S \\ \ \ A RRA ~~ SS \\ \\ AY _ i Sy WN \\ ~ S . ~ . \ Ss RIAN AY AO \\ \\ AN \\ \ \ \\\ \ \\ A AAA ‘ AI \ LIBRARY NEW YORK STATE | COLLEGE OF VETERINARY MEDICINE ITHACA, N.Y. Digitized by Microsoft® This book was digitized by Microsoft Corporation in cooperation with Cornell University Libraries, 2007. You may use and print this copy in limited quantity for your personal purposes, but may not distribute or provide access to it (or modified or partial versions of it) for revenue-generating or other commercial purposes. Digitized by Microsoft® Digitized by Microsoft® THE COMMON COLICS OF THE HORSE Digitized by Microsoft® Digitized by Microsoft® THE COMMON COLICS OF THE HORSE Their Canses, Symptoms, Diagnosis, and Treatment BY H. CAULTON REEKS, F.R.C.V.S. EXAMINER IN PATHOLOGY AND BACTERIOLOGY TO THE BOARD OF EXAMINERS OF THE ROYAL COLLEGE OF VETERINARY SURGEONS AUTHOR OF ‘ DISEASES OF THE HORSE'S FOOT” THIRD EDITION CHICAGO ALEX. EGER I9I4 Digitized by Microsoft® Digitized by Microsoft® TO SIR JOHN M’FADYEAN (M.B., B.Sc., F.R.S.E.), Principal and Dean of the Royal Veterinary College, London, AS A MARK OF RESPECT Digitized by Microsoft® Digitized by Microsoft® PREFACE TO THE THIRD EDITION Tuart a third edition of this little work should be called for is gratifying evidence that it is still serving a useful purpose. I have endeavoured to render it even more use- ful by including chapters on those derangements of the intestines which on post-mortem so often reveal them- selves as the cause of death. I refer to actual twists or to displacements of the double colon. Further new chapters will be found, too, on Subacute Obstruction of the Cacum, on The Spontaneous Reduction of the Bowel in Torsion, and on The Comparative Rarity of Enteritis. Some of the new matter may be, and I believe is, con- truversial. Where such is the case, however, I wish it to be understood that I have inserted it with two definite objects in view : (1) To give greater prominence to those conditions which many of us, I fear, are apt to dismiss in far too casual a manner; (2) to place any new matter in such a light that others may be induced to add their experiences and to carry the work on a stage further. In the new portion of the book my thanks are due firstly to Professor Gofton for furnishing me with his views on Czcal Impaction, and secondly to Major- General Fred. Smith for allowing me to embody in the final chapters certain sections from his ‘Manual of Physiology.’ My thanks for this latter material can best vii Digitized by Microsoft® viii PREFACE TO THIRD EDITION be expressed by saying that without its inclusion the chapters in which it occurs would lose much of their interest and value. Again, as in the preface to the second edition, I would like to remark on the number of unsolicited letters this book has brought me from practitioners, both English and American, concerning what I have now come to call the ‘stimulant’ treatment of intestinal impaction. Many who have, in the phrase of one of them, ‘ put their sedatives on the shelf, have written in terms expressive of their delight with the change, and assuring me that, if I needed confirmation of the correctness of the treatment, their own experience would give it. Although pleasing to me, I merely mention this fact here in order that the reader, should he contemplate a change which at first sight may appear to him startling, may be assured that, concerning its wisdom, he has not to rely on my word alone. He has now corroborative testimony. For a second time, too, I would like to draw the reader’s attention particularly to the matter in Part III. of the Appendix, for the simple reason that it deals with a change of opinion arrived at after the publication of the first edition, and which will be given greater prominence should a further edition still be called for. In conclusion, I again commend this little book to the veterinary practitioner, and ask him, as I have asked him before, to make it but an aid towards the achieve~- ment of an end we must all of us have in view—the further elucidation of the troublesome affections with which it deals. H.C. R. SPALDING, February, 1914, Digitized by Microsoft® PREFACE TO THE FIRST EDITION At the commencement of a volume, be it small or large, it is usual to make a few prefatory remarks. The cus- tom is a wise one, for it enables the author to state the various conditions and circumstances that brought the book into being, to put forth clearly the object and general scope of the work, and to apologize, where need be, for the imperfections it contains. Lastly, it affords an opportunity to inform the reader of the sources whence the material for the work was obtained. The conditions and circumstances that brought this little volume into existence are few but important. The practice into which I settled soon after qualifying was one in which cases of so-called ‘ colic’ bulked very largely. Their extreme importance to the stock-owner, the large measure of anxiety and responsibility they give the veterinarian, and the short time the horse will suffer before succumbing, are all circumstances that render their accurate diagnosis and treatment a matter of the utmost urgency. The gravity of the cases, and the urgency with which they impressed me, compelled me to look round in our literature for more than the ordinary text-book treatment. This I was unable to find, except by careful and wearisome plodding through masses of journals and 1x Digitized by Microsoft® x PREFACE TO THE FIRST EDITION periodicals. Reported matter I found in abundance, but it required to be drawn up and put into a convenient space for easy digestion. What I so pressingly needed myself, I judged others would need also. Consequently, though the work might well have been left to far abler hands than my own, I resolved to record the result of my readings and investi- gations, tempered with what experience I possessed my- self, in the form this little book presents. My first intentions as to the scope of this work were ambitious, and I commenced it under the title of ‘ The Equine Colics.’ This I found was far too embracing, for it would have led me into a consideration and de- scription of ailments that have been ably dealt with elsewhere—e.g., the colic of hernia, the colic due to parasites, etc. Finally, the title that now heads the book was selected. It will limit me to a consideration of those disorders with which I feel myself competent to deal. Regarding the imperfections the book contains, they can be apparent to no one more than the author. The very failings of a work, however, will often set going a wheel of discussion and thought that no amount of fore- sight could otherwise iniliate. That being so, [ am content to leave it. Lastly, I am to confess the source whence I gained my materials. That duty is easy. I have not scrupled to avail myself to the uttermost of anything I have heard or read. The man who sits himself down to write an original work, unless it be one of fiction, is handi- capped at the very outset. The knowledge he is already possessed of he largely owes to former brains and other people’s experiences. In medicine he is bound to pro- visionally accept what greater minds than his own have Digitized by Microsoft® PREFACE TO THE FIRST EDITION 58 been for generations establishing. If by one iota he can add to the knowledge already accumulated, he is a lucky man. My plagiarism confessed, I feel no need to publish a list of the literature to which I am indebted. I would, however, particularly like to mention two names: The first, that of William Percivall, whose writings have fallen into an obscurity they certainly do not deserve ; the second, Veterinary-Colonel Fred Smith, from whose works I have very largely drawn, and whose contribu- tions to this and allied subjects have been such as to place the veterinary profession under a deep debt of gratitude, I would also mention that the courtesy of Sir John M’Fadyean enables me to reprint from the Journal of Comparative Pathology and Therapeutics an article of my own that now forms the subject-matter of Chapter IX. Professor Macqueen has kindly allowed me to make use of his valuable experiments concerning the opera- tion of laparo-enterotomy, and Mr. E. R. Harding, of Salisbury, has furnished me with his experiences relating to the stimulant treatment of intestinal impaction. The attempt in Chapters IX., X., and XI.} to dif- ferentiate varieties of subacute intestinal obstruction may be regarded as the main original portion of this work. For the present, I simply ask for that a careful reading. This book, then, carries no pretence to being entively original. It is a gathering together of observations that other minds have made, with just so much of my own experience as would enable me to weld the loose particles into one presentable whole. I am not without hopes 1 In this, the third edition, these are now Chapters IX., XL, and XII.—H. C. R. Digitized by Microsoft® xii PREFACE TO THE FIRST EDITION that the manual will prove of help to the student, and enable him to progress still farther on the road of inde- pendent thought, upon the commencement of which his present-day tutors so ably plant his feet. To the practitioner I humbly trust this first effort of my pen will prove welcome. I ask him for his in- dulgence, and beg of him to remember that these pages were written in the moments of leisure afforded by a busy country practice. Should it be the means of bringing together such facts as will give the veterinarian a more accurate and dependable knowledge of the subjects under consideration, the main object of the book will be fulfilled. H.C. R. SPALDING, October, 1902 Digitized by Microsoft® CHAPTER I. IL Ill. IV. v. VI. Vil. VIII. Xi. XII. XIII. XIV. CONTENTS ‘COLIC,’ ITS DEFINITION - . : SURGICAL ANATOMY OF THE ABDOMEN ° HOW TO EXAMINE THE PATIENT : : ETIOLOGY : GENERAL PREDISPOSING CAUSES - ETIOLOGY: GENERAL EXCITING CAUSES - GASTRIC IMPACTION (GORGED STOMACH, GRASS STAGGERS, OR STOMACH STAGGERS) - GASTRIC TYMPANY (GASTRECTASIS, OR DILATA- TION OF THE STOMACH) - - - RUPTURE OF THE STOMACH (GASTRORRHEXIS) . SUBACUTE OBSTRUCTION OF THE DOUBLE COLON (IMPACTION OF THE INTESTINES, IMPACTION OF THE COLON, STOPPAGE OF THE BOWELS) SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE OF THE DOUBLE COLON - a SUBACUTE OBSTRUCTION OF THE SINGLE COLON SUBACUTE OBSTRUCTION OF THE SMALL INTES- TINES 2 = = 2 = INTESTINAL IRRIGATION IN OBSTRUCTIONS OF THE COLON - = ¢ = = THE SURGICAL TREATMENT OF INTESTINAL OBSTRUCTIONS > - 7 e xii Digitized by Microsoft® PAGE 21 28 35 47 80 123 137 147 161 xiv CHAPTER XV. XVI XVII. XVIII. XIX. XX. XXI. e XXII. XXIII. XXIV. CONTENTS INTESTINAL TYMPANY (WIND COLIC, FLATULENT COLIC, HOVEN, TYMPANITES, ETC.) = * ENTERITIS (INFLAMMATION OF THE BOWELS) SUPERPURGATION - = - = = SUBACUTE OBSTRUCTION OF THE C4CUM « DISPLACEMENTS OF THE DOUBLE COLON 7 DISPLACEMENTS OF THE DOUBLE COLON (con- tinued) - - - - - - DISPLACEMENTS OF THE DOUBLE COLON (con- cluded) - - - - - - ON THE POSSIBILITY OF THE SPONTANEOUS RE- DUCTION OF THE BOWEL IN TOR:ION - - ON THE COMPARATIVE RARITY OF ENTERITIS - THE TREATMENT OF YOUNG, UNBROKEN ANIMALS APPENDIX : I. THE COMPOSITION OF VARIOUS FOODS: DIGESTIVE COEFFICIENTS OF FOODS 5 ll THE USE AND ABUSE OF SEDATIVES IN THE TREATMENT OF THE EQUINE COLICS Ill, FURTHER REMARKS ON THE USE OF ALOES IN THE TREATMENT OF INTESTINAL IMPACTIONS : : - - INDEX - - oe 7 : ‘ Digitized by Microsoft® 300 317 bo Nv sa wo Vv N 336 343 359 363 FIG, I. 2. & 1o. IT. 12. a 14. best 16. 17. LIST OF ILLUSTRATIONS SURGICAL REGIONS OF THE ABDOMEN - - LONGITUDINAL SECTION OF STOMACH AND PYLORUS PHOTOGRAPH OF STOMACH TO ILLUSTRATE FIG. 2 SUPERFICIAL OR EXTERNAL MUSCULAR COAT OF STOMACH - - - : - MIDDLE MUSCULAR COAT OF STOMACH - - INTERNAL OR DEEP MUSCULAR COAT OF STOMACH KNISELY’S STOMACH-TUBE - - : THE NORMAL DOUBLE COLON - - : VOLVULUS OF THE PELVIC FLEXURE OF THE DOUBLE COLON - - - - THE SAME, WITH THE COLON PULLED OUT FROM THE ABDOMEN AND EXTENDED - : IMPACTED PORTION OF SMALL COLON SUSPENDED BY MESENTERY : - - - SEAT OF LAPARO-ENTEROLTOMY (MACQUEEN’S OPERATION) - - - ; : OPERATION WOUND (LAPARO-ENTEROTOMY) . LEMBERT’S SUTURES (IN SMALL COLON) - - CALCULUS OBSTRUCTING SMALL COLON (MR. HARDING'S CASE) - Z - - THE CAECUM OF THE HORSE (SMITH) - “ SCHEMATIC ARRANGEMENT OF THE LONGITUDINAL MUSCULAR BANDS OF THE CCUM (SMITH) : XV Digitized by Microsoft® PAGE 10 Il 17 18 19 71 124 126 127 168 177 180 FIG. 18, 19. 20. 2I 24. 25 26, 32. LIST OF ILLUSTRATIONS THE OPENING OF THE ILEUM AND COLON IN THE CCUM (SMITH) - = a THE DOUBLE COLON LOOKED AT FROM ABOVE (SMITH) : - - POSITION OF THE CCUM AND THE DOUBLE COLON ON THE FLOOR OF THE ABDOMEN SEEN FROM BELOW (SMITH) - - - - - SCHEMATIC ARRANGEMENT OF THE MUSCULAR BANDS ON THE DOUBLE COLON (SMITH) - - - » DIAGRAM ILLUSTRATING THE NORMAL POSITION OF THE DOUBLE COLON IN THE ABDOMEN - > DIAGRAM ILLUSTRATING THE POSITION OF THE DOUBLE COLON TWISTED FROM LEFT TO RIGHT - DIAGRAM ILLUSTRATING THE POSITION OF THE DOUBLE COLON TWISTED FROM RIGHT TO LEFT - THE DOUBLE COLON IN TWIST OF A HALF TURN FROM LEFT TO RIGHT ei - - - THE DOUBLE COLON IN TWIST OF A HALF TURN FROM RIGHT TO LEFT = - - - . FLEXION OR BEND OF THE INTESTINE : . . TORSION OF THE PELVIC FLEXURE - - = . TORSION OF THE PELVIC FLEXURE (PHOTOGRAPH) - . TORSION OF THE PELVIC FLEXURE—-REMOVED FROM THE ABDOMEN (PHOTOGRAPH) : = 2 . TWIST OF THE DOUBLE COLON AT ITS SUPRASTERNAL AND DIAPHRAGMATIC FLEXURES - i - TWIST OF THE DOUBLE COLON AT ITS SUPRASTERNAL AND DIAPHRAGMATIC FLEXURES—REMOVED FROM THE ABDOMEN . - - . = Digitized by Microsoft® PA 22 24 25 25 25 25 32! THE COMMON COLICS OF THE HORSE. CHAPTER |! ‘COLIC,’ ITS DEFINITION ConcerninG a disorder that has been recognised and treated for years beyond the memory of man, one would imagine that its name, and what that name conveyed, would be well known and understood. Such, however, is not the case. The word ‘colic’ is derived from the Latin colicus or the Greek holikos, signifying the colon, and, strictly em- ployed, means a painful, spasmodic affection of the intestines, especially of the colon. Far from retaining such a simple signification, colic, in the horse, has for a long time served to designate innumerable and widely differing diseases, whose only point in common has been the evidence of abdominal pain. The term must necessarily be most vague when it attempts to offer any explanation of a particular case in which the symptoms are most largely those of pain in the abdomen. If we use the word in its most restricted sense, it should mean a Digitized by Microsoft® 2 THE COMMON COLICS OF THE HORSE only pain in the bowels, or entcralgia. This is an abnormal sensibility in the region of the plexus mesen- tericus, and, as such, is not often observed in our patients. In the widest possible acceptation of the term, colic will indicate—apart from this enteralgia—all painful affections of the intestines which are not consequent upon inflam- mation or textural change of the bowel walls. It is quite plain that our first duty should be to tabulate, as far as possible, the different morbid condi- tions that may give rise to colic—using the word in its widest sense. This has already been done by that eminent and conscientious clinical observer, Professor Friedberger, of Munich. In his pamphlet, ‘Die Kolik der Pferde, Sechs Klinische Vortrage,’ he gives this table: 1. True Colic, proceeding from the intestinal canal, and stomach. 2. False Colic, arising from a diseased state of the other abdominal organs. (Under this heading will come especially affections of the bladder and sexual organs, which give rise, in the first instance, to similar external evidences of suffering.) True Colic is then taken and subdivided in the follow- ing manner: 1 The addition of the words ‘and stomach' is my own. Much though I dislike to interfere with the arrangement tabulated by Professor Friedberger, I cannot help but think that stomach troubles should be included under the heading of True Colic. Following the strict letter of all accepted definitions, I know it should be omitted. Nevertheless, the close manner in which many of the symptoms proceeding from the stomach simulate those arising from the intestinal canal, with the fact that anomalies of the former tend to the production of disorders of the latter, points conclusively to the necessity of carefully considering stomach ailments when treating of those of the intestines.—H. C. R, Digitized by Microsoft® ‘COLIC,’ ITS DEFINITION 3 A. Essential, to which may be referred the under- mentioned causes : 1. Colic without material cause, as the so-called nervous cramp (or rheumatic colic). 2. Colic consequent upon anomalies of the intestinal contents. Such are: (a) Colic produced by overfeeding. (b) Colic brought on by flatulence (wind colic). (c) The colic occasioned by stoppages in the intestinal canal. These obstructions may arise from fecal accumulations, stones, concretions, etc. B. Symptomatic. Such are: 1. The colic produced by worms. 2. The colic resulting from poisons. 3. Colic brought on by structural disease and changes in the relative position of the intestines; colic occasioned by acute catarrh and croup affecting the delicate mucous membrane of the colon; colic from carbun- cular formations on the mucous membrane; colic from dysentery, and from so-called internal cramp; colic from wounds of the stomach and entrails, and colic from spon- taneous laceration or perforation of those organs. 4 Colic resulting from morbid conditions of the abdomen and the covering of the intestines (peritoneum). _A mere perusal of this extensive and complete classi- fication of the varieties of colic will serve to impress upon us the absolute necessity of looking for much more than the mere exhibition of pain gp,the,part of our patient in 1—2 4 THE COMMON COLICS OF THE HORSE order to arrive ata diagnosis that will approach with any degree of accuracy to the truth. The human surgeon, by clear and incisive reasoning deduced from the symptoms observed by himself and the help afforded him by his patient, has the power of making such subtle distinctions in the different varieties of colic as to render his skill in diagnosis an object of admiration to the veterinarian. One word of warning is necessary to the animal surgeon. His admiration of the human physician’s diagnosis must not lead him to follow blindly those symptoms and treat- ments laid out in medical literature. Iam well aware that in very many diseases there is an extremely close analogy between the veterinary and human patient, both in regard to the symptoms and the treatment. That, however, is ot the case with colic. The ordinary text-book on human medicine seldom devotes more than a few pages to its consideration. Its treatment, unless it be the colic due to hernia or other equally serious cause, is comparatively simple, and occasions the physician no alarm. He administers an opiate, and, where occasion demands, combines the sedative with a brisk purgative. That done, the case is comfortably dismissed from his mind. He is not unduly anxious about pains whose continuance is spread over three or four days—nay, even weeks. Compare that with the twelve to forty-eight or sixty hours of anxious watching that so often falls to the lot of the veterinarian—a two days’ hurried, anxious solicitude into which is crammed the diagnosis and treatment of three weeks. To illustrate my point, compare the cases of intestinal obstruction in the horse and the human patient. Digitized by Microsoft® ‘COLIC,’ ITS DEFINITION 5 Owing to circumstances which I shall endeavour to explain in a future chapter, one day’s illness in the horse is practically of the same length as a week’s suffering from the same ailment in man, ‘The veterinarian is com- pelled to crowd into one day a diagnosis and treatment that the human medico may methodically and easily arrive at by a week’s careful study of the symptomatology and history furnished by his patient. This apparent digression is really a lengthening of the definition ; it is inserted for this reason. I desire to indicate as forcibly as lies within me one fact—human and equine colic in no material way bear likeness one to the other. My excuse for trespassing so far into the domain of human medicine in connection with this point is this: I have so frequently seen veterinarians attempt- ing to base their treatment on knowledge derived from medical literature referring to man. I feel sure that nothing could lead them further from the truth. ‘Colic,’ so long as the horse exists, will always have a terrible significance for the practitioner of veterinary medicine. It still continues, in many of its aspects, to baffle the most careful and painstaking observer. It still claims annually many thousands of victims. Anthrax, tuberculosis, and other dire disorders still persist in carrying off their spoils, but it is doubtful to my mind whether any other ailment in the whole cate- gory of veterinary diseases is accountable for more loss, more anxiety, and more self-scourging than is ‘ colic.’ Digitized by Microsoft® CHAPTER II SURGICAL ANATOMY OF THE ABDOMEN A THOROUGH knowledge of the regional anatomy of the abdomen is absolutely essential to the determination of a definite diagnosis. The man who has strongly insisted upon that, and devoted an enormous amount of time and thought to the subject, is Lieutenant-General Fred Smith, It is the result of his work that forms the subject-matter of the present chapter, and I take this opportunity of thanking him for his kindness in allowing me to incorporate it with this volume. In his letter granting me permission to use it he says: ‘The infor- mation in these few pages represents an immense amount of work. I do not remember, now, how many dissections I made in the upright position, but a large number.’ * * ~ 3K * * For surgical purposes the abdomen is best divided into a superior and inferior zone by a line drawn horizon- tally from the hip-joint to the ribs. These zones are further subdivided into three parts by means of two vertical lines carried round the abdomen, one from the body of the first lumbar vertebra, and the other passing just in front of the antero-inferior spinous process of the illum. By these means we have the abdomen mapped out into a superior and inferior zone, and each zone into 6 Digitized by Microsoft® SURGICAL ANATOMY OF THE ABDOMEN 7 an anterior, middle, and posterior region ; but in order to prevent confusion we will number these regions —thus, the anterior, middle, and posterior regions of the superior zone will be 1, 2, 3, whilst the same regions of the inferior zone will be 4, 5, 6 (see Fig. 1). Regions 1, 2, and 3 would be respectively the superior diaphragmatic, lumbar, and pelvic regions, whilst 4, 5, and 6 would be the inferior diaphragmatic, lumbar, and pelvic regions. The largest region is the inferior, and the smallest the Fic. 1.—SurGicaL REGIONS OF THE ABDOMEN, ‘1, Superior diaphragmatic ; 2, superior lumbar; 3, superior pelvic ; 4, inferior diaphragmatic; 5, inferior lumbar ; 6, inferior pelvic. superior diaphragmatic. We shall find these landmarks of great use to us in studying the relation of the viscera to its walls. The cavity of the abdomen is nearly ovoid ; its long axis is directed obliquely from above downwards and forwards; it is bounded anteriorly by the diaphragm, posteriorly by the pelvis, laterally and inferiorly by its walls, and superiorly by the lumbar portion of the spine. In order to thoroughly comprehend the arrangement of the abdominal viscera, it is absolutely necessary to bear in mind the direction of this cavity and that of the diaphragm. Digitized by Microsoft® 8 THE COMMON COLICS OF THE HORSE The Peritoneum.—The parietal layer is very loosely attached to the abdominal walls, which fact constitutes an important practical point in connection with opera- tions performed in its vicinity. The parietal portion occasionally forms part of a hernial sac, but not always, as owing to its slight elasticity it more often ruptures. The posterior surface of the bladder and a portion of the rectum and vagina are all uncovered by peritoneum — points to be remembered in connection with the surgery of these parts. The Stomach presents several details of great sur- gical importance: its small size, the presence of an arrangement usually preventing vomition, its position in the abdomen, and its shape, are all points of great interest to us, and have a direct bearing on many of the diseases affecting it. It is situated in the left hypochondrium, but under distension extends into the epigastric and right hypochondriac regions. The organ is suspended from left to right (cardia to pylorus), obliquely down- wards, with the lesser curvature looking towards the right side; the stomach is situated principally to the left of the spine, in apposition with the diaphragm, and extends from near the last ribs on the left side to the upper surface of the colon on the right half of the body. To the right it is in contact with the liver, the left extremity being in apposition with the spleen, diaphragm, left kidney, and left prerenal capsule, whilst inferiorly it rests on the double colon at the sternal curve, which prevents the stomach, no matter what its state of dis- tension may be, from ever being in actual contact with the abdominal walls. The cesophagus enters the stomach at the lesser curvature, and, owing to the peculiarity of its arrangement, prevents, under ordinary circumstances, anything from passing through it in the reverse direction, Digitized by Microsoft® SURGICAL ANATOMY OF THE ABDOMEN 9 The cardiac extremity of the cesophagus is very thick, the opening into the stomach small and filled with the folds of mucous membrane lining it, and the cardia itself surrounded by muscular fasciculi producing a powerful occlusion of the orifice. It is owing to these causes that the horse is usually unable to vomit. From careful dissection I have found the following to be the arrangement of the cardiac fibres: Around the cardia and left extremity of the stomach are three layers of muscular fibres—(r1) the external, running towards the pylorus and also over the left cul-de-sac ; (2) the middle, running round the cardia, being a continuation of the circular fibres of the cesophagus, and very thick at the portion situated in the lesser curvature ; (3) the internal, running in the direction of the long axis of the organ, passing as a loop round the left side of the cardia, but leaving the vight side, ov that portion situated within the lesser curvature, without fibyes. It is this layer, in conjunc- tion with the middle layer, which forms the so-called sphincter, for, owing to the arrangement of the fibres, the cardia is compressed on the left towards the right by the (looped fibres of the)! internal layer, and on the right towards the left by the middle layer. The pyloric extremity of the stomach is supplied with a sphincter, the so-called pyloric ring. We believe that, in addition to the resistance offered to vomition by the cardia, the contraction of the cesophagus (at least, the posterior half of it) materially assists in preventing anything passing along it in the reverse direction, for we always find that where dilatation of the cardia has occurred so as to allow vomition the cesophagus is likewise dilated and its walls are flaccid. On examining a stomach and cesophagus after death, 1 The insertion in brackets is mine.—H. C. R. Digitized by Microsoft® lo THE COMMON COLICS OF THE HORSE in a case where vomiting has occurred during life, we find the parts flaccid and easily dilatable; the fingers may be introduced with freedom into the cardia, the lining membrane of the cesophagus is no longer in apposition, and on dividing the gullet for the purpose of removing the stomach, no matter how far forward it is cut, the fluid contents of the viscus (that is, if this organ be entire) will pour out. In a case of epilepsy which occurred in my practice, I found after death, although there had been no vomiting during life, the Fic. 2,—LoNGITUDINAL SECTION OF STOMACH AND PyLorus. a, Opening of cardia; b, pylorus; c, commencement of duodenum ; d, pyloric or duodenal ‘ trap.’ cardia and cesophagus in this condition. The cardiac and pyloric orifice of the stomach are not far apart; the pyloric is below the cardiac. A very singular and important arrangement of the pylorus and duodenum exists; dissection reveals that the duodenum, where it commences at the pylorus, is S-shaped and much dilated, forming an arrangement not at all unlike an §-trap used in drain-pipes (see Figs. 2 and 3). This direction of the duodenum appears to regulate the pace at which the ingesta should pass through; as soon as the trap is formed, the duodenum ascends towards the spine lying Digitized by Microsoft® SURGICAL ANATOMY OF THE ABDOMEN a all the while on the colon. It is easy to see how simple it is for a distended stomach and intestines to press upon the pyloric trap, and practically occlude it; this is the second factor in producing ruptured stomach. The Small Intestines are divided by the anatomists Fic. 3.—PHOTOGRAPH OF STOMACH TO ILLUSTRATE Fic. 2.