Chapter XIV: Part 14

The French veterinarians assure us that rabiform symptoms are very common as the result of obstruction of the intestines with foreign bodies. The indications are signs of fury without the barking which characterizes genuine rabies. The patient becomes wicked, cross and excitable, sometimes dull and morose, and snappish, his eyes glittering and his mouth frothy. He has alternate paroxysms of fury and torpor, at one time flying at and biting any living thing he meets, or tearing some object to pieces, and at another hiding away in secluded and dark corners. Massenat saw two dogs supposed to be affected by rabies, but which recovered promptly after having vomited the foreign bodies which they had swallowed. In a country where rabies is so prevalent as in France, it would be interesting to see the results of inoculation with some of the most pronounced of these rabiform cases.

Beside the rabiform symptoms cough and epileptic seizures occasionally result from the foreign bodies.

_Course._ _Termination._ Unless relief is obtained by vomiting or purging, appetite ceases altogether, emaciation advances rapidly, the animal becomes dull and stupid, being evidently poisoned by the absorbed toxins, and death may ensue in four or five days if the obstruction is near the stomach, or in one or two weeks if in the large intestines.

_Treatment._ The general treatment advised for the horse is applicable to the carnivora. Purgatives are always dangerous as threatening the overdistension and rupture of the bowel above the obstruction. Oleaginous and mucilaginous injections with manipulations are more promising if the obstruction is in the colon or rectum.

In many cases laparotomy is the only hopeful resort. Felizet and Degive have been quite successful in removing corks in this way, and Fröhner advises the operation to be performed under opium narcosis, and with antiseptic precautions. Make an incision of 1¾ inch near the umbilicus and parallel to the linea alba, extract the blocked loop of intestine, ligature it in front of the foreign body and behind it, incise, remove the offending mass and carefully close by sutures, bringing the muscular and serous coats in accurate opposition. Remove the ligatures, disinfect, return the bowel into the abdomen, close the abdominal wound with sutures and apply an antiseptic bandage.

If such cases are to be operated on it is important that it be done early, before the occurrence of necrosis, ulceration, perforation, or general infection.

RUPTURE OF THE INTESTINE. SOLIPEDS.

Causes: overdistensions in front of obstructions, softening,
friability, necrosis, suppuration or ulceration, Duodenum from worms
or perforation by pointed bodies, exudate in verminous embolism,
petechial fever. Jejunum and ileum, by disease of walls, ulcers,
abscesses, neoplasms, caustics in umbilical hernia, clamping of
hernia. Cæcum, falls, blows, kicks, blows of horn, tusk, stump,
calculi, abscesses, cauterizing of hernia. Colon, external traumas,
calculi, worms, verminous thrombosis, neoplasms, abscesses,
overdistensions, violent straining, arsenic. Symptoms: follow
accident, signs of obstruction, no rumbling, tympany, stiffness, great
prostration, fever. Death in short time.

_Causes._ Ruptures occur as we have already seen from overdistensions of the bowel in front of some obstruction, by ingesta, concretions, calculi, foreign bodies, etc., and this may take place in the most healthy organs. In other cases, however, there has been some pathological process at work rendering the intestinal wall soft, friable, necrotic, suppurative or ulcerative, by which its substance is attenuated or its consistency or cohesion reduced.

=Duodenum.= Lacerations of the duodenum are often connected with obstruction by tumors or the ravages of worms. These latter are mostly the ascaris megalocephala, accumulated in mass, and sometimes engaged in pouches outside the walls of the gut. In other cases, the walls of the intestine have been perforated by hard woody stalks of straw or hay (Mollereau) or of still more woody plants as in a case observed by the author, and in which the pylorus was perforated. Sometimes the exudate or blood extravasation attending on petechial fever, or verminous embolism will pave the way for the rupture. Perforations by pieces of wire (Schmidt) or other metallic bodies are also observed. Adhesive peritonitis has also rendered the walls friable and predisposed to rupture.

=Jejunum and Ileum.= Lesions are most frequent toward the termination of the ileum and resulting from obstructions of the bowel or the weakening of the walls by disease, or both. Ulcerations, abscess of the closed follicles opening into the peritoneum, and neoplasms of various kinds are to be especially noted among the causes. The impaction of the cæcum, blocking the ileo-cæcal valve is also among the observed factors. Other instances have been traced to deep cauterization of an umbilical hernia, the enclosed loop of small intestine becoming inflamed and perforated. The author has observed one instance from clamping of a hernia in which the contained intestine was adherent to the hernial sac.

