Chapter VIII: Part 8

The round ulcer is usually marked by surrounding infiltration and by a tendency to become deeper and to perforate the gastric walls, with the result of inducing an infective peritonitis. This is more common in cattle and carnivora than in solipeds.

_Treatment._ If a reasonably certain diagnosis can be made the patient should be put on a restricted diet of easily digested materials, given at regular intervals. For the carnivora scraped or pulped raw meat, and milk, and for the herbivora milk and well boiled flax seed or other farina are appropriate.

Violent emesis in carnivora may demand washing out of the stomach with tepid water with or without the aid of a stomach tube. This may be seconded by anodynes, chloral, cyanide of potassium, or even morphia.

Bismuth trisintrate or oxide is appropriate in all animals, also sodium bicarbonate, chalk or magnesia to neutralize the muriatic acid.

As antiseptics calculated to obviate the formation of irritant products from the gastric contents and to check the progress of the microbian infection in the wound such agents as the following may be used: Salol (horse or ox 1 dr., dog 5 grs.), naphthol or naphthalin (same doses), chloral (horse 2 drs., dog 5 grs.).

Sometimes it is well to relax the bowels by small doses of Glauber salts, and in all cases an abundance of fresh water, butter milk, or other bland drink.

Cases of the kind are slow in their progress and unless the animal is specially valuable, treatment may be a source of loss.

PERFORATING ULCER OF THE STOMACH

Causes: round ulcer, foreign bodies, parasites. Symptoms: those of
ulcer, followed by infective peritonitis, fistula, pleuritis,
pericarditis. Treatment: of fistula.

This may be the result of the gradual deepening of the round ulcer, yet in the domestic animals it mostly comes from the presence of sharp pointed bodies. These may be enumerated as needles, pins, nails, wires, sharp bones (dog), whalebone (horse), forks, knives (cattle), and even gravel. The burrowing of the spiroptera has seemed to cause perforation in the horse. All causes of ulceration may, however, lead to perforation.

The _symptoms_ are those of gastric ulcer, already given, followed by the more specific ones of perforation. These in their turn differ according to the parts involved. In the horse and dog the perforating ulcer usually opens into the peritoneum, inducing a fatal infective peritonitis. In cattle the foreign body sometimes passes toward the heart, enveloped in a protecting mass of new formed tissue and proves fatal by heart disease. In other cases it has been found to proceed downward toward the sternum and to escape by a fistula formed beside the ensiform cartilage. In other cases it has taken a direction toward the right wall of the abdomen where it formed a fistula, discharging alimentary matters. In still other cases it has opened into the peritoneal cavity with fatal effects.

_Treatment_ in the case of external fistula, without implication of the peritoneum, consists in the removal of the foreign body, and the stimulation of granulations along the tract of the fistula by the application of an ointment of tartar emetic to the interior. Should this fail the fistulous tract may be scraped to make it raw, and the edges may then be drawn together with sutures taking a deep hold of the skin.

DILATATION OF THE STOMACH.

Adaptability to bulk of food. Dilatation with atony. Eructation.
Cribbiting. Vomiting. Age. Rare in cattle. Catarrh, overloading,
nervous lesions, intestinal obstructions, tumors, calculi, volvulus,
invagination, hepatitis. Symptoms: overfeeding, pot-belly, unthrifty
hide, emaciation, eructations, cribbiting, fatigue, perspiration,
indigestion, colic after meals, tympanic resonance. Lesions: varying
distension, contents, action of calculus or pebbles, cardiac
dilatation. Treatment: nutritive, digestible, concentrated food,
lavage, strychnia, iron, faradisation, antiseptics.

The stomach has a great power of accommodation to the amount of food habitually taken. In the horse fed mainly on grain with only a little hay, it is habitually small, while in one fed on cut straw with a little grain, on hay alone, or on green food, it is very much more capacious though within the physiological limits of health. The cow wintered on grain alone, has all four stomachs lessened in capacity, and though she maintains good condition she is ill fitted to change at once to the bulky grass diet of spring. The heavily fed swine, and the farina fed dog and cat, have both stomach and intestines increased in capacity over those of the wild boar, or the purely carnivorous wolf or wild cat.

The condition becomes pathological when associated with atony, and this may occur directly from over distension. It is especially common in the horse by reason of the difficulty of relieving the over distension by eructation or vomiting, and also by reason of the habit of swallowing air (cribbiting). The dog, which has great facility in vomiting, should be correspondingly protected from the condition, yet it is very common in old dogs, doubtless from their common vice of gourmandizing and lack of exercise. Cattle are rarely attacked, the fourth stomach being protected by the others which stand guardian over it and prevent the sudden access of excess of food even if that is rapidly swallowed.

Other _causes_ are: chronic catarrh which renders the stomach atonic, lessens its peptic secretion and determines indigestions and over distensions: habitual overfeeding which results in chronic indigestions and fermentations; lesions of the brain, and tumors of the jugular furrow or mediastinum which interfere with the functions of the vagus nerve; obstructions of the intestines which force the contents back into the stomach or hinder their exit. Thus tumors on the duodenum, calculi in stomach or intestines, volvulus and invagination have been charged with producing overdistension. Chronic hepatic disorder has also been quoted as a cause.

_Symptoms._ The subject may eat naturally or excessively yet is unthrifty, the belly is habitually distended, the hair dry and rough, there is loss of flesh, there may be eructations or (in the horse) swallowing of air, lack of endurance, a disposition to perspire easily, a tendency to indigestion and colics after meals, and hurried breathing sometimes marked by a double lifting of the flank in expiration. In the _dog_ which has the stomach more accessible to examination its outline may be followed by percussion, a tympanitic resonance being produced from the eighth rib back to the umbilicus or further. If there is any difficulty the organ may be emptied of water by a stomach tube and then pumped full of air by means of a Davidson’s syringe, and percussed in each condition. Or a half a teaspoonful of bicarbonate of soda may be given in a little water followed by an equal amount of tartaric acid, and the stomach percussed.

