretion.

The derangement in the circulation in the intestinal walls caused by verminous thrombi in the horse, acts in the same way, the imperfectly nourished walls not only losing the normal power of peristalsis, but sometimes contracting so as to cause a stricture. Parasites encysted in the walls of the bowels, like catarrhal and other inflammations of these parts tend to atony and tardy peristalsis.

A weakness of the nervous system attendant on old age, or debility, or chronic lead poisoning often tells with force on the alimentary canal, and the loss of nervous power through disease of the great nerve centers (ganglionic system, brain, spinal cord) impairs the vermicular motion. This is notoriously the case in paraplegia, chronic hydrocephalus, and vertigo.

Finally among the causes of constipation must be noted the matting of the hairs around the anus (in dogs), and painful affections of the anus, or the abdominal walls, which render efforts at defecation painful and deter the animal from attempting them.

_Lesions._ These are as varied as the diseases which give rise to constipation, or result from it. Permanent dilatation or sacculation of the intestine, and the structural changes attendant on intestinal catarrh are the most common local lesions. But proctitis, hemorrhoids and ulcers of the anal follicles are met with in canine patients and ulcers of the colon in the seat of impaction are common.

_Symptoms._ In =Solipeds= the fæces are passed, at long intervals, in small quantity, usually only a very few balls at a time, firm, dry, moulded smooth and black on the surface, often covered with mucus, or with streaks of blood. They are passed with unusual effort and straining, and even with groaning, and one or more balls that may be exposed in the act are often drawn back and retained by the inversion of the rectum and closure of the sphincter. It is liable to be complicated by impaired appetite, tympanies, slight recurrent colics, and dryness, scurfiness and unthriftiness of the skin. Not unfrequently the pressure of the impacted colon (pelvic flexure) irritates the bladder causing stretching as if to urinate, and the passage of urine often in small quantity. There may be the symptoms of any one of the different nervous affections that lead to impaired peristaltic action, or of the local diseases which tend to obstruction of the bowels.

In =dogs= there are violent and painful efforts to defecate, which may be fruitless, or may lead to the expulsion of small masses of dry, earthy looking fæces, smoothly moulded on the surface, coated with mucus, streaked it may be with blood and highly offensive in odor. The anus may be puffy and swollen with mucopurulent secretion from the anal glands, which soils the hair of the hips and tail. If the abdomen is flaccid, manipulation with both hands on opposite sides usually detects a solid mass representing the impacted rectum and colon, and extending from the pelvis forward, often to the sternum. The same mass will be reached by the oiled finger introduced into the rectum. Both methods of exploration are painful and may call forth cries from the patient. The abdomen is usually distended, largely from the impacted fæces, in which case it gives a flat sound on percussion, or from gaseous emanation, in which case it is tense, resilient and resonant. Colicy pains are liable to appear, and vomiting at first of food only, then more or less yellow and bilious, and finally of distinctly feculent matters. For a time appetite may be retained, but this is gradually lost. There may supervene diarrhœa, which in favorable cases may lead to expulsion of the impacted mass, but in others it fails to completely dislodge it. The patient is dull and spiritless, inclined to lie curled up in dark corners, and when raised walks slowly and stiffly, with the tail carried straight or slightly to one side. The male urinates like a bitch without lifting the leg. The nose is dry, the tongue furred, the teeth usually covered with tartar, and the breath fœtid. There is at first no hyperthermia, but some rise of temperature attends on the advance of the disease, and the auto-poisoning by absorbed products of the putrefaction of retained fæces.

The disease may last a few days only or it may continue for weeks or months. In the last case intestinal catarrh, ulceration, and circumscribed necrosis are likely to supervene and the animal may die of auto intoxication, acute peritonitis or enteritis. Yet the majority of cases in the dog reach a favorable termination, or recover with remaining cicatrices, strictures or dilatations.