} a, CEsophagus ; 6, pylorus ; c, commencement of duodenum ; d, pyloric or duodenal ‘ trap.’ of the present day into two portions, the fixed or duodenal and fre: or floating; they are about 70 feet in length. The duodenal portion commences from the pylorus, passes under the concave surface of the liver in a direc- tion upwards and outwards, lying on the double colon 1 JT have inserted this photograph to illustrate General Smith’s diagram. The stomach was removed from the abdomen, and the duodenal ¢-trap carefully arranged as it lies in situ.n—H. C. R. Digitized by Microsoft® 12 THE COMMON COLICS OF THE HORSE and passing in apposition with the last rib, where it may readily be found at the lower part of its upper third, just where the extremity of the transverse processes of the first lumbar vertebra reaches ; it then passes immediately behind the right kidney opposite to the second lumbar vertebra, crossing the spine transversely behind the anterior mesenteric artery; it is then attached to the colon, and terminates in becoming continued by the floating portion in the left flank, Where the duodenum rests on the colon and passes under the last ribs on the right side is a practical point of considerable importance, The free portion of the small intestines is suspended by means of the mesentery from the underneath portion of the spine in a spiral form; owing to the length of the mesentery and this mode of attachment, volvulus of the bowels is, unfortunately, only too common. The small intestines hang well in the centre of the body, and lie in the curve formed by the double colon; they terminate at the czecum, crossing to the right side for this purpose, and opening into the gut close to the colon, but below it. This part is situated beneath the third lumbar vertebra, about 6 inches from its under surface. The Large Intestines are represented by the caecum, colon, and rectum ; they occupy a fairly regular position, and a knowledge of their disposition and course is im- perative. The cecum, or ‘blind gut,’ contains, on an average, about 8 gallons of fluid, and is over 3 feet in length. It usually occupies a position obliquely from above downwards and forwards, and presents superiorly a base, and inferiorly an apex. The superior extremity, base, or arch, or, as well designated by Chauveau, ‘crook,’ is situated in the right lumbar region close under the spine; it is in relation with the right kidney, duodenum, psoas muscles, colon, small intestines, and Digitized by Microsoft® SURGICAL ANATOMY OF THE ABDOMEN 13 pancreas. The crook or arch looks forwards, and in the concavity of the curve on its inside the small in- testine opens and the colon begins, The inferior ex- tremity is placed within the double colon at its sternal curve, the apex resting on the ensiform cartilage of the sternum ; at least, this is its usual position. The colon is divided into two portions, the single and double; it is about 12 feet in length. For convenience of description the double colon is divided into four parts; commencing from the crook of the cecum it proceeds forwards and downwards, passing beneath the right kidney (having the pancreas between it and that organ) to the diaphragm, and, bending to the left, forms its suprasternal flexure ; the second portion is continued from here, running backwards and upwards into the left flank, turning inwards opposite the pelvis and close up against the spine to form the pelvic flexure ; now follows the third portion, running forwards above the second and attached to it by peritoneum: when it reaches the diaphragm it makes a curve to the right, the diaphragmatic flexure, followed by the fourth portion, which is attached by peritoneum to the first, and reaches posteriorly to the base of the caecum, where it terminates in the single colon. This crosses to the left side beneath the first lumbar and last dorsal vertebrz, being attached by peritoneum to the crura of the diaphragm and the mesenteric vessels. The double colon at its origin is very small, but it quickly enlarges, and at the supra- sternal flexure is of considerable size ; at its pelvic curve it is greatly reduced in volume, but at the diaphragmatic flexure it again enlarges, and close to where it terminates in the single colon attains its largest size, and then suddenly contracts to form the single colon. These differences in the volume of the colon are of direct practical interest. The pelvic curvature and the single colon are the most Digitized by Microsoft® 14 THE COMMON COLICS OF THE HORSE frequent seats of obstruction from calculi, gravel, etc. which have passed with ease along the more dilated portion of the canal. The Single Colon lies in the left flank, is suspended from the spine by peritoneum, and extends to the pelvis, where it becomes continuous with the rectum. The Liver is situated principally in the right hypo- chondriac region, and is placed obliquely from above downwards from right to left. Its anterior face is applied against the diaphragm, its posterior against the stomach and intestines. The upper extremity of the right lobe is in apposition with the right kidney at the space between the sixteenth and seventeenth ribs; from here the liver extends downwards, inwards, and forwards, having between it and the costal walls the posterior lobe of the right lung and the diaphragm, and passing across the abdomen its middle lobe rests on the sternum. The right lobe extends as far forwards as about opposite the eleventh rib, as far back as the sixteenth or seventeenth, and reaches as low down as the inferior part of the middle third of the ribs. It is important to remember that, excepting at one small part (between the sixteenth and seventeenth ribs), the right lung and diaphragm are always between us and that organ, an anatomical fact which renders percussion almost useless in liver disease. The Spleen is situated on the left side of the abdomen; it is attached superiorly to the left kidney and prerenal capsule, and anteriorly by peritoneum to the greater curvature of the stomach. The base of the organ extends to two or three inches behind the middle third of the last rib on the left side. The Pancreas is situated on the double colon, to the right side of the spine. At its upper part it is beneath the right kidney and close against the vena cava. Its Digitized by Microsoft® SURGICAL ANATOMY OF THE ABDOMEN {5 anterior border is in contact with duodenum and the the lesser curvature of the stomach. The Kidneys.—The vight has its anterior border reaching as far forward as the sixteenth rib, where it is in apposition with the liver; its posterior extends back to the first lumbar vertebra, its inferior edge as low as the middle third of the last rib but one. To the posterior part of this gland the base of the cw#cum is attached. The renal artery penetrates the organ immediately under the last rib. The Jeft kidney has its anterior border reaching only as far forward as the last rib, its posterior to the transverse process of the third lumbar vertebra. It lies up much closer to the spine than its fellow on the opposite side. A knowledge of the situation and position of the various abdominal organs is essentially necessary to the surgeon, for he may at any time be called upon to perform opera- tions in their vicinity. Take, for example, the simple one of ‘ puncturing the bowels,’ in performing which, by entering the trocar too high up on the right side, the duodenum or right kidney may be wounded, or the left side of the spleen or the left kidney. Such serious com- plications, liable to arise out of even a simple operation, can only be averted by a clear and certain acquaintance with the anatomy of the viscera. It is particularly important to know the position they occupy in the ving body; having to this end arbitrarily divided the abdomen into the various regions before noticed, we will conclude this chapter by stating, in tabular form, the contents of each. Ricut SIDE oF ABDOMEN, Anterior border of right kidney, Region No. 1, or superior { prerenal capsule, and _ supero- diaphragmatic. posterior part of right lobe of Digitized by MiINSSont@ 16 THE COMMON COLICS OF THE HORSE Ricut SIDE oF ABDOMEN (continued) Region No. 2, or pelvic. Region No. 3, or pelvic. Region No. 4, or diaphragmatic. Region No. 5, or lumbar, Region No. 6, or pelvic. Posterior part of right kidney, the base of the cacum, termination of the ileum, commencement of the double colon, part of the duodenum, and, in the female, the right ovary, and upper part of right horn of uterus, superior {The base of the cecum when dis- \ tended. The first and fourth portions of the double colon, part of the suprasternal and diaphragmatic flexures, the right and middle lobes of the liver, the inferior half of the cecum, the pancreas, portion of duodenum, and right \ extremity of stomach. superior inferior Lerr SIDE oF ABDOMEN. Region No, 1, or superior diaphragmatic. Region No. 2, or superior lumbar. Region No, 3, or superior pelvic. Region No. 4, or diaphragmatic, Region No. 5, or lumbar. Region No. 6, or pelvic. inferior \ Termination of the double colon. inferior {Portion of double colon, and czcum when distended. Portion of left extremity of stomach, Left kidney and prerenal capsule, base of the spleen, left ovary and horn of uterus in female, third portion of double colon. The pelvic flexure of the double colon. The second and third portions of double colon, the suprasternal and diaphragmatic flexures, the greater curvature of the stomach, portion of spleen and left lobe of the liver. Second and third portion of double colon, and coils of small in- testines, part of the single colon, commencement of the rectum, and large part of the spleen. { Pelvic flexure of the double colon, _ and coils of small intestines. inferior inferior inferior Digitized by Microsoft® SURGICAL ANATOMY OF THE ABDOMEN 17 Following this summary of the regional anatomy as written by General Smith, I wish here to refer again to the arrangement of the cardiac fibres of the stomach. Their arrangement is so striking, and of such peculiar interest when we come later to discuss gastric tympany, that I wish, if possible, to render even more clear the excellent description of them he has given us. To that Fic. 4, SUPERFICIAL OR ExTERNAL MuscuLar CoAT OF STOMACH. A, Esophagus; B, left sac ; C, right sac ; D, duodenal S-trap. end I append diagrams to illustrate them, and, although the matter arrived at is essentially the same as that set out on p. 9g, dissections I have made of the stomachal coats lead me to put their description into somewhat different words. They run as follows: 1. A Superficial Plane.—This is evidently a con- tinuation of the longitudinal muscular layer of the cesophagus (see Fig. 4). It radiates obliquely over the 2 Digitized by Microsoft® 18 THE COMMON COLICS OF THE HORSE left sac, which it completely covers, leaving the right sac (indicated by the dotted lines) uncovered. In the lesser curvature its fibres become somewhat abruptly lost, while the greater curvature retains them to the entire envelop- ment of the underneath surface of the right sac, on whose upper surface they become gradually obliterated. Fic. 5.—Mippre Muscurar Coat oF STOMACH. a, Circular fibres (in one position lined more blackly than heir neighbours). There is no aggregation of these fibres.) A, CGsophagus ; B, left sac; C, right sac; D, duodenal S-trap. 2. A Middle Plane.—The fibres of this are again a continuation of the muscular coverings of the cesophagus —viz., of its circular coat (see Fig. 5). Running beneath the fibres of the superficial plane, the middle coat also envclops the whole of the left sac. Where the fibres of the superficial plane become indistinct in the position of ? This darker lining is for purposes of emphasis only.—H. C. R. Digitized by Microsoft® SURGICAL ANATOMY OF THE ABDOMEN 19 the lesser curvature and the pyloric end of the right sac they appear on the surface, and are there plainly visible —that is, at the point immediately indicated by the line a. 3. A Deep Plane.—Like to the superficial, these fibres run somewhat obliquely in the direction of the long axis of the organ, wholly covering the left sac, and leaving the right sac free. Siena a8 Fic. 6.—INTERNAL OR DEEP MuscuLar Coat oF STOMACH. a, A peculiar aggregation of the fibres, clasping the cardiac end of the cesophagus in the manner that a cravat does the neck, A, (Esophagus; B, left sac; C, right sac; D, duodenal S-trap. As I have indicated in the diagram (Fig. 6), at the point lettered a there is a distinct ridge-like aggregation of the fibres of this coat. These closely embrace the end of the cesophagus in the manner that a cravat does the neck. Their point of greatest aggregation is the left side 2—2 Digitized by Microsoft® 20 THE COMMON COLICS OF THE HORSE of the cesophagus. On the right side of that canal (the portion situated within the lesser curvature) these fibres are wholly wanting. A brief consideration of the general arrangement of these fibres of the stomach of the horse will be sufficient to point out that the so-called cardiac sphincter is no myth. Taking the two opposite sets of fibres, those intentionally darkly lined at a, Fig. 5, and those of the cravat-shaped formation at a, Fig. 6, we see at once that, when contraction of the muscular coats of the stomach occurs, the lower end of the cesophagus, just where it enters the stomach, is bound to be gripped. While it is compressed from left to right by the fibres of the deep coat, it is at the same time compressed from right to left by the fibres of the middle coat. The sphincter thus formed is an extremely powerful one. Moreover, itis in constant operation. This explains in great part, no doubt, how it is that gases or food accumulated in abnormal quantity inside the stomach gain practically no exit by way of the esophagus. Save in cases so rare that their occurrence may be reckoned a negligible quantity, everything collected in the stomach, deleterious or otherwise, is bound to pass out by way of the pylorus. This one peculiarity alone in the build of the horse’s stomach must enormously influence the treatment of several disorders we are afterwards toconsider. For that reason I have given it prominence here. Digitized by Microsoft® CHAPTER III HOW TO EXAMINE THE PATIENT PRESUMABLY a simple matter, this is, nevertheless, a subject that requires the most careful consideration. When conducting an examination that is to lead to the diagnosis of a case of‘ colic,’ it should never be forgotten that it is always a case of the greatest gravity in the horse. On first sight, the pains of colic may often appear to be of the most simple character, and yet terminate fatally after the expiration of a few hours. I have repeatedly seen cases where the main symptoms on a casual examination were those that occasioned me no alarm. Nevertheless, one hour afterwards I have foretold the animal’s death. There is not the slightest doubt that the examination of the patient should always be of the most searching nature. If the examination is_half- hearted and hasty, an entirely erroneous opinion will be arrived at, and the horse, as a result, will suffer. Looking at the matter from a purely selfish point of view, the veterinarian should constantly have in mind the value of his reputation. By his clients, his standing as a clever, shrewd man of medicine will always be largely based upon the correctness and precision of his prognosis in the cases they entrust to his care. As much Digitized by Microsoft® 22 THE COMMON COLICS OF THE HORSE of his precision in foretelling the termination of his case of colic will depend on the thoroughness of his first in- spection, it is clear that the manner of examination must be of the greatest importance. Of such importance have I deemed it, that I have devoted a chapter especially to its consideration. In the first place, I wish to lay the greatest possible stress on this fact. The examination must be a lengthy one; and my advice, especially to the young practitioner, is this: After your examination on the lines laid down in the following paragraphs, compose yourself, at any rate, for a wait of half an hour. From the patient you have no verbal description of the seat of pain, neither have you any information as to its character. Nevertheless, the sufferer, dumb as he is, will show you much if you will but carefully watch him. It is not fair to suppose that the animal will hold out for your inspection all possible symptoms of his malady during the first five minutes you are in his box. Con- sequently, you must watch him patiently until all his postures for affording himself relief have made him run the entire gamut of the symptoms that evidence his com- plaint. This careful watching should be followed bya systematic mode of inspection. 1. All possible history concerning the attack should be obtained from the owner or the attendant. The length of time the animal has suffered, the nature of his food, the manner of his attack, whether ushered in by shivering attacks or not, the nature of the water-supply, what emergency medicine has been administered, whether previously at work or rest, whether a quick or slow feeder, etc., are all important points in making the first inquiry. Digitized by Microsoft® HOW TO EXAMINE THE PATIENT 23 2. A rapid glance over the animal should next occupy the veterinarian before attempting to handle his patient. This generally reveals some special symptom that the animal will not show so well when he gives himself up to control. More especially is this latter advice to be followed when the patient is a young, unbroken colt, or an animal of an excitable, nervous temperament. Such patients, directly man commences interference, seem to possess the power of hiding the intensity of the pain they are suffering, and to stand so quietly as to fully deceive the rough and hasty observer. A few minutes’ careful watching in these cases will be productive of facts of more real diagnostic help than the most thorough and painstaking after examination. During this preliminary inspection such details as the following may be noted: The amount of injection of the nasal mucous membranes, the beat of the heart as counted by the jugular pulsations, the amount of tympany present, and the number and character of the respirations. The respiratory movements are valuable. In extreme distension of the abdomen the chest and diaphragm carry on the breathing, the action of the abdominal muscles being suspended. In enteritis and peritoneal inflamma- tion the same thing occurs. In rupture of the diaphragm the respirations are often similar to those of ‘broken wind,’ and, owing to the pressure on this muscle, the same appearance will be met with in extreme gastric distension. In all bad cases of abdominal disturbance the respiratory movements will be increased in number, sometimes enormously, and the character of each respira- tion altered from a noiseless movement to a gasping sob. . All this may be noticed in the few minutes’ quiet Digitized by Microsoft® 24 THE COMMON COLICS OF THE HORSE observation I have advised, and the beginner may be- lieve me when I say that the owner of the animal is far more likely to be impressed with the man who makes a careful and systematic examination of this nature than with the man of rapid diagnosis. The latter he may admire, the former he will trust. Now and again you may meet with a client who is visibly struck with the ‘lightning diagnosis business,’ and, whenever you see a chance, and a safe one, of exhibiting this ability yourself, by all means take advan- tage of it with that particular client. It is not, how- ever, to be recommended as a usual plan of procedure. Methodical carefulness will tell the best in the long-run, and will lead you into fewer blunders. 3. The actual examination of the patient may now commence. The pulse, that grand tale-bearer in these cases, should be carefully noted both in regard to the number of beats and its general character—constantly frequent, or its number of beats only increasing with each paroxysm of pain, etc. ; wiry and thin, or full and bounding, etc. While taking the pulse, the hand in the axilla should note the amount of perspiration present, and also ascer- tain the condition of the external temperature—whethe1 the sweats are warm and comfortable, or chilly and deathlike. The vectal temperature, though not alone of diagnostic aid, should always be taken; for, considered in conjunc- tion with the pulse and number of respirations, it will sometimes prove of help in prognosis—e.g., see the chapter on Subacute Obstruction of the Double Colon. 4. The examination of the abdomen should then proceed in the following manner : (1) By Palpation.—This method of examination will Digitized by Microsoft® HOW TO EXAMINE THE PATIENT 25 reveal to a very great extent the amount of tension ot tympany present. In a bad case of intestinal trouble the whole of the abdominal muscles will feel hard and tense to the touch, conveying to one’s fingers the sensa- tion of a muscle in tetanus. Even in the flanks, where a certain amount of resilience is expected, the same tense condition is met with. In some cases palpation exposes the existence of pain or tenderness, as, ¢.g., in peritonitis and enteritis. In others the very reverse will be noticed, the pressure affording the animal an appreciable amount of relief. It is wise to add, however, that external pressure will not always cause the animal to exhibit signs that may be absolutely relied upon, It is often difficult to elicit symptoms of pain from our patients, but it is still more difficult to distin- guish between pain produced by pressure and ticklish- ness, restlessness, and fretfulness, which may simulate pain when pressure is brought to bear upon any part, particularly the abdomen. Still, by palpation the surgeon will be able to deduce a large amount of information, favourable or unfavourable as the case may be. (2) By Auscultation—This aid to diagnosis should never be omitted. The sounds occasioned by peristalsis will sometimes be in abeyance or altogether wanting, and the appropriate remedy sufficiently pointed out. Or it may be that peristalsis is abnormally in evidence, as in the colic occasioned by the presence of fermenting foods. Both flanks should be auscultated, and also the region of the stomach. In the latter position evidence is some- times obtained as to the condition—tympanitic or other- wise—of that organ. If unduly full, regurgitations will often be heard that are so slight as to be easily missed by a mere observation of the cesophagus in the region of the neck, Digitized by Microsoft® 76 THE COMMON COLICS OF THE HORSE (3) By Rectal Exploration. — No grandiose affecta- tion of gvandesse should cause the surgeon to neglect this. Carefully and intelligently performed, it is one of the grandest means at our disposal for arriving at an accurate knowledge of the condition of the bowels. The bladder and a large portion of the posterior masses of intestines are well within reach, and the infor- mation gained by their examination will be found in- valuable. Notice should be taken as to the fulness or otherwise of the rectum, of the consistence of the fecal matter re- moved, whether semi-fluid or hard and solid, whether the removed lumps are covered with mucus or not, and whether of normal odour or comparatively stinking and offensive. It should be noticed also whether or not this organ is open (‘ballooned’) or exerting a clinging movement on the operator’s arm. In cases of acute obstruction— calculi, faecal matter, and twist—this clinging action will be particularly noticeable, and, with it, the operator will observe a painful straining on the part of his patient, together with the presence of tympanitic or impacted intestines in the pelvis. In many cases where this latter has been observed the obstruction has turned out to be in the single colon, and it may be taken as a general rule that in any case where the pelvis contains other bowels than the last portion of the rectum the practitioner has a case of a dangerous nature to deal with, To the right the operator should feel the head of the cecum and colon ; their contents should not be hard, and on pressure the bowel should give; to the left and centre should be felt the pelvic flexure of the colon with its elastic contents, and to the centre may be found some of the small intestines. They should not be distended Digitized by Microsoft® HOW TO EXAMINE THE PATIENT 27 with gas. No intestine, large or small, should exhibit pain or tenderness on pressure. (4) By Percussion.—This is performed by tapping the abdominal walls with the tips of the fingers of the right hand, with or without the left hand interposed. It will yield evidence relating to the contents and size of the viscera. Percussion over an intestine filled with gas gives a clear sound; over one containing solid matter a dull sound. Where the contents are fluid the sound is modified. This will conclude the examination of the patient, and, although taking time to describe, its actual performance will be found to occupy but a very short time. The veterinary fledgling should always follow some such line of systematic inspection as I have here laid down. In course of time he will find that it has become part of his nature, and will be able to rattle through it in so short a time as to convey no impression of painful plodding to the outside observer. If possessed of tact, he will manage to maintain a running conversation with the owner the while he is doing it. He will become fond of his work, find it both interesting and instructive, and give all satisfaction to his client. Digitized by Microsoft® CHAPTER IV ETIOLOGY: GENERAL PREDISPOSING CAUSES Recarpinc his predisposition to colic, the horse stands apart from almost every other animal. A brief considera- tion of such predisposing causes as are mentioned in this chapter will be quite sufficient to make us marvel that cases of ‘colic’ are not of even more frequent occurrence. At any rate, it will reveal quite enough to account for the enormous preponderance of these cases in veterinary practice. To commence with, there are several physiological and anatomical conditions, perfectly normal in themselves, which, nevertheless, are entirely favourable to the pro- duction of these disorders. In the first place, the relatively small capacity of the stomach compared with the animal’s size must be borne in mind, and, together with this fact, the normal process of digestion must be remembered. It is evident to the most casual observer that the small stomach of the horse cannot possibly contain the enormous amount of pro- vender that he is able to consume at one meal. As a -matter of fact, it has been proved to us that at a certain period of stomach digestion the amount of food passing out of the pylorus into the intestine equals the amount entering the stomach by the cesophagus. Notwith. Digitized by Microsoft® _ GENERAL PREDISPOSING CAUSES 29 standing this provision of nature to avoid gastric impaction, it is easy to understand that a quick or greedy feeder may so bolt his food as to bring about one of two conditions: either impaction of the stomach with food insufficiently acted upon by the salivary fluids, or the pouring out into the intestine of a large amount of improperly digested material from the stomach. The mere fact of its being imperfectly digested in the stomach leads to other troubles in the intestines. The material there is unable to become properly assimilated, and the result is either a troublesome diarrhoea or, what is more frequent, a condition of stasis or obstinate impaction. In addition to this, we may carefully consider the tremendous volume of the large intestines, their thin and delicate walls as compared with the enormous amount of bulky material they are called upon to deal with, and, finally, their great length. This done, we shall not be much astonished at a fairly frequent occurrence of gastric and intestinal disorders in the horse. Again, notice what a careful dissection of the stomach reveals (pp. g and 17). It is an anatomical fact that its very build is a distinct bar to the act of vomition. Con- sequently, no matter how sick the animal may feel, no matter the amount or irritancy of any deleterious matter he may have swallowed, there it must remain, or travel the whole length of the sensitive and absorbent surfaces of the intestines before gaining exit from the body. The anatomical facts that lead to that statement are as follows : 1. The small size of the stomach and its want of contact with the abdominal walls. This is a decided hindrance to its effectual compression. - 2. The narrowness of the cesophageal opening ; the thickened and contracted arrangement of the fibres Digitized by Microsoft® 30 THE COMMON COLICS OF THE HORSE of the cardiac extremity of the cesophagus; the oblique manner in which the latter enters the gastric walls; the peculiar arrangement of the folds of mucous membrane lining its interior; and the presence of the cardiac sphincter, already described on pp. 9 and 20—these are all factors in bringing about complete occlusion of the cesophageal opening. 3. The pyloric outlet—comparatively distended— lying close to and below the sealed cesophageal inlet. That being so, it naturally follows that any compression of the gastric walls forces the stomach contents with equal strength towards both the cesophageal and duodenal openings. The contained material finds the readiest road of exit—the pylorus. The offending material, which may have given rise to inclination to vomit, is passed by adverse force of circumstance into the intestine. Proceeding with the intestines themselves, we note first of all the formation of the so-called ‘ duodenal trap,’ as illustrated on pages 10 and 11. In cases of distended stomach or intestines this S-shaped piece of intestine is compressed and its contents rendered stationary. This is undoubtedly another great factor in the production of gastric and intestinal obstructions, with their attendant colicky pains. Following this, we observe the differences in the size of the various parts of the colon, together with its several flexures, and note also the length and com- paratively free location of this organ and the cecum. Taken collectively, these circumstances, though quite normal in themselves, must still be held to be favourable to the production of colic. Again, I think every practitioner will bear me out when I say that age is frequently a predisposing cause of these complaints. With advancing age there is not the amount of what is commonly called ‘ tone’ in the system. Digitized by Microsoft® GENERAL PREDISPOSING CAUSES 31 The teeth do not perfectly perform their proper function, and the food is passed on in a half-masticated state, and without the requisite admixture of salivary fluid. The digestion is far from being so quick, and a large amount of bulky food is less easily disposed of. The circulation, too, is not so free, in consequence of which there is less gastric juice secreted—often not sufficient—and impaction is the result. Here, also, attention may be given to the time occupied in the passage of food through the digestive canal of the horse. Henry Jarvis, in 1872, in four experiments, observed the following : Horse No. 1, fed on oats, performed half an hour’s exercise, and passed oats in twenty-four hours. Horse No. 2, fed on oats, performed a nine miles’ journey, and passed oats in twenty-two hours. Horse No. 3, fed on oats, kept quiet in stable, and passed oats in twenty-seven hours. Horse No. 4, fed on oats, kept quiet in stable, and passed oats in twenty-seven and a half hours. These periods, I need hardly add, are comparatively short, and the average time has been estimated by other authors to be nearly four days. In either case the time is wonderfully short. This fact must be remembered in close connection with another: I refer to the nature of the horse’s food. We know quite well that a very great pro- portion of his provender is of an indigestible nature, and that a very large amount of the material taken into his body is excreted unchanged. We know equally well that this excretion is going on with almost mathematical regularity throughout the day. In other words, the horse in health requires to empty his rectum eight to ten or twelve times during every twenty-four hours. © Digitized by Microsoft® 32 THE COMMON COLICS OF THE HORSE It requires but a few moments’ consideration to dis- cover what a great bearing this has upon the frequency of his attacks of colic. I have repeatedly seen cases where, without actual or complete stasis, the horse’s bowels have performed only one evacuation daily. In every case so observed dull colic pains have supervened before the expiration of twenty-four hours. Compare this with the human subject in health. The average man is able to comfortably rid himself of his twenty-four hours’ excreta by the passage of one stool daily. This means that the horse’s bowels perform in one day what those of a man perform in seven or eight, and that cessation of the act of defecation for twenty- four hours in the horse is practically equivalent to a cessation of seven days in man. That is putting it at its lowest computation. In view of that, it is easily understood why it is that pain follows so rapidly on apparently slight stasis of the bowels in the horse. We may now see how it is that cessation of the normal act of defecation for twelve hours, or even less, is quite sufficient to bring on symp- toms of pain, except under extraordinary circumstances. It is this that renders equine colics of such serious importance to the veterinarian. It explains in great measure the rapid and oftentimes fatal course they run, and impressively points out the urgent necessity for prompt and precise remedial measures. This, more than anything else, should induce the veterinary surgeon to carefully weigh his data before jumping at a diagnosis. Above all, it should cause him to deliberately ponder, and pevhaps stay his hand, before administering those agents which. tend to kill pain, but at the same time tightly lock the bowels. He may exhibit opiates or sedatives with the most humane of all objects—that of alleviating agonizing Digitized by Microsoft® GENERAL PREDISPOSING CAUSES 33 suffering in a dumb animal—but he should never forget that his first duty is to preserve life. I have remarked thus fully upon this in order that. I might point out as conclusively as possible this fact. Of all the predisposing causes to attacks of colic, this regular frequency with which the horse evacuates the contents of his bowels is to be looked upon as of supreme importance. Hereditary Predisposition.