_Lesions._ The distension of the stomach may reach ten times its normal size in the horse (Leisering). Kitt found a stomach with a capacity of 84 quarts. Fitzroy Philipot took from a dilated equine stomach 140 lbs. of contents. The contents of the viscus are usually largely of solids which the weakened and attenuated walls failed to pass into the duodenum. On the contrary and as if by compensation, the pylorus and duodenum are constricted and the latter has liquid contents which pass from the stomach with very little of the solids.

Special dilatations are sometimes met with, thus an equine stomach has been found largely dilated at the greater curvature where concretions formed in the viscus or pebbles introduced with the food had habitually lodged. In other cases the cardia has been dilated like a funnel, so that the animal could eructate or vomit with great facility. This last dilatation is especially common in cribbiters.

_Treatment._ This must necessarily be prolonged as time must be allowed for a tonic contraction of the viscus. Food must be given often in small quantity, of easy digestion, and of aqueous composition. For dogs, milk, eggs and soups, or pulped raw meat furnish examples. For horses milk gruels, boiled flax seed, pulped roots may suffice. If the stomach is loaded as is usually the case, it should be washed out with the stomach tube, which when passed into the stomach should be raised at its free end and filled with tepid water; it is then suddenly lowered so as to act as a syphon in evacuating the liquid contents of the stomach. This may be repeated again and again, the stomach in the case of the dog being manipulated so as to mix and float the solids and favor their exit through the tube. Daily washing out of the stomach by the tube is of the greatest possible value.

Meanwhile we should seek to improve the tone of the stomach by strychnia (horse 2 grs., dog ¹⁄₆₀ gr. daily), by salts of iron, and by faradisation.

To counteract fermentation, antiseptics (salol, naphthol, freshly burned charcoal) may be given with each meal, along with pepsin and hydrochloric acid.

RUPTURE OF THE STOMACH IN SOLIPEDS.

Mainly in solipeds. Causes: overloading, fermentation, impossibility
of eructation, violent concussions, falls, galop, concretions,
dilatation, catarrh, ulcers, cicatrices, abscesses. Symptoms:
Anamnesis, colic relieved, followed by prostration, sinking, complete
anorexia, tender abdomen, vomiting, no abdominal rumbling. Lesions:
tear in greater curvature, most extensive in outer coats, shreddy,
bloody edges with clots, contents in omentum, other seats, partial
ruptures. Treatment: in partial ruptures, stomach pump, diet.
Prevention.

This is pre-eminently a disease of solipeds for the reason that they alone of domestic animals are especially liable to overload the comparatively small stomach and are mostly unable to relieve the overloaded viscus by eructation or vomiting.

_Causes._ These are in the main overloading of the stomach and overdistension, by the gases of indigestion. To this are usually added violent concussions when the animal throws itself down violently. The stomach distended to the fullest possible capacity, and lodged in a cavity which is not all equally tense, is comparable to a very tense bladder which is liable to burst when forcibly struck, or suddenly compressed.

Apart from such indigestion, cases are recorded in which the full stomach has been burst by a sudden fall in the shafts or elsewhere. Miles even records a case which occurred during a rapid galop after a full drink of water.

The presence of solid bodies (calculi, gravel) in the stomach or even in the intestines has appeared to cause rupture by blocking the outlet of ingesta and determining indigestion.

Certain conditions predispose to rupture, notably dilatation of the stomach with attenuation of its walls, cribbiting, old standing catarrh of the viscus, pre-existing ulcerations, cicatrices and abscesses.

_Symptoms._ There is usually the history of a full feed of grain, followed by violent colic, and indications of gastric overdistension, tense abdomen, dullness, then the rejection of the gastric contents by vomiting, the matters escaping by the nose, and then collapse. The violence of the colics may cease, but the pulse becomes rapid, small, and finally imperceptible, the breathing hurried, the head depressed, eyelids, ears and often the lower lips drooping, the face becomes heavy and expressionless, the belly distended and tender, the skin covered with cold sweat, and the temperature exalted above or depressed below the normal. There is never any disposition to eat nor drink. Death follows in a few hours.

In the vomiting which is independent of rupture, the symptoms are usually at once relieved, when the emesis occurs, since not only liquid and solid matters escape but also gaseous material. The pulse retains its fullness, the facial expression is that of intelligence and comfort, rumbling may be resumed in the bowels, fæces and urine may be passed, and colics are less acute. In favorable cases the animal may even desire to eat or drink.

_Lesions._ The usual seat of rupture is on the great curvature and may extend longitudinally for from six to ten inches. The laceration is usually most extensive in the outer coats, and the mucosa is carried outward with the escaping ingesta, which helps to efface the normal mucous folds at the cardia, and to render vomiting possible. The edges of the wound are more or less shreddy, and of a dark violet color from blood extravasation and clots. The escaping contents are rarely diffused in the cavity of the abdomen, but remain enclosed in the omentum through the thin meshes of which they can be easily seen, and which has sometimes been mistaken for the walls of the stomach reduced to this attenuated condition by disease. When the omentum gives way the contents are at once diffused through the abdominal cavity between the convolutions of the intestines. In exceptional cases the rupture has its seat in the lesser curvature, or even at the cardia. In still others the laceration implicates the muscular and peritoneal coats only, and the looser mucosa, filled with ingesta bulges outward as a hernia. In such a case a recovery seems possible if the viscus could be relieved of its contents.

_Treatment_ is virtually hopeless. Yet a moderate laceration of the two outer coats only might be followed by recovery through the formation of a cicatrix. The first consideration would be the unloading of the stomach spontaneously or by the aid of the stomach pump, and thereafter the adoption of a rigidly restricted diet of easily digestible food (such as gruels) in small quantities at a time.