_Treatment._ In =solipeds= accustomed to an idle or pampered life, plenty of daily exercise will often correct the torpor. A run at pasture will often effectually counteract the tendency. If the patient must be kept in the stable a full drink of cold water every morning before feeding will often succeed. Regularity in feeding and watering is of the utmost importance, and the addition of a little wheat bran or flaxseed to the grain is often of material advantage. Next may be added a moderate allowance of carrots, turnips, or ensilage to furnish the needed succulence and organic acids. If in addition medicinal measures are wanted, a small handful of common salt, or of Glauber salts, in the morning drink to be taken ten or fifteen minutes before the first feed, will usually operate well. This may be continued for a length of time if necessary, without the ill effects of purgatives given at other times. It may be rendered slightly more effectual by the addition of 10 grains nux vomica on each occasion. A morning injection of a quart or two of cold water with one or two ounces of glycerine may be tried. Another resort is 2 or 3 grains of barium chloride in the morning drink or hypodermically repeated daily for some time.

In the more severe cases with already existing impaction of the colon, purgatives and copious injections will be demanded as advised under that disease.

In =dogs= the first object is the unloading of the rectum and colon and this usually demands direct mechanical intervention. (See Intestinal Indigestion with Constipation.) In case of hypertrophied prostate this may be rendered somewhat difficult, yet with a free use of oily, soapy or mucilaginous injections it can usually be accomplished.

The further treatment is on the same line as for the soliped. An abundance of exercise in the open air is a prime essential, together with a free access to fresh water. House dogs must be taken out for urination and defecation at regular times that are not too far apart. The food must be of a laxative nature. At first fresh whey or buttermilk only may be allowed, but as some action of the bowels is obtained well salted beef tea, pulped or scraped red muscle seasoned with salt, or milk treated in the same way is permissible. If the bowels fail to respond when the dog is taken out at the regular times an injection of cold water may be given. Sulphate of eserine (⅕ gr.) may be given daily by the mouth or hypodermically, or castor oil (½ to 1 oz.) may be administered at one dose to be followed by careful dietary and hygienic measures. Or sweet oil, calomel and jalap, podophyllin, or colocynth may be substituted. When the bowels have been freely opened a daily morning dose of a drop of the fluid extract of belladonna and ½ gr. of nux vomica will often materially improve the peristalsis. Active manipulation of the abdomen may be employed, or, if available, a current of electricity through the torpid bowels for 10 or 15 minutes daily.

CONSTIPATION IN BIRDS.

Causes: Matted feathers, impacted cloaca, arrest of eggs, debility,
catarrh, parasites, nervous disorder. Symptoms: swelling of anus,
pendent abdomen, waddling gait, straining without effect. Treatment:
remove obstruction by mechanical means, cut off matted feathers, egg
matter may demand laparotomy, castor oil, tincture of rhubarb,
enemata, green food, ensilage, roots, onions.

In birds torpid and obstructed bowels may come from the effects of a previous diarrhœa, which has led to the matting together of the feathers over the anus at once obstructing defecation and rendering it painful. It may result in and be aggravated by a slow accumulation of indigestible matters in the intestine or cloaca (pebbles, feathers, etc.), and the arrest of eggs in the oviduct, pressing upon and obstructing the bowel. In a recent case the author removed 18 ozs. of impacted egg matter from the oviduct of a hen, which when divested of this load weighed barely 2 lbs. Debility of the general system and particularly of the walls of the bowels, and its various causes (old age, exhausting disease, intestinal catarrh, parasites, nervous diseases, etc.) retard defecation and favor impaction as in the mammal.

The _symptoms_ may be; hard dry droppings, matting of the feathers over the anus with feculent matters, a firm swelling surrounding the sphincter, a pendent condition of the abdomen which when manipulated is felt to be firm and resistant, ruffling of the feathers, drooping of the head, wings and tail, walking sluggishly with legs half bent and a waddling gait, and ineffectual attempts to defecate.

_Treatment._ As in dogs remove the obstructing mass by mechanical means. Matted feathers may be clipped off, and feculent accumulations may be dislodged by the aid of the finger, or in small birds of a blunt prob. This may be favored by manipulation through the abdominal walls, and the injection of soapy or oily enemata. Accumulations of impacted egg matter may be similarly removed, or, failing this, by an incision made through the abdominal walls and oviduct. As a purgative give one or two teaspoonfuls castor oil according to the size of the hen, or a few drops to a small cage bird. For the latter Friedberger and Fröhner advise a few drops of tincture of rhubarb in the drinking water. Injections of warm or cold soapsuds or water may be continued as symptoms demand. Green food, ensilage, roots, worms, snails and insects are indicated to correct the tendency to costiveness and may be continued until the bowels have acquired their proper tone. A moderate allowance of onions is often of great value.

