Chapter VII: Part 7

Violent exertion immediately after a meal arrests digestion, and tends to a fatal indigestion. An animal fed grain and immediately put to severe work, or subjected to confinement for a painful operation, may die in two hours from tympanitic indigestion.

This weakness of the digestion may come from profuse bleeding, from the anæmia caused by parasites (sclerostomata), or from injuries to the pneumogastric nerves or their centres. It can be produced experimentally by cutting both vagi; the gastric contents then remain packed and solid, without peptic juices and without digestion.

Iced water, like frozen food, may temporarily arrest the gastric functions and entail fermentation. It acts most dangerously on the overheated and exhausted horse, and though the indigestion may not prove fatal, it may induce a sympathetic skin eruption or laminitis. The mere exposure to external cold is less to be dreaded as there is a compensating stimulus which drives the blood to internal organs, the stomach included. Standing in cold water or wading or swimming a cold river, is commonly less injurious than a full drink of iced water, when heated and fatigued.

Certain kinds of food are far more dangerous than others, and especially such as should be digested in the stomach. Thus the different grains—barley, rye, buckwheat, wheat, oats, Indian corn, and even bran, have been especially objected to. The amount of proteids in oats, for example, is 11.9 per cent., while those of hay are but 7 per cent. The same bulk of oats, therefore, demands nearly double the work of the stomach to reduce its nitrogenous constituents to peptones than does hay. But when fully insalivated the difference is even greater, for oats take but the equivalent of their own weight of saliva, whereas hay takes four times its own weight. There is 1 part of proteids in 16.7 parts of insalivated oats, and but 1 in 71.4 of insalivated hay. If the oats are bolted without mastication, which can never be the case with hay, the discrepancy becomes greater still. Grain is best fed often, in moderate amount, and without further loading of the stomach immediately with either solids or fluids. Above all never feed grain to a thirsty horse and then lead him direct to the watering trough. Even should he fail to have the stomach paralyzed by the cold water, and indigestion developed, yet much of the proteids will be washed out into the small intestine to threaten indigestion there.

Selenitic waters may induce indigestion by neutralizing the hydrochloric acid of the stomach and interrupting digestion.

Finally all forms of gastritis—catarrhal, toxic, and phlegmonous—induce atony, fermentation and indigestion.

_Symptoms._ There may be simply tardy digestion or grave disorder with impaction or tympany.

In the former case there is impairment or perversion of appetite, refusal of food, irregular feeding, licking earth or lime, or eating filth, even fæces, with some dullness, apathy, or signs of pain such as pawing with the fore feet, or looking round at the flanks. There is rumbling of the bowels, followed in favorable cases by the passage of flatus, of softened fæces containing imperfectly digested food, and distinct diarrhœa which proves curative.

The more violent attacks set in suddenly, usually within one or two hours after feeding. There are usually colicy pains, pawing, looking back at the flank, kicking of the abdomen with the hind feet, lying down, rolling, rising again quickly, yawning, anxious pinching of the countenance, rigid loins insensible to pinching, and heat and dryness with an acid odor in the mouth. There is soon observed some swelling and tension of the belly with tympanitic resonance on percussion in the left hypochondrium. There is no elevation of temperature as in gastritis, and no complete intermissions of pain as in spasmodic colic, but pain is continuous, though worse at one time than another. There is an utter indisposition to eat or drink and if liquids are given by force there is manifest aggravation of the sufferings. As a rule there is no rumbling of the bowels, and though the animal may strain violently, little or nothing is passed, except at the first a few moulded balls of dung. The bowels like the stomach are paralyzed. In some cases there are attempts at regurgitation, the fore feet are placed apart, the neck arched, the lower cervical muscles are contracted and the nose drawn in toward the breast. In some instances relief is obtained by belching gas or by actual vomiting of solid matters. Vomiting in the horse is always ground for suspicion, since it usually occurs when the muscular coat of the stomach is ruptured. An important hindrance to vomiting lies in the loose folds of the mucosa covering the cardia, in the flaccid condition, and as these folds may be entirely effaced in hernia of the mucosa through the muscular coat as well as in the overdistended condition, vomiting may be either a fatal or a favorable indication. If vomiting takes place, without attendant prostration and sinking, and if on the contrary there is manifest improvement after it, it may be looked on as a beneficent outcome.

If no such relief is obtained the patient becomes increasingly dull and stupid; the breathing is accelerated, short, moaning or wheezing; the nostrils dilated; the nasal mucosa dark red; the superficial veins, especially those of the face, are distended and prominent.

The nervous symptoms may vary. Usually the dullness increases to stupor, the animal rests his head on the manger or against the wall, or if at liberty he may move forward or around blindly until some obstacle is met and he stumbles over it or pushes against it. In some instances there is champing of the jaws, or irregular motions of the limbs, but more commonly the dullness goes on to stupor and coma, the animal falls helpless and dies in a state of profound insensibility.