_Prevention_ is much more available. In violent colics with overloading or tympany of the stomach, employ anodynes to keep the animal from throwing himself down violently, give a soft bed of litter where the shock on lying down will be lessened, employ antiferments to prevent gaseous distension, and whenever possible relieve the plenitude of the viscus by the stomach pump or tube.

TORSION OF THE STOMACH IN THE DOG.

Causes: mobility of dog’s stomach when empty, leaping, running down
stairs. Lesions: viscus doubled forward, pylorus in front of cardia,
duodenum compresses cardia, liver, spleen and omentum displaced,
stomach tympanitic, lungs and heart compressed, latter gorged with
dark blood. Symptoms: tympanitic abdomen, and half thorax, no
rumbling, murmur in front of thorax, abdomen tender, patient stands,
dyspnœa, emesis impossible. Course: violent symptoms in twelve hours,
death in thirty-six. Diagnosis: sudden, severe seizure, complete
anorexia, tympany, tenderness, dyspnœa, no vomiting, arrest of
peristalsis. Obstruction. Peritonitis. Choking. Treatment: tapping,
laparotomy, replacing the viscus.

This has been demonstrated by Kitt and Cadeac who believe that it is quite a common occurrence.

_Causes._ The predisposing cause is the extreme mobility of the canine stomach which hangs from the œsophagus like a pear from its stalk, the remainder of the viscus being only attached to the loose omentum, spleen, and commencement of the duodenum all of which it can carry with it easily when it rolls on itself. Its mobility is, however, very restricted when full, the liver on the one side and the spleen and intestines on the other proving almost insuperable obstacles to rotation. But when empty it moves with great freedom and by a sudden shock in leaping, gamboling or running rapidly down stairs the pylorus is carried forward and to the left until it and the commencement of the duodenum are jammed in front of the cardia. The result is the obstruction of the cardia and duodenum by their mutual pressure in crossing each other, and the interruption of the gastric circulation and functions.

_Lesions._ As just stated the stomach which would normally extend from the cardia downward and to the right is bent forward and doubled upon itself, the pylorus lying in front of the cardia, the duodenum extending from before backward above the cardia and tightly compressing it, the liver drawn to the left by the hepato-duodenal peritoneum, and the spleen displaced to the right by the traction on the omentum. The stomach enveloped in its omentum is distended by gas to perhaps ten times its normal dimensions and appears to fill the entire abdominal cavity while the intestines are pushed aside and concealed. The chest is compressed by the strong pressure on the diaphragm, and the lungs are congested of a deep blue and the right heart distended with dark blood. The animal appears to have perished of apnœa.

_Symptoms._ In fully developed cases the abdomen is greatly distended and tympanitic. The drumlike resonance is met with in the anterior part of the abdomen including the umbilical region. It extends forward over one-half of the thorax, excepting only a space of 5 or 6 inches square in the right hypochondrium, which represents the situation of the liver, and spleen. Auscultation furnishes no sound in the abdomen, and only in the anterior portion of the thorax is there a distinct respiratory murmur. The heart may beat strongly and rapidly, or weakly and slow, and the pulse is small and thready. The abdomen is tender. The animal stands, dull, and breathes with great effort. If made to walk it is done slowly, stiffly and with head extended, mouth open and tongue protruding. There is no sign of vomiting and this cannot be brought about by tickling the fauces, or even by giving apomorphine subcutem, though retching may be induced.

_Course._ The disease may develop into dullness and anorexia in two hours after boisterous health; in twelve hours there may be considerable tympany and dyspnœa; and a fatal result is reached in about thirty-six hours.

_Diagnosis._ This is based on the transition from vigorous health to sudden illness, with complete anorexia, inability to swallow or to vomit, tympany of the stomach as shown by percussion, tenderness of the abdomen, dyspnœa, disturbed heart-functions, and inactivity of the bowels. With intestinal obstruction on the other hand there is free vomiting of bilious and feculent matters. With peritonitis there is much greater and more uniform abdominal tenderness, vomiting and higher fever, but less tympany in the anterior abdominal region, and no such complete suspension of defecation. With choking there is no such progressive tympany, appetite and defecation are not so completely suspended, and liquids may often pass the obstruction in small quantities in both deglutition and vomiting. Choking is by no means so speedily fatal.

_Treatment_ is essentially surgical. When tympany is already established the gas must be evacuated by a small cannula and trochar. Then resort is had to laparotomy, the incision is made on the right side large enough to introduce the fingers, which must follow the great curvature of the stomach as far as the pylorus which is pulled back into its normal position on the right. The incision is now closed by an ordinary continuous suture.

FOREIGN BODIES IN THE STOMACH. HAIR, WOOL, BRISTLE, CLOVER AND COTTON
BALLS.

Hair balls, wool balls, bristle balls, cotton balls, clover-hair
balls, oat-hair balls, paper balls, phosphatic calculi, sand and
gravel, nails, wires, needles, pins, etc., cloth, leather, whalebone,
playthings, etc. Symptoms: of catarrh or colic, dullness,
restlessness, arched back, in dog vomiting of blood, fistula.
Diagnosis. Treatment: emetic, feed potatoes, laparotomy.

=Hair Balls.= These are common in the rumen of cattle and have been found in the fourth stomach. They are especially injurious to young animals by reason of their irritating the gastric mucosa, but they also occasionally block the pylorus, producing indigestion, gastric dilatation, gradually advancing emaciation and even a fatal result.

=Wool Balls.= These are found in sheep and are especially injurious in young lambs.

=Bristle Balls.= These are found in swine as round, or ovoid balls or long ellipses bent upon themselves. The sharp projecting ends of the bristles render them very irritating, especially to young pigs.

All of these are caused by licking themselves or their fellows, and particularly during the period of moulting or as the result of some skin affection. Lambs which are nursed by ewes with an excess of wool on and around the mammæ, and old sheep with a disposition to eat wool are frequent victims.