HAIR BALLS IN THE INTESTINES—HORSE. EGAGROPILES.

Seat, colon, cæcum; hair of oat seed, clover leaf, vine tendrils, hair
of horse, nucleus, calcic admixture, straw, in horses on dry food,
with depraved appetite, or with skin disease. Symptoms: none, or
torpid bowels, colics, recurring, fermentations, tympany, obstruction,
rupture, peritonitis, rectal exploration. Lesions: impacted ball, with
excess of liquid and gas in front, rupture, ragged bloody edges.
Treatment: extraction, enemata, eserine, barium chloride.

Hair balls, received the name of egagropiles because of their discovery in the alimentary canal of the wild goat, but they are found in various forms in all the domestic animals. In _horses_ they occupy the cæcum and colon and are most frequently composed of the fine vegetable hairs that surround the grain of the oat, or the leaf of clover, of the woody tendrils of vines, and of the hairs of themselves and their fellows taken in at the period of moulting. They sometimes contain a nucleus of leather or other foreign body which has been swallowed but in many cases no such object can be found, the hair having become rolled and felted by the vermicular movements of the stomach and intestines. An admixture of mucus assists materially in the felting, and calcareous and magnesian salts may make up the greater part of the mass, rendering it virtually a _calculus_. They may further have a large admixture of straw and vegetable fibres of larger size than oat or clover hairs. They are most frequent in horses kept on dry food, (sweepings of oatmeal mills) and at hard work, and which show depraved appetite and lick each other. Omnibus horses suffer more than army horses. Skin diseases, by encouraging licking, contribute to their production.

_Symptoms._ In the great majority of cases hair balls do not seriously incommode the horse. They do not attain a large size, and being light do not drag injuriously on the intestine and mesentery. They do, however, retard the movement of the ingesta, and when grown to a considerable size they may block the intestine, more particularly the pelvic flexure, the floating colon or rectum. Under such conditions they produce colics which may be slight, transient, and recurrent, or severe and even fatal, having all the characteristics of complete obstruction from other causes. Fermentations, tympanies, and straining without defecation are common features. When the obstruction takes place in the pelvic flexure, the floating colon or rectum, it may often be detected by rectal exploration. When complete obstruction occurs all the violent symptoms of that condition are present, and these may pass into those of rupture (Peuch, Leblanc, Neyraud), and shock or peritonitis. If the animal has passed hair balls even months before, the colics may with considerable confidence be attributed to other balls of the same kind.

_Lesions._ In case of death there are the usual lesions of gaseous indigestion, with or without enteritis, but with the accumulation of a great quantity of liquid contents, above the ball, which is felt as a firm body impacted in the gut. In other cases the distended bowel has given way and the liquid contents and often the hair ball as well are found free in the abdominal cavity. In such a case the edges of the laceration are covered with blood clots and thickened with inflammatory exudation, and there is more or less peritonitis.

_Treatment._ Relief may sometimes be obtained by the extraction of a hair ball lodged in the rectum or adjacent part of the floating colon. In other cases abundant soapy or oily enemata, and the employment of eserine or barium chloride subcutem are indicated.

HAIR AND BRISTLE BALLS IN DOG AND PIG.

From licking in skin disease. Symptoms: of obstruction. Treatment:
manipulation, enemata, oil, antispasmodics, eserine, barium chloride,
laparotomy, diet in convalescence.

The hair balls of _dogs_ come mainly from licking themselves when affected with skin diseases or parasites. In _pigs_ they are mostly attributed to depraved appetite.

The hair balls of the _dog_ are small, open in texture, and easily disintegrated, having little mucus and no earthy salts in their composition.

The bristle balls of _pigs_ take the form of straight or curved rods of firm consistency, but without earthy salts. The projecting ends of the bristles render them particularly irritating.