If the _stomach should become ruptured_ there is often vomiting, the ingesta escaping by the nose, without any relief of the general symptoms, but with an increasingly haggard expression of countenance, sunken eye, and accelerated, weak, and finally imperceptible pulse. Cold sweats, which may have been already present, become more marked and the prostration becomes more extreme and the abdominal tenderness more marked. There are muscular tremblings of the shoulders and thighs, dilatation of the pupils, rapid breathing and stupor which presages death.

Recovery may be hoped for if rumbling in the bowels commences anew, if defecations continue and become soft and liquid, if urine is passed abundantly and if the general symptoms are improved. Complete relief may be had in five or six hours, and even in protracted cases in two days.

_Lesions._ The body is swollen, tense and resonant; the rectum usually projects somewhat and is dark red; the intestines, small and large, are tympanitic; the stomach is double or triple its usual size, tense and resistant, and with its contents may weigh as much as 40 pounds. When cut open its contents are seen to be disposed in the order in which they were eaten, in stratified layers, the motions of the stomach have not operated to mix them. There is no sign of digestion, unless it be in a thin surface layer or film which may be white, pulpy and chymified. The cuticular mucosa is usually unchanged further than its attenuation by stretching, the alveolated mucosa also attenuated is congested, opaque or slightly inflamed. The great curvature may be the seat of a rupture the edges of which are slightly swollen, congested and covered with small blood clots. The escaping ingesta usually remains enclosed in the omentum, which thus looks like a larger stomach with extremely thin gauze-like walls. If this is ruptured then the food floats in masses among the convolutions of the intestines. The peritoneum is red, hemorrhagic and covered with more or less exudation.

Another occasional lesion is rupture of the diaphragm. The liver and spleen are usually small and comparatively bloodless, owing to the compression.

_Diagnosis._ This is largely based on the speedy supervention of the attack on a feed, the animal having been apparently well before, on the onset by slight colics, rapidly passing into great and continuous suffering and stupor, with tympanitic tension of the abdomen, and suppression of the intestinal movements, in the absence of any distinct or marked hyperthermia. The rapid progress to death or recovery is equally characteristic.

_Treatment._ In mild cases the prompt use of aromatics will sometimes succeed; tincture of pimento, anise or coriander 2 to 3 ounces, oil of peppermint, 20 to 30 drops. Stimulants, aqua ammonia, 1 to 2 drachms, largely diluted, ether 1 ounce, brandy or whisky 1 pint, will sometimes succeed. A good combination is dilute hydrochloric acid, 1 drachm, oil of turpentine 1 ounce, olive oil ½ pint.

Still more effective in the rousing of the torpid vermicular movements are eserine sulphate 1.5 grain or pilocarpin 2 grains, or barium chloride 7 grains subcutem.

These largely replace the old plan of giving a dose of aloes in bolus, yet in case of need aloes may still be given in ounce doses in cold water injections. The cold serves to rouse the vermicular movements of the bowels and sympathetically of the stomach.

Walking exercise, friction over the abdomen, and even electric currents through the epigastrium and left hypochondrium may be helpful.

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

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

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

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

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

GASTRIC INDIGESTION IN CARNIVORA.

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

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

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

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

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

ACUTE GASTRIC INDIGESTION IN SWINE.

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

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

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

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

ACUTE CATARRHAL GASTRITIS IN THE HORSE.

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

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

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

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

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

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

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

PHLEGMONOUS (PURULENT) GASTRITIS IN THE HORSE.

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

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

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

_Symptoms._ These resemble those of catarrhal inflammation, but are usually attended by greater hyperthermia, and the colicy symptoms are more marked. There is also greater tenderness in the epigastrium and left hypochondrium, and icterus is more marked. When it occurs as an extension of strangles or pyæmia the symptoms of these affections elsewhere are pathognomonic. When the abscess bursts into the stomach there may be vomiting of bloody mucus (hæmatemesis) which is not necessarily followed by a fatal result.

_Lesions._ As these are seen only in fatal cases, the presence of an abscess is the characteristic feature. This is usually submucous, or less frequently subperitoneal, and may vary in size from a hazelnut upward. The tendency appears to be to open into the stomach, though it may burst into the peritoneum and cause general infection of that membrane. In case of parasites, the spiroptera or œstrus larva may be found in the abcess cavity having a narrow opening into the stomach. In certain cases the abscess on the pyloric sac has been found opening into the duodenum. Congestion, thickening, puckering into rugæ and laceration of the adjacent mucosæ may be a marked feature, a circumscribed catarrhal gastritis complicating the local phlegmon.