—‘ Are diseases of the bowels hereditary ? Why not? Cannot an amount of susceptibility be transmitted from parent to progeny ? May there not be a diathesis transmitted, by which the structure of the bowels is more susceptible to disease in some than in others? If cases were carefully traced back, might we not find that the sire or the dam had been subject to some disease of the bowels ?’ ° These are questions asked by a practitioner in the Veterinayy Journal. To all of them I can confidently answer in the affirmative. I have frequently been told, when attending a case, that the animal’s mother was always subject to colic. ‘Ay, and her mother died from it, too !’ is often the close of the owner’s remarks. Seeing that as many as 50 to go per cent. of the total cases in some practices are those of colic, it is no great argu- ment, I admit, to say that because one patient’s mother died from colic the offspring of other victims of the disorder must necessarily inherit a fatal predisposition. Nevertheless, the point that has struck me is the frequency with which one hears the word ‘always’ inserted. With a certain amount of hesitancy, I also put down ‘weather’ as a predisposing cause of these complaints. We all know the way in which the weather exerts an effect—baneful or beneficial—upon ourselves. It is only fair to add that these same influences are at work among 3 Digitized by Microsoft® 34 THE COMMON COLICS OF THE HORSE the lower animals. In short, every practitioner must have noticed the prolific crop of colic that speedily follows a spell of cold, showery weather, when previously all has been warm and dry. Temperament as a Predisposing Factor.—This should really come under the heading of heredity. All I need add to what I have already said in that paragraph is that I have frequently noticed that animals of a sluggish, lymphatic nature are more liable to repeated attacks of colic than are others. Last, but by no means least, in this lengthy category of predisposing causes comes a reference to the mucous membrane of the intestines. I think no one will deny that the delicate lining of the bowels in the horse is much more sensitive to deleterious matters than that of any other domestic animal. In proof of which, witness the agonizing pains that accompany the least disturbance of his alimentary tract, and the rapidity with which the animal succumbs. Witness, also, the rapid and fatal effects of comparatively small doses of irritant poisons: the animal’s dejected and downcast demeanour, and his absolute indifference to everything except the torturing pain which is rendering his case hopeless and pitiable in the extreme, This chapter, then, details some, though not all, of those causes that tend to the production of equine colic. The practitioner need not, however, be dismayed by their apparent infinity. Although, for anatomical and physio- logical reasons, the horse is fearfully liable to paroxysms of these agonizing pains, the veterinarian should en- deavour to remember that many of these predisposing causes are often energetically helped into being active ones by the crass stupidity of the animal’s attendant. Digitized by Microsoft® CHAPTER V ETIOLOGY: GENERAL EXCITING CAUSES In this chapter I intend to briefly enumerate such exciting causes of colic as will render repetition un- necessary in future pages. As far as possible I shall describe those circumstances and influences that are commonly at work in the production of these disorders, It will save me the trouble, and my readers the annoy- ance, of repeating several times the same matter under different headings. It matters but little in what district the practitioner of veterinary medicine may pitch his tent, he will be certain to find that far and away the most common cause of the equine colics is the one that may be best described by the single word ‘domestication.’ The horse, probably more than any other animal, is under man’s control and at man’s disposal. So long as he is allowed to roam the fields, gathering his food in a rough and scanty manner, taking his exercise as he himself sees fit, and resting when nature dictates, so long will he remain a picture of perfect health. Man steps in, and the colt’s life of freedom is at an end. The nature of his food, its quality and quantity, and the frequency with which he may be allowed to partake —2 Digitized by Microsoft® 3 36 THE COMMON COLICS OF THE HORSE of it—all these circumstances are entirely under man’s control, often caprice. His manner of living may vary from several days per week of a constrained idleness in the stable—with its attendant evils of sluggish liver, swelled legs, uncalled-for corn, and unnecessary fat—to an enforced life of yearly labour far beyond his endurance, with a lack of proper maintenance, and a disgraceful neglect of his comfort when ailing. The ill effects of domesticating the horse, so far as they tend to the production of colic, 1 purpose describing under separate heads as follows: (a) Food.—There are several reasons that lead one to look upon the food as a prominent factor in the causation of colic. In the majority of cases, unless the horse be one of a large stud, where the business of feeding is reduced almost to an exact science, this food is selected without any regard for the proper balance of its constituents as a suitable, easily digested, and economical diet. Even in cases where some little atten- tion is paid to this essential by the owner, his well-meant intentions fail in that the animal’s attendant will use far too much of the food so chosen, or, in others, the niggard- liness of the owner prevents the requisite amount being given. In my own district it is absolutely impossible to arrive at any just measure of the amount weighed out per diem to each horse. The owner will tell you one thing, the men another, and the horse, by his illness, contradict both. Oats, the food par excellence for the horse, is very seldom used even in country districts. It is sent in bulk to market, and maize purchased in its stead. In agricul- tural districts the maize has added to it whatever else may by chance be on the farm. More often than not this is wheat or barley—two notoriously bad foods for Digitized by Microsoft® GENERAL EXCITING CAUSES 37 horses. If these be not available, then bran is the next obtained. Bran mixed with maize forms much too laxative a diet for the horse in work; it is certainly not economical, and is, moreover, a frequent cause of an attack of colic. Nor must we forget the enormous quantities of foreign feeding materials that are poured into our markets in these days of rapid trans-oceanictransit. It is principally the equine dwellers in our large towns that are likely to suffer from their introduction, and we have had startling evidence of the ill effects of these materials in out- breaks of such serious importance as ‘poisoning by muttars’ and the conveyance of anthrax. Putting diseases of that nature on one side, it is a well-known fact that cargoes of such materials are notoriously full of dust and other foreign substances—e.g., scraps of iron, sand, stones, etc. In some districts it is a common practice to feed the animals once weekly with food that has been boiled, or, when making them up for sale, to diet them largely on it for several weeks prior to selling. Though probably more easy of digestion, I fear such food is often ravenously bolted, and in that way lays the foundation for colic. The several questions bearing on the matter of food, its economic value, mode of administration, etc., are various and widely differing. In the hope of rendering this little volume of direct practical value to the prac- titioner of veterinary medicine and to the stock-owner, I have added an appendix entering more into detail on this matter; there is, therefore, no need for me to enlarge upon it here. (b) Water.—Personally, I am not of the opinion that this can often be looked upon as the direct cause of colic. Unless it is sufficiently impregnated with the salts of Digitized by Microsoft® 38 THE COMMON COLICS OF THE HORSE calciurn to lead to the formation of calculi, which by their presence act mechanically as obstructive agents, I do not think we need often consider the water-supply | when treating a case of colic. There is one exception of importance: cases where the water is likely to be contaminated by passing through new leaden pipes, or stored in leaden cisterns, or in tanks whose joints have been cemented with a putty composed largely of lead carbonate. Since these statements forbid us to regard the water itself as a cause of colic, we are compelled to look deeper into the matter. We must endeavour to trace its ill effects, if any, to the manner or time of its administration. Tirstly, there is but one mode of allowing it that need be considered at all seriously. Should the water be given excessively cold to an animal greatly heated with exercise? As there is nothing definitely proved upon this point, it remains largely a matter of common-sense reasoning based upon experience. It must be remem- bered that an animal just returned from violent exertion has had his system greatly depleted of fluid. That this fluid needs replacing is beyond question. Personally, I am led to believe that while the animal is still warm is the best time to allow him to have it. The way I reason it is this: Prolonged muscular exertion has robbed the body of a large amount of combustible material; this certainly requires to be given back again in the form of food. The animal will not eat sufficiently until his thirst has been satisfied, therefore the water should come first. Why not allow him to cool first, then water and after- wards feed him ? That question may be answered thus: After violent exercise the body temperature rapidly sub- sides—at any rate, the feeling of warmth does; in other words, there is a corresponding reaction. If after this Digitized by Microsoft® GENERAL EXCITING CAUSES 39 reaction has set in—i.e., when the animal begins to feel chilly—he is allowed to drink freely of cold water, his system is sure to feel its effects with double intensity, and a condition of the body will be induced decidedly unfavourable to the proper digestion of the feed to follow. The temperature and high degree of functional activity occasioned by the exercise should be utilized to raise the temperature of the requisite amount of water the system requires before reaction has commenced; the animal is then enabled to take in the necessary fuel for further combustion. These remarks do not apply to an animal that has returned to his stable in a state of great exhaustion or fatigue. In my own stables the above has been the custom for a great number of years. Never once have I been able to attribute to it any ill effects. It must not be forgotten, however, that custom in watering animals should never be quickly changed. Anyone who has accustomed his steed to a different procedure from that mentioned should not suddenly alter it. Secondly, we come to the time of its administration. Should horses be watered before, between, or after feed- ing? This again opens up a question regarding which nothing is clearly settled. In an attempt to determine it, Professor F. Tangl, of the Veterinary College, Budapest, offers some interesting experiments and conclusions.) Without detailing his experiments, which would encroach too far on my space, it will suffice to give this gentle- man’s summary. He says: ‘ Horses may be watered before, during, or after meals without interfering with the digestion and absorption of the food. All these methods of watering are equally 1 Journal of Comparative Pathology and Therapeutics, vol. xv., p. 21. Digitized by Microsoft® 40 THE COMMON COLICS OF THE HORSE good, and each of them may be employed according to circumstances. It is obvious that certain circumstances may make it necessary to adopt one or other method. I need only mention as an example that, after severe loss of water, such as occurs in consequence of long- continued exertion, the animal should always be allowed to drink before it is fed, as otherwise it will not feed well. Although all methods of watering are equally good for the horse, it is not desirable to change un- necessarily from one method to another. Animals, or at least some of them, appear to be not altogether in- different to such a change. We observed in our experi ments that whenever a change was made from the plan of watering after food to that of watering before, the appetite fell off for some days; not that they did not consume the whole of the food given to them, but for some days together they did not eat with the same avidity, and took a longer time to consume their rations completely. A similar effect was not observed when the change was from watering before to watering after food, or from watering after to watering during meals, or when the change was in the opposite direction to the last. It is possible that this method of watering before food, until the animal has become accustomed to it, produces a certain feeling of satiation. Further experiments would be necessary to show to what extent, apart from the bad effects of an excessive consumption of water, the plan of watering after meals acts injuriously on digestion in the case of foods that are difficult of digestion or tend to induce tympany, such as grains provided with an envelope.’ (¢) Errors in the Proper Distribution of Work, Rest, Watering, and Feeding.—Of all the baneful effects of domesticating the horse that tend to the pro- Digitized by Microsoft® GENERAL EXCITING CAUSES 41 duction of colic, by far the greater part will be found under this heading. The small stomach of the horse offers a fair reason to suppose that it should be often filled during the day, in order that the amount of ingesta required by his volumin- ous intestines may be adequately provided. Observation of the horse’s natural habits sufficiently points this out, and yet how often we see this teaching of nature grossly ignored. Percivall, with his usual terseness of argu- ment, suggests that when the natural habits are changed for new ones, by confirmation of time and usage these come to appropriately take the place of those ordinarily natural. He is evidently referring to the ‘ three meals a day ’ system of feeding the horse, which custom has come to substitute for the animal’s constant grazing when at large and at pasture. Probably, if man were content to allow even these necessary three meals, and at regularly fixed hours, cases of colic would be far less numerous. Such, however, is not the case. Percivall himself goes on to remark: ‘ How often do we see horses, hunters especially, taken to work at eight or nine o’clock in the morning, and not returned to their stables before five, six, or seven o’clock at night.’ He then proceeds to point out that the well-bred horse will endure this long fasting, and subsequent repletion, with comparative impunity; that coarse-bred ones and cart-horses will not, but suffer, as a vesult, from stomach troubles As an example of the way in which the animal's constitution is sometimes abused in this respect, I cannot do better than quote from a former article of mine referring to the feeding of horses in my own district :? @ ‘Whether the horse be in hard, every-day work, or 1 The italics are mine.—H. C. R. 2% Journal of Comparative Pathology and Thevapentics, vol. xili., p. 27 Digitized by Microsoft® 42 THE COMMON COLICS OF THE HORSE out of harness altogether, he has at the customary hours the same quantity of food thrown into his manger. These hours, by-the-by, are only twice daily—one large, long feed at daybreak, and another large feed towards evening. Then, again, in Lincolnshire, the district I am speaking of, there is often one long spell of work from seven o'clock in the morning until three in the afternoon, during which time no break is made to refresh the animals; no water to drink; no nose-bag to their faces. A break they certainly get at eleven o’clock, when they stand in a profuse perspiration, still harnessed to the harrow or the plough in the middle of a field, their heads down, and a biting, cutting, cold east wind, from which in the Fens there is not a particle of shelter, blowing about them, while the man in charge, under the lee of a close-cut hedge, sits stolidly munching his lunch. Again, without bite or sup, the horses resume their work and remain at it until three. Then, in a state of exhaus- tion and fatigue, when the powers of the digestive tract are probably at their lowest, the animal is placed in front of an enormous feed of indigestible, bulky food. After filling his stomach, he is allowed to drink heartily of the water he has perhaps been craving for all day. Every practitioner in this district must well know the Monday evening crop of colic. Sunday’s rest, Sunday’s gorging, and Monday’s day of ceaseless work and fasting, all combine to produce the colic of Monday evening. ‘This is the state of things existing in the winter months, with, perhaps, the break in field operations occasioned by a spell of frost, which again only means another period of gorging in the stables. In the summer months the animals live the greater part of the time in the open, and the veterinary surgeon’s sphere of use- fulness, for a time, is limited, with one exception. It is Digitized by Microsoft® GENERAL EXCITING CAUSES | 43 no uncommon thing for a farmer to take his nag straight away from pasture, give him a feed of corn, and drive him, full of grass, long-coated, ungroomed, and _per- Spiring, six, eight, or ten miles to the nearest market town. Here he is allowed to stand huddled up with several of his fellows in a dirty and badly-ventilated stable, from eight, nine, or ten o’clock in the morning, until three, four, or five in the afternoon, during which time he has not eaten or drunk a mouthful. He is then geared to the cart again, and does the return journey. His reward for that, on reaching home, is an extra large feed of corn, given at a time when I unhesitatingly say he should have less ; after which he is again turned out into the field for the night, to stand, perchance, the whole of the time in a pouring rain.’ Referring again to Percivall’s observed immunity of the hunter, it must not be forgotten that this animal, as compared with the cart-horse, has the advantage of the excitement of the chase. For him it has not been a day of ceaseless, unvaried toil. Every huntsman knows full well that the steed, as much as the rider, partakes of the exhilarating influences engendered by the sport. In other words, it is the matter of temperament, already referred to in Chapter IV. The Influence of the Time of Day on the Production of Colic.— As far as I remember, General F. Smith was the first to point out the enormous number of colic cases that occurred after the hour of 2.30 p.m., as compared with those occurring earlier in the day. Following his example, I have tabulated my cases, and the table on p. 44 will show that the majority of cases in this district are attacked between the hours of 12 noon and 7 p.m. inclusive. Digitized by Microsoft® 44 THE COMMON COLICS OF THE HORSE IIouv, Cases, Hour. Cases, Hour. Cases 4a.m. oO 12 noon 3 8 p.m. ° Sah I I p.m. oO Oi ° Oi 2 Din vie ° TO. 45 oO Oe es I a? 2 OF a ° SF ei ° ay 3 1zmidnight o Osis oO Sat oO Iam, ° IO gy ° Os 2 2 is oO II ,, 2 Tow 2 3 ° In this district I account for the preponderance of cases after noon by attributing it to the long stretch of work without food, and the ravenous feeding on bulky, indigestible material immediately afterwards. I havealso noticed that the great bulk of the cases occurring in the early morning—say from 4 or 5 a.m. until noon—are those that turn out to be fatal. Other and Various Exciting Causes of Colic. —Ingestion of food contaminated with sand or gravelly material, or containing substances (scraps of iron, wire nails, etc.) likely to form nuclei of calculi, Catarrh of the intestines often accompanies influenza and many respiratory affections, and animals convalescent from these maladies have a weakened digestive tube, and are prone to constipation and impaction. Aneurism of the anterior mesenteric artery, due to the presence of strongyles, frequently determines the impaction of faeces, owing to the interference with the blood-supply to the cecum and colon. Pieces of the thrombus break off, and effectually plug smaller arteries supplying, mainly, parts of the cacum and colon. In the anaemic area of bowel thus produced peristalsis is diminished, or perhaps altogether in abeyance. As a consequence we get great weakness, or even paralysis, of that portion of the bowel, with a tendency to stasis of its contents, and obstruction from fecal accumulations. Other factors that, directly or indirectly, tend to produce constipation Digitized by Microsoft® GENERAL EXCITING CAUSES 45 and fecal obstructions are: large quantities of omental fat, pressure of tumours, and repeated pregnancies, dis- tending and weakening the abdominal parietes. For my own part, I am quite satisfied that the mere presence of the foetus, in the later stages of gestation, is mechani- cally accountable for many of our cases of colic, par- ticularly obstructive. Occupying, as it does, a large proportion of the abdominal cavity, it must interfere considerably with the actions and movements of the intestines ; that is leaving out of the question entirely the fact that a large portion of the blood-current of the mother is necessary for its development. In these days, too, the rapid strides of bacteriology must not be forgotten. J should not be surprised at any moment to pick up one or other of our veterinary journals and read that some eminent scientist had discovered a specific germ for such of our cases of colic as run the rapid and fatal course of from twelve to twenty-four hours only. One would imagine that in cases of twist, for example, the pain, however agonizing, would not of itself be sufficient to kill the patient. To my mind there is only one solution that fairly fits the case—bacterial infection of the blood-stream commencing from the intestines. More especially do these remarks apply to what is known among veterinarians as‘ enteritis.’ That, however, I will deal with in the chapter reserved for its discussion. In this chapter I think I have now indicated sufficient to direct the veterinarian’s attention to the errors he sees daily perpetrated around him. Customs vary in different counties, and it is sometimes only necessary to step across an imaginary boundary to see manners and usages totally unlike those to which one has been accus- tomed. It is, therefore, quite impossible that I can dis- Digitized by Microsoft® 46 THE COMMON COLICS OF THE HORSE cuss them all. It remains for the practitioner to take the initiative in his own district, and to fight strenuously and continuously against customs and usages which his better education and wider experience show him to be wrong. Digitized by Microsoft® CHAPTER VI GASTRIC IMPACTION (GORGED STOMACH, GRASS STAGGERS, OR STOMACH STAGGERS) ‘Definition Under this heading I purpose describing a disorder which is familiarly known to veterinarians as ‘stomach staggers’; and throughout this chapter I wish to indicate that I am referring to that state of the stomach in which it is overfilled or gorged with food. No tympany. In other words, it is a condition of affairs in the stomach comparable to, and agreeing in every way with, that state of the intestines known as ‘subacute obstruction,’ or ‘impaction.’ _ Williams, in his ‘Principles and Practice of Veterinary Medicine,’ looks upon this disorder as merely a symptom attending inflammation of the brain and its meninges, and concludes his paragraph on its definition in these words: ‘The most common form of congestion of the brain and its membranes, both in the horse and horned cattle, is that called stomach staggers, or grass staggers, a disease which sometimes rages as an enzootic.’ I cannot say that I agree with him. Rather I prefer to turn to an older writer (Percivall), and quote again: ‘A stomach surcharged with food, without any accompany- ing tympanic distension, does not appear to occasion any Digitized by Microsoft® 48 THE COMMON COLICS OF THE HORSE local pain, but operates that kind of influence upon the brain which gives rise to symptoms, not stomachic, but cerebral; hence the analogy between this disease and “ staggers,” and hence the appellation for it of “stomach staggers.”’’ It may be that the total absence of colicky pains has led to the actual seat of mischief being overlooked, and the symptoms proceeding therefrom arrogated to some abnormal condition of the brain. It is not for me to deny that certain conditions of the brain or its coverings may give rise to symptoms simulating those aroused by a gorged stomach. Nevertheless, I feel it is only right to point out that in many cases a searching inquiry into the history will plainly indicate that many of these © attacks have the origin of their symptoms in an abnor- mally gorged condition of the stomach. Unless we are fully decided upon this point, our treatment of a particular case is sure to be at fault. Causes.—Remembering the inability of the horse to vomit, we shall not be surprised to find that excessive cramming of the stomach after a long fast is a frequent factor in determining this complaint. It is not, however, so much the quantity of food that needs consideration as its nature, A plentiful supply of succulent, easily-bolted herbage is the one food that is extremely likely to bring on an attack. It matters not whether the herbage be rye-grass, clover, vetches, or ordinary mixed pasture, this fact remains: An unlimited supply of tasty, suc- culent provender will cause some animals to go on feeding long after their actual wants are satisfied, and the result is an impacted state of the stomach with a mass of food it is unable, mostly mechanically, to deal with. Regarding what has been written concerning some narcotic quality of over-ripe grasses (Dick), I am quite Digitized by Microsoft® GASTRIC IMPACTION 49 prepared to grant that in some cases such may be the exciting cause. That admission, however, does not detract one iota from what I have already said. If one is to always accept that explanation of the case, how is one to account for those odd attacks occurring in the winter months, when the whole of the provender is dry corn and chopped wheat or oat straw? I have seen cases where the diet was wholly composed of the foods I have mentioned. Again, how is it that one animal out of five or six, all eating the same food from the same manger, is sometimes seen to be attacked ? No explanation of the latter case can be found save the fact that the animal under observation is a notoriously ‘ greedy feeder.’ Symptoms.—Percivall sagely remarks: ‘The un- naturally filled stomach produces for the first time a sense of satiety; the horse grows heavy and drowsy, reposes his head upon the manger, falls asleep, and makes a stertorous noise.’ His whole appearance is dull and listless, and the abdomen is visibly distended, though not to the extent of causing pain. The pulse becomes full and bounding and its number of beats below the normal, while the respirations are heavy and slow. The bowels become more or less torpid, though the rectum is frequently found full of fecal matter. The torpidity seldom or never runs the length of actual stasis or obstruction. Commonly the visible mucous membranes are injected and tinged with yellow. The mouth is dry and clammy, and its odour offensive. There ave no eructations of gas and no attempts at vomition. When urged to move, the animal does so in a semi-unconscious manner, reeling and staggering in his walk, and blundering blindly into any object near him. 4 Digitized by Microsoft® $0 THE COMMON COLICS OF THE HORSE Allowed to stand, he remains quiet, with head down and eyes half closed, a sudden rousing causing him almost to fall to the ground. Diagnosis.— Knowing that symptoms like the above may be the result of some lesion in the brain itself, the veterinarian is urged to make a careful inquiry into the history of his case. That done, the diagnosis becomes a comparatively simple matter. Receiving an account of an abundant feeding after a long fast, learning that the animal has been in a position to glut himself with food of which he is especially fond, or hearing that he is always a voracious and greedy feeder, will lead the veterinary surgeon to be on the alert. Either of these circum- stances, together with the symptoms presented, will render any chance of error small. Proceeding further, and by negative reasoning placing aside this and that article of diet as containing no narcotic principle, the surgeon advances with his diagnosis, and finally arrives at a correct decision. Prognosis.—My experience leads me to the con- viction that this, in most cases, may be favourable. The absence of tympany and the continuance of peri- stalsis, though it be but slight, justifies that statement. Treatment.—This must be mainly directed to the conservation and assistance of such favourable conditions as are present. It should be borne in mind that the occurrence of tympany would quickly lead to arapid and fatal termination. An agent which will be found to prevent that, act as an antiseptic, and exert an excito-secretory action on the intestinal tract, is to be found in sodium chloride. Should that be the drug selected, it may be given either in the form of a baJl or a draught. Those who prefer it may use instead hydrochloric acid in small and frequently Digitized by Microsoft® GASTRIC IMPACTION 51 repeated doses, taking care to keep it well diluted. The administration of these two drugs will be best followed by the exhibition of an oleaginous purgative. It will act beneficially in two ways, serving both to empty the overladen bowels and to counteract any irritant or corrosive effects of the salt or acid. The lethargy of the nervous system should, at the same time, be overcome by the judicious use of nux vomica, in this case preferably given in the form of the tincture, owing to the likelihood of its becoming more rapidly absorbed. Another and perhaps more suitable line of treatment is the administration of an aloetic purgative, together with the use of the alkaline stimulants (ammonia com- pounds), which, while acting as cerebro-spinal stimulants and urging the circulatory and secretory organs into activity, also prevent the formation of gases. In all cases, no matter what the medicinal agent em- ployed, the animal should be well rugged down, in order to promote warmth and the action of the remedies adopted. At the same time, he should be kept slowly walking to overcome the lethargy and tendency to som- nolence. The use of copious warm and stimulating enemata is beneficial, and should always be persisted in. Digitizedé-by Microsoft® CHAPTER VII GASTRIC TYMPANY: GASTRECTASIS, OR DILATATION OF THE STOMACH Definition.