=Cotton Balls.= These have been found in lambs fed on cotton seed cake. A certain amount of the cotton fiber is incorporated in the cake, and this is rolled together and felted by the movements of the stomach and agglutinated by mucus.

=Clover-hair Balls.= The fine hairs from the clover leaf have been found rolled into balls in the abomasum of lambs producing all the evil effects of the other pilous masses.

=Oat-hair Balls.= The fine hairs which cover the seed of the oat are found matted together and cemented by mucus in the stomach of horses fed on the _dust_ of oatmeal mills. They are especially common in Scotland, where oatmeal has been so extensively used.

=Paper-ball.= In the museum of the N. Y. State Veterinary College is a conglomerate ball of paper taken from the stomach of a hog by Dr. Johnson, Sioux City.

=Phosphatic Calculi= have been described as found in the stomach, but this is evidently an error, as the acid secretion would have speedily dissolved them. The error doubtless came from mistaking the transverse colon for the stomach.

=Sand and Gravel= arrive in the stomach of the _horse_ from pasturing on loose sandy land, the plants being pulled up by the roots and swallowed together with the sand adherent. Also from drinking water from shallow streams with sandy bottoms. Feeding of grain from the ground is a cause of swallowing sand, earth and pebbles. Licking the soil in acidity of the stomach is another cause. Fodder that has been packed down and mixed with earth, and that which has been blown full of sand or dust, and roots eaten from the ground in wet weather lead to the ingestion of much sand or earth. Shetland ponies taken from the islands pass sand for some weeks. Dogs taught to fetch and carry, swallow stones, pebbles, marbles, etc., accidentally.

=Nails, Wires, Needles, Pins, etc.= More or less pointed metallic objects are often taken in with the food by gluttonous horses and though usually arrested in the intestines they sometimes irritate or wound the stomach.

=Fragments of cloth, leather, or whalebone= are similarly taken with the food, or in case of depraved appetite are deliberately chewed and swallowed.

=Playthings and small household articles= are especially taken by puppies through mere wantonness. Rubber balls, pieces of metal, thread, cord, cloth, bits of leather, sponge, horse hair, human hair, corks, bits of wood and everything obtainable of small size may be swallowed and found in the stomach.

=Pigs= swallow pieces of wood and other objects.

=Birds= habitually swallow pebbles and ordinary objects are ground down in the gizzard. They also readily vomit feathers, bones and other offensive matters that have proven indigestible.

_Symptoms._ In =horses= there are no especial symptoms, though the foreign bodies sometimes cause gastric catarrh, and in other cases produce wounds and ulcers or block the pylorus causing violent colic. Most commonly the foreign bodies pass on into the intestines, where they may directly wound the walls, form nuclei for the deposition of earthy salts in the form of calculi, or in case of fibrous materials (cords) roll into firm balls.

In =dogs= the foreign bodies may cause gastric catarrh, or puncture or abrasion of the mucosa, and they may be rejected by vomiting. The more rounded, smooth bodies may lie for a length of time in the stomach without doing any manifest injury, as in the case mentioned by Nichoux in which a dog carried in its stomach for twelve years a four franc piece and a large sou. Sometimes the objects block the pylorus. Then the subject is dull, depressed, inclined to lie on the right side but continually changing his position, gives a stifled yelp when he lies down or occasionally when he stops walking. He carries the back arched, and the abdomen tucked up, and drags his hind limbs. Vomiting, is frequent and accompanied by violent and painful retching. The vomited matters may be mixed with blood. The epigastrium is tender to pressure. Death may ensue in twenty-four hours or not until after weeks or even months.

In other cases there is gastro-enteritis with vomiting, colic, anorexia, trembling, hyperthermia, constipation or diarrhœa, and finally the passage of the offending agent per anum, when recovery ensues.

In other cases sharp pointed bodies perforate the walls of the stomach, and determine the formation of abscess or fistula opening at any point around the abdominal cavity. This may be followed by recovery, by gastric or intestinal fistula, or by chronic disease of some important organ like the liver.

In =dogs=, _diagnosis_ is often possible by manipulation of the stomach through the walls of the abdomen. If the belly is very lax it may be compressed between finger and thumb, or between the two hands; if more tense, pressure with both hands just behind the sternum may detect the resistance of a solid body.

_Treatment._ In the =horse= this is hopeless.

In the =dog= much may be expected from the use of emetics, (ipecacuan, tartar emetic, apomorphine, tepid water, tickling the fauces). In some cases of sharp pointed bodies an exclusive and abundant diet of well boiled potatoes proves successful. The object is to pass much of the starchy matter through the small intestines undigested, so that it may envelop the sharp body and protect the mucosa. When it reaches the colon, the ingesta as a whole becomes more solid and invested by this, the body is often passed without danger. Other methods failing laparotomy remains. The dog is stretched on his back on a table with the forelimbs held well apart. The skin of the epigastrium is denuded of hair and washed with antiseptics (mercuric chloride solution 1:500). Hands and instruments are also made aseptic. Then an incision is made in the epigastrium or in the situation where the offending body has been felt, and the finger is introduced to locate the body. At this point a thread is passed through the walls of the stomach, and these are drawn well out through the abdominal wound and incised to the extent of an inch or more. Through this orifice the foreign body can be easily felt and extracted. Then in case the stomach is over-filled it may be emptied, and the edges washed with the antiseptic and carefully sutured with sterilized catgut. The usual care must be taken to turn the mucosa inward and bring the muscular and serous coats in accurate opposition. Finally the abdominal wound is closed by a continued suture of silk or catgut.

The greatest care must be taken to prevent the escape of any of the gastric contents into the abdominal cavity, to render both wounds aseptic and to protect the external wound especially against infection. A wash of carbolic acid (1:100) with a little of some intense bitter (quassia) will often succeed in preventing licking or gnawing.