_Treatment._ This is less hopeful than in catarrhal gastritis, but should be conducted along the same lines. The same careful diet, with daily antiseptics and bitters may prove valuable in limiting the inevitable suppuration, and, if the pus should escape into the stomach, in healing the lesion. Sulphites of soda, sulphide of calcium, chamomile, and quinia, are to be commended and pepsin may be added to secure at once proteid digestion and antisepsis. Laxatives may be required to counteract constipation or expel irritants, and these may be combined with the antiseptics already named or with salol, eucalyptol, sodium salicylate or other non-poisonous agent of this class.

TOXIC GASTRITIS IN SOLIPEDS.

Causes: caustics or irritants acting on mucosa, accidently, or
maliciously. Symptoms: colics, pinched face, small rapid pulse,
hurried breathing, hyperthermia, sometimes salivation, color of buccal
mucosa, odor, congestion of tongue, thirst, urination, icterus,
albuminuria, analysis of urine or vomited matter. Lesions: congestion,
corrosion, necrosis or ulceration of gastric mucosa, discoloration.
Treatment: antidote, stomach pump, demulcents, coagulants.

_Causes._ Toxic gastritis in solipeds is peculiar in this that it must be due to one or other of the more caustic or irritant agents, which act chemically on the tissues, while those agents that require to be absorbed to establish a physiological irritation are comparatively harmless. This depends on the fact that few or none of the poisonous agents are absorbed by the gastric mucosa of the soliped, and if ingested they must pass on into the duodenum before they can be absorbed into the tissues and blood-vessels. Hence the horse is injured mainly by actual caustics like mercuric chloride, zinc chloride, ferric or cupric sulphate, the caustic alkalies or earths, or alkaline carbonates, and the mineral acids. These may be taken accidently or administered maliciously, or as medicines.

_Symptoms._ Morbid symptoms vary according to the agent swallowed. There are colics, anxious countenance, small accelerated pulse, rapid breathing, hyperthermia, and salivation, especially marked with mercuric chloride. The buccal mucosa may give valuable indications, becoming white with muriatic acid, or zinc, or antimony, or mercuric chloride, yellow with nitric acid, and white changing to black with sulphuric acid or silver nitrate. Ferric or cupric sulphate may give their respective colors to the saliva, and the former will darken the fæces.

The mouth is usually dry, hot, and clammy, and the edges of the tongue red. Temperature is usually elevated, yet with tartar emetic it may be distinctly reduced. Thirst is usually marked, and urination frequent. Icterus and albuminuria attend on phosphorus poisoning. When vomiting takes place the appearance or analysis of the matters rejected, or otherwise of the urine, will often indicate the nature of the poison.

_Lesions._ The gastric mucosa is congested and discolored, but the corrosion and even the ulceration are especially characteristic. Patches of necrotic mucous membrane may be more or less detached exposing a deep red submucosa. The coloration otherwise varies;—white or black with sulphuric acid or silver nitrate; white with muriatic acid, the caustic alkalies, or zinc chloride; yellow with nitric acid; or green with salts of copper.

Similar lesions are found on the buccal, œsophagean and intestinal mucosæ, and even at times on the respiratory.

_Treatment._ In the treatment of this form of gastritis the first consideration is to expel, or use an antidote to, the poison. In the soliped, emetics are useless. The stomach pump or tube may, however, be applied with good effect in nearly all cases, alternately throwing in water and drawing it off. Demulcents and coagulants are also universally applicable. Milk, eggs beaten up in milk, blood albumen, flaxseed tea, well boiled gruels, or slippery elm bark, may be used as may be most convenient. Next come the other chemical antidotes the use of which however demands a previous knowledge of the poison present. For the mineral acids one can make use of calcined magnesia, lime water, chalk, or carbonate of soda in weak solution. For alkalies the appropriate antidote is vinegar. For carbolic acid, vinegar, alcohol, or failing these a weak solution of soda or oil. For tartar emetic, gallic or tannic acid. For bichromate of potash or chromic acid, calcined magnesia, magnesia carbonate, or lime carbonate. For phosphorus, old oil of turpentine and demulcents—no oil. For ammonia, vinegar followed by almond, olive or sweet oil. In case of œdema glottidis, tracheotomy. For copper salts yellow prussiate of potash, which precipitates the copper in an insoluble form, and demulcents. For mercuric chloride, demulcent drinks can be resorted to, there is no other reliable antidote. In all cases after the evacuation of the stomach and the use of the antidote, mucilaginous agents must be given freely with morphia or other anodynes.

CATARRHAL INFLAMMATION OF THE FOURTH STOMACH.