The _symptoms_ are those of obstruction of the bowels, and the _treatment_ consists in efforts to dislodge them. If situated near the anus they may sometimes be reached with the finger, or copious oily injections may facilitate their passage. Manipulations through the abdominal walls may be helpful in the dog. Oleaginous laxatives and antispasmodics may be tried, or these failing, eserine or barium chloride. As a last resort laparotomy may be performed, the ball abstracted and the intestine and abdominal wall carefully sutured (Siedamgrotzky). In such a case the diet should be restricted for a week to beef soups, buttermilk, and well boiled gruels, especially flaxseed.

INTESTINAL CALCULI. ENTEROLITHS. BEZOARS.

Earthy basis, nucleus, stratification, in cæcum or colon, multiple,
size, number up to 1000. Composition, phosphates of lime, magnesia,
and ammonia, silica, mucus, epithelium, organic matter.
Ammonio-magnesian tend to crystalline form, common phosphate of lime
to smooth forms. Concretions. Source in food. Ammonia from bacteridian
fermentation, action of colloids, varied nuclei, rapid growth.
Lesions: catarrh, dilation, obstruction, rupture, peritonitis.
Symptoms: intermittent colics with obstruction, tympany, bowel
distension, liquid and gaseous, before obstruction. Diagnosis: by hand
in rectum, hard obstruction with distension in front. Treatment:
purgative dangerous, but exceptionally successful, extraction,
oleaginous enemata, laparotomy.

=Horse.= Intestinal calculi have an earthy basis (ammonio-magnesian phosphate, or oxalate of lime, and more or less silica) glued together by mucus and having a central nucleus usually of some foreign body, (a particle of sand, pebble, morsel of hair, lead, cloth, nail, coin, blood clot, or inspissated mucus) around which the earthy salts have been deposited layer after layer. They are usually formed in the cæcum or double colon and may be multiple and moulded upon each other, so that they become discoid, angular or otherwise altered from the globular shape. The worn, flattened surface in such cases shows concentric rings representing the layers as deposited in succession.

The _size_ of the masses may be from a pea or smaller, up to calculi of six inches in diameter.

In _number_ there may be a single calculus or there may be an indefinite quantity. Zundel counted 400 in a single colon, and Gurlt 1,000.

_Composition._ They are usually composed of phosphate of lime and of magnesia, of ammonio-magnesian phosphate, with a little silica, mucus, epithelium, and organic matters from the ingesta. Traces of sodium chloride, and iron oxide may also be present.

The phosphates of lime, magnesia, and of ammonia and magnesia usually constitute the main part of the calculus. Fürstenberg found specimens in which the ammonio-magnesian phosphate amounted to 72 to 94 per cent.

The calculi containing an excess of ammonio-magnesian phosphate tend to assume a crystalline or coralline form which causes them to be specially irritating to the mucosa. When broken they show a radiated structure from the centre to the circumference in addition to the concentric rings. These are usually of a yellowish brown or a gray color and have a specific gravity of 1694 to 1706.

Calculi in which the common phosphate of lime abounds are likely to be smooth on the surface and on section show the concentric rings more distinctly and the radiating lines less so. The brownish calculi of this variety are much more compact, and harder than the crystalline or mulberry calculi, and have a higher specific gravity—(1823).

Bluish calculi with a smooth glistening surface and lower specific gravity—1681—, have been found of small size and in great numbers in the colon (1000 in the colon, Gurlt).

In some calculi there is a large admixture of alimentary matters, and a low specific gravity (1605 to 1674). These were designated as _pseudo calculi_, by Fürstenberg.

In still other cases a calculous looking mass, when broken into, is found to be composed of a mass of dried alimentary matter enclosed in a thin layer of lime salts. These have a low specific gravity (1446 to 1566) and have been named _concretions_ by Fürstenberg.

_Causes._ As a large proportion of the calculus is phosphate of lime or ammonio-magnesian phosphate, we must look for the source of these in the food and then at the conditions which determine their precipitation.