=Cæcum.= From its position on the lower part of the abdomen and from its habitual plenitude with food or water, this organ is especially exposed to direct mechanical injuries and ruptures. A sudden fall, more especially if the umbilical region strikes on a stone or other projecting solid body, kicks with heavy boots or with the feet of other animals, blows with a cow’s horn or a boar’s tusks, and violent contact with stumps, poles and other objects may be the occasion of the rupture. These are usually found near the base of the viscus and across its longitudinal direction.

Inflammations, connected with punctures, calculi, parasites, etc., may render the walls so friable that they give way under slight strain or injury. Abscesses have been found in the walls of the viscus leading to perforation, and extension of inflammation from an umbilicus cauterized for hernia has determined adhesion and perforation.

=Colon.= The loaded colon is even more liable to mechanical injury than the cæcum. Occupying as it does the more lateral parts of the abdominal floor, it is even more exposed to kicks and blows, and extending as it does back toward the inguinal regions, it is especially in the way of blows of horns so often delivered in this region. From the solid nature of its contents the presence of calculi, the presence of blood sucking worms, and its implication in the congestions and extravasations of verminous thrombosis, this organ is especially liable to degenerations and inflammations which render its walls particularly friable. Neoplasms of various kinds, cancerous, tubercular, etc., have been found on its walls as occasions of rupture. Abscesses of strangles have ruptured into the viscus. Overdistensions in front of an obstruction in the pelvic flexure, floating colon or rectum are the most frequent causes of rupture. Again, cases have been seen as the result of violent exertions, as during straining in dystokia. It has been a complication of phrenic hernia, of volvulus of the double colon, and of ulceration caused by the prolonged ingestion of arsenic. In severe impaction the necrosis of the intestinal walls has proved a direct cause of laceration. The seat of these ruptures may be at any point, but it is most frequent in front of the pelvic flexure, or in the floating colon, or directly in the seat of impaction.

_Symptoms._ The attack comes on suddenly, perhaps in connection with some special accident or injury, and is manifested by violent colicy pains which show no complete intermission. In many respects the symptoms resemble those of complete obstruction of the bowel, there is a suspension of peristalsis, rumbling, and defecation, a tendency to roll on the back and sit on the haunches, an oblivion of his surroundings and pain on pressing the abdomen. Usually the shock is marked in the dilated pupil, the weak or imperceptible pulse, the short, rapid breathing, cold ears, nose and limbs and the free perspirations. Tympany is usually present as the result of fermentation. Signs of infective peritonitis and auto-intoxication are shown in the extreme prostration, unsteady gait, dullness and stupor, and general symptoms of collapse. The temperature, at first normal, may rise to 105° or 106° as inflammation sets in, and may drop again prior to death.

_Termination_ is fatal either by shock or by the resulting peritonitis and auto-intoxication. Exceptions may exist in case of adhesion of the diseased intestine to the walls of the abdomen and the formation of a fistula without implication of the peritoneum.

RUPTURE OF THE INTESTINES IN RUMINANTS.

From blows of horns, tusks, etc., from rectal abscess. Symptoms:
colic, resulting in septic peritonitis and sinking. Treatment.

Lesions of this kind usually come from blows with the horns of others. They may lead to artificial anus as in a case reported by Rey, or the formation of a connecting sac as in that of Walley. In a case seen by the author a large abscess formed above the rectum, from injuries sustained in parturition. This ruptured into the gut leaving an immense empty cavity in which the hand could be moved about freely, but which gradually contracted so that the cow made a good recovery.

André furnishes an extraordinary record of rupture of the colon, blocked by a potato. It seems incredible that a potato could have traversed the stomachs and intestine without digestion.

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

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

LACERATION OF THE INTESTINE IN SWINE.

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

LACERATION OF THE INTESTINE IN CARNIVORA.

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

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

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

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

ABSCESS OF THE BOWEL IN SOLIPEDS.

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

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

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

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

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

ULCERATION OF THE INTESTINES.

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

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

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

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

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

DILATION OF THE INTESTINE.

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

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

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

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

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

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

Dilatation of the rectum into a cloaca is found in the horse and ox, often connected with disease or injury of the terminal part of the spinal cord, and is very common in dogs and cats in connection with the compulsory retention of the fæces indoors. Pigs also present instances of the kind.

The _symptoms_ are in the main slight colics, with or without tympany and recurring after each meal. In the small animals the distended gut may often be recognized by palpation through the abdominal walls, and in the larger animals by rectal exploration. The distended viscus has not the firmness nor hardness of impaction or calculus and is mainly recognizable by its bulk and form. When the distension is in the rectum it may be easily reached and contents dislodged with the effect of giving complete relief for the time being.