Even greater care must be given in the matter of diet. At first a few teaspoonfuls of cold water only need be given. After twenty-four hours a little well strained beef tea; later milk or gruel may be added, and by degrees more solid food. In three weeks the ordinary food may usually be resumed.

In case the foreign body has escaped into the peritoneal cavity, the same method may be pursued, the edges of the gastric or intestinal wound being made raw, treated antiseptically and carefully sutured, and the abdomen washed out with an antiseptic solution (aluminum acetate solution) and closed.

TUMORS OF THE STOMACH.

In horse—sarcoma, papilloma, lipoma, adenosarcoma, epithelioma, in
cattle—scirrhus, in dog—sarcoma, lipoma, epithelioma. Symptoms:
chronic gastritis, periodic indigestions, colics, vertigo, salivation,
impacted gullet, blackened fæces, eructations, vomiting, rumbling,
stiffness, emaciation. Treatment: laparotomy in dog.

The peptic stomach in the different animals is subject to a great variety of tumors. In many of the recorded cases, however, the true nature of the tumor has been left uncertain.

=Sarcoma.= In the =horse= this is the common tumor of the pylorus, and less frequently it is found on the cardia and body of the stomach, especially on the greater curvature. These are usually firm and resistant, though sometimes soft and friable; they tend to swell out in lobules, and show areas of ulceration, or even suppurating excavations opening through the mucosa. In some instances, however, they start under the serous coat, and the ulcerous surface may open into the peritoneum. At other times they are but a local manifestation of a general affection.

In the =dog= multiple sarcomata have been found on the stomach varying in size and easily mistaken for recent tubercles. In these cases the small round cells were especially numerous in the centre of the tumor rendering it soft and predisposing to degeneration.

=Papilloma.= In the horse these are found as branching or filamentous dependent projections from the mucosa of the left sac having evidently started from the sores formed by the attachment of the œstrus larvæ. They are also found around the pylorus and of such size as to seriously obstruct that orifice (Stadler).

=Lipoma.= Fatty tumors have been seen on the stomach of the =dog= and =horse= in the submucosa.

=Adenosarcoma.= This formation in the =horse= leads to a thickening of large patches of the mucosa. It also grows out in mushroom like masses, or is irregularly lobulated.

=Epithelioma.= In the =horse= epithelioma has been found at the pylorus and on the great curvature of the stomach. It usually grows out as a rounded mass varying in size from an egg to an infant’s head, and may be even a diffuse thickening of the mucosa. Microscopically the individual lobules, are composed of cylindroid cells surrounding a central mass of epidermoid cells. The stomach may be greatly contracted, and the surface of the neoplasm, ulcerated or even excavated. In the =dog= similar formations are found.

=Carcinoma.= In =cattle= _Scirrhus_ of the abomasum is described. Small tumors rise to a height of ½ to 3 inches, and are closely packed together so as to assume polygonal forms. The surface is smooth, or perforated by orifices leading into ulcerous or suppurating cavities. On section the mass shows a fibrous or a lardaceous consistency. They are most common in the pyloric region, and may partially obstruct this orifice.

_Symptoms._ These are necessarily obscure. In the =horse= periodic gastric indigestions and colics may be the sole indications, which are certainly not pathognomonic. In other cases, have been noticed: vertigo, salivation, impacted gullet, and blackish, sanguinolent fæces due to ulceration and hemorrhage from the tumors.

In =cattle= have been observed variable and capricious appetite, imperfect rumination, tympany, eructations, vomiting, rumbling of the bowels, constipation, slow painful walk, progressive emaciation and debility. When blood is discharged by emesis or defecation the suspicion of gastric tumor may be strengthened.

In the =dog= there are the usual signs of chronic gastritis, thirst, anorexia, stiffness, a disposition to lie, sunken eye, dyspnœa, vomiting, often of blood. The discharge of blood by mouth and anus, the distended abdomen, the tumor usually easily detected by manipulation, and the progressive loss of condition are strongly suggestive.

_Treatment_ of these cases is hopeless. In the dog alone for a circumscribed tumor, laparotomy, the removal of the tumor and closure of the wound may be tried.

ACUTE INTESTINAL INDIGESTION IN THE HORSE. INTESTINAL TYMPANY.

Definition. Causes: Debility—general and local, and its causes,
fermentescible food, legumes, new grain, paralyzing seeds, musty
fodder, defective teeth, jaws and salivary glands, iced water after
grain, verminous embolism, chill. Symptoms: Anamnesis, colic, gaseous
distension, stupor, death, diagnosis from spasmodic colic. Course:
Fatal in two hours, or more. Recovery. Lesions: Distension of bowels
with carburetted hydrogen, carbon dioxide, and nitrogen, redness of
intestinal mucosa, anæmia of abdominal organs, congestion of cutaneous
and surface vessels. Treatment: Stimulants, antiseptics, enemata,
chloral hydrate, puncture, eserine, pilocarpin, friction, massage,
exercise, dieting, bitters.

_Definition._ A gaseous overdistension of the intestines, from fermentations in the ingesta, but also in part from air that has been swallowed, and from carbon dioxide exhaled from the blood circulating in the intestinal mucosa.

_Causes._ These are to a large extent the same as those of gastric tympany. General and digestive debility resulting from former disease, from spare diet, from unsuitable or indigestible food, from anæmia, from parasites, from hemorrhages, is a potent predisposing cause.

Weakness of the alimentary canal from catarrh, or other persistent disease, from impaired innervation, from embolism of the vessels and imperfect circulation also predisposes, or again the lack of vermicular movement and of the mingling of the digestive fluids with the food, leaving the latter in a specially fermentescible condition. As direct _exciting causes_ may be named:

Very _fermentescible food in excess_, such as the leguminous products (beans, peas, vetches, cowpea, alfalfa, sainfoin, clover) in their green condition. These contain an excess of protein compounds, which should be mainly digested in the stomach, and if passed rapidly in large quantity into the intestines, they fail to be sufficiently acted on by the trypsin, and are specially liable to fermentation. Very rapidly grown and aqueous grasses are similarly liable to decomposition.