The percentage of ash and of phosphoric acid in the common foods of horses may be seen in the following table:

PO_{5} in the PO_{5} in the Ash. Ash. entire food. Per cent. Per cent. Per cent. Wheat bran 7.3 50 3.65 Wheat grain 3.0 46.38 1.3914 Oats grain 2.50 26.5 0.6625 Barley grain 3.10 39.9 1.2276 Bean grain 3.10 31.6 0.9864 Pea grain 2.75 34.8 0.957 Tare grain 3.00 36.2 1.086 Indian corn grain 1.5 Rye grain 1.6 39.9 1.0384

The source of the magnesia may be found to a large extent in the grains represented in the following table:

Ash. Mg. in Ash.
Per cent. Per cent.
Oat, grain 2.50 7.3
Barley, grain 3.10 8.5
Rye, grain 1.6 2.4
Wheat, grain 2.12 9.98
Wheat, bran 7.3 11.2
Bean 3.1 6.6
Pea 2.7 5.6

The amount of magnesia in each of these grains is amply sufficient to furnish the material for the constant growth of a calculus. Wheat bran is preëminent in the amount of its magnesia and therefore wheat bran has been charged with predisposing to calculi. In the perisperm as a whole, Fürstenberg found 1 per cent. of phosphate of magnesia, and in coarse bran not less than 2.5 per cent.

The ammonia which is essential to the precipitation of the phosphate of magnesia in the form of the compound salt (ammonio-magnesian) can be found wherever proteids are in process of septic fermentation. The slightest failure to peptonize every particle of such proteids, implies septic change and the evolution of ammonia, which on coming in contact with magnesia phosphate instantly precipitates the insoluble salt.

This fully agrees with the doctrine of the formation of urinary calculi through the agency of bacteria, since the ammonia is essentially a fermentation or bacterial product.

It may also be noted that the experiments of Rainey and Ord showed that in the presence of colloids (mucus, epithelium, pus, blood) the earthy salts are precipitated as minute globular bodies which by further accretions become calculi. In the absence of colloids the salts tend to precipitate in angular crystalline forms, so that the mulberry and coralline calculi may possibly have been precipitated in the absence of such bodies. From the solvent quality of ammonia, however, the contents may easily pass from a fermenting liquid containing colloids to a non-fermenting and noncolloid mixture.

The presence of a solid body which may act as a nucleus is an essential element, and the condition of the food or drink will often supply this. It has been noticed that army horses in the field, feeding from the ground and taking in sand and pebbles, are unusually liable to intestinal calculus. Horses which lick earth in connection with acidity of the stomach or other dyspepsia are specially subject to it. Horses watered from shallow streams with sandy bottoms, where they take in sand with the water, have been similarly affected. Millers’ horses, in the days of old process milling, suffered not alone because of the abundance of oat hairs in the feed but also on account of the grit from the millstones. Hay and other fodders that have lain on the ground and which contain earth and sand furnish other sources of such nuclei. Shingle nails and other small nails, pins, needles, coins, etc., which have mixed with the feed are common causes of trouble, and indeed any foreign body may become the centre and starting point of a calculus.

Catarrhal affections and other lesions of the mucosa, which furnish excess of mucus, beside pus, lymph and even blood as nuclei, are invoked as starting points of the calculi, but however true this may be in particular cases, irritation and catarrh appear to be much more frequently the result than the cause of the calculus.

Attempts have been made to estimate the time taken in the formation of a calculus by allowing a ring for each feed and successive deposit therefrom (Fürstenberg, Colin). Thus a calculus of 14 pounds with 720 layers, it was estimated could be formed in one year at two feeds per day. More definite evidence was found in the case of Pastore in which a coin with the mint mark of 1847 was found as the nucleus of a calculus the size of the fist in 1848.