_Treatment._ Treatment is necessarily mainly palliative and consists in the removal of abnormal accumulations. From the rectum this can be done with the hand, or in the smaller animals with the finger. For abnormal dilatations more anterior, purgatives and mucilaginous injections are required, with kneading of the bowels through the abdominal walls, or through the rectum in the larger animals, and stimulation of the peristalsis by nux vomica, ergot, barium chloride or eserine.

Having unloaded the dilated portion of any undue collection, further accumulation should be guarded against by giving nutritious food in small compass, and of a laxative nature, by stimulating peristalsis by nux vomica or other nerve stimulant and by the daily application of electricity. Enemata and laxatives should be employed when necessary.

STRICTURE OF THE INTESTINE.

From healing of ulcers, inflammation or infiltration, neoplasms, ring
like or sacculated, in small intestine in horse preceded by a
dilatation, an effect of verminous thrombosis; in cattle; in dog.
Symptoms: Progressive, if in duodenum can’t eat full meal, belches
gas, has colics and tympany; in cattle tympany, unthrift; in dog
vomiting, tympany, colic, accumulations. Treatment: Gradual stretching
by bougies if within reach.

Strictures of the intestine are in the main the result of ulceration of the intestinal walls which contract in healing, or inflammation, and infiltration which leads to contraction in their organization into tissue. Neoplasms of the walls (cancer, myxoma, lipoma, polypus, melanosis, actinomycosis, tubercle) are additional causes of constriction. If resulting from a lesion which completely encircled the bowel there is an uniform constriction in the form of a circular ring; if on the other hand it started from a longitudinal ulcer or lesion the bowel is shortened on that side and puckered.

In =solipeds= strictures are most frequent in the small intestine, or rectum. The pylorus is often affected. When on the small intestine there is constantly a dilatation just in front of the obstruction. The constricted portion is usually short, but as seen from outside of the gut may be duplicated a number of times. Cadeac mentions seventeen such strictures in the same animal, each preceded by a dilatation. The individual stricture may be less than two inches in length and so narrow as just to allow the passage of the index finger. The walls of many times their natural thickness, are still further thickened by an external layer of adipose tissue. It may be the seat of a small abscess, or of a tumor. Internally the mucosa may show ulcerations.

The stricture or strictures in solipeds often depend on the disturbance of the circulation which results from verminous thrombosis, the exudate into the intestinal walls, undergoing organization, at once thickens and constricts the tube, and determines as secondary result the dilatation in front of it.

Professor Mauri of Toulouse records the case of a horse with a rectal stricture 4 inches from the anus, and a great dilatation in front. The removal of the stricture, secured normal defecation, (whereas before this the fæces had to be removed by hand) and the colics entirely disappeared.

In =cattle= strictures have been found mainly at or near the pylorus, less frequently in the rectum, and on one occasion (Revel) in connection with a cancerous tumor, in the colon.

In the dog the pylorus is also the favorite seat of thickening and stricture, yet it may occur in the small intestine, the rectum, or the colon.

_Symptoms._ These are gradually advancing, as the stricture approaches more and more nearly to a complete stenosis. If the stricture is in the pylorus or duodenum, the patient can not eat a full feed of grain without discomfort. He stops, hangs back on the halter, plants the fore feet in front, arches the neck, drawing in the nose and eructating gas. If he cannot eructate he is liable to show colics, tympany, and the general symptoms of gaseous indigestion of the stomach.

In =cattle= there is tympany, partial loss of appetite, tardy rumination, and loss of condition.

=Dogs= show vomiting as a prominent symptom. When the stricture is in the rectum there is a gradual lessening of the amount of fæces passed at a time and an accumulation of feculent masses in advance of the obstruction, recognizable by rectal exploration. When in the terminal part of the small intestine or in the colon, a gradual lessening of defecation, with tympanies and colics, culminating in complete obstruction, may afford a suggestion of the trouble but no means of certain diagnosis. In the smaller animals some additional indications may be had from abdominal palpation.

_Treatment_ is usually hopeless unless the stricture is in the terminal portion of the rectum. In the latter case gradual dilatation by the passage of the hand, the finger, or of bougies which are used larger and larger, as they can be forced through with moderate pressure may secure a sufficient dilatation. Forced dilatation, or even careful incision at several different points of the circumference of the stricture may give good results in certain cases.

INTESTINAL INVAGINATION. INTUSSUSCEPTION IN SOLIPEDS.