Usually a complication. Causes, predisposing, exciting, changes of
food or water, spoiled, frosted or fermented food, green potatoes,
caterpillars, nitrogenous food, irritants. Symptoms: Separation from
herd, grinding teeth, eructation, depraved appetite, fever, tender
epigastrium, coated dung, red eyes, fixed or retracted, dilated, blind
eyes, drooping ears, nervous symptoms, reckless unconscious movements,
bellowing, tender skin, tremors. Lesions: Congestion and exudate in
gastric mucosa, hemorrhagic discoloration, desquamation, excess of
mucus, resemblance to rinderpest, Texas fever and malignant catarrh.
Treatment: Empty stomach by bland laxatives, stimulants of
peristalsis, calmatives, cold to head, counter-irritants, enemata,
bitters.

This affection is by no means rare in cattle, though it is usually complicated with inflammation of the first three stomachs or of the intestines. Nevertheless, when the disease appears to be concentrated on the fourth stomach mainly, it may well take its name accordingly.

_Causes._ A predisposition to the affection occurs in the weak and debilitated, the overworked oxen, underfed cattle, in those that are just recovering from a severe illness and in which the gastric secretions and functions are still poor. The usual exciting cause is some fault in the food, it may be a sudden change from one kind to another, and especially from dry to green, or from one kind of green food to another and more tempting one, as when the animal breaks into a field of grain which is advancing to maturity. Even a sudden change of water, as from soft to hard has seemed in our experience to contribute to its development. Next come spoiled aliments, frosted or frozen turnips, beets, carrots, potatoes, apples, turnip tops, fermented grasses, musty hay, sun-exposed potatoes, putrid vegetables, and caterpillars on cabbages, tree leaves and other vegetables. Next come products that are highly nitrogenous, like vetches, alfalfa, sainfoin, clover, and the cakes of linseed, rape and cotton seed. Irritant plants such as colchicum, digitalis, yew, radish, etc., have been charged as causative agents.

_Symptoms._ These are often difficult to distinguish from those of indigestion or acute lead poisoning, and they vary in different cases according to the severity of the attack. In the milder cases there may be loss of appetite and rumination, some tympany, arching of the back, uneasy movements of the hind limbs and tail, a disposition to leave the herd, grinding of the teeth, and frequent gaseous eructations. Some show a depraved appetite, picking up and chewing various non-alimentary substances. Somewhat more characteristic are the dry, hot muzzle, the hyperthermia of the body, the tenderness to pressure of the epigastrium, and the baked appearance and glistening surface of the fæces. In the more severe forms the suffering is increased and the nervous system participates in the disorder. The eyes are congested, fixed or rolled back, the pupils dilated, the vision appears to be abolished, the ears are pendant, if tied the subject attempts to get loose, if at liberty he moves steadily in some one direction regardless of obstacles or dangers, he bellows, pushes against walls or other obstructions and may seriously injure himself or others. There is, however, no mischievous purpose, he is simply impelled to blind motion, and no regard is had to anything which may be in his way. In some instances the nervous disorder is manifested by a sensitiveness of the skin, so that the animal shrinks when handled or pinched along the chine or back. Tremors is another marked symptom.

_Lesions._ These consist mainly in congestion and swelling of the gastric mucosa, which is further covered by a thick layer of mucus. The folds are especially thickened and discolored, and the seat of hemorrhagic extravasations (petechiæ) and exudations in spots and patches. Desquamation of the epithelium may be met with at points and even distinct ulcers. Exudation in the submucous tissue, and petechiæ in the peritoneum are common. The condition may bear a close resemblance to what is seen in rinderpest or malignant catarrh.

_Treatment._ The first desideratum is the elimination of the irritant ingesta from the stomach. But for this purpose emetics are useless and we must fall back on laxatives. Again we are met by the consideration that the inflamed stomach will neither readily absorb nor respond to a stimulus. Yet as a rule the viscus is not equally inflamed throughout, and even the affected parts do not necessarily have the whole muscular coat involved and paralyzed. We can therefore hope for a measure of response which once started will deplete and improve the adjacent and more violently affected parts. But irritant and drastic purgatives like croton, podophyllin or gamboge are proscribed as very liable to aggravate the inflammation. Pilocarpin 3 grs. hypodermically may be given or in default of this, 1 lb. each of Glauber and common salt in not less than six quarts of water, free access being allowed to pure water until it shall have operated. Bismuth may also be given as a calmative. Active rubbing of the abdomen will assist in rousing the stomachs to action, and hasten the action of the purgative. If there should be any sign of cerebral disorder, cold water or ice may be applied to the head, and oil of turpentine, followed by a pulp of the best ground mustard may be applied to the epigastrium and right hypochondrium. This may be accompanied and followed by copious enemata, and doses of quinia, gentian or still better nux vomica three times a day.

CATARRHAL GASTRITIS IN SWINE.