—That condition of the stomach in which it is abnormally distended with gas, the result of fer- mentation of its contents or the introduction of air from without. This disease, by no means a rare one, appears to have been but little noticed by veterinarians, if we may judge by the paucity of literature relating to it. A redeemnig feature presents itself in that the reported cases, though few in number, are extremely well stated, and leave no doubt in the mind of the reader that the authors are well acquainted with the condition they describe, cog- nisant of the real nature of the complaint, and convinced of the dangers attending it, Of all the gastric and intestinal disorders we are able to diagnose this is one of the most rapid, and at times one of the most fatal, the veterinary surgeon is likely to meet with. The patient is in those extreme agonies of pain that quickly run on to death, and nothing but a prompt recognition of his complaint and the administra- tion of suitable remedies will bring about a favour- able issue. A few hours’ indecision will place his chances of life, already small, beyond all hope. This latter statement is rendered the more important by the Digitized by Microsoft® GASTRIC TYMPANY 53 fact that the attack is oftentimes treacherous at the out- set, the mildness of the premonitory symptoms effectually masking all possibility of the fearful, agonizing spasms to follow. Percivall, though including both this disorder and intestinal tympany in one description, still manages to steer clear of ambiguity, and leaves his reader fully in- formed that tympany of the stomach, and stomach only, is often to be dealt with in veterinary practice. Hesays: ‘In the horse, however, who has no vumen, veritable hove is arare occurrence. ... I shall never, probably, see so many blown or hoven! horses as I witnessed in the march of the British army from Waterloo to Paris in 1815. A brigade of horses had been allowed to feed in a field of growing wheat, and the consequences were that several amongst them swelled in the body, and turned almost frantic with pain, and died.’ Other authors have also given excellent descriptions of this disorder. Mr. Henry Thompson, Aspatria, under ‘Rupture of Stomach’ beautifully describes a case which had its starting-point in this condition. Here is his description: ‘This horse was reported ill about ten o’clock in the morning, and, on examining him, I found that he was apparently suffering from flatus.1... Treat- ment was continued, but without any beneficial effect, and early in the afternoon the “ eructation”’ was noticed, the pulse rapidly assumed the “ running down” character, great prostration came on, and the horse died about eight o’clock in the evening. From the time when the eructation appeared no medicine was given, as from my experience in former cases I was as certain as it was possible to be that a rupture had occurred.’? 1 The italics are mine.—H. C. R. + Veterinary Journal, vol. iii., p. 259. Digitized by Microsoft® 54 THE COMMON COLICS OF THE HORSE Mr. Alfred Broad, too, relates a case of acute gastric tympany followed by recovery. It is noticed also by Messrs. E. Wallis Hoare, Cork?; John Young, Edin- burgh; and R. Shaw Craig.4 These writers all distinctly recognise this condition of distended stomach. Causes.—As is the rule with cases of equine colic, we may confidently look to dietetic errors as the main factor in the causation of this complaint. Those in country practice may expect the bulk of their cases from the hasty bolting of a quantity of young and succulent herbage, particularly clover, growing corn, lucerne, or vetches. Other cases will occasionally crop up where the animals have been allowed a large quantity of mixed ground corn. These attacks are frequent, too, in localities where animals are turned, fresh from a winter’s stabling, on to a field of young spring grass, more especially if the pasture be marshy. In some districts it is customary, immediately after harvest, to put by a number of unthreshed oat-sheaves, which are cut up and used as chaff, with or without the admixture of other seasoned hay. This, again, is a cause of numbers of cases of tympanitic stomach. The same may be said of newly-threshed oats. Where such palpable causes as these are absent the practitioner must look with suspicion upon food that has been badly harvested—mow-burnt hay and mouldy corn. Personally, I am not an advocate for the use of boiled foods, and look upon them as a frequent cause of colic troubles. Such foods, unless the men are well superin- tended and the supplies kept fresh, will turn sour and inevitably give rise to fermentation when eaten. For the 1 Veterinary Journal, vol. ii., p. 174. 2 Veterinarian, vol. lxix., p. 794. ® Ibid., vol. xlviii., p. 593. § Veterinary Record, vol. ix., p. 214. Digitized by Microsoft® GASTRIC TYMPANY 55 same reason the use of steeped barley or wheat is not to be advised, while wheat or barley in the unsteeped form may be looked upon as a poison. This same complaint, though not in an acute form, may be occasioned by the vicious habit of crib-biting; the stomach and abdomen become visibly distended, colic pains following closely after. Greedy feeding and imperfect mastication of food may also be put down as acause. In Mr. Broad’s case he distinctly states that it was the hasty swallowing of oats in an unmasticated state which produced indigestion, this giving rise to tympanites of the stomach and intes- tines. Mr. Broad also relates another case in which the most serious tympanites resulted from the eating of ‘cinquefoil.’ Other and rarer causes may occasionally be found in some diseased state of the stomach, giving rise, in the first place, to indigestion, and, secondly, to fermentation of its contents—e.g., the ulcerative condition occasioned by the presence of large numbers of bots, gastric calculi, etc. General F. Smith, in dealing with this disorder, quotes from the pen of Mr. Gillespie to illustrate the dangers of mouldy food! I cannot do better than repeat it here. ‘On a certain morning I was called to see some horses of the 5th Punjab Cavalry in camp, and on arriving at the lines, about 250 yards off, found several horses dead, and others apparently dying fast, and all extremely tym- panitic. Either three or four had died during the night, and five or six more had been attacked, but some so slightly as to be fit to go to the lines after exercise. 1 Proceedings of the Fifth General Meeting of the National Veterinary Association, p. 79. Digitized by Microsoft® 56 THE COMMON COLICS OF THE HORSE ‘I remember that one, when about to receive an enema, went down, and I thought it was all over with him, for he looked more dead than alive. However, to my great - surprise, he showed a desire to get up, and, once on his feet, he was kept trotting until his bowels began to act, and he was saved. I think this was the only bad case that recovered, I blamed the grass at once, and got a sample, which, from mouldiness, was truly enough to set up any amount of fermentation in the internal economy; and be it known tympany was the sole cause of all this mischief. ‘I attended the post-mortem of all those that had died, and no sooner were the abdominal walls severed than the stomach, and sometimes the colon, exploded with con- siderable noise, scattering the contents for many yards around, ‘In some instances there were traces of congestion of the mucous membrane of the intestines (not confined to any particular point), and in one case there was a leaden colour of part of the ileum. I looked upon the immediate cause of death as being suffocation. The pressure on the walls of the stomach must have been enormous, for it split like a bubble, and so did the large intestine, but the latter only burst on a few occasions.’ Symptoms.—In most cases these will be fairly well pronounced before the arrival of the veterinary surgeon. Nevertheless, I must again warn the practitioner that the outset, even of a serious attack, may be comparatively simple. The horse is seized with colic pains soon after the offending feed. The pulse at first is but little quickened, and the respirations are not increased to any marked extent. Asa consequence, the animal is treated in the usual way by the attendants before calling in skilled advice, Digitized by Microsoft® GASTRIC TYMPANY $7 During this time the patient has been gradually getting worse, the pains have become more severe, and the tympany more marked. The owner eventually becomes alarmed, and the veterinarian is sent for. The symptoms now presented are of an excessively alarming nature. The unfortunate animal is in a bath of perspiration; his countenance is suggestive of the most agonizing torture; and, staggering blindly about, he is a danger to himself and those about him. His pains have rendered him unmanageable, and with the greatest diff- culty can he be kept upon his legs. That is one state of affairs that meets the eye of the surgeon. In other cases a totally different set of symptoms will be presented for his inspection. Instead of madly flinging himself down, only to rise and rush in frenzy round his box, the poor brute stands in patient agony. He appears now to have some God-given instinct that violence will only render worse his well-nigh hopeless case. He occa- sionally makes quiet crouching attempts to lie, but stands for the most part quiet. The distressed nature of his respirations, however, and the pinched, haggard expres- sion of his countenance reveal the intensity of his suffer- ing, as, with appealing-looking eyes, he turns from one to the other of those standing by for help in his agony. In both cases examination reveals an alarming state cf the pulse and respirations. The pulse, weak in character, is found to be hammering frantically at a rate of 100 to 120 beats a minute, and the breathing, of a painful, gasp- ing, see-saw character, is accelerated from the normal to as many as 140 to 150. Oftentimes the abdomen is found to be tensely tympanitic; rarely, it will be found to be about the normal, no noticeable distension, and peristalsis evident on auscultation. Iu those cases where abdominal dis- Digitized by Microsoft® 58 TIIE COMMON COLICS OF THE HORSE tension is marked, rectal exploration will sometimes reveal coils of distended intestines occupying the pelvis, and the operator’s arm is met with painful straining efforts on the part of the patient. At times the rectum is found to contain a few hard lumps. Distension of the abdomen, however, is not a constant symptom. It is sometimes almost entirely absent, in which case what tympany there is will be seen on the left side and fairly well forward. My experience leads me to the conviction that those cases in which the bowels are free from tympany are the ones that yield most readily to treatment. When the case has occurred without previous feeding on green food, careful inquiries will elicit the fact that the passage of faeces has been fairly regular throughout the day, and that the pains only came on soon after partaking of a particular feed. The most striking and most diagnostic symptom is the frequent eructation of gas, and here one word of caution is necessary. I have called it ‘eructation,’ possibly giving my reader to under- stand that large volumes of gas are escaping by the cesophagus. I need hardly say that such is not the case, for, if that were happening, the animal would soon gain natural relief. In the great majority of instances the spasmodic contraction of the cervical muscles, the retch- ing noise emitted by the patient, and the gurgling noises in the cesophagus serve to relieve the patient no further than the expulsion of quite a small quantity of gas, and, at times, a thin trickling of ingesta from the nostrils. Should relief not soon be obtained, the symptoms become worse still, and quickly post on to the end. The breathing becomes more and more distressed; the abdomen fills further and further with gas, and the small quantity of fluid ejected from the nostrils increases Digitized by Microsoft® ' GASTRIC TYMPANY 59 in volume until it becomes a disgusting vomit. Saliva hangs in strings from the muzzle; the gurgling noise in the cesophagus becomes louder and more frequent, and is further augmented by the rattling of fluid ingesta that has gained entrance to the trachea; patchy perspirations bedew the body, and the whole appearance is indicative of the greatest concern and anxiety. Later, the animal becomes pulseless, delirium comes on, and he staggers unconsciously round and round his box. ‘ Doing the Dead March !’ mutters the veterinarian to himself, turning aside to hide his vexation. Shortly afterwards the poor brute expires in convul- sions, in his agony clutching the ground with his teeth, as he draws his final gasps. The eyes recede, the limbs stiffen, and the patient slave has finished his toil. Diagnosis.—When the case is fairly well advanced this should offer no great amount of difficulty. As I have stated before, attacks of tympanitic stomach are somewhat deceiving at the outset, and the very mildness of the early symptoms may lead the veterinarian to look too lightly upon his case. At the most, however, from one to two hours will produce unequivocal symptoms, and the veterinary surgeon is able, with all confidence, to set about treating the case. The manner in which the diagnosis may be proceeded with is something after this fashion: The veterinarian finds his patient so frantic with pain, so bedewed with sweat, and his pulse so quickened as to immediately suggest that dire disease ‘enteritis.’ He is relieved on that score by an examination of the conjunctiva, It is not of that ‘raw-beef’ redness so invariably associated with that fell malady. The respiration to his practised ear suggests, in addition to pain, something of suffocating Digitized by Microsoft® 60 . THE COMMON COLICS OF THE HORSE pressure on the diaphragm. While engaged in this, the examiner will often hear sounds of peristalsis, with some- times the passing of a small volume of flatus per anum. He knows, again, that in enteritis these movements and sounds are almost always entirely absent. The eye, though expressive of excruciating pain, has not the haggard ‘I’m done for’ kind of expression that the animal in the fatal grip of enteritis always shows. Having dismissed enteritis from his calculations, the field of error is considerably reduced. The pains are not those of ordinary impaction of the stomach or intestines ; they are much too acute in character. Is it twist, volvulus, or strangulated hernia? In a typical case of _ the affection even these serious-sounding suggestions are easily disposed of. The abdomen is not hard enough, tense enough, tympanitic enough to allow of such an idea being seriously entertained for long. It will not be for- gotten, however, that, as previously stated, the abdomen may be tympanitic, so that, to assist him in his diagnosis, the veterinarian must look for signs more convincing still ere he comes to a final conclusion. Perhaps he has punctured the abdomen, and still finds tympany remaining. In the positions in which he has operated he knows he should have encountered the cecum and colon. He knows of no other bowel that is able to distend to the extent that his case presents. He is compelled, and rightly, to fall back on the stomach as the seat of mischief. He is struck by the catchy, see-saw breathing, and the trickling fluid, small in quantity, running from the nostrils. He auscultates the trachea, and obtains distinct evidence of fluid in that passage. The idea of an inspired drench is emphatically negatived by the owner and attendants; sometimes, even, one has not been ad Digitized by Microsoft® GASTRIC TYMPANY 61 ministered. The balance of evidence, even now inclining heavily towards ‘stomach trouble,’ is weightily dropped by the exhibition of a definite and characteristic set of symptoms on the part of the patient. There is an entirely involuntary regurgitation of the cesophagus, with a peculiar gurgling, bubbling noise in the chest, as, with a suppressed squeal of pain, and a slight depression of the head, the animal exudes a small quantity of ingesta- stained fluid from the nostrils. The veterinary surgeon knows now he has a case of tympanitic stomach, and that a bad one, on his hands. Should it happen, however, that he is only partly con- vinced, he will be made more certain still by closely watching the animal’s movements. The act of lying down is performed with care, and, should his case fortunately be uncomplicated by intestinal tympany, he will notice distinct signs of tympany right forward, under the last rib, on the left side. In addition to this, some practitioners have observed that the perspiration is confined to the left side, or more pronounced over the region of the stomach. I cannot say that I have noticed it. One other symptom, and that a fairly diagnostic one, still remains. When down, the animal sometimes raises himself on his fore - feet, and sits, dog-like, on his haunches. Mr. Broad of Bath has declared that to be almost, if not quite, diagnostic of stomach affection. He says: ‘Sitting on the haunches has its diagnostic value; it indicates the seat and nature of the pain evinced—that is, overdistension of the stomach and anterior part of colon, or both—the horse taking this position to relieve the diaphragm of their weight and pressure.’ With a set of symptoms like the above the veterinary surgeon should have no great difficulty in summing up Digitized by Microsoft® 62 THE COMMON COLICS OF THE HORSE his case. Even should only one-half of them be exhibited, a right understanding should be arrived at. There is another, and more grave condition, however, which may so closely simulate tympanitic stomach as to lead to serious error. I refer to twist of the double colon, at either its sternal or diaphragmatic flexure, or both. It is in the elimination of this possibility that the greatest difficulty in the way of a correct diagnosis lies. An animal in which that condition is present will, during the first pains arising from it, exhibit signs that even the most skilled may be excused for confounding with flatulent stomach. There is the same quick pulse, 80 tc go, or 120; the same catchy, see-saw breathing; the same signs of attempted eructation, and the same ingesta- stained fluid running from the nose. Everything seems in order, and the case is treated, as its symptoms appear to warrant, for gastric tympany. Six to eight hours elapse, and the practitioner pays another visit. He finds the symptoms no whit abated, and recognises the case is a dangerous one. Even on his first visit he had been struck by the intense redness of the conjunctiva. This has increased now to a condi- tion resembling that seen in the disease known as enteritis, and the pulse has grown weaker and faster than before. Still—and this is the circumstance that leads first to wonder, and then to an alteration in the diagnosis —the animal spends a great deal of his time in a re- cumbent position. eared upon his chest, he lies in apparent half-comfort. Were it not for the redness of the conjunctiva, and the peculiar catching sob that is now taking place with each respiration, his position would indicate ease. In other words, his pains, on a first glance, would come under the category of ‘ dull,’ and be thus correctly referred to the colon. Digitized by Microsoft® GASTRIC TYMPANY 63 But why the stomach symptoms? They are there in alarming abundance, and the practitioner feels bound to treat them. : The third and fourth visits find the same symptoms present, but the animal visibly weaker. Twenty-four to forty-eight hours sees the end. While writing this I have a case in my mind which ran an exactly similar course to the one described above. It was treated for gastric tympany, and its real nature unsuspected until the expiration of twelve to twenty-four hours. It was then apparent that some serious condition was impeding the egress of food from the duodenal end of the stomach, and the possibility of the presence of twist was suggested to the owner. It was even ventured to locate the seat of twist as the duodenum. The end of the second day saw the death of the animal, and a post-mortem examination cleared things up satisfac- torily. The double colon was twisted two or three times upon itself in the position of the sternal and diaphragmatic flexures, thus completely shutting off the second and third portions of the bowel from the first and fourth. In that portion of the bowel immediately anterior to the twist was a huge mass of accumulated ingesta. This was lying in close apposition with and pressing on the stomach, accounting to some extent, no doubt, for the preponderance of stomach symptoms that presented so perplexing a part of the history of the case. It will be seen from this that the utmost care is necessary when giving a diagnosis of, or foretelling the issue of, a case of tympanitic stomach. In the majority of cases the symptoms I have described will lead the practitioner to a correct estimate of his patient’s con- dition. He should never forget, however, the possibility Digitized by Microsoft® 64 THE COMMON COLICS OF THE HORSE of twisted colon, and should take care that his examination of the sufferer is a long and searching one. The only signs that will serve to distinguish the two complaints are the following: The palpable stomach symptoms must be laid aside for the minute, and a great deal of reliance placed upon the one symptom ef the animal’s desire to lie about for lengthy periods. Ina typical case of tympanitic stomach that does not occur. The respirations, in addition to being catchy and see-saw in their character, are added to by a plain and unmis- takable sob—not a gasp for breath owing to pressure on the lungs, but a sob of pain. Finally, the gradual in- crease of the conjunctival mucous membranes in redness and the fatal indications afforded by the quickened and fastly weakening pulse will lead one, a few hours after the commencement of the attack, to a knowledge of its true nature. Prognosis.—It may be said that all cases of tym- panitic stomach, especially when the tympany is of such an extent as to be easily diagnosed, offer a grave element of danger. Anatomical reasons, already discussed in Chapter II., warrant one in that statement. When the tympany of the stomach is accompanied with impacted or tympanitic intestines, it is always wise to warn the owner that the case may have a fatal termination. When the tympany is confined to the stomach, the abdomen fairly flaccid, and the bowels acting, a more favourable issue may with safety be prophesied, always reserving the promise by indicating the likely finish, should tympany of the intestines supervene. A further reservation will also have to be made in the very early stages of the case when allowing for the condition of twisted colon. The owner may safely be advised that a few hours will settle the question. Either his case of stomach tympany, Digitized by Microsoft® GASTRIC TYMPANY 65 under suitable treatment, will begin to mend, or the fatal and unequivocal signs of twist be in evidence, Again, it is always policy, when dealing with a case of this description, to point out the probability of rupture occurring. The veterinarian may, with all justice, inform his client that vomiting is not necessarily a sign that such has already taken place. It is impossible to diagnose this lesion until its fatal signs are present (see Chapter VIII), and the veterinary surgeon may con- fidently proceed to treat his case, promising to advise his client immediately symptoms of an alarming nature present themselves. Treatment.—This offers to the veterinarian one or two interesting little problems. Primarily, the lines upon which he may start and upon which his treatment must be based are simple indeed. They may be succinctly summed up in these two immediate instructions: (1) Rid the stomach of gas already present. (2) Prevent the formation of any more. Before attempting to dispose of the gases, it is neces- sary to know their composition. Recent experiments have shown that those which bulk most largely in the dis- tended stomach are carbonic acid, carburetted hydrogen, sulphuretted hydrogen, and nitrogen, the nitrogen form- ing only a small proportion. As carburetted hydrogen cannot conveniently be absorbed by any vehicle which may be administered per ovem, our remedial agents must be mainly directed against carbonic acid and sulphuretted hydrogen. We are again compelled to fall back upon what may be regarded as the veterinary surgeon’s sheet-anchor in the treatment of the equine colics—ammonia. In this case, however, the success of the treatment will entirely depend upon what form of ammonia is used, 5 Digitized by Microsoft® 66 THE COMMON COLICS OF THE HORSE In this particular instance the use of the carbonate would be well-nigh fatal: and this is the reason. We may safely assume with a tympanitic stomach that we have an acid condition of its contents. That being so, the administered carbonate would, by the action on it of the acid, be caused to evolve carbonic acid, and add still further to the volume of that gas already in the stomach. The form of ammonia indicated is the solution of ammonium hydrate (the liquor ammoniz fort. of the pharmacopeeias), because by its exhibition the carbonic acid gas present in the stomach will readily be absorbed (to form ammonium carbonate), while, with a suitable addition (as, for example, iron or bismuth) the sul- phuretted hydrogen may also be combined, and caused to leave its gaseous form, thus greatly lessening the volume of gases in the stomach. Such an admixture is easily prepared as follows: Ferri sulph. pulv. - : 2 - Zi. Aqua (fervens) - - . - Oii. Liq. ammon. fort. : : : Biv. This mixture, with its resulting precipitate, should be administered at once. The freshly precipitated hydrate of iron combines with the sulphuretted hydrogen, while the free ammonia, still exerting its stimulant and anti- spasmodic actions, absorbs the carbonic acid. This is the treatment I would recommend as the most suitable for disposing of the accumulated stomach gases. This done, it is wise to follow on with the exhibition of some form of mild antiseptic, one with stimulant pro- } One word is necessary in order to explain the apparently excessive dose of liq. ammon, fort. An estimated 3 drachms of that goes to the formation of hydrate of iron, thus leaving really only 1 drachm of free ammonia for stimulant and antispasmodic purposes,—H, C. R, Digitized by Microsoft® GASTRIC TYMPANY 67 perties preferred—e.g., terebene, ol. tereb., or water strongly impregnated with ol. menth. pip. Either of these will tend to stay the fermentation going on in the stomach, and render the evolving of further gas from the mass unlikely. It is usual with most practitioners to combine with the ammonia a carminative and sedative ; also to administer at the same time an aloetic purgative. As fair samples of the many drenches so given, I select the following : 1, Tinct. opii - - Bi. 2. Terebene pur. - - Bil. Spt. ammon, ar. - Bi Chlorodyne : - Biv. Ether sulph. - - Biv. Spt. eth. nit. « - Bil. Aloes sol. - : + 3yvi. OL lini - . - Oiss. Ol. lini - : - Oss, These two drenches are both open to serious objection, No. 1 more so than No. 2. In No. 1 the only medicine at all calculated to act on the stomachic gases is the spt. ammon. ar. The amount of free ammonia in that pre- paration, however, is not enough to work any beneficial result unless given in far greater doses than there laid down, while, if given in large doses, its greater proportion of contained ammonium carbonate will act adversely, as before described. : Drench No. 2 offers us a useful antiseptic in the form of terebene. This, in all probability, will prevent the formation of any further gas than that already in the stomach. That it will effectually dispose of the volume already there, and so relieve the distended stomach, is, to say the least of it, highly problematical. In these draughts the ingredients to which I take serious exception are the opium and the chlorodyne with its contained morphia and mixture of other and various sedatives. I most strongly advise all and everyone to avoid, as they would avoid poison, giving sedatives to the 5-2 Digitized by Microsoft® 68 TIE COMMON COLICS OF THE HORSE horse with colic—what form of colic matters but little, unless accompanied with violent purging. By all means adopt any other part you wish of the treatment here laid down. Give aloes, even, if you are so inclined, though that is useless and unnecessary. But if you earnestly wish your list of successful cases to increase, if you wish to give satisfaction to yourself and to your client, give the widest possible berth to sedatives. Leave them severely alone. My reasons for this advice will be found more fully stated in the chapter on Intestinal Impaction. Applying this advice to the disorder we are now dis- cussing, we shall find the explanation simple enough, thus: We have a horse with his stomach enormously distended with gas. In all probability tts distension is materially assisting in the closuve of the duodenal trap (see Chapter II., Figs. 2 and 3) by the mere force of pressure. We have alveady shown (Chapter IV., p. 28) that the horse is anatomically unable to adequately relieve himself by way of the esophagus. Ergo, the only natural velief we can possibly hope for is the unlocking of the duodenal trap by violent and energetic intestinal movements. And these movements the practitioner proposes to altogether vestrict by adnunistering a dose of opium. ... Not only is that unveasonable—at ts crinunal. Weve our patient a human being it would be considered, and vightly considered, slaughter. It is no mere fad of mine, this wholesale condemnation of the use of sedatives in equine colic. It is the outcome of many an unconscious experiment, the fruit of much bitter experience, and the careful weighing together of the data so obtained. I would ask all who seriously read my little volume to give the most weighty and thought- ful consideration to the paragraph immediately preceding this. The matter it contains is small in bulk, but offers much food for quiet reflection. Digitized by Microsoft® GASTRIC TYMPANY 69 I have said that the only possible natural means of relief we can hope for is the unlocking of the duodenal trap by violent and energetic intestinal movements. Nature may be assisted in bringing that happy state of affairs about, and it is the veterinary surgeon’s manifest duty to so assist her by giving his patient a dose of eserine and pilocarpine, or any other drug that will stimulate the involuntary muscle of the intestines into immediate action. For my own part, in whatever way I have treated the stomach gases by per orem remedies, I have always administered with the happiest results a simple hypodermic dose of eserine sulphate (2 grains to 2% grains). When it acts, it is surprising to note, although the abdomen is previously not tympanitic, the immense volumes of flatus that are passed per anum. After only an hour’s severe pain, its effect is complete and lasting relief. As illustrative of its beneficial action, I will quote the following case occurring in my own practice, : September 16, 11 p.1.