Definition. Seat: ileum into cæcum, rectum through sphincter, duodenum
into stomach, floating small intestine into itself, cæcum into colon.
Lesions: blocking, or tearing of mesentery, dark congestion,
peritoneal adhesions, incarcerate gut, necroses, sloughing of
invagination. Symptoms: colics of obstruction, enteritis, and septic
infection, eructation, emesis, tenesmus, signs of sepsis and collapse,
death in seven hours or more, or recovery by disinvagination or
sloughing. Diagnosis: by rectal exploration or passing of slough.
Treatment: oily laxatives, demulcents, enemata, mechanical restoration
of everted rectum, laparotomy.

_Definition._ The sliding of one portion of an intestine into a more dilated one, as if a few inches of the leg of a stocking were drawn within an adjoining portion which is continuous with it.

_Seat._ It is most commonly seen in the inversion of the small intestine into itself or into the cæcum, or next to this the passage of the rectum through the sphincter ani, to constitute eversion of the rectum. It would appear to be possible at any part of the intestinal canal in the horse, in which the bowels are more free to move than they are in ruminants. Peuch records a case of invagination of the duodenum into the stomach and Cadeac gives a woodcut of such a case, which one would suppose the fixed position of the duodenum would render impossible. It is conceivable that the jejunum could be invaginated into the duodenum, and that this should have continued until it extended into the stomach, but it is difficult to see how the duodenum itself could have passed into the stomach without tearing itself loose from its connections with the pancreas, liver and transverse colon.

Schrœder, Serres and Lafosse describe cases in which the small intestine was everted into the cæcum and thence through the colon and rectum until it protruded from the anus.

The invagination of the floating small intestine into itself is common at any point, and extensive and even repeated. Marcout records a case in which 24 feet were invaginated, and Rey a case of quadruple invagination at the same point.

The invagination of the cæcum into the colon is frequent, the blind end of the cæcum falling into the body of the same organ, and this continuing to increase until it passes on into the colon, and even carries a portion of the small intestine with it. This lesion is more rare in solipeds because the cæcum has its blind end lowest and gravitation opposes its invagination.

_Resulting Lesions._ In any case of invagination it must be noted that it is not the intestine alone which slips into its fellow, but it carries with it its attaching mesentery, which, dragging on one side of the invaginated gut, shortens and puckers that and turns its opening against the wall of the enclosing gut so as to block it, while the opposite or free side passes on and tends to form convolutions. If the outer and enveloping intestine is too small to allow of this, the detaining mesentery of the invaginated mass must be torn or stretched unduly and its circulation and innervation correspondingly impaired. When the invagination occurs of one portion of the small intestine into another of nearly equal size, the resulting mass is firm like a stuffed sausage, and this enlargement and consolidation ends abruptly at the point of visible entrance of the smaller contracted portion, into the larger dilated one.

If recent, the invaginated mass is still easily disengaged from the enveloping portion, though considerably congested and dark in color in proportion to the duration of the lesion. When it has been longer confined the incarcerated portion is the seat of extreme congestion, and extravasation, and has a dark red or black color. The exudation into its substance, which is especially abundant in the mucosa and submucosa, produces a thickening which may virtually close the lumen, and on the opposing peritoneal surfaces leads to adhesions which prevent the extraction of the imprisoned mass. The interruption of the circulation and the compression of the invaginated mass, leads soon to necrosis and thus a specially offensive odor is produced, and if the animal survives the whole may be sloughed off and passed with the fæces, the ends of the intussuscepted portion and of that receiving it meanwhile uniting and becoming continuous with each other.

_Symptoms._ These are the violent colic of obstruction of the bowels, soon complicated by those of enteritis and finally of septic infection.

The animal looks at his flank, paws, kicks with his hind feet, lies down, rolls, sits on his haunches, waves the head from side to side, and sometimes eructates or even vomits. Straining may be violent, with the passage of a few mucus-covered balls only, and rumbling may continue for a time if the small intestines only are involved.

The partial subsidence of the acute pains, the presence of tremors, dullness and stupor, the coldness of the ears and limbs, the small, weak or imperceptible pulsations, the cold sweats, dilated pupils, and loss of intelligence in the expression of the eye and countenance may indicate gangrene, and bespeak an early death which may take place in seven hours.

The subsidence of the acute symptoms with improvement in the general appearance and partial recovery of appetite may indicate a spontaneous reduction of the invagination, an issue which may happily arrive in any case in the early stages, but especially in those implicating the cæcum and colon.

An absolutely certain _diagnosis_ is rarely possible, unless the lesion is a protrusion of the rectum, or unless as the disease advances the invaginated part is sloughed off and passed per anum.