Definition. Causes, irritants, fermented, putrid swill, spoiled
vegetables, irritant molluscs or larvæ, hot or cold food, alkalies,
indigestible food, specific germs and toxins, parasites. Symptoms:
inappetence, restlessness, vomiting, colic, constipation, diarrhœa,
fever, stiffness, tender abdomen, arched back, chill, plaintive
grunting, drooping tail. Lesions. Treatment: change diet,
mucilaginous, milk, protection from saprophytes, change pen, emetic,
laxative, calomel, bismuth, cleanliness, washing.

_Definition._ Inflammation of the gastric mucosa with mucopurulent discharge.

_Causes._ Irritants of various kinds, fermented or putrid swill, spoiled vegetables, irritant molluscs or larvæ, too hot or too cold aliment, excess of brine, excess of alkalies, in swill (dishwashings), indigestible foods of all kinds. The stomach may also be the seat of catarrhal inflammation in hog cholera, swine plague, rouget, diphtheritic affections and in the case of gastric parasites, so that it is very important to distinguish the affections due to simple irritants, from those dependent on plagues and parasitism.

_Symptoms._ There is inappetence, vomiting, restlessness and constant movement, colics, vomiting, constipation or diarrhœa, hyperthermia, stiffness, tenderness of the abdomen to handling, arched back, a disposition to hide under the straw, plaintive grunting when roused, drooping of the tail. The tendency is to a rapid recovery after the evacuation of the stomach by vomiting, though it may persist under a continuance of the irritating ingesta.

In these last cases the _lesions_ may closely resemble those of the contagious affections of the abdomen, but the disease may be distinguished by its indisposition to spread beyond the herd which is subjected to the unhealthy dietary.

_Treatment._ Change the diet to one of pure and easily digestible materials, soups, mush, fresh whey or buttermilk, boiled farinas or flax seed, and even fresh grass. If there is violent diarrhœa boiled milk is often of great value.

Whatever food is given should be furnished in a vessel into which the animal can’t get his feet, as these are usually charged with septic germs which are pathogenic to the diseased stomach, though they may have started from ordinary saprophytes.

For the same reason it is usually desirable to change the pen, as the animal grubbing in the ground charges the snout with the same offensive microbes.

If vomiting is not already established, 30 grains of ipecacuan may be given, or tepid water may be used to assist the process. If constipation is present 10 to 30 grains of calomel (according to size) may be given. In case of diarrhœa a combination of calomel 1 part and chalk 12 parts, may be given in 3 grain doses, two or three times a day. Or ½ to 1 drachm nitrate of bismuth may be substituted.

Cleanliness in food and surroundings is among the most important measures, and if the skin has been filthy, repeated washing with soap and warm water may be resorted to with great benefit.

CHRONIC GASTRIC CATARRH IN SOLIPEDS.

Causes: Debility, age, anæmia, leucæmia, lymph gland, kidney, heart or
lung disease, parasitism, dental or salivary disease, coarse, fibrous
food, spoiled food, putrid water, gastric neoplasms. Symptoms:
Impaired appetite, eating lime or earth, weariness, costiveness,
coated dung, tympanies, diarrhœas, fatigue, sweating, unthrifty hide,
pallid mucosæ, emaciation, colics. Lesions: Thickened right gastric
mucosa, discoloration, mucus, petechiæ, opaque granular epithelium,
gastric dilatation. Treatment: Remove causes, diet, watering,
exercise, sunshine, bismuth, pepsin, acids, bitters, electricity,
antiseptics, stomachics.

_Causes._ These are in the main the causes which operate in producing the acute affection. In most chronic cases they act continuously on a system rendered susceptible by debility or otherwise. Among predisposing causes may be named: The debility of old age, anæmia, leucæmia, chronic diseases of the lymph glands, of the liver, kidney, heart, or lung, parasitic diseases, diseases of the jaws, teeth, or salivary glands which interfere with proper mastication and insalivation. Among exciting causes may be named: A coarse, fibrous, innutritious diet, a too bulky diet, spoiled fodders of all kinds, putrid drinking water, and stomach parasites (spiroptera, œstrus larva). Actual disease of the stomach—papilloma, cancer, actinomycosis, tumors, and oat-hair or other concretions are further causes.

_Symptoms._ Impaired or capricious appetite, a disposition to lick the walls or earth, or to drink impure water, yawning, constipation with glossy mucus-covered fæces, and slight tympany, alternating with diarrhœa, small, accelerated pulse, susceptibility to perspiration and fatigue on slight exertion, unthrifty skin and hair, hide-bound, dry, hot mouth, coated tongue, pallor of the mucous membranes, loss of condition, and increasing weakness. Slight colics may occur at intervals, and the sluggishness may deepen into stupor or vertigo.

_Lesions._ The right sac is usually the seat of more or less hypertrophy of the mucosa, which is thickened, rugose, with patches of dark red, gray and slate color, and covered with a layer of tenacious mucus. The surface may show warty-like elevations, or papillary projections, with here and there patches of blood extravasation. The epithelial cells are increased, opaque and contain many fatty granules.