_Lesions._ Formed in the most spacious parts of the colon and cæcum, calculi usually rest there for a length of time without visible injury, and it is only when they are moved onward and get arrested at a narrow part of the gut (pelvic flexure, floating colon, rectum) that they cause appreciable trouble. Yet it is claimed that by their weight they drag upon the yielding walls of the bowel, causing dilatation and attenuation, weakening the peristalsis and predisposing to rupture. The compression of the vessels also tends to anæmia and atrophy. In the case of rough crystalline calculi the mucosa is subjected to attrition, irritation, and inflammation. The more serious and urgent trouble is that of obstruction of the narrower portions of the colon and rectum, which may be absolute and persistent, leading to rupture and death or a fatal inflammation on the one hand, or may end in recovery on the other, in connection with a displacement onward or backward of the calculus as the result of peristalsis or anti-peristalsis.

_Symptoms._ These are intermittent colics, each reaching a climax and followed by a sudden recovery as the calculus is displaced into a more spacious part of the colon. A significant feature is the complete obstruction, fæces being passed for a short time at first and then suddenly and absolutely stopped. Coincident with this are tympany, violent colics, straining, rolling, sitting on the haunches, perspirations, anxious countenance, and all the symptoms of obstruction.

_Diagnosis_ is never quite certain unless the practitioner with his oiled hand in the rectum can detect a hard stony mass obstructing the pelvic flexure of the double colon with a tense elastic distended bowel immediately in front of it, or a similar hard obstruction of the terminal part of the floating colon with a similar distension in front of it. The pelvic flexure may usually be felt below and to the right at the entrance to the pelvis, and the floating colon above, under the right, or more commonly the left kidney. Calculi in the more spacious parts of the double colon or in the cæcum are inaccessible to manipulation. The feed (bran, ground feed) will be suggestive, as will the occupation of the proprietor (miller, baker).

_Treatment._ This is rather a hopeless undertaking. No effective solvent of the calculus can be given, and purgatives usually increase the danger by increasing the peristalsis and dangerously distending the bowel above the point of obstruction. It is true that this is sometimes followed by a temporary recovery the calculus being loosened and falling back into the dilated portion of the bowel. Less frequently the increase in the peristalsis forces on a moderately sized calculus to complete expulsion. It is a desperate though sometimes successful resort. A more rational course of treatment is the dilation of the bowel back of the obstruction by copious mucilaginous, soapy or oleaginous enemata. Trasbot suggests CO_{2} produced by injecting sodium bicarbonate and tartaric acid. This may be seconded by the hypodermic injection of barium chloride or of atropia. When the calculus is lodged in the floating colon or rectum it may be possible to reach it with the hand and extract it at once. The last resort, is by laparotomy for the removal of the calculus. One such successful case is on record in which Filizet removed a calculus as large as an infant’s head. In other cases the horses failed to survive. Desperate as the resort may be it is not to be neglected in a case of undoubted calculus, solidly impacted and of such a size that its passage is impossible. A fatal result is imminent, and even if the present attack should pass off it can only be looked on in the light of an intermission, so that there is practically nothing to lose in case the result should prove fatal. Anæsthesia and rigid antiseptic measures should of course be adopted.

FOREIGN BODIES IN THE INTESTINES OF SOLIPEDS.

Sand, pebbles, earth, lime, nails, pins, needles, coins, shot, cloth,
leather, rubber, sponge, tooth, bone, wood, twine. Symptoms: as in
intestinal indigestion or calculi, or sand or pebbles in fæces;
peritonitis, phlegmon. Lesions: congestion, catarrh, ulceration,
abscess, needles may travel to other organs. Treatment: laxative,
enemata, or as for calculi.

All sorts of foreign bodies are taken in with food and water and find their way to the intestines. Sand from drinking from shallow streams with sandy bottoms, from browsing on sandy pastures where the vegetation is easily torn up, or from feeding grain from sandy earth will sometimes load the intestines to an extraordinary extent so that such horses will pass sand for some weeks after leaving the locality. Small stones and gravel are taken in in the same way or from the habit of eating earth or licking crumbling lime walls. Nails, pins, needles, coins, shot, pieces of cloth, leather, caouchouc, sponge, and even a molar tooth and a piece of a dorsal vertebra have been thus taken. Recently the author saw a small twig of hard wood transfixing the pylorus and duodenum with fatal effect. In another case were balls of binding twine which had been taken in with the fodder on which it had been used.