—I was called to a farm 6 miles distant to attend a heavy cart mare. The following history of the case was quickly obtained. The patient had left the stable at 6.45 a.m. in her usual good health, had been at plough all day, and was returned to the stable at 3.45 p.m., and given a full feed of chopped new oat straw and Indian corn. Immediately after this she was put to work at a circular chaff-cutting machine, following upon which she was quickly taken ill. I found the poor brute in agonies of pain (far too bad to roll), pulse 120, respirations enormously quickened, and of a gasping see-saw nature, and a temperature of 103° F. The rectum contained a few hard lumps and was non- contracting; there was no abdominal distension; the other bowels were fairly empty, and auscultation gave Digitized by Microsoft® 70 THE COMMON COLICS OF THE HORSE slight evidence of peristalsis, With each respiration there was a peculiar forward movement of the cesophagus, with, every now and again, distinct sounds of attempted eructation. There was no ingesta returning through the nostrils, and yet auscultation of the trachea revealed sounds of fluid in that passage. Inquiries elicited the fact that the animal was choked with the drinks administered before my arrival. I diagnosed tympanitic stomach, with inability of the pylorus to pass it. Having administered the usual remedies, I resolved to at once empty the intestines, for, seeing that I had already obtained slight evidence of peristalsis, I apprehended no difficulty in so doing. To that end I administered a full dose of eserine sulphate (23 grains hypodermically), and prepared myself to watch results. September 17, 12.30 a.m.—The end of half an hour saw full and frequent passage of tremendous volumes of flatus per anum, and by this time the mare was distinctly relieved, though still blowing hard from the effects of the inspired drenches. The attempts at eructation were far less frequent, and I saw that I had now overcome the stomach trouble. I gave a guarded prognosis, however, not knowing how the tracheal disturbance was likely to end. September 17, 10.30 a.m.—Mare picking at provender. Entirely free from colic pains, but causing grave anxiety on account of the pulmonary congestion. The usual remedies were administered, and, though ailing some days, the animal made an uninterrupted recovery. I have now laid down a simple and rational treatment for combating this distressing disorder. Before closing the chapter, however, it is my duty to mention two other means which are sometimes discussed, but seldom or Digitized by Microsoft® GASTRIC TYMPANY 71 never practised. I am referring to the use of a trocar and cannula on the stomach, and the passing of an cesophagus-tube. I think that most veterinarians will agree with me in saying that puncturing the stomach is not without a grave ele- ment of danger, and therefore not to be advised. However, should tympany of the intestine also be present, the opera- tion of puncturing the bowels should be the first consideration. It is simple, unattended with serious risk, and imme- diately effectual in affording instant relief. The use of the cesophagus - tube | is hardly likely to come into vogue. 7 It was first suggested by Percivall, and afterwards advocated by General Smith. That it would afford relief if introduced no one would attempt to deny. As General Smith’s writings, however, so far as I can trace them, leave the instrument yet ‘imperfect,’ che veterinary surgeon must either ex periment in that line himself, or wait until someone has further improved upon this mechanical means of treatment.! 1 Since the above was written I have received letters from two American practitioners, the F ae eae me contents of which are at any rate interesting in Syomacu-TuBE. this connection. I give them here: : Dr. A. T. Everett, of South Omaha, Nebraska, to whom I am indebted for Fig. 7, says: ‘ With reference to the cesophagus-tube, which you say is as yet “ imperfect,’’ I enclose you a cut of a stomach-tube invented by Mr. D. O. Knisely, which seems to give Digitized by Microsoft® 72 ’ THE COMMON COLICS OF THE HORSE It is not likely to be adopted by the average prac- titioner as a principal line in his treatment, for these reasons: It is rather cumbersome, adds to his impedi- menta, and can only be required in quite a small percentage of the cases of ‘colic’ he is called upon to attend. Whatever treatment the practitioner has decided to adopt, let him carefully remember one detail of the utmost importance. When he has with certainty diagnosed tympany of the stomach, it is his duty to emphatically warn the owner and attendants of the danger the horse runs if allowed to roll. It is extremely likely to bring about the lesion I describe in my next chapter, rupture of the stomach. excellent results in the hands of several veterinarians who have used one. The single tubes are practically useless, as they block up with food ; and a man using one throws it away in disgust. With this you do not experience this trouble.’ This tube here illustrated is 10 feet in length, is double for 7 feet, and has the balance in separate tubes. The double part has the tube cemented together, so as to make the outside circumference small enough to be readily passed through the cesophagus into the stomach. The large opening is 4 inch across, and is the outlet from the stomach through which the food and the gases will return. The smaller opening is } inch in diameter, through which water is passed into the stomach. This latter procedure is presumably to aid the egress of the food through the larger tube. Dr, T. B. Rogers, of Woodbury, New Jersey, says: ‘ With regard to the passing of the stomach-tube, this is nowastandard procedure with our more scientific practitioners, and if you wet the tube and roll it in powdered, slippery elm-bark, instead of greasing it, pass it slowly, waiting for the efforts at deglutition its passage excites, the operation presents no difficulty.’ It would seem from this that the cesophagus-tube, which with English practitioners has remained in the experimental stage, has in America been improved on to the extent of being rendered a useful agent in affording relief in both gastric tympany and gastric engorgement. Digitized by Microsoft® CHAPTER VIII RUPTURE OF THE STOMACH: GASTRO- RHEXIS Definition.—A breach or disruption, complete or in- complete, of the tunics forming the walls of the stomach, with consequent escape of the contents of the organ. Causes.—Principally we may regard this lesion as a direct result of the disorder considered in the previous chapter, the mere mechanical pressure of the accumulated gases being sufficient to bring it about. More for that reason than that it offers any particular medical problem have I seen fit to insert its description here. Rupture may also result from ordinary impacted or gorged stomach (Chapter VI.), though it is well to add that cases following upon that condition are not nearly so many in number as those succeeding acute gastric tympany. It will naturally follow that those causes enumerated as giving rise to tympanitic stomach might be again stated here as indirect factors in the production of gastric rupture, laying special stress on the overfeeding with young green stuffs, and the excessive use of boiled or steeped foods, with a period of work immediately on the full stomach. What I have already advised under that heading will bear repeating here: ‘Never allow the Digitized by Microsoft® 74 THE COMMON COLICS OF THE HORSE horse with a tympanitic stomach to indulge in rolling.’ There can be no doubt whatever that the violent strains and falls the frantic animal inflicts upon himself when in the paroxysms of acute gastric tympany are directly accountable for many of our cases of rupture. Cases are also on record where rupture of the stomach has been accompanied with, and no doubt preceded by, a thinned and ulcerated condition of the stomach walls, occasioned by the presence of large numbers of bots (CEstrus equi), giving rise, in the first place, to imperfect digestion of food, with its concomitant process of fermen- tation, resulting in tympany and pressure. Sometimes a sudden heavy fall is responsible for the lesion. Mr. Broad instances that as follows: ‘An aged horse, in a very weak condition, fell while at work, and was with difficulty made to rise. He again fell on reaching a stable close by, and died almost imme- diately. The coats of the stomach were attenuated and ruptured.’} Other and tarer causes of this lesion may be found in the atrophy of the stomach walls produced by the vice of crib-biting, or in the ravages produced by the Spiroptera megastoma. I shall not concern myself here with a consideration of the nature and size of the rupture, nor its position or pathological appearances. Our interests will be mainly confined to its relation to colic, and the way in which it affects our diagnosis of the various disorders we are dis- cussing. It is, therefore, from that standpoint that I shall conclude this chapter. Symptoms.—I have already indicated that this lesion 1 Veterinary Journal, vol. ii., p. 178. 2 Proceedings of the Fifth General Meeting of the National Vetcrinary Association (Smith), Digitized by Microsoft® RUPTURE OF THE STOMACH 75 may occur with the stomach wall in one of two con- ditions, Either the tunics are in a state of health, or they are suffering from the ulcerated and atrophied condition occasioned by the inroads of parasites. We may take it from this that when the stomach walls are weakened by previous disease, an attack cf simple colic may be quite sufficient to bring about the rupture. In the paroxysms of pain the animal flings himself violently to the ground, and the mischief is done; in which instance the case, though finally diagnosed as ruptured stomach, is primarily looked upon as simple in its nature, owing to the regularly intermittent character of the pains. It is, in fact, first put down as, what it really is, a simple attack of colic, the rupture occurring afterwards. At times in his career every practitioner is bound to make that—I was almost calling it ‘ mis- take.’ He knows himself that it was a correct statement of the case as it first presented itself to him. When rupture suddenly changes his case from a simple to a fatal nature, it depends entirely upon his standing with his client and his amount of ready tact whether the veterinarian retires from the situation in ignominy or emerges therefrom with credit. I have not much hesita- tion myself in declaring this to be one of the vave causes of this lesion. Nevertheless, it occurs with sufficient frequency to confound our carefully-laid prognosis in other cases. In those instances where the rupture is primarily pro- duced by previous enormous tympany, the pains, almost from the very outset of the case, are agonizing and continuous. Our case of ruptured stomach, then, may be ushered in with either intermittent or continuous pain. Once established, however, rupture of the stomach offers Digitized by Microsoft® 76 THE COMMON COLICS OF THE HORSE symptoms only too painfully diagnostic in their character. Diagnosis. —‘ There exist two cogent reasons for wishing to be able to pronounce at once upon a case of ruptured stomach: the first is, the preservation, if not enhancement, of the medical attendant’s reputation ; the second, the saving of solicitude on his part, and the annoyance on the part of his patient, of administering anything under such hopeless circumstances.’ Difficult to describe, it is the character of the pulse that gives the experienced veterinarian his first warning of the fatal nature of his case. During the early stages— that is, before rupture has occurred—the pulse is full and firm in its beats; contracted to a thread only during the paroxysms of colic; again becoming full and bounding in the intervals of comparative ease. With the appear- ance of rupture its whole character is altered, and it grows small, frightfully quick, and as frequent as go to 120. I cannot better describe ‘small’ than by saying it is that kind of pulse the novice has difficulty in detecting at all—the vessel is not fully distended. The respirations become accelerated, and the conjunctiva slightly injected. The pains increase in violence, and the patient becomes almost ungovernable. Later, the unfortunate animal is bathed in sweat, trickling in drops down the face, running down the mane, coursing in streams down the inside of the arms and thighs, and splashing in drops from the belly. Violent tremors shake the body, the tail is out- stretched and quivering, and the extremities are deathly cold. The hand that takes the pulse in the brachial region is withdrawn with a shudder ; the signs conveyed to it lead to an almost instinctive dread, a significant intuition of fast-coming dissolution. } Percivall's '‘ Hippopathology,’ vol. ii., p. 24. Digitized by Microsoft® RUPTURE OF THE STOMACH 77 The patient may now sit for several minutes at a time on his haunches, or, as is more general, may stand quietly, giving the uninitiated the appearance of greater ease. His countenance, however, is still indicative of his condition. It is almost ‘sardonic’ in the expression it conveys. The ears droop, the angles of the mouth are retracted, and the teeth protrude in a ghastly grin. It is now that the vomiting —the much-discussed vomiting—begins to occur. Every now and again the duid-like ingesta of the stomach is ejected with or with- out symptoms of vomiting on the part of the patient, and the administration of medicines only tends to aggravate his suffering. In some cases the emesis is but an in- voluntary, though constant, dribble from the nostrils; in others it is an act of distinct and painful retching, accompanied with all the equine phenomena of vomiting. One other symptom there is which, if only constant, would lead to diagnosis always being absolute. I refer to the escaped ingesta being detected in the peritoneal cavity when exploring fey vectum. It is unfortunate that this evidence is not constantly obtainable. The pulse now becomes more and more imperceptible, the muscular tremors increase in severity, the breathing is a shivering sob, and the legs are propped out wide apart to keep the unfortunate animal from falling. When he drops it is all over, for a very few seconds then ends the scene, and the poor brute usually expires with the ingesta gushing in streams through his nostrils. These symptoms are the ones that may fairly be taken as diagnostic—that is, as far as we are able to diagnose this affection. They will lead to a correct diagnosis in the majority of instances. In addition to the signs here given, however, the young practitioner must remember that all the usual symptoms of ‘colic,’ as described in Digitized by Microsoft® 78 THE COMMON COLICS OF THE HORSE other chapters (Tympanitic Stomach, for instance), may be shown in gastric rupture. The reader will have gathered from the foregoing that we have no really diagnostic symptoms of ruptured stomach. General F. Smith sums the matter up thus: ‘Diagnosis of this affection is anything but easy; we have no diagnostic symptoms, and no two cases of this lesion present the same appearances, I think the symptoms on which we can place the most reliance are: paroxysms after the administration of medicines, extreme anxiety of countenance, in some cases the presence of particles of ingesta in the peritoneal sac detectable on exploration peyv vectum, running down pulse, cold sweats and rigors, with coldness of the surface; and should vomiting and sitting on the haunches occur in conjunction with these, it only strengthens the diagnosis, but theiy absence in no wise weakens it. Prognosis.—Once positively diagnosed, the case, of course, is hopeless. The question the veterinarian is most likely to ask, however, is this: ‘What dependence am I to place on the symptom of vomiting? When vomiting occurs, am I to positively declare my case one of rupture?’ Owing to this vomiting question being a much vexed one, several facts stand out with greater distinctness than they otherwise would have done. For instance, it is certain— 1, That cases of rupture occur in which vomiting is a most marked symptom. 2. That cases of rupture occur in which vomition is altogether absent. 3. That cases of vomiting occur, followed by speedy recovery, from which we may reasonably infer that there was no rupture, It follows from this that vomition is not absolutely Digitized by Microsoft® RUPTURE OF THE STOMACH 79 diagnostic of rupture. It is only fair to add, however, that it is so frequently an accompaniment of that lesion as to render it of great value when summing up our case. Even when vomiting is present in alarming degree, it is the veterinary surgeon’s duty to persist in treating his case for gastric engorgement, gastric tympany, or whatever he may have decided it is, reserving all his statements by saying ‘that it is just possible rupture may occur,’ and declining to advise his client of the advent of rupture until all or most of its absolutely fatal signs are present. Taken singly, there are no diagnostic symptoms of ruptured stomach. Collectively, however, the evidence obtained from the patient should, in most cases, allow of a prognosis being given. Needless to say, it is a fatal one. Treatment.—Beyond prophylaxis, the treatment of ruptured stomach is out of all question. Means for its prevention, however, may be discussed with advantage. Nevertheless, it is not my intention to enlarge on them here. They are so largely dependent on common-sense reasoning, deduced from the causes of other stomach troubles, that it would be but tedious repetition on my part to mention them in detail again. We may take it that the reader of this volume will gather sufficient information from the chapters on The Predisposing Causes of Colic, Gastric Impaction, and Gastric Tympany to enable him to appropriately point out the suitable preventive measures likely to guard against the occurrence of this most distressing and fatal lesion, Digitized by Microsoft® CHAPTER IX SUBACUTE OBSTRUCTION OF THE DOUBLE COLON: IMPACTION OF THE INTESTINES, IMPACTION OF THE COLON, STOPPAGE OF THE BOWELS Definition. — Intestinal impaction or obstruction, if loosely used, is a term which will cover a multitude of widely differing disorders, and I cannot help but think that the time is now ripe for an attempt to separate a few of them from their confusing surroundings, and essay to consider them singly. { am not without hope that in so doing a more dependable knowledge of their peculiarities will be gathered—a knowledge which must inevitably lead to a more correct diagnosis, and a cor- responding improvement in the particular line of treat- ment adopted for each. To further that end I have, somewhat arbitrarily, I admit, and yet not without a due amount of just reason for so doing, divided the subacute intestinal obstructions into four separate and distinct forms—viz., subacute obstruction of the small intestine, subacute obstruction of the double colon considered generally and without regard to special position, sub- acute obstruction of the pelvic flexure of the double colon, and subacute obstruction of the single colon. Taking the three forms of intestinal obstruction I have mentioned in their correct anatomical order, Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON &1 ‘subacute obstruction of the small intestine’ should properly have been described first. I have my reasons, however, for giving this general obstruction of the double colon prior place. Among them is the fact that it is this particular variety that occurs most often in practice, and has led to the terms ‘impaction of the bowels’ and ‘stoppage of the bowels’ being so loosely applied to other and distinct types. The word ‘subacute’ is purposely inserted in order to exclude such acute occlusions of the bowels as partial or complete twist, strangulated hernia, intussusception, etc. That being done, we are compelled to a consideration of such disorders as are brought about by any circumstance that causes a stationary or torpid condition of the bowels, or the surcharging of the intestinal tract with bulky, indigestible food. The present chapter, then, is given over to the descrip- tion of all obstructions of a subacute type that occur in any position in the large or double colon, with which, until differential means of diagnosis present themselves, I include typhlitic or cecal impaction. Before coming to its actual description, it will be necessary to continue this definition further. A reference to Professor Friedberger’s table in Chapter I. shows plainly enough that it comes under the second division of the essential form of true colic—z.e., colic consequent upon anomalies of the intestinal contents. The question, then, arises, Will it be (a) the colic produced by overfeeding, or (b) the colic occasioned by stoppage in the intestinal canal? In my opinion, the definitions thus indicated are, to a very great extent, interchangeable, for in the colic I am about to describe (that occasioned by stoppage in the intestinal canal, known commonly as impac- tion of the intestines) there can be no doubt that over- feeding is responsible for a great majority of the cases. Digitized by Microsoft® 82 THE COMMON COLICS OF THE HORSE There may or may not be colic pains with the over feeding, and yet the overcharging of the horse’s intestines may give rise to impaction, or stoppage—fecal accumula- tion. To make myself plainer, we may have overfeeding and yet no symptom of colic, until it has become really a case of impaction or stoppage. That is really what always occurs in the great majority of cases of so-called impaction of the intestines, the only premonitory symptoms (prior to constipation or stoppage) being dul- ness. No exhibition of abdominal pain whatever. Then, again, take (0), or the colic brought on by flatulence. Here, also, it is evident that it may arise merely as a result either of overfeeding or of obstruction. So that, to sum up, we may say: ‘ The (a) form of colic— viz., that produced by overfeeding— may or may not be accompanied by flatulence, and may or may not be pro- ductive of obstruction, again with or without flatulence.’ That is what one really sees if notes are taken of a series of cases, and I will endeavour to make my statement still clearer directly. I do not wish to convey that there is no such thing as a pure type of flatulent colic ; in fact, Chapter XV. is solely reserved for its consideration. I merely wish to point out that in a great many cases the flatulence is solely dependent on previous conditions that are in themselves another and distinct variety of colic. Causes.—For these I must again ask the reader to refer largely to Chapters IV. and V. He will find there an enumeration of such general predisposing and exciting causes of colic as will render my work in this particular section very short. I would, however, ask him to particularly remember what I have written re- garding the anatomical reasons for expecting the horse to be peculiarly liable to attacks of ‘colic’: the small size of his stomach, the great length and complicated Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 83. distribution of his intestines, together with their com- paratively fragile structure and the enormous loads they are called upon to carry, and the natural bars to vomition. His judgment should also be guided by a due considera- tion of such physiological reasons as the short length of time the food requires to remain in the digestive tract, the matter of age and defective teeth, hereditary predis- position, and the question of temperament. I would also enjoin on him not to forget the effects of change of climate, all those little errors resultant on the horse’s domestication : the matter of correct feeding and proper watering, the length of his hours of work and rest, and the number of times he is fed in the day. Among all these will be found numberless causes of obstructive colic. More particularly still would I request him to bear in mind such causes as the collection of sandy or gravelly deposits in the colon from the ingestion of fodder so contaminated, the weakening and lowering of tone of the intestinal muscles consequent on debilitating diseases, aneurismal interference with the blood-supply to various portions of the digestive tube, and the presence of the foetus in animals heavy with foal. Of these and others fuller details will be found in the chapters mentioned. All are likely, in their turn, to have a preponderating influence in determining an attack of ‘intestinal obstruction.’ Nevertheless, we may correctly sum up by declaring that a very great majority of the causes of intestinal impaction are directly referable to errors in diet. Symptoms.—These will be found to vary, in greater or less degree, in nearly every case the veterinary surgeon is called upon to attend. Before proceeding, however, it will be wise to remind the reader that I am not dealing with acute intestinal obstruction (under which head 6—2 Digitized by Microsoft® 84 THE COMMON COLICS OF THE HORSE would come partial or complete twist of the bowels, etc.). In those cases the character of the pain is acute and agonizingly persistent, and the disease runs a rapid and fatal course of from twelve to twenty-four hours. I have made a second notice of the acute disorder here in order to firmly impress on the mind of the veterinarian that it will be absolutely necessary for him to negative the idea of his case being of that description before a suitable and proper treatment can be adopted. I do not imagine for one moment that this conclusion may be arrived at by a hasty and half-hearted examination of our patient; for, as a perusal of the table of cases at the end of this chapter will show, we may be deceived by the symptoms, the pulse, the temperature, or the respirations, or we may be misled by all combined, if our examination be not a lengthy and a searching one. Dull Subjective Symptoms.—The symptoms of a sub- acute attack will be in main what are nearly always, and I think correctly, described by practitioners as ‘dull pains.’ They are so plainly of a dull character as to lead the owner to treat the case lightly and to neglect sending for assistance at the outset. Frequently he allows twelve or even twenty-four hours to elapse before sending for skilled advice. The animal is dull and list- less, perhaps refuses his food, or picks a little now and again. At this stage the pulse, temperature, and respira- tions are but little altered. These, however, change as time goes on, and the animal begins to show signs of un- easiness and pain, such as walking round the box, and smelling atthe bedding. Otherwise he leans heavily with his hind-quarters against the nearest post or wall, with an occasional pawing movement of the forelimbs or an irritant stamp of the hind. Perhaps the animal even ventures to lie down, and, if so, only after repeated and Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 85 careful crouching movements. As he stretches himself out, he emits a long-drawn sigh, or a slight but lengthy groan, and then lies out at full length, for, it may be, an hour at a time. While down, his pain is manifested by his occasionally bringing the head round to the side, and looking with anxious and troubled countenance towards his flank. Also, the breath is held after the act of in- spiration, and retained until the voluntary muscle is overcome by the deoxygenated state of the blood in the vessels of the brain. After lying for some time, he will get up and exhibit the same set of symptoms again from beginning to end. Dull Objective Symptoms —Examination per vectum will generally show that bowel to be empty, or containing at the most a few small, hard, and mucous-covered lumps. The bowel is sometimes, though not always, what is termed ‘ ballooned,’ and we may or may not notice violent straining and attempts on the part of the animal at de- feecation. It may be, howevcr, in some cases that the rectum is not empty, but full, to a state of impaction, with material varying from a semi-fluid to a solid con- sistence. The bladder is usually empty, and nearly always other portions of the intestines can be felt crammed to their full with impacted fecal matter. Ascultation of the abdominal walls reveals not the slightest sign of peri- stalsis, Sometimes there is an accompanying slight tym- pany, and during auscultation we may then hear a peculiar metallic tinkle, caused by some feeble attempt of the bowel at peristalsis. Contrary to many, I attach no grave im- portance to that sound—rather the reverse. The ex- tremities are cold, and the mouth clammy and feetid. When hereafter I allude to‘ dull’ pains, I am referring to the symptoms described above. Often, however, we may have symptoms much more violent and alarming. Digitized by Microsoft® 86 THE COMMON COLICS OF THE HORSE Acute Subjective and Objective Symptoms in Subacute Colic.—It will appear odd, I confess, to talk of the oc- currence of acute symptoms in subacute colic, and yet we must be prepared to admit that the frequent and vapid recovery of animals showing acute symptoms suf- ficiently negatives the idea of their ailment being of such an acute variety as twist, etc. Without attempting to argue that spontaneous recovery from twist, or other serious condition, is impossible, we may, with every regard for logic, allow that symptoms of an acute nature may be observed in subacute colic. The pain becomes much more violent. The animal walks round and round his box. The ears and extremities grow deathly cold. Cold, patchy perspirations bedew the underneath surface of the abdomen, and break out between the forearms and thighs, while the expression becomes anxious to an alarming degree. Tympany becomes much more notice- able; the animal reels in his walk, and casts himself down with such violence as to almost resemble a fall. The pulse is increased in frequency, and is not so full to the fingers. The visible mucous membranes become in- jected, and appear of a deep red hue. Frequently, too, in this special form of colic, the membranes are tinged with yellow, reminding one of the early stages of jaundice. Such are the usual symptoms of intestinal impaction, and their average duration may be anything from twelve or fifteen to twenty-four hours, The longest period that I myself remember an animal suffering, and ultimately recovering, is eight days. In fatal cases forty-eight to thirty-six hours usually sees the end. Diagnosis.