_New grain_ is specially liable to fermentation the more so that it sometimes contains a paralyzing agent, which acts like intoxicating ryegrass. The ripening seeds of many forage plants often act in this way, (annual and perennial ryegrass, millet, Hungarian grass, chick vetch, vetches generally). The same has been observed of the leaves of growing maize, grapevine leaves, and potato plants.

_Musty and spoiled fodders_ of all kinds are very dangerous, the toxic principles of the fungi and bacterial ferments paralyzing the sympathetic nervous filaments.

_Fodders_ that are _imperfectly masticated and insalivated_ owing to defective teeth or diseased jaws or glands are liable to prove hurtful in a similar way.

_A full drink of water_ and especially of ice cold water _after a feed of grain_ is one of the most potent factors. The stomach and intestines are both roused to violent peristaltic action, the undigested food is washed on into the bowels, and too often the action of the cold induces congestion and partial paresis, and exposes the undigested mass to the uncontrolled action of ferments.

_Circulatory troubles_ caused by verminous embolism (see intestinal congestion) is another very prolific factor. _A sudden chill_ in an animal that is perspiring and fatigued may precipitate an attack, by causing a retrocession of blood from the skin to the intestines, with resulting paresis of their coats.

_Symptoms._ The condition is usually complicated with gastric tympany, so that we have a complication of symptoms. The history of the case is often diagnostic, showing one of the above mentioned causes, and above all a full drink after a feed of grain, speedily followed by abdominal pain, gaseous distension of the abdomen, causing death in two hours or upward. The distension of the abdomen usually shows more on the right than the left, and the resonance on percussion is greater. Colics are usually less violent than in intestinal congestion, and the actions of the animal are less precipitate or disorderly. He may lie down, roll and rise, but the constant restless movement, the sitting on the haunches, and the frequent agonized turning of the nose toward the flank are rarely shown. The animal is rather dull and prostrate, passing finally into a stupor, the face is pinched and anxious, the back arched, the head pendent, the walk slow and unsteady, and respiration and pulse accelerated. There is no complete intermission of pain, though it is more acute at one time than another, for some time there is rumbling in the bowels followed by complete silence, as they are fully paralyzed, fæces may be passed at first, but this ceases as the floating colon is emptied and the gaseous distension becomes extreme, and urination which may take place in the early stages is no longer effected in the advanced ones. The compression of the thorax causes severe dyspnœa, accompanied, when the patient is down, by a slight groan.

_Course_. In the advanced stages the animal may sink to the ground oppressed by the shock, poisoned by the carbon dioxide which can no longer be exhaled through the lungs, and by hydrogen sulphide and other toxic products of intestinal fermentation. Death may follow two hours after a hearty meal and is rarely long delayed in fatal cases.

Improvement may be recognized by the termination of the paresis, the lessening of the abdominal tension, the return of the rumbling in the abdomen, the passage of fæces and flatus, and of urine and by general relief.

_Lesions_. In case of death the overdistension of the intestines and abdomen is the most marked lesion, the composition of the gas varying with the nature of the ingesta and the duration of the illness. Carburetted hydrogen compounds abound as a rule in the early stages, while carbon dioxide predominates later. Pinner found 49 per cent. of carburetted hydrogen, 8 per cent. of carbon dioxide, and 42 per cent. of nitrogen.

The contents of the large intestines are usually in considerable amount and in an undigested condition. The walls of the distended bowels are greatly attenuated and may show congestion, petechiæ, or rupture. Rupture of the diaphragm is not uncommon. Congestion of the lungs, but especially of the skin and superficial structures of the body, and of the brain are natural results of the expulsion of blood from the abdominal cavity.

_Treatment_. The desiderata are: relief from existing gaseous tension; arrest of further fermentation; and the restoration of the vermicular movement of the intestine.

The two first indications may sometimes be successfully met by stimulants and antiseptics. Formerly, mild cases were successfully treated by oil of peppermint and oil of turpentine in oil, and a free use of enemata. A more modern resort is a large (virtually soporific) dose of chloral hydrate (1 oz.) given in solution. This is at once a powerful antiferment and an antispasmodic. It is moreover highly volatile and in the heat of the stomach is readily passed on into the duodenum and absorbed. Employed early it not only checks the production of gas, but it relaxes the whole intestinal tract and allows the free passage of accumulated gas which passes off rapidly per anum.

But in severe cases the gaseous distension is too great to hope for relief by such measures and puncture of the cæcum or double colon is the only hopeful resort. This is made with a small trochar and cannula not more than ¼ inch in bore, which is inserted at the point of greatest resonance. The point usually advised, as in the ox, is the centre of the space circumscribed by the last rib, the ilium and the transverse processes of the lumbar vertebræ. A better plan is to percuss and puncture the point where the drumlike resonance is greatest. The higher the puncture the more promising as the cannula is less likely to be blocked by the ingesta which accumulates in the lower part of each viscus. The cannula may be left in place for some time to keep the bowel flaccid and allow time for the restoration of its contractile functions. The cannula may be utilized to inject antiferments (chloral) and peristaltic stimulants (eserine, pilocarpin, barium chloride). In cases in which puncture is not imperative these agents may be used hypodermically, eserine 1½ gr., pilocarpin 2 grs. or barium chloride 7 grs.

Enemata of soapsuds, with or without stimulants prove effective in emptying the floating colon and soliciting the action of the large intestines generally and the passage of flatus. Friction of the abdomen and walking exercise are desirable. After recovery a restricted diet, laxatives and bitters serve to restore the lost tone of the alimentary canal.

ACUTE INTESTINAL INDIGESTION WITH IMPACTION OF THE LARGE INTESTINES IN
THE HORSE.