The _symptoms_ are usually those of intestinal indigestion or calculi. In some cases, however, they are peculiar, thus there may be a constant passage of sand, there may be indications of peritonitis, or there may form a phlegmonous swelling of the abdominal walls in the abscess of which the foreign body is found.

_Lesions._ Pechoux found 56 lbs. of a brownish earth in the cæcum and colon. Congestion and ulceration of the intestines are common, with occasionally abscess. All the lesions that attend on or follow obstruction may be met with. Boullon saw a remarkable case of the ingestion of needles in which these bodies were found in the small intestine, liver, pancreas, diaphragm, kidney and lung.

_Treatment_ varies with the character of the bodies ingested, sand and gravel may be passed on by a laxative diet and even by the use of mild laxatives. Bernard gave 10 quarts of water and 4 oz. Glauber salts every hour for eight days, and the same amount by enema. For the larger solid bodies which obstruct the intestines the treatment is the same as for calculus. For sharp pointed bodies causing abscess and fistulæ, we must follow the indications, ever aiming at the discovery of the whereabouts of the offending object and its removal.

FOREIGN BODIES IN THE INTESTINES OF RUMINANTS.

Foreign bodies are usually arrested in the rumen of cattle and unless sharp, pointed or rough so as to cause mechanical trouble or caustic so as to act chemically, rarely do much harm. The most extraordinary objects that have found their way into the intestine are snakes. Gherardi claims that he found in the intestines a snake of 25 inches long; Jager found one of 21 inches in length, in an advanced state of decomposition, in the rectum of a calf. It is supposed that both had been taken in with the food. In each case there was obstruction of the intestine with severe colicy symptoms.

FOREIGN BODIES IN THE INTESTINES OF CARNIVORA.

Small bodies, especially playthings, feathers, hair, bristles, bones
of prey. Lesions: congestion, inflammation, hemorrhage, ulceration,
perforation, invagination. Symptoms: colic, vomiting, tucked up belly,
straining, palpitation, rabiform symptoms, cough, convulsions. Course:
emaciation, prostration, death in five days or two weeks according to
seat of obstruction. Treatment: Oleaginous injections, laparotomy.

_Causes._ The dog is especially liable to this form of trouble, in consequence of his habit of carrying objects in his mouth and of playing with different objects especially the playthings of children. Marbles, pebbles, spinning-tops, corks, coins, nuts, peach stones, pieces of rubber, cloth or leather, bits of wood, sponge, needles, pins, potato, bone, cord, hair, bristles, feathers, wire, and a number of other objects. Some of them like feathers, hair, and bones are swallowed with food, and when that has been digested, they are either vomited or failing in this, are passed on into the intestine. Lately the author made a post mortem of a house dog with over 24 inches of the jejunum virtually blocked with fragments gnawed from a caouchouc ball and pieces of twine.

=Cats= also swallow a variety of objects. Benjamin and Megnin record three cases of intestinal obstruction by the crystal drops of shades.

_Lesions._ When the lumen of the intestine is blocked with a round solid body like a marble or peach stone there occur active congestion, inflammation, blood stasis and hemorrhage, with in many cases necrosis, ulceration and perforation. Similar lesions occur from cord. In a recent case of impaction with gnawed fragments of caouchouc and cord, the 24 inches of the bowel implicated were the seat of extended patches of necrosis and of deep, and even perforating ulcers on the lesser curvature of the intestine, evidently caused by the tension of the stretched cord on the shorter attached border of the gut. Cadeac says the lesions from cord are always at the point of attachment of the mesentery, whereas those coming from round or cubical solid bodies are mainly on the greater curvature. Mathis found at the pylorus a piece of net from which a cord extended through the small intestine and ended in a ravelled mass near the ileo-cæcal valve. The dragging of the cord on the intestine often causes invagination at one or several points.

_Symptoms._ There may be slight colic, dullness, a disposition to lie curled up in some secluded place, loss or caprice of appetite, vomiting, tucked up abdomen, arching of the back, straining, and unless the bowels are distended with gas, the obstruction can usually be felt by the two hands applied on opposite sides of the abdomen. The matters vomited are at first alimentary, then bilious and in the advanced stages always feculent.