—I am fully persuaded that this is the most easily diagnosed of all our cases of colic, and con- cerning it a mistake ought seldom or never to be made. Such a thing, however, as a diagnostic symptom is not Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 8&7 to be looked for. It is only by a complete and orderly analysis of the whole of the history, and by a proper weighing up of all the signs, that a correct diagnosis can be arrived at. Nevertheless, upon one fact I wish to place the greatest possible emphasis. The value of taking the indications of the pulse, temperature, and respirations collectively, in order to avoid error in prog- nosis, cannot be overestimated. I never look upon a case as approaching dangerous unless I get a full warning from all three. A reference to Case No. 7, at the end of this chapter, will explain what I mean. Here was an animal which had been rolling in violent pain before my arrival, but was now standing perfectly quiet. An alarming state of the pulse was evident, hammering away at the rate of 108 to the minute. The temperature, however, was only ror° F., and the number of respira- tions 12. The animal recovered. Take, again, Case No.6. The respirations here were a continual sob of 32 to the minute, and the horse wasin a bath of perspiration for over anhour. The pulse was only 48, and the temperature 101°4° F. The animal recovered. Or take Case No. 3. The temperature, 96°6° F. (which may be taken as subnormal in shire horses), was counter- balanced by the pulse (48) and the respirations (13). This animal also, after a lengthy illness, recovered. Here I will take the opportunity of stating that I believe it to be absolutely impossible to diagnose ‘straight away ’ even this, the most easily diagnosed and best understood of all our cases of colic. No committing statement ought to be made and no large amount of drugs exhibited until the case has been closely watched for some time. For example, witness Case No. 13. Judging from my foregoing remarks, the irregularity of the respirations aid temperature in this case should Digitized by Microsoft® 88 THE COMMON COLICS OF THE HORSE certainly have merited a bad prognosis. Still, I was tempted to hold out hopes, for the reason that we had a perfectly normal pulse—normal in tone and normal in number. The conclusion of that case alone warrants me in giving the advice to take the pulse, temperature, and respirations collectively, for an hour later saw the character of the pulse enormously changed for the worse. I was compelled to give a fatal prognosis, and the animal died nine hours afterwards. The attentive reader will notice that this case was really one of acute gastric tympany. It was, however, inserted with this list of cases of obstruction to illustrate more forcibly the remarks I have just made, This special attention paid to the character of the pulse in conjunction with the temperature and respirations, the symptoms I have given well weighed, and his own powers of observation brought well into play, should leave the veterinarian in a fair way to satisfactorily come to a right conclusion. Prognosis.—The subacute obstructive colics are the ones among these many disorders that allow the veteri- narian ample time in which to judge pretty accurately of the probable termination of the attack. Having diagnosed his case, and ascertained that he has a fairly normal pulse, he may, with every confidence, rely upon the great majority of his patients recovering, if not too seriously hampered by the administration of unsuit- able drugs. He should in most instances carefully explain the nature of the complaint to the owner; point out the fact that the condition of the pulse is such as to occasion him no alarm; advise him that an alteration in the pulse will be the first sign of a likely fatal conclusion ; and pledge himself to immediately warn his client should such alteration unfortunately occur. So long as the pulse remains good, the patient’s strength is maintained, Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 89 and his system responds readily to the action of stimulants, so long may a favourable prognosis be in- dulged in, and the medical attendant need not necessarily be alarmed at the continuance of pains spread over a period of three or four days. In fact, the comparative cessation of pains, if unaccompanied by an action of the bowels, may sooner be regarded as an unfavourable sign. The time at which the circumstances look their blackest, when the pains are most severe, and the uninitiated lookers-on the most anxious, is often the turning-point in the case, and it is at such moments that I would carefully caution the worried veterinarian to rigorously hold him- self in check, and arbitrarily abstain from the exhibition of sedatives. Could he but bring himself to do so ina few successive cases, he would soon come to look upon the pain, distressing to witness no doubt, as only a necessary factor towards a complete and rapid resolution, and would be able, even in that anxious time, to hold out to the solicitous owner still further hopes of a near recovery. Treatment.—My ideas concerning this are somewhat unorthodox. I cannot, therefore, detail my own without first giving that more generally practised. Probably the most common of all is the administration of an aloetic ball, the dose varying from 6 to 7 or 8 drachms, according to the size and age of the animal. Those who follow this usually administer at the same time antispasmodics and anodynes. Others there are who discard the aloes; and rely simply upon the exhibition of the anodynes. For the aloes it is said that the colic in this case is due to a collection of irritating food in the intestine, and that the rational treatment. is the administration of a purgative to remove the offending substance. The antispasmodics and anodynes are exhibited for the relief of spasm. Those who so treat their cases Digitized by Microsoft® 90 THE COMMON COLICS OF THE HORSE appear to regard spasm as a condition standing alone. Percivall even goes so far as to describe finding spasmed portions of bowel after death. He says: ‘The seat of spasm, in common, is the small intestines; in particular, the jejunum and ileum. I have seen the duodenum, however, contracted as well; in one case, a few inches from the stomach, its canal appeared to be perfectly im- passable. I have also, in three or four instances, met with it in the large guts; in one all three of them exhibited evident marks of spasm; the caecum was exceedingly distorted by contraction; . . . even the rectum had manifestly been spasmed.’ If spasm, as spasm only, is what we are to treat in these cases, then the exhibition of a suitable anodyne is doubtless the most correct treatment. Nothing more need be given. Opium in the crude, as a watery decoc- tion, or in the form of a tincture, was usually resorted to, Modern treatment, however, calls for the administration of morphia, or morphia and atropine, hypodermically. Extract of cannabis indica, too, has crept to the front a great deal during the last few years. It is said not to derange the stomach and intestines to the extent that opium does ; that it relieves spasm and pain as quickly and more permanently, and without arresting the action of the bowels. Chloral hydrate, also, is a favourite drug with those who adopt this treatment. Even when the more simple explanation of uncom- plicated spasm is denied, and the case admitted to be one of obstruction, practitioners still continue the adminis- tration of sedatives or anodynes for a different reason. ‘It is the pain,’ they say, ‘ that will wear the animal out.’ We are not, therefore, to administer a purgative, and simply wait for its operation. We must at the same time alleviate the animal’s sufferings. Those who Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 91 follow this line of reasoning will, therefore, administer some such remedy as Percivall’s: Aloes sol. - : : - + Bxii. Tr. opii ayes Spts. eth. nit. } . ‘i 7 ae OMe Aq. fervens - - - - Oss. Misce; fiat haust. In the treatment of to-day that would resolve itself into the administration of a 7-drachm ball of aloes, 6 to 8 grains of morphia hypodermically, and about 2 ounces of spts. eth. nit., in a drench. In addition to the administration of sedatives alone, or combined aloes and anodynes, enemas are frequently thrown into the rectum. Many also advocate the use of hot fomentations to the belly, in order to promote peristalsis. So long as the case lingers on, the exhibition of sedatives in decreasing doses is persisted in; and if the practitioner be particularly bold, the aloes is supple- mented by a dose of linseed-oil. It is common, also, to find oil of turpentine administered to prevent the rise of fermentation and tympany. It cannot be gainsaid that the above line of treatment is successful. At any rate, it has been continuously adopted by a large number of practitioners for a great many years. If anything new is to be introduced, it must show advantage over the old. Whether or no the treatment 1 am about to advocate will do that can only be judged from experience. For my own part, it has caused me to entirely cast aside the aloes and anodynes in its favour. Several years’ experience of a solely stimulative treatment has led me to believe it a great deal more rational than either of those de- scribed, and certainly more successful. I have also found it wise to refrain from using aloes. A treatment based upon these lines I shall, therefore, next describe. Digitized by Microsoft® b2 THE COMMON COLICS OF THE HORSE The Stimulant Treatment.—When first I came to rely mainly upon stimulants in the treatment of equine colic, I naturally turned to what literature I had, in order to see how far I was justified in so doing. This surprised me. Having properly and correctly diagnosed a disease, I used to think that its treatment would follow naturally. A long plodding through the annals and records of veterinary medicine has shown me, however, that such is not the case with this particular disorder. In no single disease, I should imagine, have so many and widely differing drugs been given. From the most potent sedatives we know of to the most drastic purge or power- ful stimulant the Pharmacopceia possesses, they have all been given. Not only have they been given in the treatment of like disorders in different patients; they have been indiscriminately mixed in single cases. Now, I do not believe in giving purgatives and stimulants with one hand and administering sedatives with the other. Above all things, whether the occasion demands the exhibition of aloes, the administration of stimulants, or the injection of morphia and atropine, let us abide by the one treatment we have decided the case merits. So far as we have gone, our summing-up stands thus: In the treatment of subacute intestinal impaction many practitioners rely wholly upon sedatives; others always combine the sedatives or anodynes with aloes; while a few advocate the use of stimulants. So long as matters remain so, a description of any particular treatment of this disorder should be accompanied with fairly sound reasons for its recommendation. I have therefore made the few following pages as argumentative as possible. Without wishing to disturb the routine of those who have for many years practised a particular method with a reason. Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 93 able amount of success—a method which, perhaps, the need of their district calls for—I would still wish to appeal strongly to those who are yet wavering. To commence with, provided we have diagnosed our case, and are certain that we have purely a condition of subacute intestinal obstruction to deal with, we cannot do better than ask ourselves the following questions: 1. What ts the exciting cause of the attack ? 2. What is the cause of the pain ? 3. What is the actual condition we ave called upon to treat ? 4. What part of the animal system is it best to operate through—the digestive ov the nervous ? Oy should our attack be divected mainly upon the offending substance itself ? 1. What is the exciting cause of the attack? To that question I answer, Undoubtedly in the great majority of cases it is the nature, bulk, or mode of administration of the horse’s food. Whether of an indigestible nature, given in too large a quantity, or whether given in such a manner and at such a time as not to admit of a free action upon it by the gastric and intestinal fluids, the result remains the same—viz., impaction of a certain portion, or portions, of the alimentary tract with a mass of improperly digested food. 2. What is the cause of the pain? The pain, I think we may safely answer, is brought about by active peri- stalsis, followed by spasm of the bowel, either on both sides of, or before, or behind the point of obstruction. This pain, of the severity of which we may judge by noting the animal’s symptoms in the most acute case of obstruction we have—viz., twist—we may designate ascramp. This explanation of ‘cramp,’ however, does not altogether meet the case when we are talking of obstructive colic in its subacute form. Here, in thé Digitized by Microsoft® 94 THE COMMON COLICS OF THE HORSE majority of cases, we have a state of impaction from end to end of the alimentary tube. What, then, will be the cause of the pain now? It may be, and is partly, due to pressure on, and consequent irritation of, the delicate nerve-endings in the bowels themselves. When, how- ever, we consider that the bowels, already crammed to their full with half-digested matter, are sometimes further distended by the evolution of gases from the accumulated facal masses, we may confidently assert that we have another and totally different condition of the bowels to reckon with. I am alluding to ‘tonic spasm.’ When a muscle or its motor nerve receives an abnormal number of vibrations or is overstimulated, instead of contraction being followed by relaxation, permanent contraction or tetanus ensues. The bowels, distended beyond a certain point, are retained in a state of tonic cramp in their ineffectual attempts to deal with the enormous masses they contain. That this is so is fully proved by the entire cessation of peristalsis in many of our cases, as witnessed by auscultation. Call it tonic spasm, atony, paralysis of the bowel, or what we will, it still remains that we have a torpid and stationary condi- tion of the bowels to treat. It is this state of tonic spasm of the whole of the intestinal tract that has, in my opinion, been so generally overlooked in the treatment of veterinary obstructive colic. 3. What 1s the actual condition we ave called upon to treat ? The favourite, but evasive, reply of the practi- tioner of veterinary medicine to that question is, ‘Remove the cause, and the effects or actual condition will cease,’ and, accordingly, in every case he gives a dose of physic. - That physic is invariably aloes. I maintain, however, that, before we proceed in an attempt to empty the bowels by such a mechanical method as the adminis- . Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 93 tration of aloes, we ought rather to stay and ask our. selves: ‘Can we by any other means put the tetanized wall into a state approaching its normal condition, and so enable it itself to deal with the offending obstruction ?’ I think we can, and, reserving my reasons for so saying, will conclude my remarks on this question by stating that, in my opinion, it is the tonic spasmodic seizure of the bowel itself which is the actual condition we are called upon to treat in obstructive colic. 4. What part of the animal system is it best to opevate through—the digestive ov the nervous? Or should our attack be divected mainly against the offending substance itself ? The whole crux of the argument concerning the treat- ment of obstructive colic lies in the answer to these questions. For my own part, I believe that the treat- ment of the nervous division of this ailment should receive our almost undivided attention; and I further believe that the administration only of drugs that act wholly or mainly on the digestive tube itself, and not on its nervous supply, is unproductive of good, if not altogether harmful. Remember, we cannot depend on the physiological action of the drug being sure to ensue in this case. We are putting our drug into contact with - a diseased organ, and must not expect that organ to take up, assimilate, and respond to that drug as the same organ would doin health. In this case the disease of the organ is its atony, spasm, or paralysis. Relieve that, and: the bowels will relieve their impaction them- selves. Intestinal movements are dependent on the ganglia of Auerbach’s plexus, situated between the longitudinal and inner circular layers of muscle. Secretion is believed to be influenced by Meissner’s plexus, lying in the sub- mucous coat. Both of these ganglia, however, are con. Digitized by Microsoft® 96 THE COMMON COLICS OF THE HORSE trolled by cerebro-spinal centres and nerves, notably the vagi and the splanchnics. Here, then, is pointed out a ready and open road to a correct treatment, and one which may be followed without the aid of a single dose of purgative medicine. Give a large enough dose of a cerebro-spinal stimulant, and theoretically the case should at once begin to mend. Practice in this case, I can confidently state from experience, only bears the theory out. To make my standpoint clear, I must analyze a few of the actions of the more important drugs used in everyday practice in the treatment of this dis- order. As in this chapter I determine to direct attention to what I believe to be the dangerous practice of giving aloes, and to the greater success following a nervous stimulant treatment, I shall confine myself to a few drugs under those headings, concluding with a brief paragraph on the use of anodynes and sedatives, (a) Aloes.—Reasons advanced in favour of its administva- tion : It causes a purge, not only of the bowels, but also of the blood. While in contact with the intestine it pro- duces secretion and peristalsis. It also increases the flow of bile. Reasons why it should not be used : 1. The length of time it takes to act (sixteen to twenty-four hours) is much too long to have to wait in the horse for an action of the bowels. That must be evident to everyone in view of the short time that is occupied in the passage of the food through the digestive organs. 2. Weare waiting then for a something only proble- matical ; for oftentimes it never acts at all, but is excreted wholly by the kidneys, causing hypereemia of those organs and diuresis. 3. The drug is always more or less nauseating. “4. Its effects are confined mainly to the large intestine ; Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 9} consequently, if atony of the small intestine exists, it may never reach the position in which its action will be the most marked. 5. It needs to be saponified and emulsified by bile before its prompt solution can be counted upon. These last two reasons may be considered a little more in detail. It is they that have already made me refer to the action of aloes as ‘ mechanical.’ In face of state- ments Nos, 4 and 5, no one will dispute that two purely mechanical processes have to be gone through before we can confidently calculate on a dose of aloes creating a purge. It has to pass almost passively through the small intestines before it can reach the large, and it requires also to be mechanically mixed with bile before its solution can be expected. Unfortunately, in subacute obstructive colic these very two processes that are necessary for the prompt action of aloes are not at all likely to come about. Regarding the first, I have already pointed out that there is very little movement of the bowels in this form of colic ; consequently, the drug may remain almost stationary in the stomach, or at the most gain the first few feet of the small intestines. With regard to the second process comment is well- nigh useless. In subacute obstructive colic there very frequently is considerable jaundice and torpidity of the liver, in which case the aloes cannot act, or, to say the least, its action is most certainly delayed, owing to the fact that the bile necessary for its prompt emulsification and solution is deficient or altogether wanting. 6. Finally, in the horse there is always a danger of superpurgation, followed by enteritis, laminitis, or possibly death. This ought never to be overlooked. I am sure that every practitioner who has been in the habit of exhibiting aloes in this disorder must have 7 Digitized by Microsoft® 98 THE COMMON COLICS OF THE HORSE | sometimes been grievously disappointed and mortified— disappointed and annoyed to see his case recover from the disease he has been treating it for, only to turn round and die in a few short hours as a result of the treatment itself. Truly, that treatment was worse than the disease. I say here that, if there is a possibility of that occurring in only 1 per cent. of our cases, then aloes ought never to be used. Asa matter of fact, when aloes is regularly given, it happens very much more often than that.2 (2) Ammonia.—Although there are many more to choose from, the drugs I have used as stimulants, and more particularly as nervous stimulants, have been ammonia and nux vomica. For ammonia, and especially the carbonate, I have a particularly strong penchant. That I am not the only one so inclined, I will show by a few remarks extracted from an article on ‘Ammonia and the Stimulative System of Treatment in Disease.’ ‘This was written by the late Principal Walley, in 1879 ; but, I may add, I had arrived at almost similar conclusions long before reading his opinions. He says: ‘Physiologically ammonia acts as a powerful stimu- lant, but does not, like alcohol, increase mental activity, nor does it to the same extent increase the force of the circulation. Its action. as a stimulant—owing to its being quickly excreted—is as fugitive as it is rapid, but it does not produce much secondary depression... . It is, too, a powerful stimulant to all the glands of the body, as well as to the mucous surfaces generally, acting upon the mucous membrane of the alimentary tract, upon the kidneys, the skin, and the liver. Its effects as a general gland stimulant are well seen in those cases where. the pulse is firm, the skin dry, the kidneys in- 1 See Appendix III. Digitized by Microsoft® SUBACUTE OBSTRUCTION OF TIIE DOUBLE COLON 99 active, the mucous membranes icteric, the bowels sluggish, and the faeces coated with mucus, with a hot, dry, and furred condition of the mouth, A few doses of ammonia here will, by stimulating gland function, rapidly alter these conditions. In the stomach and intestines ammonia acts as an antacid and antitympanitic. It is useful in acute or subacute indigestion in horses and cattle when pur- gatives have failed to act, and the animal shows signs of exhaustion, alternated with strychnine or nux vomica. In the early stages of tympany, the liquor or the car- bonate unites with the liberated carbonic acid, and fixes it, and in any stage is beneficial by stimulating the mucous membrane to increased activity, by rousing nervous energy, and by assisting in preventing decom- position.’ Like Professor Walley, I can speak from experience as to the beneficial actions of this drug in subacute indigestion, and I prefer the carbonate for these reasons: it is less volatile and rather more permanent in its actions than the hydrate; also.it is more easy of administration, as it may conveniently be given in the form of a bolus. (c) Nux Vomica.—I consider the use of this drug to be specially indicated in the treatment of subacute obstruc- tion. It is a gastric, vascular, and nervous tonic, and antiparalysant; and considering that I have already pointed. out that the condition we are to treat in this disorder is mainly one of nervous atony and spasm of the bowel, it must be apparent to everyone that none but the most favourable results will follow its administration. I must not finish my remarks on this drug, however, without a brief reference to two articles in the Journal of Comparative. Pathology and Therapeutics (vol. v.). Two cases are reported there of salivation caused by the administra- tion of nux vomica in Zi. and 3Zii. doses respectively. The dose I am about to adyocate exceeds this by 6 or igitized by Microso 7—2 100 THE COMMON COLICS OF THE HORSE 7 drachms, and I can confidently assert that in no single case have I observed anything of a similar nature. (2) Turpentine.—It will be seen, on referring to the section on Posology, that in every case I advocate the use of turpentine combined with linseed-oil. I have chosen that drug on account of its antiseptic and stimulant actions. I have given it mainly to satisfy local prejudice, which thinks that no medicine can be a medicine unless in the form of a drench, and have selected it particularly as conforming closely to the lines on which my treatment is based—viz., stimulative. (ce) Eserine or Physostigmine.— Regarding the use of this preparation, I have nothing to say that is not in its favour. I regard it as the most valuable of all recent additions to veterinary medicines. Should we give it to pregnant animals? In vol. ii. of the Veterinary Record Horner describes two cases of mares in advanced preg- nancy receiving one-tenth of a gramme of eserine and aborting soon afterwards. That should be sufficient to point out that its use must be tempered with caution. Only after all other means have failed, and it becomes not only a question of the life of the foal, but of that of the mother, should it be given. For my own part, I have given it to in-foal mares repeatedly, and have not met with an untoward result yet. With this one excep- tion, I firmly believe that it may be administered advantageously in every case of subacute obstructive colic. To those who complain of its action being uncertain and unreliable, I would reply in the words of one of our greatest veterinary writers: ‘Give a dose sufficiently large, and you will not be disappointed.’ It will, when all our other efforts have proved futile, restart that peristalsis, which means life to our patient, and whose cessation means death. I do not, however, believe a full Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 1101 dose to be always necessary, and have seen doses of 1 grain do all that the most fastidious would require. That dose is sufficient to incite the bowels to action in most cases, and that without an exhausting and painful evacuation of large volumes of feces. If it fails, it may safely be repeated later in an increased quantity—say, 2 grains, beyond which it is not wise to push its ad- ministration. (f) Pilocarpine.—In this drug we have a most useful adjunct to eserine. Possessing as it does the property of promptly and energetically stimulating glandular secre- tions, including the salivary and intestinal, it at once recommends itself for use in the disorder we are con- sidering. While in eserine we have an agent which in large measure confines itself to exciting to action the muscular coat of the bowel, we possess in pilocarpine a drug whose administration will cause the various gastric and intestinal juices to be secreted in large quantities and poured into the bowel. It is plain, therefore, from a physiological point of view, that the exhibition of a com- bination of these two will be an ideal method of dealing with obstruction caused by accumulated fecal matter, and accompanied with torpidity of the bowel wall. Practice quite bears this out. It is true that it is only since 1904 that I have been in the habit of using it. I have given it a sufficiently long trial, however, to prove its usefulness. This, combined with eserine, I am now convinced is far preferable to the exhibition of eserine alone. As to the dose, I have found that 1 grain of eserine in conjunction with 2 grains of the pilocarpine is satisfactory and efficient. (g) Arecoline.—Of late years the use of arecoline hydrobromide as an intestinal stimulant has crept to the front. Its action is said to be allied to that of pilo- carpine, but of somewhat,shorter,duration, Although I 102 THE COMMON COLICS OF THE HORSE have used it on several occasions, I have not been sufficiently impressed by the results obtained to substitute it for the combination of eserine and pilocarpine. (k) Sedatives.—Our choice of these is a large one, but before saying more I would ask: ‘ Should we give sedatives at all in obstructive colic?’ Personally, I think we should not. I know that in saying so I am opposed to a large number of practitioners, but still, after the experience of a very large number of cases, such is my conviction. In the horse I am convinced we have a type of colic to deal with that can in no way whatever be compared with the same disorder in the human subject; and when reading the report of a case, nothing gives me greater annoyance than to find the veterinary writer trying, in conclusion, to bolster up his theories, arguments, and treatment with extracts from books on human medicine. As a profession, we are undoubtedly largely indebted to the medical for much kind help afforded us in the first tottering steps of our babyhood. Now, however, we can and must stand alone. We have here a subject that fairly allows us to do so. It needs a distinct and totally different line of thought from that the medical profession can supply us with in order to enable us to properly grapple with it. There is still room for special research of the most pains- taking order. What is wanted is a long array of con- secutive cases, with notes and remarks taken on the spot, and not afterwards altered and enlarged in order to fit in with some preconceived idea. In the tabulation of cases, points invariably strike one that would otherwise be missed—points of value and interest that only a method like that will show up. Think for a moment. Think that immediately we give a sedative, especially if that sedative be opium, peristalsis is hindered, if not stopped altogether, for a Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 103 while, Think, again, that cessation of peristalsis, if only of a few hours’ duration, is to the horse a very grave and serious matter. It is no use blinding ourselves with the idea that, if aloes has previously been given, we may safely lull the pain while the aloes continues to act. Remember that ‘lulling the pain’ to a very great extent means also ‘lulling the physic,’ and that lulling the bowels in the horse suffering from subacute obstruction, with bowels already stagnant, means lulling him to death. Although I do not advise it, to those who must and will use a sedative, let me recommend to them the use of chloral hydrate in r-ounce doses in preference to opium. It is antiseptic in its action; there are not the after bad constipating effects of opium, there is not that mad delirium, and there is not the amount of dangerous tympany that opium invariably calls up. It is safe to use, its action is soon apparent—usually well within ten minutes—and if its effects are somewhat transient, why, then the same dose may safely be repeated after a short space of time. It is not followed by nausea, and, com- pared with opium, it does not seriously interfere with the peristaltic movements, and does not hinder intestinal secretions.. Here, again, I have notes of a case in front of me where the veterinary writer states that medical men pooh-pooh the idea of chloral being of any use in these cases. Well, let them do so. They are not in the habit of prescribing for the horse, they are not acquainted with his internal anatomy, and they certainly are not largely experienced in the action of drugs upon him. That chloral is not an anodyne in the strict sense of the word, I know. I know that it does not act as a sedative to the periphery of sensory nerves. It acts, however, in an indirect manner through the nerve-centres, and almost invariably induces sleep. Compare the stretched-out, comfortable sleep of the griped animal under the in- Digitized by Microsoft® 104 THE COMMON COLICS OF THE HORSE fluence of chloral with the mad delirium so often seen with opium, and one can no longer remain in doubt as to the superiority of the former in treating equine colic. Here are a few of Mr. Hunting’s remarks on the use of sedatives in colic, and with them I must close. He says: ‘It was argued that in the human subject they administered sedatives with the intention of alleviating the pain, and when they had once stopped the spasm there was no fear of impaction. After the spasm was got rid of, that the normal condition of the bowels would be resumed, and the indigestion pass away. Personally, he (Mr. Hunting) believed that, so far as the horse was concerned, that was arguing upside down. He held that the impacted food was the cause of the spasm or pain, and that the proper thing to do was to remove the cause, even if they inflicted a little more pain. He could say honestly and fairly that he had had a greater number of recoveries under the aperient and stimulant treatment than under the sedative treatment alone.’ I can emphatically endorse all that Mr. Hunting says there. The same good results immediately followed when I refrained from giving sedatives. I am able, moreover, to assure the practitioner that the number of his successful cases would further increase if he also discontinued the use of aloes, and substituted linseed- oil, Posology.—Provided the animal is suffering from a bad attack of the disorder, with all the symptoms well marked, and the least possible chance of error in diagnosis, I exhibit the following : B. Ammon. carb. pulv. - - Si. Nucis vom. pulv. - - 3i. Sapo mollis - : - q.S, ut fiat bol. Misce ; fiat bol. iv. Sig. : The four balls to be given at once. Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 108 R. Ol, tereb, . : . aa ii Spt. ammon, ar. } a Ol. lini - - - . - ad Oi. Misce ; fiat haust. Sig.: The drench to be given at once. This treatment, with the exception of the nux vomica, I repeat again at the expiration of three to four, five, or six hours if the animal is still in pain. In the meantime I throw up frequent enemata of hot water, with some- times the addition of 4 to 6 ounces of ordinary soap liniment. Should the case tend in any way to become protracted, and if the pulse is strong and not too frequent, I inject hypodermically eserine sulphate, 1 grain. If on the next occasion of my seeing the case there has been no action of the bowels, and peristalsis is still in abeyance, I repeat the eserine in larger quantities—viz., 2 grains. The preparation of eserine that I have found to be the most reliable is the following : §. Eserine sulph. - : - gts. viii. Aq. chloroformi - - ad Zi. Dose, 1 to 2 drachms. I would recommend every practitioner to prepare this himself. He will have the satisfaction of knowing exactly the strength of his injection, and he may rely on that preparation keeping practically for any length of time. It should be made in fairly large quantities (say 12 ounces), and, during the handling of the raw drug, it should be remembered that it is highly hygro- scopic. So long as the animal remains ill, I continue the administration of ammonium carbonate, this time com- bined with zingib. rad. pulv. in place of nux vomica. In fact, it may be taken as a general rule that from the com- 1 This, too, may be obtained in tablet form, in varying combina- tions with pilocarpine, and quite reliably dispensed, from any firm of druggists of repute.Digitized by Microsoft® 106 THE COMMON COLICS OF THE HORSE mencement of the pains until relief is obtained ammonium carbonats may be given at intervals of three hours in I to 2 ounce doses. The only modification to be made is when treating a very young cart animal or a nag. In this case the dose of nux vomica should be reduced to half an ounce. : Should the reader think these doses too large, I would ask him to remember that the results embodied in the writing of this chapter are the outcome of several years’ sole practice of the treatment here laid down, and that nothing but the marvellous and striking statistics following its adoption have led me to give to it the prominence I have done in the past few pages. To anyone who might feel disposed to adopt it I would offer a few words of caution. If carried out in a half-hearted manner—the doses reduced by one-half to guard against accident, or the administration of eserine deferred until the patient is in a state of collapse—then he may look for nothing but failure. Having diagnosed his case, the veterinarian must be possessed of the courage of his convictions, and be prepared to push them to their ultimate and right conclusion. Should he doubt, should he waver, I am able to honestly assure him that I have seen no case in which the apparently excessive doses have proved in any way harmful. On the contrary, after the experience of a long array of cases, I am able to declare the exact opposite to be the fact, and am thereby led to insist so strongly on the correctness of the treatment. In the whole of my practice for certainly the last five or six years I have had_no occasion save one to give aloes. That occasion is included in the list of cases at the end of this chapter, and I may say that, even then, I had serious cause to regret its administration. This section on posology is the one I would ask the reader to ponder over most. If Digitized by Microsoft® ~ SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 107° my description of the disorder is correct, there can be no doubt that the treatment is right in every detail. To further set at rest the mind of those who think the _doses of ammonium carbonate beyond all reasonable limit, I may state here that one animal, in addition to the usual doses of nux vomica and ol. tereb., received considerably over 1 pound of that drug—1 pound in 2-ounce doses spread over a period of thirty hours. I need hardly say it was an extreme case. It is the occurrence of cases like that which has proved to me the value of the treatment—cases that, under the old treat- ment of aloes and sedatives, invariably used to die. Only a few trials will convince any unbiassed mind of the splendidly beneficial action of a solely stimulative treatment.? Although very much more might be written on this subject, I feel that already this chapter is lengthy enough. My main object has been to pomt out what I believe to be the dangerous though common practice of administer- ing aloes or sedatives to the horse suffering from intestinal obstruction in its subacute form. One can always see more, feel more, and know more than one can write. It is not easy to gather up, classify, and tabulate all the facts, theories, and circumstances that lead one to a certain conclusion. It is still less easy to so arrange those facts as to carry conviction to the minds of others. If I have failed in that, I have failed in a good cause. lf I have been successful, I am conscious of having per- formed a good work for my brother veterinarian, for the stock-owner, and for our equine patients. 1 See also Part II. of Appendix. Digitized by Microsoft® 108 THE COMMON COLICS OF THE HORSE REPORT ON EIGHTEEN CONSECUTIVE CASES OF No. ‘ 8 S . . . Subject S 3 Conjunc- | Since how} = ae. Date. | (ime. and Age. & & Resp. tia. long Ill. Diets it |Oct. 10,| 7.30 | 5-years- | 70 | 101°6 14 Injected. a.m. | No green meat. 1898. | p.m | old cart same day.| A mixture of gelding. maize, boiled potatoes, and barley - meal ; soaked linseed e. | 2 |Oct.1r.| 8.45 | 13-years-] 88 | 103"4 36 Highly 11a.m. | Ground maize, p-m. | old brown injected. |same day.| new oats. and cart cut new oat gelding. straw; soaked linseed cake. Oct. 12.} 10 = = 2 as = om == a.m. 3 | Oct. 12.| 2.30 | 22-years-| 48 99°6 13 Highly 6 p.m. | New oats, cut p.m. | old black injected. | of rth. oat straw, old cart mare; and hay, kohl had been yellow. rabi; soaked used linseed cake. largely for breeding; barren. Oct. 13. | 10.30 _— 48 99°6 13 Do. _ = a.m. Oct. 14. 10.30 = 88 | 101 13 Do. - _ a.m. Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 109 SUBACUTE OBSTRUCTIVE INTESTINAL COLIC. sy — Water. je - supe. eee Medicine given. Symptoms, Remarks, etc. Rain. Nil. At 7.30 p.m. Dull pains at intervals. Lying quiet. Stand- Ammon. carb., 2} oz. ing quiet. Eating occasionally. Rectum Nucis vom. p., 1 02. empty and ballooned. I watched this case Sapo mollis, q.s. three-quarters of an hour before pain was M.; ft. bol. iv. evinced at all, and nearly left the farm declaring to the owner that I had been At 9.30 p.m. called out for nothing. I did not see the Ol. tereb., 2 oz. case again, and it afterwards did well. Spt. ammon, ar., 1 G2. Ol. lini, 1 pint. M. ; ft. haust. ; “Drain | Ol. lini, | Ammon. carb. p., 2 02. General dull pains, with excessive strain- (dyke). | 1 pint. Nucis vom. p., 1 0z. ing attempts at defacation at intervals, Sapo mollis, q.s. _ Symptoms somewhat masked, owing to M.; ft. bol. iv. pneumonia (congestive stage) set up by the inspired linseed-oil given by the owner. Impossible, or rather unwise, to drench. The rectum contained a few hard lumps covered with mucus, and the bowel was ballooned. . = me a Animal quite well in all respects. Drain Nil. Ammon. carb. p., 2 0z. Dull heavy pains the whole time. Never (dyke). Nucis vom. p., x 0z. violent. Impossible to drench owing to Sapo mollis, q.s. awkwardness. Rectum empty and bal- M.;; ft. bol. iv. looned. Other bowels, as far as could be Injected hypodermically : Eserine sulph., 2 grs. Treated exactly as on previous day, with ex- ception of eserine. Ene- mata given. Treated as on r2th, with the addition of a hypo- dermic dose of eserine, 3h grs. Mare much weaker, and evidently, owing Still no feeces had been passed, and still no felt, impacted. No peristalsis on auscul- tation. to old age, unable to stand against the attack. Rectum still empty and ballooned. No faces had yet been passed. evidence of peristalsis could be gained by auscultation. The temperature, however, was decidedly improved; and the pulse, having gained in strength and become more full to the touch, indicated that the mare would still stand active treatment. Accordingly, I repeated the previous treat- ment, and also ventured on another and larger dose of eserine sulphate, with the happiest results. The bowels answered to the stimulus, and the case afterwards did well. Digitized by Microsoft® THE COMMON COLICS OF THE HORSE (10 REPORT ON EIGHTEEN CONSECUTIVE CASES OF aay 7 No. Date. \Ti Subjeet 3 $ R Conjunc- |Since how Diet Poe ees me) and Age. & < esp. tiva. long [ll * 4 | Oct. 14.| 10.15] 6 years- | 68 | 10174 13 Injected. | 3.30 p.m. | Soaked split p.m. fold in-foal same day.| maize and new chestnut oats,with bran, cart mare. cut oat straw, old hay, and linseed cake. iP 5 4 Oct. 15.} 10.45] 7-years- 48 | 1014] A con-| Injected 7 p.m. Green clover, p.m. | old cart tinual and same day.| bran, wheat, gelding. sob of | yellow. sharps, and 32 per cut hay and minute. straw. Oct. 16./8 a.m. ~ _ _— _ _ ~~ - 6 | Oct. 17.] 10.45 | r4-years- | 52 Io 13 Injected | 7 p.m. | Wheat chaff, a.m, | old nag and of 16th. maize, and i gelding, yellow. bran. property ofa miller. 7 | Oct. 27.| 6.30 | 24-years- | 108 | 100 12 Injected | 3.30 p.m. | Maize, cut oat p.m. jold brown and | sameday.| straw, wheat cart yellow. chaff, soaked gelding. linseed cake. Oct. 28 | 7.30 = 50 | 100°2 12 Injected. = = a.m. 8 |Nov. 17.| 7.30 | 5-years- 70 10L 13 Injected | 6 am. | Out at pasture, p-m. | old roan and same day.| but receiving nag yellow. twice daily stallion. two feeds of maize, _ oats, and wheat chaff. Nov. 18.| 10 - 62 101 13 a oe mer p.m. Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON Ir SUBACUTE. OBSTRUCTIVE INTESTINAL COLIC—continued. hibeoea Medicine Medicine given. Syniptoms, Remarks, etc. Dirty | Ol. lini, | Ammon. carb. p., 2 02. Usual dull pains. Animal subject to these drain. 1 pint. Nucis vom. p., 1 02. attacks, and with difficulty rallied from one Sapo ae in August, 1896, when I treated her with ft. bol j iv. aloes and anodynes. I did not see the case again, but the owner afterwards informed me that the mare did well. Drain | Ol. lini. | Ammon. carb., 2 o2z. Pains violent. Animal almost ungovernable. (dyke). | Ol. tereb. | Nucis vom. p., 1 oz. Ears and extremities cold. Cold sweat small Sapo mellisy q:S. bedewing underneath surface of abdomen, quantity. ft. bol. iv. and between the forearms and thighs. Spt. ammon. ar. Rae 0% Expression anxious. Rectum empty, Ol. tereb. eu ballooned, and dry. Bladder empty. I Ol. lini, 10 oz. watched the case for an hour, during which M.; ft. haust. there was not one moment of ease. I left Hypodermically : Eserine her in pain. sulph., 2 grs. _ ~~ - Mare quite well. I learned from the owner that the animal gained ease at 3 a.m., and . first passed at 7 a.m. a large mass of yellow mucus weighing 3 pounds, together with a few hard knots of feeces, which were saved for my inspection. Soak or| Ol. lini, | Ammon. carb., 24 oz. Usual dull heavy pains. Rectum contained surface-| 1 pint. Nucis vom. p., 14 oz. a few hard mucus-covered lumps, and was well, : Sapo mollis, q.s- ballooned. Other intestines (colon) could 3 ft. bol, iv. be felt impacted. Bladder empty. Did Ol. tereb. not see the case again. Lid well. Spt. ammon. ar. f #2 3 02 Ol. lini, 12 oz. M.; ft. haust. Soak or Nil. As Case 4. Had been in violent pain, but on my arrival surface- was standing perfectly quiet. The counte- well. nance, however, looked anxious, and was, to say the least of it, alarmed at the state of his pulse. eee = Did not treat. All symptoms of pain absent. Drain | Ol. lini, | Ammon. carb. p., 2 oz. Usual dull pains. No evidence of peristal- (dyke). I pint. Nucis vom. p., 1 oz. sis on auscultation. There had been no Sapo mollis, q.s. evacuation of feces all day, but the rectum 3 ft. bol. iv. was full of a semi-fluid dark-green mass. Ol. tereb. aa This I removed, and gave enemata. Spt. ammon. ar. BOE: O]. lini, 12 oz. ; ft. haust. = _ Repeated the same treat- | Rectum again full, but there had been no ment, with the addition voluntary evacuation of its contents. ‘he of eserine sulphate, 2grs.| case subsequently did well, and there was _ no purging. Digitized by Microsoft® 112 THE COMMON COLICS OF THE HORSE REPORT ON EIGHTEEN CONSECUTIVE CASES OF Ne. Subject | 3 | § Conjunc-| Since how . 2 > onjunc- | Since ‘ ae Date. |Time. aH ay Age. & é Resp. Soa long 111. Diet. 9 |Nov. 23.| 10.30|Aged(15?)} 57 | 1014 12 Injected. | Found ill] Cut oat straw, a.m. | in-foal at5a.m.| wheat chaff, cart mare.| same day.| maize. Nov. 23.| 12.50 —- = cs = ras = - p-m Nov. 23.]7 p-m. _ 46 | 102 12 — — —_ io! |Nov. 30.| 7 5-years- 62 | 101 17 Normal. | 6a.m. | Bran, maize, p-m. | old chest- sameday.| linseed, cut nut cart c oat straw, and gelding. wheat chaff. Nov. 30] 10 =- = = = - = - p-m. Dec. 1. |7 a.m. = = = = — = = 11 | Dec. 5. | 9-20 | 5-years- 65 | ror 15 Injected. | 12 noon | Maize, bran, p-m.| old nag same day.| ground wheat. mare ; cut oat straw. barren. Dec. 6.| 12 = _ = a — - - noon, Dec. 7.| 12 _ _ _— _ —_ _— - noon. 1z | Dec. 22.) 11.30] 2-years- | 44 to| 104°4 28, Injected.| 3 p.m. | Cut oat sheaves, p-m.| old cart |74, ac- sobbing same day.| bran, maize, gelding. cord- mangels. ing to pain. ¥ On the night of November 30 I had also two other cases of a similar nature. Circumstances did not permit Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 113 SUBACUTE OBSTRUCTIVE INTESTINAL COLIC —continued. Water- supply. Previous Medicine: Medicine given. Symptoms, Remarks, ete. Dyke. Nil. Ammon. carb., 24 02. Nucis vom. p., 6 drs. Sapo mollis, 3 ft. bol. iv. Drench as for No. 8. Injected hypodermically : Eserine sulphate, 2 grs. Periods of dull pain. Slight tympany. ballooned. Violent at intervals Rectum empty and No change whatever. Mare quite easy. One hour after the injec- tion of the eserine and during the day there had been several evacuations of feeces of a normal consistence, accompanied by the discharge of much flatus. Dyke. Nil. Same as No. 8, with addi- tion of eserine sulph., 2 grs. Dull pains. Rectum ballooned and contain- ing a few hard mucus-covered lumps. Colon impacted. No signs of peristalsis on auscultation. Tympany very marked. This I tried to relieve with the trocar, but, failing twice, desisted at owner’s urgent request. The eserine had greatly increased peristalsis, but as yet there had been no passage of faeces. Horse quite easy. Slightly purging. Case did well. Surface- Nil. well. Ammon. carb., 2 oz. Nucis vom., 1 oz. Sapo mollis, q.s. M.; ft. bol. iv. Spt. ammon. ar. Ol. tereb. Ol. lini, 10 oz. M. ; ft. haust. I was in this case tempted by the owner to give a dose of aloes, 7 drs. jaa 202. Sharp pain at intervals. For the most part remaining dull. Eating at intervals. No tympany. Rectum full of a semi-fluid, half -digested material, resembling more, both in smell and appearance, the contents of a stomach. The mare continued dull all day. Purged towards evening. This purging I could not attribute to the aloes, as it was too soon after its administration. Mare still continued dull and listless, but picking a little. Dung of a normal con- sistence. She then purged again towards evening (this time, I think, from the aloes), and caused me no little anxiety for some few days, fearing superpyrgation as a con- sequence of the already irritated bowels. Dyke. Nil. As Case 11, but no aloes. One hour later, eserine sulph., 2 grs. Pains violent and almost incessant. Per- spiration in patches, but animal warm. Anxious, distressed look. Mouth dry, clammy, and hot. The horse got relief at 3-30 a.m. on 23rd. —t These were treated on identical lines with the foregoing, and did well. v! my reporting them in full. Digitized by Microsoft® ity THE COMMON COLICS OF THE HORSE REPORT ON EIGHTEEN CONSECUTIVE CASES OF No. 2 & ws 5 3 Subject x 5 Conjunc- \Since how = a Date. \Time. dnd dee. a & Resp. Soa. long Til. Diet. I an. 27,|3 p.m.| 22-years-| 54 98'4] 35, Injected. | 12 noon | 16 pounds of 3 ee PP old eae hurried, same day.| material per cart short, diem, consist- gelding. and ing of maize, gasping. » (3 parts), wheat (1 Part), oat straw and wheat chaff. 14 | Feb. 7. /5 p.m.| 13-years-| 52 99°2 20 Injected | 12 noon | 1 stone or more old in-foal ‘ and same day.| per diem of half-strain yellow. maize, bran, mare. and wheat sharps, with cut oat straw. One third of the mixture was wheat. Feb. 7. | 10.30 _ 48 | 100 13 - _- _ p.m. 15 | Feb. 8. /8 p.m.| q-years- | 40 | 100 16 Normal. | 6p.m. |? stone of old cart same day.| mixture of gelding. maize, oats, and ground wheat. Oat straw, hay chaff, and carrots. 16 |Feb. 13./7 p.m.| 4 years- | 50 | ror-4 20 Normal. | 3.30 p.m. | 1 stone or more old brown same day.| per diem of cart oats, with oat gelding. straw and cut hay. Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON m5 SUBACUTE OBSTRUCTIVE INTESTINAL COLIC—continued. Water- supply. Previous Medicine. Medicine given. Symptoms, Remarks, ete. Dyke. Ol. lini, I pint. As Case 1x. No eserine. In this case the bowels had been greatly emptied by repeated evacuations of small quantities of faeces before my arrival. Started work at 7.a.m. Continued well until 12.30. Received the mid-day meal, im- mediately after which she was ill Bathed in perspiration. Pains violent and inces- sant. No tympany of bowels. Rectum and colon, as far as could be felt, empty. Rectum flaccid. Continually looking round at stomach (not flank). Medicine return- ing through nose. Regurgitations in cesophagus. Pulse gradually got higher in number and weaker in tone, and one hour after my first arrival I diagnosed tympany of stomach, with possible rupture and death. Death occurred at 1 a.m. of 28th, and I much regret that circumstances did not allow of a post-mortem being made. There was no rupture of stomach. This case shows that too great a rcliance must not be placed on the indications of pulse, temperature, and respiration in the first stages of colic. Surface - well. Nil. As Case 11, but no aloes. At 6 p.m. injected eserine sulph., 1 gr. Pains dull when animal was down. Violent when up. With difficulty could keep mare on her legs. Much groaning and painful attempts at defecation. Rectum empty and ballooned, but mare had passed a few hard lumps of mucus-covered dung during the day. Slight tympany, but no sign of peristalsis on auscultation. Animal was at work from 7 to 11 a.m. Mare quite easy. Drank water greedily. Picking her bedding. Food withheld until morning. Had passed immense quautities of flatus and one large heap of faces. Surface- well. Nil. Ammon. carb., 2 oz, Nucis vom., 1 oz. Sapo mollis, q.s. e M. ; ft. bol. iv pt. ammon. ar. {.- Ol. tereb. baa 2 ee Ol. lini, 10 02. M. ; ft. haust. Animal had been at work in the morning. Dull! pains. Rectum ballooned and con- taining three or four fairly soft dung-balls. Other bowels could be felt impacted. Bladder empty. Case did well. Gin, ginger, opium, and linseed-oil. As Case 15. Dull pains. Groaning when lying. No peristalsis on auscultation. No tympany. Rectum full; flaccid when emptied. Case did well. ; Digitized by Microsoft® 116 THE COMMON COLICS OF THE HORSE REPORT ON EIGHTEEN CONSECUTIVE CASES OF © r= No. c 3 & 5 , . Subject 8 ® Conjunc- |Since hew, . eee Date. \Time| tig ‘Aiges 3 é Resp. aN long Ul. Diet. 17 |Mar. 26.) 3.30 | 5 years- 72 | 101'2 13 Injected. |10.30 a.m.| Maize, cut oat p-m. | old brown sameday.| straw, man- cart gels, and lin- gelding. seed cake, Mar. 26.| 9.30 _ 50 | 10r 13 = = = p.m. Mar. 27.| 10.30 _ 65 | 101'2 13 Normal. Pains = a.m. again com- menced at 5.3! am. Mar. 27.| 5.30 — 46 | tor 13 Normal. i - p-m. 18 | April 1.| 10.30] ro-years-| 72, | 103 17, Normal. | 3p.m | Wheat chaff, p.m. | old cart | inter- sobbing. same day.| cut oat straw, mare; | mit- oats, linseed barren. | tent. cake, man- gels. April 1.] 11.45 _ _ _— — as = - p-m. April 1.]8 a.m. _ 63 | 1012 15 Normal. - - April 1.) 12.45 - _— —_ 2s pan 2s, ae a.m. i Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 117 SUBACUTE OBSTRUCTIVE INTESTINAL COLIC—continued. Water- Prev‘ous Nucis vom., 1 oz. Sapo mollis, q.s. +3 ft. bol. iv. Spt. ammon. ar. | == OL. tereb. \ aa 23 02. Ol. lini, 1 pint. M.; ft. haust. Hypodermically: Eserine sulph., 2 grs. Injected bypodermically, morphia and _ atropine, to stay excessive action of bowels from eserine. Gave boli, as before. supply.| Medicine. Medicine given. Symptoms, Remarks, ete. Drain. Nil. As Case 15, Dull pains. No tympany. No peristalsis. _and eserine sulph., 2 grs. Rectum ballooned, and containing a few hard, mucus-covered lumps. — - Enemata and_ repeated | Slight peristalsis. Animal apparently easy, smaller doses of am-| but no action of bowels. monia and nux vomica. — — Ammon. carb., 2 oz. Rectum still empty and ballooned. Peris- Nucis vom., r oz. talsis quite absent. Usual dull pains. Sapo mollis, q.s. No tympany. Animal was quite easy all M.; ft. bol. iv. night, but pains commenced again at Ol. lini, x pint (haust). 5.30a.m. After giving the medicines and Hypodermically: Eserine | injecting the 2 grains of eserine, I left sulph., 2 gis. the case until 11.40. During my absence of a little under an hour the horse had evacuated several copious lots of semi-fluid feeces, preceded by one or two mucus- covered hard quantities. Seeing the eserine was still in operation, and that a sufficient action had been arrived at, I injected an ordinary dose of morphia and atropine. — _ No treatment. Animal standing up eating a bran mash and apparently comfortable. Case did well afterwards. Drain. Nil. Ammon. carb., 2 0z. Dull pains. No tympany. No peristalsis. Rectum ballooned, containing a few hard, mucus-covered lumps. Straining attempts at defecation when hand was introduced. Still in pain, but bowels acting freely. Animal in pain and peristalsis again in abey- ance, owing to the sedative. Did not this time give eserine, but relied solely on ammonia carbonate and nux vomica. Animal easy and picking a little food. Case afterwards did well. Digitized by Microsoft® 118 THE COMMON COLICS OF THE HORSE The stimulative treatment advised in the foregoing pages was first published in 1900. Since then it has been favourably mentioned by Mr. E. R. Harding, M.R.C.V.S., of Salisbury, who made it the subject of an address delivered before the members of the Southern Counties Veterinary Medical Society in 1901. The subject of Mr. Harding’s remarks was the ‘ Treatment of Intestinal Impaction.’ For his words I am indebted to the report contained in the Veterinavy Record} They are as follows : ‘My reason for choosing this subject was, not that I have anything original to offer you, but rather the reverse. It is to give you my experience of the treat- ment advocated in a very able article by Mr. H. Caulton Reeks, F.R.C.V.S., of Spalding, Lincolnshire, which appeared in the Journal of Comparative Pathology and Therapeutics for March, 1900. ‘The disease is a common one to practitioners in agricultural districts, owing mainly to the domestic mis- management of the farmer’s horses. The system which prevails in the district in which I practise seems to be pretty general. The horses have their first meal about five o’clock in the morning. It consists of a small portion of corn, generally soaked maize; in some cases half maize and oats. With this is mixed a large quantity of wheat or oat hulls or cut straw chaff. After they have been feeding on this for an hour and a half, they are turned out to drink, then harnessed, and start for work at seven. They are kept at it, with but very few excep- tions, without more food or water, until between three and four in the afternoon. They certainly have a rest about noon, when the men get their lunch, but they have to stand in their harness, mayhap, in the hot sun or cold 1 Veterinary Record, vol, xiv., p. 108, Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 1g wind and rain. When they return to the stable they have a similar large feed to the morning one—if anything, a little more—without any water until after they have finished. They are then turned out to the trough, and we can imagine the quantity they drink after eating such a large meal and working all day. In a few cases nose- bags are provided for them at noon, and on those farms “ colic” cases are not so frequent. ‘ The exciting causes, then, may be said to be the long intervals between feeding and the large amount of in- digestible food given them at each meal. ‘The symptoms of a subacute case are those which do not give rise to any alarm on the part of the owner or attendants. The animal looks dull, refuses food, lies down in the natural position, and remains quiet for some little time, with the exception, perhaps, of looking round tohis flanks. He will then get up and pick a few mouth- fuls of straw. After standing for some little time, pawing occasionally, he will gradually make up his mind to lie down again. There may be little or no tympany, the pulse, temperature, and respirations practically normal ; examination fey rectum will reveal that bowel to be almost empty, while other portions of the intestines will be found to be full of a mass of dough-like feces. There will be an entire absence of abdominal sounds. If relief be not afforded, the symptoms will soon become more alarming. The animal will be up and down constantly, and, when down, rolling; in fact, not still a moment. The tympany becomes much greater, and he breaks out in patches of sweat; pulse and respirations accelerated. Oftentimes we are too late to watch the subacute symptoms, but on our arrival the patient is in a desperate condition, perspiration literally pouring from him, great tympany, pulse nearly 100, respirations much accelerated, Digitized by Microsoft® 120 THE COMMON COLICS OF THE HORSE nostrils dilated, an anxious expression—in fact, apparently dying. ‘I should like here to quote a paragraph from Mr. Reeks’ article. Hesays: ‘I cannot lay too great a stress on the value of taking the indications of the pulse, temperature, and respirations collectively, in order to avoid error in prognosis. I never look upon a case as approaching dangerous unless I get a full warning from all three.” Then he refers to a case in which the animal had been rolling in violent pain before his arrival, but was then standing perfectly quiet with a pulse hammering away at 108. But the temperature was only 101, and respira- tions 12. The animal recovered, ‘Treatment.—In my younger days this consisted of aloes and opium or belladonna, with warm water enemas. This was successful to a certain degree, but there was frequently two days’ purging. About twelve or fourteen years ago eserine was introduced, and I have used it ever since, and, with Mr. Reeks, I have nothing to say of it which is not in its favour. But itis his nervous stimulant treatment to which I wish to draw your attention. I must quote from him again. He says: ‘‘ The bowels, distended beyond a certain point, are retained in a state of tonic cramp in their ineffectual attempts to deal with the enormous masses they contain, and then we havea torpid and stationary condition of the bowels to treat.” ‘The treatment he advocates is a large dose of a cerebro- spinal stimulant, and he chooses carbonate of ammonia and nux vomica, I must admit to being astonished at his dose, viz., 2 ounces ammon. carb. and 1 ounce nux vom., made into four balls and given at once—that is, to a big agricultural horse, with well-marked symptoms. This is followed by a draught consisting of 2 ounces of spts. 1 The italics are mine.—H. C, R. Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 121 tereb. and spts. ammon. arom. and a pint of ol. lini. He repeats the ammon. carb., substituting pulv. zingib. for nux vomica in three to four, five, or six hours, if the animal is still in pain, and in the meantime gives frequent hot-water enemas. Should the case tend to become protracted, and the pulse is strong and not too frequent, he injects hypodermically eserine sulph. I grain, and if on the next visit the bowels have not acted, he gives eserine sulph. 2 grains, still continuing the ammon. carb. ‘I have adopted this treatment with a little modification with great success! The patients recover much more quickly, and without the nausea and purging occasioned by aloes. I at once inject hypodermically 2 grains of eserine, and give the dose of ammonia and nux vomica in three balls, and leave the draught to be given in two hours. In many cases this has effected a cure, but if there is no improvement in six or eight hours I repeat the ammonia and sometimes the eserine. Uf the horse is very tym- panitic, I puncture the bowel with the trocar and cannula before injecting the eserine. In several cases in which the first dose of eserine did not give the required result I have repeated the 2 grains in two hours with excel- lent results. I never give aloes nov opium now} . Since I have adopted this treatment the horses get better much more quickly. It used to be two or three days, but now I seldom have a case last more than thirty-six hours.’ The reading of Mr. Harding’s paper led me to write asking him to favour me with a short report of some of his cases. He was kind enough to forward the following history of three selected cases of obstruction : 3 The italics are mine.