_Treatment._ The failure to make a certain diagnosis usually stands in the way of intelligent treatment. Oleaginous laxatives and mucilaginous gruels are advised to keep the contents liquid, and favor their passage through the narrowed lumen of the invaginated bowel. In cases implicating the floating colon and rectum abundant watery or mucilaginous injections may assist in restoring a bowel which has not been too long displaced. In case of eversion of the rectum, the hand should be inserted into the protruding gut and carried on till it passes through the sphincter ani. Then, by pushing it onward, the arm carries in a portion of the invaginated gut and usually of the outer portion next to the anus as well, and this should be assisted by the other free hand, and even if necessary by those of an assistant, and whatever is passed through the sphincter should be carefully retained, while the arm is withdrawn for a second movement of the same kind, and this should be repeated until the whole protruding mass has been replaced.

Invaginations situated more anteriorly and which can be correctly diagnosed by rectal exploration or otherwise, will sometimes warrant laparotomy, especially those of the cæcum into the colon, where adhesion of the peritoneal surfaces is less common or longer delayed. The patient should be given chloroform or ether, the abdominal walls should be washed and treated with antiseptics, and the incision made back of the sternum and to one side of the median line, and large enough to admit the exploring hand. It has also been suggested to introduce the hand through the inguinal ring, or behind the posterior border of the internal oblique muscle.

INTESTINAL INVAGINATION IN RUMINANTS AND SWINE.

Double colon cannot be invaginated, floating small intestine, cæcum
and floating colon can. Causes. Lesions. Symptoms: Acute, violent,
persistent colic, palpation of right flank causes gurgling, rectal
exploration, prostration, collapse. Duration 1 to 5 weeks. Treatment:
Laxative, enemata, injections of sodium bicarbonate and tartaric acid,
laparotomy.

In these animals the double colon is rolled around itself between the folds of the great mesentery the free border of which supports the small intestine. The arrangement is as if a piece of rubber tubing were first doubled upon itself, and the end of the loop were then turned inward and the remainder wound round it as a centre. If this were then sewed between two pieces of cloth, the stitches passing between the different windings of the tube at all points, we would have an arrangement fairly representing that of the double colon of ruminants, and, for our present purpose, of swine as well. It must be evident that no portion of a tube arranged in this way can slide into another. It would also appear that the small intestine cannot become invaginated to any extent into another portion or into the cæcum without extreme stretching or laceration of the small portion of mesentery left between it and the coils of the double colon above. The anatomical arrangement is therefore opposed to the formation of invaginations in a way that is not the case in the horse.

Yet invaginations are by no means unknown in these genera. The small intestine can be invaginated into itself or into the cæcum. The cæcum, which floats loose at the right side of the mesentery that envelopes the double colon, can be invaginated into the colon, and the floating colon can be invaginated into the double colon on the one hand and into the rectum and through the anus on the other. Invagination into the rectum, for eight inches, in a bull calf, of six days old, is reported by Cartwright in the _Veterinarian_ for 1829. In a similar case of Youatt’s the intussuscepted portion sloughed off and was discharged per anum.

The _causes_ are like those acting in solipeds, and which give rise to excessive and irregular peristalsis. A drink of ice cold water, indigestions and colics of various kinds, diarrhœa, chills, the irritation caused by poisons or parasites, and the paresis and dilatation of portions of the intestine into which the more active portions can easily pass. Almost any irritation or congestion may cause intussusception, and young animals in which peristalsis is most energetic are the most liable.

_Lesions._ The intussusception is usually found in the ileum and to a less extent in other parts of the small intestine, or involving the cæcum and colon, or again the floating colon and rectum. The successive conditions of congestion, exudation, adhesion, obstruction, necrosis, sloughing, and repair by union of the remaining ends are the same as in the horse.

_Symptoms._ There is acute, agonizing and dangerous colic in an animal in which these troubles are usually comparatively slight and transient. The animal looks at the right flank, paws or stamps with fore feet as well as hind, lies down and rises often, strains to pass manure but passes only mucus or a few small hard masses, if anything. If pressure is made on the right side of the abdomen and the hand suddenly withdrawn there is a significant gurgling and the corresponding hind foot is lifted or moved forward or backward, appetite and rumination are lost, the pulse becomes rapid and weak, and the animal becomes prostrate, dull and stupid, often remaining recumbent in spite of all efforts to raise him. Rectal exploration may detect the firm tender mass in the seat of the invagination. The disease may last from one week to five, according as the obstruction is complete or partial. The usual termination is a fatal one, though a certain number of spontaneous recoveries are met with.