Definition. Causes: dessication of ingesta in colon, sacculation,
constriction at pelvic flexure, debility, ill health, local
peristalsis, diseased teeth, jaws or salivary apparatus, excess of
food, heating grain, hard fibrous indigestible fodder, green
leguminosæ, privation of water, inactivity, verminous aneurisms,
tumors, strictures, obstructions. Symptoms: colics after meals,
becoming more severe, tension and firmness of right side, sitting on
haunches, stretching, small, hard, dry coated stools, obstruction felt
on rectal exploration, frequent attempts to urinate, tympany. Course:
six hours to six days or more, signs of aggravation and improvement.
Lesions: large intestines tympanitic, impaction often at pelvic
flexure, or other constriction, adherent mucosa has thick mucus or
blood, is discolored, friable, necrosis, perforation, liquid contents
of distended bowel in front, rupture, invagination, volvulus.
Treatment: laxative diet, injections, aloes, pilocarpin, eserine,
barium chloride, chloral hydrate, morphia, henbane, belladonna,
puncture, cold or oleaginous enemata, empty or knead rectum and colon,
cold compress, electricity, friction, laparotomy.

_Definition._ This is an impaction and obstruction of the colon, and usually of the pelvic flexure with dried and badly digested alimentary matters.

_Causes._ Certain anatomical and physiological conditions contribute to this disease in the horse. The ingesta as it leaves the stomach is liquid or pultaceous and throughout the small intestines it remains so, so that they are little liable to impaction. But by the time the cæcum is reached much of the liquid has been absorbed, and as the contents pass into the double colon they are usually a soft solid, which gradually becomes dried as it advances through the double and floating colon. The sacculation of cæcum and colon tends to delay the masses and favors absorption. The pelvic flexure, the narrowest part of the double colon, is formed by an acute bend of the viscus on itself so that the dried masses advancing from in front are especially liable to become arrested and impacted at this point. Impaction may, however, occur at any part of the large intestine.

Any debility or atony of the intestines predisposes to the condition. The ingesta accumulates in the portion which does not contract sufficiently to pass it onward, and this soon becomes distended to a state of absolute paresis. All conditions of debility, and all prolonged ill health tend to operate in this way by lessening vermicular movement.

Again in cases of nausea or intestinal disorder the supervention of antiperistaltic movements, will tend to accumulate the ingesta at one point and favor impaction (Ernst).

As in the case of other indigestions the imperfect preparation of the food is an active factor. Diseased teeth, jaws or salivary glands, act in this way and a functionally weak stomach contributes to this as to other intestinal disorders.

An excess of food and especially indigestible food will contribute to impaction. Heating grain, like corn, wheat, buckwheat, passed rapidly through the stomach in an imperfectly digested condition, tends to accumulate in the larger intestines. Hard, fibrous fodders like hay and straw that have run to seed, or which have been washed out by rains, bleached or heated, rye-straw, the stalks of beans, peas, vetches, which have been similarly spoiled, and clover hay affected with cryptogams or other ferments act in the same way. Even clover eaten green, produces in foals impactions to which the hairs of the leaves and chalices materially contribute (Verrier). The allied plants alfalfa and sainfoin when passed rapidly through the stomach tend to impaction of the large intestines. But any fibrous, indigestible and innutritious fodder, taken in excess to make up the deficiency of nutriment is liable to act in this way.

Other conditions that contribute to impaction are lack of water, especially at night when much hay is consumed, and lack of exercise which tends to torpor of both liver and bowels.

Finally verminous aneurisms and embolism of the intestinal arteries induce congestion, paresis, spasms, and other disorders which tend to aggregation and impaction. Also tumors, strictures and obstructions of all kinds tend to impaction.

_Symptoms._ A certain amount of impaction is not incompatible with ordinary health, but as this increases all grades of colic may be met with from the most simple and transient to the most persistent and severe.

In the milder forms slight and transient colics come on after meals, for days in succession, before any serious attack is sustained. These are especially marked under dry bulky fodder (hay), less so on grain, and less on green food or roots. The animal paws, moves the hind limbs uneasily, looks at the flanks, he may even kick at the abdomen, lie down and roll, rise, pass a little manure or flatus, and seeming relieved may resume feeding, until the next attack. The intermissions may last a few minutes, a quarter of an hour or longer, and they gradually become more prolonged until they disappear for the time. Sooner or later, however, the obstruction becomes more complete and the colic more severe and persistent. To the ordinary symptoms of violent abdominal pain there are added symptoms which point to bowel impaction or obstruction. There is a special tension of the right side of the abdomen, with flatness on percussion. When down there is a tendency to sit on the haunches to relieve pressure on the diaphragm and lungs. When standing there is a disposition to stretch the fore limbs out forward and the hind ones backward. Fæces may be passed at first in a few small round balls at a time, but this soon ceases, and very little or none can be obtained even by the use of enemas. The straining is usually so violent as to expel the enemata as soon as introduced. The hand introduced into the rectum can easily detect the solid impacted pelvic flexure of the colon pressing backward into the pelvis or impinging on the right pubis. Another common symptom is the frequent passage of urine in dribblets, due to the irritation of the bladder by the pressure upon it of the impacted colon during straining. In cases of this kind the colon and cæcum become tympanitic as first shown by a resonant distension of the right flank obliterating the hollow in front of the ilium, and later by a similar condition of the left flank.

The abdominal pain is usually less acute than in simple spasmodic colic or intestinal congestion. The face is less pinched and anxious, the eye less frightened, the kicking at the belly less violent, and the lying down more deliberate and careful. Very commonly the patient merely rests on his belly or side without attempting to roll.

_Course._ The disease may last six to twelve hours, or even as many days before it ends in recovery or death. The colicy symptoms usually increase, with the complication of dyspnœa when tympany becomes well marked, hyperthermia in case of the supervention of enteritis, and signs of general peritonitis and collapse in case of rupture of the bowel. A sudden increase of the pain may otherwise indicate the occurrence of invagination.