Dilatation of the stomach is not uncommon especially in old horses, and then the mucosa may be attenuated and smooth.

Hyperthermia may be present, but is so slight that inflammation cannot be predicated from it and it is difficult to establish a diagnosis from chronic dyspepsia.

_Treatment._ It is important to first correct any curable predisposing disorder, in teeth, jaws, salivary glands, blood, or internal organs, to carefully regulate feeding, watering and work, to secure as far as possible an outdoor life, and to employ bitter and other tonics. All over-exertion or fatigue must be carefully avoided. The food may be as advised for the more acute affection. Costiveness may be best met by boiled flaxseed, or in case of necessity by bran mashes, or green food. The irritation of the stomach may be benefited by nitrate of bismuth (3 to 4 drs.) and pepsin, and dilute muriatic acid with each meal are often of value. Nux Vomica (10 to 25 grs. twice daily) will help to restore the lost tone, and a current of electricity may be sent through the epigastrium daily. As alternatives, sulphate of quinia or gentian may replace the nux, and salol or salicylate of bismuth may take the place of the nitrate. Bicarbonate of soda in ½ dr. doses, common salt in ½ oz. doses, and fennel in ½ oz. doses are sometimes useful in re-establishing gastric functions.

CHRONIC GASTRITIS IN RUMINANTS.

Causes: As in acute form, parasites, gravid womb, insufficient ration,
overwork, exhaustive milking, chronic diseases. Symptoms: deranged
appetite, rumination, pica, eructations, regurgitations, tympanies,
colics after feeding, coated dung, diarrhœa, fever, hot clammy mouth,
sunken eyes, small weak pulse, palpitations, emaciation, weakness,
tender hypochondrium. Lesions: hypertrophy of gastric mucosa, granular
epithelium. Treatment: tonic regimen, diet, green food, roots,
sunshine, bismuth, salol, strychnia, pepsin, muriatic acid, common
salt, counter-irritants.

_Causes._ These are in the main the causes of the acute affection. There may, however, be special persistent factors like parasites (strongylus contortus and filicollis, spiroptera) in the stomach, the pressure of a gravid womb, an alimentation deficient in lime or phosphorus, overwork, exhausting milking, or chronic disease of important organs (heart, liver, lung, kidney).

_Symptoms._ These are indefinite and not easily distinguished from those of disorders of the third stomach. There is impaired or capricious appetite, a disposition to eat lime, earth, and all sorts of non-alimentary objects, rumination is rare or altogether suspended, efforts to regurgitate are ineffectual, or result in gaseous eructations only, there are tympanies and abdominal pains especially after feeding, and constipation with a firm glazed appearance of any fæces passed, may alternate for a short time with diarrhœa. The mouth is hot and clammy, the eyes sunken and semi-closed, the pulse small and weak, though the heart may palpitate, and there is a constantly progressive emaciation and prostration. Among the more characteristic symptoms are tenderness of the right hypochondrium to manipulation and percussion, and the presence of slight hyperthermia.

_Lesions._ The changes consist mainly in hypertrophy of the gastric mucosa, with changes in the epithelium and submucosa such as are already described in the horse. The pyloric region suffers most, and here ulcers are not at all uncommon.

_Treatment._ The main aim must be to remove the causes, and to build up the general health, so that the patient may rise above the debilitating conditions. More is to be expected from the change of diet to green food, roots, mashes, etc., and an outdoor life than from the action of medicines, which are liable to disappear by absorption in the first three stomachs, so that they can only act on the fourth through the system at large. Yet benefit may be expected from the use of nitrate of bismuth, and salol, as calmatives and antiferments, nux vomica as a tonic and even from pepsin and muriatic acid as digestive agents. The two last are not dependent on the fourth stomach for their activity but will digest the contents more or less in the first three, and the finely disintegrated and partly peptonized ingesta coming to the fourth stomach in a less irritating, and less fermentescible condition, lessens the work demanded of that organ and gives a better opportunity for recuperation. Small doses of common salt and one or other of the carminative seeds may be added. The application of mustard or oil of turpentine to the right hypochondrium will sometimes assist in giving a better tone to the organ.

CHRONIC GASTRITIS IN SWINE.

Causes. Symptoms: inappetence, dullness, arched back, colic, irregular
bowels, fever, emaciation. Treatment: diet, green food, milk, mashes,
cleanliness, bismuth, salol, sodium bicarbonate, strychnia, pepsin,
muriatic acid, sunshine, washing.

_Causes._ These are like those producing the acute affection which may easily merge into this by a continuation of such causes.

The _symptoms_ too are alike. Inappetence, dullness, prostration, arched back, vomiting, colic, constipation, with alternating diarrhœa. There is hyperthermia with hot dry snout, thirst, increasing emaciation, and anæmia.