_Treatment._ By a happy accident the peristalsis or anti-peristalsis determined by a purgative will sometimes disengage the intussuscepted bowel. Copious injections into the rectum may also prove useful in case of intussusception of the floating colon or rectum. Or the disengagement of carbon dioxide from the injection of solutions of sodium bicarbonate and tartaric acid may be tried. Laparotomy is however the most radical measure when a certain diagnosis has been made and this is less dangerous in the cow than in the horse in which peritonitis is so grave. Under antiseptic precautions an incision is made in the right flank and the invagination found and reduced. In case firm adhesions have already taken place, and above all if the included gut is apparently gangrenous, the latter may be exposed by breaking down the connections at the side opposite to the attachment of the mesentery, or where the adhesions are least firm, then cutting out and removing the incarcerated gut and carefully closing the opening between the ends by suture. The use of a sublimate or carbolic acid solution and careful suturing and bandaging of the external wound with carbolated cotton wool will often give a successful issue.

INTESTINAL INVAGINATION IN DOGS AND CATS.

Anatomical conditions favor. Causes: as in other animals, common in
icterus, and surgical operations from deranged peristalsis. Lesions:
most common in small intestines, congestion, inflammation, necrosis,
sloughing. Symptoms: may be colic, but not always, dullness, anorexia,
vomiting, constipation, palpation, swelling firmer than from impacted
twine. Treatment: shot, castor oil and exercise on hind legs.
Demulcents. Laparotomy.

The intestines of the carnivora are more open to invagination than in other domestic animals for even the colon is free enough throughout its course to allow of one part sliding into another. The _causes_ to which it is attributed are in kind the same as in other domestic animals. The swallowing of ice cold water in excess when heated, diarrhœa, superpurgation, intestinal worms, the active peristalsis of early life, and jaundice have been especially blamed. Reynal found intussusception twenty times in forty cases of icterus and Rancilla four times in five cases. It has been frequently seen after severe surgical operations, and it is surmised that in both cases alike the deranged peristalsis attendant on severe suffering was the cause of the accident.

_Seat and Lesions._ The most common seat of invagination is in the small intestines, and less so in the cæcum and colon, or rectum. The lesions are as in the other animals, congestion, infiltration, adhesion, necrosis, gangrene and sloughing.

_Symptoms._ There may be colics as in the larger animals, but in some instances there are simply prostration, dullness, inappetence, vomiting, constipation, or the passage of a little liquid and fœtid excrement. Palpation of the abdomen detects a firm, cylindroid and very tender swelling on the line of the softer intestine which taken with the other symptoms is nearly pathognomonic. If situated in the small intestine and disconnected from the rectum and pelvis the diagnosis is more satisfactory. Impaction is most commonly in the rectum and floating colon and can be traced into the pelvis and even felt by the finger introduced into the anus. It might be confounded with obstruction of the intestine by the ingestion of twine, but the swelling is usually firmer and the cylindroid outline more uniform in intussusception.

_Treatment._ The measures recommended for the larger animals are applicable to the dog. Cadeac has had four recoveries in seven cases after the use of leaden shot and castor oil. Three balls of No. 16 calibre are dipped in castor oil and given to the dog. This is followed by ½ oz. of castor oil slightly heated, and walking or running exercise, or take the dog by his fore limbs and walk him around on his hind. No drink is allowed for 24 hours, and a quart of decoction of flax seed on the day following.

Should these measures fail, laparotomy is available, yet it is more promising in proportion as it is resorted to early, before ulceration, or gangrene has set in. The manipulations are practically the same as in the ox and the outcome is even more promising. The diet should be restricted to milk or mucilaginous gruels for a week after the operation.

VOLVULUS (TWISTING) OF THE INTESTINE IN SOLIPEDS.

Definition: rolling of a loop on its mesenteric axis, bending in a
vicious direction, rolling of one loop round another. Causes: laxity
of mesentery in hernia, relaxation or rupture of linea alba, pot belly
in old breeding mares, sudden movements in falls, leaps, draught,
galop, slipping, mounting, warm weather, casting, rolling, rising,
sudden filling of a loop, heavy feeding and fermentescible food, cold
drinks, chills. Lesions, most in double colon, next in jejunum, cæcum
wrapped in small intestine, floating colon, tympany and pallor of
obstructed loops, later congestion, infiltration, extravasation,
adhesions, necrosis, sloughs, infective peritonitis. Symptoms: sudden
severe attack, violent, reckless colicy movements, pain constant with
exacerbations, fever, prostration, collapse. Diagnosis: only by rectal
exploration and exceptionally. Treatment: by rectal manipulation,
eserine, castor oil, laparotomy.