As indicating a favorable termination there may be restoration of the rumbling, the passage of fæces at first perhaps in the form of solid cylindroid masses, and later as a mixture of broken up ingesta, liquid and gas, the tension of the abdomen disappears, the pains lessen and cease, and there is a gradual restoration to health.

_Lesions._ The abdominal walls are tense and more or less drumlike, and when these are cut through the large intestines protrude strongly. When punctured there is a free discharge of gas. The most common seat of obstruction is the pelvic flexure, but it may occur in the floating colon, or rectum, in the double colon even at other parts than its pelvic flexure, in the cæcum or in the ilio-cæcal opening. The impacted mass is firm, rather dry, covered with mucus and sometimes blood, and manifestly only partially digested. Its size and form vary greatly as it is moulded into the affected viscus. The mucosa in contact with the impacted mass is covered with a thick layer of viscid mucus sometimes streaked with blood. The mucosa itself is congested, thickened, friable, and marked with spots or patches of various colors (white, gray, green,) indicating commencing necrosis. In old standing cases this may extend to the other coats of the bowel determining perforation or laceration.

The portion of the bowel immediately in front of the obstruction is filled with liquid which has been forced down upon the barrier by the active peristaltic movements, and the distension by liquid and gas may have increased until rupture has ensued with the escape of the contents into the peritoneal cavity. Invagination, volvulus and peritonitis are common.

_Treatment._ This will vary according to the stage and degree of the illness. In slight cases with transient colics only after meals, a more laxative diet may suffice. Boiled flaxseed, roots, potatoes, apples, green cornstalks, silage, or even sloppy bran mashes, with an abundance of good water and active exercise may prove efficient. Copious injections of warm water, soapsuds, or linseed oil emulsion may be added.

In the more violent cases we must resort to more active measures and yet drastic purgatives are full of danger. The free secretion from the vascular small intestines and the active vermicular movements, lead to the speedy overdistension of the bowel just in front of the obstruction, the current being strong and active all around the contracting gut in contact with the mucosa, while a weaker return current sets in in the centre, but is effectually checked and arrested at no great distance in front of the impaction by the strong backward peripheral stream. If therefore the impaction is not broken up, it is inevitable that the gut above must be more and more distended until a rupture ensues.

Yet in a certain number of cases a moderate dose of aloes or castor oil supplemented by frequent enemata and other measures, succeeds in safely overcoming the obstruction. The solid impacted mass is gradually softened and removed, and finally after perhaps three or four days of complete obstruction the fæces begin to pass and recovery ensues.

With or without the aloes, the hypodermic use of pilocarpin or eserine or both will often succeed in obtaining successful peristalsis. Barium chloride while inducing more active peristalsis is, on that account, somewhat more dangerous.

Pain may be moderated and fermentation checked by chloral hydrate (½ oz.), or, an anodyne, morphia (2–4 grs.), may be given hypodermically. In the absence of these, extract of hyoscyamus or belladonna (2 drs.) may be given by the mouth, and repeated as may be necessary. If tympany is dangerous use the trochar and cannula. Enemata and other accessory measures must not be neglected.

W. Williams has resorted to rectal injections of 2 oz. aloes forced into the rectum by a syringe furnished with a long elastic tube, and repeated when expelled. Brusasco has used copious liquid injections poured into a rectal tube the end of which is raised at least ten feet above the croup, so as to gain the requisite force. Schadrin uses injections of cold water to stimulate the bowels to contractions. Injections of oils or mucilaginous matters when they can be carried far enough lubricate the walls and favor the passage of solid matters. Castor oil which acts to a large extent locally is especially applicable.

Mechanical applications are often valuable. If the obstruction is lodged in the rectum or floating colon it can usually be reached by the oiled hand and carefully extracted. If this is not successful, impactions in the floating colon or pelvic flexure may still be to a large extent broken up and loosened by the knuckles of the oiled hand in the rectum. I have often resorted to this with excellent effect. Impactions in the cæcum or elsewhere in the double colon are however inaccessible for such treatment. For these, external measures are available. Wilhelm wraps the abdomen in cold compresses. Causse and Lafosse recommend the electric current. Friction to the skin of the abdomen is a common resort. Rudofsky turns the animal on his side or his back, to remove the weight of the small intestines from the impacted cæcum or colon, and favor the exit by gravitation of the contents from the cæcum into the colon. Kneading of the abdomen with the fists or knee when in this recumbent position may also be resorted to.

As a _dernier resort_, Gaullet performed laparotomy but with no success as the animal died the following day. The horse was, however, in extremis at the time of the operation and a portion of the intestinal wall was blackish and gangrenous. To be successful such an operation should be practiced before there is any probability of gangrene, and while the patient is still in good condition for recuperation. But these are just the cases in which success is to be hoped for from less dangerous measures. Again the conditions for its success are best in case of obstruction of the pelvic flexure, as that could easily be drawn out through a spacious abdominal wound, incised, emptied and sutured with careful antiseptic precautions, and with little risk of infection of the peritoneum. But this is just the point where an obstruction can be efficiently dealt with in a less dangerous way, by kneading through the rectum for example. The operation, however, is not one to be utterly condemned, but in any case in which it is certain that the obstruction is otherwise irremediable, it should be adopted at as early a stage as possible, under anæsthesia, and with antiseptic precautions. The after treatment would consist in a restricted diet of milk or gruel with antiseptics to prevent fermentation and bloating.

IMPACTION OF THE COLON IN RUMINANTS.

Causes: Debility, hard, fibrous food, dry winter feeding, privation of
water, astringents, smut, ergot. Symptoms: Hard, moulded, coated dung,
blood-streaked, and in small quantity, tympany, dullness, debility,
splashing sound when right flank is pressed, rectal exploration.
Treatment: Laxative food, water, salt, strychnia, eserine, barium
chloride, enemata, oils.