_Treatment._ An entire change of diet, to green food, roots, fresh milk, and soft mashes in limited quantity. Allow pure water freely. Adopt all precautions against contamination of the food by the feet or snout. The stomach may be quieted by oxide of bismuth (20 grs.) or salol (10 grs.) two or three times daily, and the tone and secretions of the stomach may be stimulated by bicarbonate of soda (1 dr.) and nux vomica (1 to 2 grs.) thrice daily. In addition pepsin and muriatic acid may be given with each meal in proportion adapted to its amount. A life in the open air, and an occasional soapy wash will do much to restore healthy gastric functions.

CHRONIC GASTRITIS IN THE DOG.

Causes: faults in diet, musty food, foreign bodies, poisons, lack of
sunshine, retained fæces, parasites, ill health, chronic diseases, icy
bath, septic drink. Symptoms: irregular appetite and bowels, fever,
foul breath, red tongue, tartar on teeth, dullness, prostration,
vomiting of mucus or bile, tender epigastrium, arched back, fœtid
stools, emaciation. Treatment: regulate diet, sunshine, pure water,
scraped muscle, soups without fat, antiseptics, calomel, pepsin,
muriatic acid, strychnia.

_Causes._ The irregularity and variability of the food, overfeeding, highly spiced foods, putrid or spoiled food, musty food, the swallowing of pieces of bone, and of indigestible bodies, the consumption of poisons, the absence of open air exercise, the compulsory suspension of defecation in house dogs, and the presence in the stomach of worms (spiroptera, strongylus), are among the common causes of the affection. As in other animals, ill health, debility, lack of general tone, and chronic diseases of important organs (liver, kidney, heart, lungs) must be taken into account. The plunging into cold water when heated and the licking of septic water must also be named.

_Symptoms._ Appetite is poor or irregular, the nose dry and hot, the mouth fœtid, the tongue reddened around the borders and furred on its dorsum, the teeth coated with tartar, the animal dull and prostrate, vomits frequently a glairy mucus mixed with alimentary matters or yellow with bile, and there is constipation alternating with diarrhœa. The epigastrium is tender to the touch, the back arched, the fæces glazed with mucus or streaked with blood, and offensive in odor. Emaciation advances rapidly and death may occur from marasmus.

_Treatment._ Adopt the same general plan of treatment. Stop all offensive and irritating food, give regular outdoor exercise, free access to pure water, and every facility to attend to the calls of nature. Give plain easily digestible food in small amount. In the worst cases pulped or scraped raw meat, in the less severe mush, or well-prepared soups with the fat skimmed off, and bread added. Check the irritant fermentations in the stomach by salol, bismuth, salicylate of bismuth, or naphthol. In case of constipation give 8 to 10 grs. calomel. Then assist digestion by pepsin (5 grs.) and hydrochloric acid (10 drops) in water with each meal. If the bitterness is not an objection 1 gr. nux vomica may also be added.

ULCERATION OF THE STOMACH.

Causes: peptic digestion, paresis, caustics, irritants, acids,
alkalies, salts, mechanical irritants, hot food, parasites,
thrombosis, embolism, specific disease poisons, aneurism, tumors,
infective growths, nervous disorder, debility, toxins of diphtheria,
staphylococcus, etc. Symptoms: slight colics, tympany, emaciation,
vomiting blood, tender epigastrium, dark or bloody stools, irregular
bowels; in carnivora abdominal decubitus, arched back, bloody, mucous,
acid vomit, colics after meals. Lesions: in horse erosions, ulcers,
parasites, neoplasms, discolorations, extravasations; in cattle and
dogs on folds, nature of ulcer. Treatment: restricted, digestible
diet, lavage, anodynes, bismuth, antacids, antiseptics, salol,
naphthol, chloral, pure water.

_Causes._ Gastric ulcers may arise from quite a variety of causes which determine necrotic conditions of the mucosa and the gradual invasion of the resulting lesion by destructive microbes. One of the simplest factors is the peptic juice, the stomach, being struck with paresis (in inflammation, fever, nervous disorder), while containing a quantity of its secretion, undergoes an autodigestion which affects particularly the lowest (pyloric) portion, toward which the liquid gravitates, and the free edges of the folds which are the most exposed to its action.

The swallowing of irritant and caustic agents (the mineral acids or alkalies, mercuric chloride, tartar emetic, antimony chloride, Paris green, arsenious acid, etc.) by corroding or causing destructive inflammation of the exposed mucous membrane may similarly operate. This is especially the case with monogastric animals, (horse, pig, dog, cat), as in the ruminants such agents tend to be diluted in the first three stomachs and rendered more harmless.