Strictly speaking this lesion consists in the twisting of a loop of intestine upon its mesenteric axis, so that the portion which is drawn spirally over the mesentery of the other is more or less completely obstructed. The term has, however, been applied as well to the turning of a viscus at a sharp angle from its normal direction so as to interfere more or less with the passage of its contents and with its circulation. This has been especially seen in a vicious direction given to the cæcum, but also at times to the double colon. The simple twisting on the mesenteric axis is common to the floating portion of the small intestines, the double colon, floating colon and rectum. A third form of twisting which is, however, rather a strangulation, consists in the rolling of one loop of intestine round the loop of another, the mesentery of which has become unduly long.

_Causes._ The predisposing cause is a certain laxity or undue lengthening of the mesenteric attachment of the intestine. This is sometimes formed in connection with the existence of hernia, into which the bowel protrudes, or short of this a relaxation or rupture of the linea alba so that the whole of the intestinal mass hangs down unduly, or finally in unthrifty pot-bellied animals and in breeding mares in which the abdomen is unduly pendent.

Next comes the question of sudden movement as in falls, in leaping, in violent exertions of draught, or galop, in sudden slipping upon wet or icy ground, and of stallions in mounting mares. In the Omnibus Company’s (Paris) horses Palat found 35 cases in entire horses, 23 in mares, and 11 in geldings. The stallions in the stables were fewer than the mares and geldings put together, but it does not appear that the difference was sufficient to make the above figures very significant. These stallions it should be added, are not used for breeding, so that the statistics have no bearing on the effect of mounting.

Palat’s figures show a greater number of cases in summer, than in winter. There were 58 cases from April to October and but 21 from November to March. It would seem as if the relaxation of the system and mesentery in summer more than counterbalanced the combined effect of slipping on ice and sudden chills.

A large proportion of the cases have been found in horses that have died of colic, or which have been cast for operation, and the recent character of the lesions has often shown that we must look upon them as the result of the tumultuous peristalsis, and the lying, rolling, sitting and other sudden and unwonted movements performed. A heavily loaded portion of bowel, occupying a position slightly lower than a lighter portion or parallel to it, suddenly moves by gravitation when their relative positions are altered as in rolling, decubitus, or rising, and it thereby becomes twisted upon itself. Or a portion of intestine filled with liquid or gaseous contents is suddenly emptied by the passage of these onward into another and the latter portion of intestine or some other lodged alongside it, in moving to fill the place, rotates upon itself and establishes a volvulus.

Hard worked horses which are subjected to stimulating feeding are much more frequently attacked than those which have light work and feeding. In the same way newly harvested hay or oats, spoiled or otherwise indigestible food have apparently been productive causes. Cold drinks, and exposure to cold draughts have been similarly charged. Indeed any cause of indigestion and colic may be held to predispose to volvulus.

_Lesions._ _Seat._ Twisting of the small intestine is impossible in the duodenum, and for the floating portion it is far more common in the ileum and terminal portion of the jejunum where the mesentery is long than in the anterior jejunum where it is short.

The double colon from the sternal portion to the pelvic flexure being free from any restraint by omental or mesenteric bands is especially liable to torsion. Palat found four cases of torsion of the colon to one of the small intestine, and Schutze gives the ratio as 56 of the first to 13 of the second.

The cæcum has been frequently found twisted upon itself with a portion of the small intestine rolled round it.

The floating colon like the small intestine is rolled around its mesenteric axis, but cases are much more rare than in the case of the small intestine.

In a recent and complete twisting with obstruction of the bowel, the loop of intestine is distended with gas the result of fermentation of its contents, and its walls may be thin and pale. Much more commonly and when the lesion is of longer standing there is hyperæmia, and infiltration and thickening with inflammatory products, and blood extravasations. At the seat of torsion the compressed intestine is congested, covered with petechiæ, and its peritoneal surface with fibrinous exudate tending to bind the parts together. Later there may be seen spots of necrosis and perforating sores and semi-detached sloughs, or the whole mass of twisted bowel may be gangrenous. The patient usually dies before this last stage has been reached. If the animal survives long enough the lesions of infective peritonitis are constantly present.

_Symptoms._ The disease usually sets in suddenly with intense severity. In exceptional cases there is an insidious onset, the twist being at first but partial and gradually increasing and for a time the contents pass on in a restricted but still physiological manner. Colics at first slight become by degrees more and more intense until all the symptoms of obstruction and acute inflammation are developed.