Mechanical irritants may cause the lesion and infection atrium in any of the domestic animals, pins, needles, nails, pieces of wire and other sharp pointed bodies being swallowed by horse and ox, and small stones, pieces of bone, and all sorts of irritant objects picked up by the puppy or rabid dog.

Cooked food swallowed hurriedly at too high a temperature is especially liable to start necrotic changes in the single stomach of horse, pig or dog, the ruminant being in a measure protected by the food passing first into the rumen.

The wounds caused by gastric parasites may become the starting points of molecular degeneration and ulceration. In the horse the spiroptera megastoma, s. microstoma, and the larvæ of the various œstri; in cattle and sheep the strongylus contortus, s. convulutus, s. filicollis and s. vicarius; in swine the spiroptera strongylina, Simondsia paradoxa, and gnathostoma hispida; in dogs spiroptera sanguinolenta, and in cats the ollulanus tricuspis act in this way.

Gastric catarrh debilitates the affected mucosa and lays it open to necrotic microbian infection especially in the pyloric sac and on the summit of the folds.

Interruption of the local circulation in the deeper parts of the mucosa as in inflammation and capillary thrombosis, arterial embolism, venous thrombosis, may lead to local sloughing and ulcerous infection. This may be seen in the petechial fever of the horse, malignant catarrh, rinderpest, and anthrax in cattle and sheep, and in canine distemper in dogs. Vogel found ulcers resulting from a gastric aneurism in the dog.

Tumors and infective growths in the walls of the stomach may prove an occasion of ulceration. Thus sarcoma, epithelioma, actinomycosis and tubercle may be the primary morbid lesion in different cases.

Gastric ulcers have also been attributed to morbid nervous influences as in dogs they have been found associated with lesions of the dorsal myelon, and the corpora quadrigemini, and faradisation of the vagus has apparently led to their production.

General constitutional debility has been alleged as a factor, and experimentally in dogs, the hypodermic or intravenous injection of various microbes or their toxins (diphtheritic toxin, Enriquez and Hallion, staphylococci, Panum, Lebert, Letulle, and a bacillus of dysentery in man, Chantemesse and Widal), have produced gastric ulcers.

_Symptoms._ In _horses_ and _cattle_ these are very obscure, being mainly in the nature of chronic gastritis. In both there are recurrent attacks of slight colicy pains, with tympany in cattle, and gradual emaciation. Vomiting has been exceptionally seen in both class of animal and if the rejected matters are very acid and above all if mixed with blood it is more suggestive of ulcer. In the horse the attacks of colic are mostly in connection with eating. or (in case the ulcer is duodenal) an hour or two after a meal. In this animal it is possible to withdraw liquids from the viscus by the stomach pump, and any hyperacidity or blood may be almost diagnostic. Tenderness to pressure on the epigastrium or hypochondrium is often present, yet the colics of ulceration are often relieved by pressure and friction. Blood is sometimes present as such in the excrements, but more commonly these are simply blackened by the exuded blood as acted on by the gastric acid and intestinal liquids. The bowels may be alternately constipated and relaxed. A gradually increasing feebleness is a characteristic feature and in cattle paraplegia may precede death.

In the _carnivora_ the symptoms are less obscure. The animal is dull, prostrate, weak, lies on its belly, but rarely long in one place, and when up has arched back, stiff movements, and tucked up abdomen. The epigastrium is painful to touch, which tends to arouse vomiting of food or bloody mucus. As in the horse the rejected matters are very acid. Constipation may alternate with diarrhœa, the fæces being blackened (melæna) or even streaked with blood. The occurrence of suffering after meals, the constancy and persistency of the symptoms and the steadily advancing emaciation and weakness are very characteristic. If the tenderness is referable to a given point, it is even more distinctive.

_Lesions._ In the _horse_ ulcers and erosions occur in the cardiac sack in connection with œstrus larva and spiroptera which destroy and remove the cuticular covering, or with sarcoma or epithelioma growing in the gastric walls. In the right sac there may also be round ulcers from the hooklets of the œstrus, or irregular excavations on the summits of the folds in connection with catarrhal inflammation. Ulcers from autodigestion are usually in the right sac, in the most dependent part of the viscus, between the folds, and of a more or less circular outline. The raw surface is black, brown, slaty gray or white. The ulcers which result from petechial fever are irregularly notched and marked by a mass of dark blood coagulated in their depth.

In _cattle_ and _dogs_ the ulcers are most frequent near the pylorus, and when of catarrhal origin may be round or irregular, and on the summit of the fold, or if peptic, may be round and between the folds. In malignant catarrh and rinderpest, they are mostly formed on the summits of the folds. They may vary in size from a pea to a quarter of a dollar. The surrounding mucosa is usually congested, swollen, and projecting, and the surface of the ulcer itself of a dark red, black, yellowish, slaty or gray.