More commonly symptoms of extreme gravity appear at once, the patient stops, paws, kicks at his belly, tries to lie down, strains to defecate or urinate, lies down, rolls, sits, gets up and moves round uneasily trying to lie down again. He looks at the flank with anxious eye and countenance and has all indications of the most violent colic. Pain is constant, but worse at one time than another, the pulse is from 50 to 90 and becomes weak and even imperceptible as the case advances, and hyperthermia, at first slight or absent rises with the onset of inflammation. Finally great prostration, depression and stupor, sunken, glazed eye with dilated pupil, and cold sweats and extremities bespeak collapse or general infection.

_Diagnosis_ is rarely certain. The sudden onset, extreme violence of the symptoms, and rapidly fatal progress are significant and in exceptional cases rectal exploration will detect obstruction in the rectum or floating colon, or a tympanitic condition of the pelvic flexure.

_Treatment._ A rational treatment is only possible in those rare cases in which the diagnosis is certain. When the lesion can be reached in the rectum or adjacent part of the floating colon, the oiled hand may be made to drag on the interior of the viscus so as to restore it to its normal position.

Cadiot has had recoveries from supposed volvulus by the use of eserine hypodermically, and Trasbot by the use of castor oil and it is just possible that active peristalsis, and plenitude of the bowel running into the volvulus, may serve to unwind slight cases. When the diagnosis is certain and the case, as usual, intractable the resort of laparotomy and the attempt at untwisting is fully warranted. The case is a fatal one if unrelieved.

VOLVULUS IN RUMINANTS.

This condition is almost unknown in ruminants, Reichert recording a single case of volvulus of the ileum involving 8 inches of the gut. The reason for the habitual immunity is to be found in the arrangement of the small intestine at the end of a mesentery which is strengthened and stiffened by the winding folds of the colon until twisting is practically impossible. There remains, therefore, only the floating colon and rectum at all exposed to the lesion. The isolated case of Reichert only proves the rule.

VOLVULUS IN DOGS.

Rare. Short mesentery hinders. Occurs with hernia. Symptoms:
obstruction, prostration, colic, tense, painful abdomen, retching,
anorexia, exhaustion. Treatment: laparotomy.

The carnivora seem to be protected against volvulus by the shortness of their mesentery, the comparative lightness of the intestinal contents, and the restricted area of the abdominal cavity. Cadiot, Müller, and Friedberger and Fröhner agree in ignoring the subject as a canine disease, while Cadeac mentions only such cases as are complicated by mesenteric hernia, the protruding loop becoming twisted in the wound through which it has protruded.

“The _symptoms_ are those of invagination or intestinal obstruction; sometimes the animal is dull, anxious, resting almost constantly down on his belly, and this prostration dominates the table of symptoms; sometimes, on the contrary, the subject manifests signs of excitement and intestinal pain; it trembles, lies down, glances at its flanks; sometimes it even lets itself fall abruptly, straightens out stiffly its limbs and head, clenches its jaws and rolls its eyes.”

“In all cases the belly is hard, drawn up, painful to pressure or palpation; but these means of exploration are insufficient to feel the intestinal knot.”

“Constipation is persistent, obstinate, and efforts at vomiting continuous; anorexia is incomplete, or the animal rejects the solid and liquid aliments immediately after their ingestion. Vomited matters, when they exist, become glairy, bilious toward the end of the attack; but sometimes the animal becomes exhausted in his fruitless efforts; one is rendered uncertain and hesitates to confirm his diagnosis by laparotomy.”

The only treatment advised is by laparotomy.

INTESTINAL STRANGULATIONS BY ADVENTITIOUS BANDS.

Result of circumscribed peritonitis. Extends from one part of
abdominal wall to another, around or between intestines, on omentum,
or adhesion of omentum to inguinal ring. In cattle tubercular products
strangulate bowels. Symptoms: the colic of obstruction, rectal
exploration. Treatment: laparotomy, removal of constricting band.

Adventitious fibrous bands in the abdomen are the result of a pre-existing peritonitis of a circumscribed area. The fibrinous exudate thrown out on the parietal peritoneum is detached in its median part but remains adherent at the ends, and when organized into tense resistant white fibrous tissue remains as a trap to entangle and strangulate the intestinal folds. In other cases they form on or between intestines or other viscera which are for the moment torpid and inactive, and contracting as they become organized, they bind these together and hamper their movements, and endanger the integrity of all movable viscera in the vicinity. Again they form on the omentum and threaten the integrity of the bowels by strangulation. The omentum protruding at castration becomes adherent to the inguinal ring and forms a dangerous band.

In _cattle_ the growth of peritoneal tubercle often binds the small intestines together in an inextricable tangle leading to considerable compression, and obstruction without a complete stenosis.