—H. C, R. Digitized by Microsoft® THE COMMON COLICS OF THE HORSE 122 codAy pardafur ‘ud “si3 c ‘ ydins auliesa _ —/—};-|}—-}]-|] - € Ys] T 1sye 8 49119q 103 uoos ays 1eY? Pfo3 SEAL “UIYI a1INb sodka paissfat we ynq ‘ured 91931] & UT [TVs OE" 9e Jay Ya] [ “4193L| ogad z ing Bere 5 s! yos aimnb 3nq ‘prey say ye ‘saowy Jo UOTFENILAD ae Hosa Caley snotdos paonpoid stqy, ‘autiasa yo asop puosas ‘eens [=| = aaed os ‘Suruinjor sayuedwAy pue ‘yay10q 7o"0 FSW pur ‘sjny |S Bl “saeak ou SEM ays HI0[9,0 seq) YY “A[UO sMILY jo *b *}fou odes qeoym Bs f 9 UWOIENIEAS paonpul aulsasy “[[NJ sjamoq 1930 ‘ZO % “UIOA SIONN ‘azieur ag 9 ‘gaeur jurd | -Zr £Aydwea wmider { AuedwAy apy {sured [up pensq, | “20 @ “ques ‘uommy | [2A | paxZog |” 7) €r | oor | #S Jareg | 4 froaq}] € *Pooy JO} JNOYe Zuryoo] sen ays pue = ‘auo3 AuedurA3 |e pue Asea aiinb sem aietu aq “METS oO] SINOY OM} UT “s[BAIa3UL WOYS Je passed sem pue syny | 5 | & snjep yonur pus ‘sutzasa ay} Aq pasevesout yonur yeaym | & 8 saead Moos sem sIsjeueag ‘yeas Ava AuedwAT, *Aypeoturap £780 mB: a1 *Zumolq pur Suivams — uoyrpuos Surwirye -odfy payoafur ‘sid pue azieu] 2 | * ‘areur |rurd | °6 ue ur Arewsyur Aur 03 3yZnorq sem aivur siggy, | 2% ‘ayeydins surrasy 112A] pexeog | = of |P.zor| og | yea | 2 foaq] z sulede asioy ayy ‘ysneyq 4} SW aas JOU PIP] ‘ewoY 393 0} pazuEM | pur ‘aje] -yuid 1 pe enby ‘urd BZurjjaZ sem YW yNq { sutJasa jo y[Mset [ensn 3aqz *pAy [er0[yD, _ —/—};—{|—-—;]-]}] — 6 Sti qZnoynye ‘stq3 anpqns 07 UaAIs sem [e10[YO an ayy, ‘paving uonesndser {sayojed ur sur "1 z ‘gutiasa jo “mers |, >} a -qeams {aynoe aiour ured aq? ‘ pajendeas useq asop o1msapoddy os[y qeaym nd 5 = = prey seowy jo AqQuenb aZ1e] & yD0]9,0 suru Ag Ssuvaq pue|e@ S| < “sea “S|BAIOWUT JOYS Je passed usaq pey seowy prey ut Toq "J SW ‘Kapreq [a5] 5 6 jo sanmuenb yemg “Aqdura uinjooy —“sIs|ey *s'b ‘jour odes ‘sead ‘syeok 9 a ‘Sut -stiad jo s.uaptas oN, = *AuedurA} yonur you 3nq ‘ZO $ “UIOA STONNT ‘azreu |" FB] oF -plas jrurd | -oz ‘Ny UsWOpqyY ‘UMOp Zuld] Ayysour ‘sured [NG Zot “qres ‘uomWY |"[[2A4 | 2 PAXtIy O& | $1 | ror | op} weg] g jaonl 1 a| Hs 2 | a gs sel] S fag] y ALP al sto ‘SYyLDUlIY [vLIuIL UIT aUIIIpILY Sa pid JAR) S| PTs] sz So] a R =e asf RP Riss] elas] Pe |] sys sy Rg Se y a s sue | oe f 2 ' ape “NOILONULSAO TVNILSALNI ALNOVANS AO SHSVD AAUYHL NO LYOdaY SONIGUVH “A “A “UN d by Microsoft® igitize CHAPTER X SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE OF THE DOUBLE COLON Definition.—So long as the full wording of this chapter ' heading is adhered to, no definition will be needed. It sufficiently explains itself. On reference to p. 81 it will be seen that the preceding chapter is ‘given over to all obstructions of a subacute type that occur in any position in the large or double colon.’ No attempt is made there to indicate any special seat of trouble, or to single out any particular portion of the colon’s course as calling for more than ordinary mention. At the time when that was written—namely, in 1902—I did not feel that I had anything sufficiently clear in the shape of a differential diagnosis to offer. Nevertheless, it will be noticed that, even then, I indicated, if only vaguely, that such might be furnished by fuller investigation. Since that time, a record of several cases, together with the evidence gathered during post-mortems of twist of the double colon, has shown me that often we have a form of obstruction mainly, if not entirely, confined to the pelvic flexure of that bowel. It has shown me, too, that quite often the condition may be diagnosed, and the 123 Digitized by Microsoft® 124 THE COMMON COLICS OF THE HORSE exact nature of the case explained to the owner. If only for this last reason, seeing the added reputation it gives to the veterinarian, it merits recording. Fic. 8.—TuHe NorMaL COLON EXPOSED, AND ITs PELVIC FLEXURE DRAWN OUT FROM THE ABDOMEN. 1, 2, 3, and 4, The first, second, third, and fourth portions, respectively, of the bowel ; 5, the pelvic flexure. Causes.—Putting on one side the causes of colic generally, merely referring the reader to Chapters IV. and V., we shall still find one or two reasons why obstruction should be specially prone to occur at the Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE 125 point with which we are dealing. We shall find these in the anatomical arrangement and distribution of this portion of the colon. The first point of importance is the fact that in this position there is a somewhat marked constriction in the lumen of the gut. Considering the two portions of the colon forming the flexure—namely, the second and the third—we see at once that while the second portion, from the suprasternal flexure backwards, is of considerable size, the third is comparatively small. Further, we notice that the diminution in lumen is not gradual, but that it occurs with some degree of suddenness, thus occasioning the constriction referred to. A glance at Fig. 8 will explain. It needs no great amount of demonstration to point out that the circumference of the bowel taken around the second portion at a point indicated by the dotted line a i, is distinctly larger than when taken around the pelvic flexure ated. This, asa matter of fact, is more evident with the actual bowel before one than with merely the photograph to refer to. It is distinctly more marked, too, in an animal that has been taking a normal amount of food. In the case from which this illustration was taken the animal had died from a wasting disease, and the bowels were comparatively empty. In so much as that to some extent it exaggerates this difference in size between the second and the third portions of the colon, Fig. 9 will more clearly illustrate it. This is a photograph of one of the several cases of twist of the pelvic flexure that have come under my ‘notice. Here, owing to the displacement of the bowel, the ingesta is prevented from passing out of the second portion of the bowel into the third. The second portion is therefore shown distended to the full with accumulated Digitized by Microsoft® 126 THE COMMON COLICS OF THE HORSE ingesta, while the third is nearly empty. In this manner the abrupt transition from the bulky and voluminous form of the second portion to the small and comparatively shrunken build of the third portion is accentuated. In Fic. 9.—VoLvuLus oR Twist OF THE PELVIC FLEXURE OF THE LarGE COLON, ILLUSTRATING THE DIFFERENCE IN SIZE BETWEEN THE SECOND AND THIRD PoRTIONS OF THE BowEL. 1, 2,and 3, The first, second, and third portions, respectively, of the bowel. Note.—The fourth portion is hidden from sight. such a case as this it might be that either the accumu- lated faecal matter in the end of the second portion, by reason of cramp-like efforts on the part of the bowel to pass it along, was responsible for the twist, or that the Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE 127 twist itself was accountable for the engorgement of the distended second portion of the bowel. Of that I may have more to say at some future date. It is sufficient now if it serves to point out the difference in size of these two sections of the colon, and the special liability of this portion of the intestinal tract to trouble accruing from obstruction. In order to make this point quite clear, I insert here a further photograph of the same case of twist (see Fig. 10). Fic. 10.—VoLvuLus OF THE PELVIC FLEXURE OF THE COLON— THE COLON PULLED OUT FROM THE ABDOMEN AND EXTENDED, 1, The pelvic flexure of the bowel ; 2, the second portion; and 3, the third portion of the bowel. Here we have the suprasternal and diaphragmatic flexures obliterated by removing the colon from the body and drawing it out to its full length. The marked difference in size of the two portions of the bowel we are considering is then made quite apparent. Portion number three, nearly empty, lying beneath the over- Digitized by Microsoft® 123 THE COMMON COLICS OF THE HORSE charged portion number two, looks small almost to the point of being shrunken. A further anatomical fact of importance to be noted in this connection is that a portion of bowel with such an abrupt turn in it as this pelvic flexure should have so free a distribution in the abdomen. We have here a bowel several feet in length, of voluminous build, and designed to carry enormous weights of ingesta, with a heavy and unattached end. Devoid of mesenteric or other stay to hold it in position, this heavy end is free to move at will in the abdomen. This must, one would think, lead at times to troubles which could easily be re- ferred to slight displacement. One could easily imagine, for instance, that displacement, similar to that depicted in Fig. 10, though less in degree, would be able to occur to the point of engendering a troublesome case of obstruc- tion, without leading to actual twist, or causing the animal’s death, At any rate, it is astonishing how often in cases of obstructive colic one is able to feel per rectum this particular portion of the intestinal tract quite plainly in a state of dangerous engorgement. Again, though to some extent it may be labouring the point, I think another reason for tendency to obstruction at this particular spot may be found in a physiological explanation. Comparable to the sluggishness of the circulation in the distal end of a limb, we may take it that the force of the blood-supply at the pelvic flexure is not so great as elsewhere in the bowel. It is, of course, at the extreme end of both the direct and retrograde colic arteries; and if stasis of the bowel wall is ever due to imperfect circulation, which in other portions of this work we have admitted it is, then one would quite expect to find the pelvic flexure one of the seats of trouble when such cause is in operation. Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE 129 As a matter of fact, cases that occur in practice bear out this latter contention, More often than not the subject of subacute obstruction of the pelvic flexure is an aged animal. Several other causes, it is true, have at the same time to be reckoned with. Imperfectly masti- cated food, growing diminution in the proper secretion of gastric and intestinal fluids, and the gradual lessening in nerve force consequent on senility, all play a part in determining an attack of obstruction in a bowel so voluminous in extent and so peculiar in build as the double colon of the horse. Add to these facts the further reasons that I have here endeavoured to explain, and it will be seen that obstruction of the pelvic flexure is quite often a thing to be looked for. In conclusion, I may add that I have not yet met with a case of this description in a nag animal. It appears mainly to occur in animals of a heavy and lymphatic type, owing partly, perhaps, to the larger size of the colon, but more certainly to the grosser manner in which some of these animals are fed. Symptoms.—Again the general symptoms of subacute obstruction of the colon, as detailed in Chapter IX., are to be expected. To those I have nothing to add. There are, however, one or two points concerning ‘them that in this particular connection require to be dwelt on. Quite a prominent feature in a case of pelvic obstruc- tion is the ‘dull’ character of the pains, which dulness has for so long been associated with impaction of the colon. Although at times there is evidence of restless- ness, a troubled walk round the box, anxious looks round at the flank, and patchy perspirations, the animal is able to remain for the greater part of the time in a comfort- able stretched-out position on the floor. In this manner rest is often taken for long periods at a time. Save for 9 Digitized by Microsoft® 130 THE COMMON COLICS OF THE HORSE the fact that occasionally the head is lifted, while the animal stares with what might best be termed a ‘puzzled’ expression into his flank, the ordinary looker- on would see nothing very untoward. The pulse, taken at these times, is always reassuring to the veterinary attendant. In so far as the number of its beats is concerned, it is little, if any, disturbed from the normal. It is firm and full to the fingers, and in no way at all offers suggestion of anything grave. Called in at such a moment as this, the veterinary surgeon, unless he methodically makes a rectal examina- tion in every case of colic he attends, may dismiss the case rather lightly. He will simply administer the usual dose of aperient medicine and such other remedies as he deems the case necessitates, probably concluding by suggesting to the owner that a further visit will be unnecessary—that a few hours hence will see the end of the trouble. In such a case as I am describing, however, he will most certainly be called in again. This time he may be fortunate enough to find his patient in one of the periods of unrest. The pulse is then plainly disturbed. Flutter- ing and irregular, and accelerated in number of beats, it is plainly indicating that some more serious condition than at first the surgeon suspected is in existence. Patchy perspirations bedew the body, and the respirations become quickened in number. At this point the veterinary surgeon may be informed that since his last visit the patient has passed several different lots of feces. In no great quantity at one time, he is told, but in quite little lots. Led to it by further questioning, the owner also informs him that even prior to the time of his first visit this has been going on. The veterinary surgeon is thus brought up against the fact Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE 131 that, if only in separately small quantities, some con- siderable amount of faeces, when taken in the bulk, has been expelled, and this, too, during such time as the animal has plainly been suffering from obstruction. If he has not already done so, he is led at this stage to explore the rectum. He finds it empty, open, and ballooned. He finds further that, within easy reach of his arm, his hand comes into contact with a portion of impacted intestine of considerable size, which leads him at once to a correct understanding of his case. Diagnosis.—This is arrived at by further manipula- tion of the impacted bowel. The surgeon finds that, although larger in size, and probably not so angular, it is comparable in shape to the flexed knee of a man pushed there towards him. What he is feeling is the impacted pelvic flexure. That at its point of constriction (see where the number 5 is placed on Fig. 8) represents the knee; and the surgeon, passing from one side to the other of this central point, makes out with the flat of his hand the rounded and engorged portions of the bowel, which, to heighten the rough simile he has already framed, he may compare to the calf and the thigh of the flexed imaginary limb. In other cases, according to the position the impacted bowel has taken up, it suggests to the exploring hand the further simile of a partly developed foetus. This is the more noticeable when, by reason of its increased size or other cause, the whole thing has taken up a more central position than is normal. As to the nature of the contents, these are quite hard, and can only with difficulty be indented with the fingers pressing on them. Inasmuch as that in the following chapter I shall déal with a further form of obstruction which may also be g—2 Digitized by Microsoft® 132 THE COMMON COLICS OF THE HORSE felt pey vectum—namely, obstruction of the single colon— it is necessary at this point to show means of differentia- tion. A reference to that chapter will show that in the condition there described we have a set of general symptoms far more alarming. There is continuous pain, an always troubled state of the pulse, a tendency to stand in a stretched-out position, with ejected penis and quiver- ing tail, and a gradual increase in the severity of the pains unless the condition is soon relieved. Also we have violent straining attempts at defecation and a clinging grasp of the rectum on the inserted arm, together with a violently expulsive action of the bowel, called forth at once by anything inserted therein. Without committing myself to the statement that none of these symptoms are ever witnessed in a case of obstruction of the pelvic flexure, I can unhesitatingly declare that they are never marked. I can further assure the reader that in no instance will more than one or two of these more serious signs be seen at one and the same time. So far as he is yet able to sum up his case, the veterinarian is now confident that he has before him a case of obstruction implicating to a grave extent the pelvic flexure of the colon, and he is able to read at its full value a symptom that until now may have been somewhat puzzling. I refer to the constant evacuation of small quantities of faeces. It appears now that the single colon, and also the third and fourth portions of the double colon, have, in irritable manner, been discharging their contents. It appears, further, that nothing now remains to hinder the normal evacuation of the contents of the rest of the intestinal tract save the obstruction at the pelvic flexure. One other point has yet to be decided before his Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE 133 diagnosis is complete. Is there or is there not displace- ment of the bowel to the extent of actual twist? Although for some years I have been looking for it, I cannot yet say definitely that I have been able to detect any pecu- liarity, either in the shape or in the distribution of the bowel that I can put down as diagnostic. So far, how- ever, as my knowledge of these cases at present goes, I am of the opinion that in nearly every instance where this knee-shaped and ingesta-packed piece of bowel is present in the pelvis it may be taken as certain that twist has not occurred. Prognosis.—In face of the opinion I have offered, that once this condition is diagnosed volvulus is unlikely to be in existence, I still advise that only a guarded prognosis should be given. It may be that-further inves- tigation still will reveal the fact that such a condition as this may occur concomitantly with twist. This advice, however, applies only to that occasion on which during his visits the surgeon is first aware of the exact nature of his case. He should then explain to the owner exactly what he is dealing with, tell him that relief will certainly not be obtained for several hours, and, finally, if only to protect himself against contingencies, suggest the possibility of twist. After this, should his next visits find the pulse still near the normal, and his patient still exhibiting long periods of freedom from acute pain, he may, notwith- standing the fact that somewhat alarming paroxysms occur at intervals, indulge in a more favourable forecast. Such paroxysms as then occur may be taken as evidence 1 J have found that a very convenient method of doing this is to lay out on the floor an ordinary roller-towel, doubled in such a way as to represent nearly the course of the double colon in the abdomen, —H. C.R. Digitized by Microsoft® 134 THE COMMON COLICS OF THE HORSE that the bowel is attempting to deal with the adverse circumstances under which it is placed. In other words, it is but a sign that the administered purgative is acting, and that the obstruction is being moved. Treatment.—In no particular does this offer any special difficulty. It is quite evident, even from the commencement of the case, that what we have to treat is a torpid condition of the bowel wall. After what I have written in the previous chapter, therefore, I need hardly say that, whatever else we do, we should carefully abstain from the use of sedatives. They can but render worse what is already a sufficiently bad case. Instead, I again advise the exhibition of stimulants, and, in such a case as this, we are wise if we suggest their administration at very frequent intervals. The balls of ammonium carbonate and nux vomica may, therefore, be given as before, and followed up at intervals of a few hours with other balls of ammonium carbonate, combined this time with zingib. rad pulv. instead of the nux vomica. Quite early in the case a reliable purgative should be administered. This may be either full doses of linseed oil, or an aloetic ball of medium strength. Regarding the latter, I have found that 6 drams is a suitable dose for a large cart animal, while to a nag I make a practice of giving somewhat less. All we have to bear in mind in this connection is that the dose shall be such as to allow of a vigorous stimulant treatment being afterwards maintained without risk of superpurgation. While busy with the treatment, it is well for the practitioner to mention to the owner the fact that in this particular form of colic speedy relief need not be looked for. Quite confidently he may predict that some eighteen to twenty-four hours must elapse after administration of the purgative before cessation of the pains may be expected. Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE 135 Should the case linger longer than this, which in an aged animal it is very apt to do, I have found the patient to derive great benefit indeed from hypodermic doses of ether, given in sufficiently large doses to maintain the flagging energies of the heart. It is astonishing how soon the drug, administered in this way, exerts its effects. The irregular circulation is almost immediately equalized; the pulse becomes somewhat slower, but stronger and fuller; and at the same time action of the bowels is certainly promoted. In fact, the best way in which one can sum up its effects is to use the comprehensive expression that it ‘gives tone’ to the system generally. Next, as to the administration of eserine. So far as my own experience goes, I may say at once that in obstruction of the pelvic flexure I have found it unwise to exhibit this drug in the early stages of the case. Had that not been so, I should have mentioned it before. We have here an obstruction within easy reach of the hand, the changes in the consistency of which can be noted hourly; and it seems a far more desirable thing, to my mind, to wait until the administered medicines have effected some degree of softening therein before we push the bowel to extreme efforts to dislodge it. Given earlier, it is productive of acute pain, and with no bene- ficial result, so far as one can see, to the patient. Directly, however, one is able to detect some tendency on the part of the obstruction towards softening down, then the eserine may be administered with the happiest results. One further point in the treatment and I have done. It is important, however. On no account should the constant throwing into the rectum of warm enemata be neglected. I had almost said they should be ‘hot.’ At any rate, they should be as near that as prudence directs. Digitized by Microsoft® 136 THE COMMON COLICS OF THE HORSE The rectum is ballooned, and fluid thrown in is retained some little while. Although not in actual contact with the obstruction itself, such fluid occupies as nearly that position as one could wish, only the thin walls of the rectum and the colon lying between it and the offending substance. I am unaware of any proved process by which such fluid may percolate through or become absorbed. It certainly appears, however, that some such process is in operation, or that the continual application of warmth by this means to the wall of the colon excites it to increased secretion. At any rate, the obstruction is slowly but plainly softened.2 To do good, these enemata must be frequent. Hourly injections are not at alltoo frequent. Far from irritating the patient, as one might perhaps expect, they appear to exert a soothing influence, and play a safe and effectual part in bringing about resolution. 1 See here also Chapter XIII., on ‘Intestinal Irrigation in Obstructions of the Colon,’ and refer to the case on page 169. Digitized by Microsoft® CHAPTER XI SUBACUTE OBSTRUCTION OF THE SINGLE COLON Definition.—Obstruction or stoppage of a subacute type occurring in the single or floating colon, or in the rectum. For my purpose in this chapter I have considered the rectum as, what it really is. the last portion of the small colon, and shall therefore refer to rectal impaction under this heading. Causes.— Without referring the reader to any general cause other than those already mentioned in Chapters IV., V., and IX., I would ask him to remember one or two peculiar to this disorder only. Anatomically the build, and physiologically the function, of the floating colon offer two fairly powerful predisposing incentives to obstruction, and that of a rather dangerous type. Firstly, the sacculated nature of this viscus is such that it compresses the faecal matters into rounded or oval-shaped masses, peculiarly fitted to form obstructive lumps when other causes favouring impaction concur. Secondly, the function of this intestine is largely to complete the absorption of the fluid matters of the ali- ment, and we may easily understand, when this absorp- tion of fluid is carried on to an abnormal extent (as, to offer a simple instance, in a case of acute and prolonged Digitized by Microsoft® 138 THE COMMON COLICS OF THE HORSE febrile disturbance), how that the accumulated lumps of feecal matter become so hardened by the withdrawal of moisture as to seriously prejudice their chance of effectual displacement by normal intestinal movements. Also, regarding this portion of the intestinal tract, some little attention should be paid to the consideration of nervous trouble as a primary cause. I do not wish the reader to imagine anything obscure in its nature or of comparatively rare occurrence. It is something quite simple to understand, and of more or less every-day happening. Everyone is aware of the fact that a nerve is paralyzed—its function temporarily inhibited—by being in contact with an overworked or tired muscle, a muscle that is impregnated with effete materials that its long continuing work has left it too fatigued to rid itself of. It may be, perhaps out of sympathy, perhaps by a process of absorption whereby it takes up a certain amount of the poisonous muscle waste, that nerves or nerve-centres in close apposition with such overworked muscles become paralyzed, and fail temporarily to per- form their proper function. . In this manner the posterior mesenteric plexus (formed in great part by the lumbar portion of the great sym- pathetic system, and furnishing branches for the supply of the small colon and the rectum) may often be so induced to a state of dangerous lethargy. The lumbar portion of the sympathetic, lying as it does in close con- tact with the psoz muscles, and being largely covered by the posterior vena cava, would be almost the first nerve- centre supplying the intestinal tract to feel the ill effects of the waste materials from the muscles of the hind limbs and the loins. At any rate, whatever the explana- tion may be, it is certain that prolonged and excessive work, especially that of a heavy hauling nature, telling Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE SINGLE COLON 139 principally on the muscles of the lumbar region, has a peculiar depressive action on the urinary apparatus and the last portions of the bowels—a depressive action that effectually tends to a torpid and stationary condition of the bowel contents. We are not to be greatly surprised, then, that the effects of a long day’s heavy carting are likely, from a constipating point, to settle themselves in the small colon or rectum. Apart from this temporary derangement of the nervous system, the practitioner will occasionally—very occasion- ally—meet with cases of total paralysis of the rectal walls, which, until noticed and correctly treated, will again lead to subacute obstruction. Symptoms.—All the usual symptoms of colic will be found in evidence here. There is the usual getting up and down, the anxious looks round to the flank, the patchy perspirations, and the common changes in the temperature and respirations. The pulse, almost from the very commencement of the case, is weak, or, rather, undecided, in character, at one moment filling the artery to a comfortable firmness, at another dwindling down to an indistinctness nearing the imperceptible. This may all occur within a few seconds and during one observa- tion, and its number of beats will vary from 70 to 80 or go per minute. Compared with the other two forms of obstructive colic, there is not that period of total ease so frequently occurring between the paroxysms of pain. In obstruc- tion of the double colon, for instance, we commonly have periods of ease in which the pulse drops to a normal condition, both regarding its tone and number of beats. in obstructions of the single colon that seldom or -Digitized by Microsoft® 140 THE COMMON COLICS OF THE HORSE never occurs. What does happen, however, is so mis- leading to the casual observer and of such importance to the careful inquirer as to merit special attention. The patient, certainly for some few minutes, will stand, to outward appearances, quiet. If the judgment is hurried, this will be confused with the usual period of ease in ordinary colic. The case will be dismissed as ‘ nothing dangerous.’ The pulse tells a different tale. It is still maintaining a troubled, fluttering beat of 70 to 80, and is evidence enough of serious conditions within. The con- junctiva is reddened, though not to such a degree as the continuous pains would at first appear to point to, while the perspirations mentioned above do not incline to become cold or clammy. If not relieved, towards the end of the first twelve hours the animal shows more or less tendency to stand in a stretched-out condition, as though attempting to urinate. The marked frequency with which this stretch- ing occurs in this form of colic is a warrant sufficient for pointing it out as a special symptom. Later, the periods of apparent ease become fewer and farther between, and the animal is in more or less constant pain. Another symptom, frequent to a point approaching the diagnostic, is violent straining, which is persisted in with such force as to move the onlookers to fear for the patient’s safety.» During the straining the patient emits a series of painful groans, and the mucous lining of the rectum is often everted to the extent of several inches. If a mare, and especially if she be with foal, the vulva is in like manner everted, and the pains sometimes of such a severity as to suggest the act of foaling. The hand inserted in the rectum is met by a violent expulsive action of the bowel, accompanied by straining Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE SINGLE COLON 141 efforts on the part of the patient, while the bowel itself exerts a peculiar glove-like clasp upon the arm. The pelvis is found to contain portions of bowel beyond its normal contents: if small intestines, empty ; if single colon, more or less impacted with ingesta. Sometimes it fortunately happens that the very portion of bowel giving rise to the trouble is well within reach of the operator’s arm. If so, no further doubt as to the exact nature of the case he is treating need remainin his mind. In different cases the obstructed bowel varies in shape and size from a small portion resembling a large cocoa- nut to an impacted length of from 6 to 12 inches. That this impacted portion is the actual cause of trouble is fairly evidenced by the symptoms induced by its manipu- lation. Pressure on it, even if of a careful and tentative nature, will cause the patient to evince unmistakable signs of pain. Swerving from side to side, he endeavours to escape the inserted arm; and, persisted in, the manipulative movements will bring him with successive crouching gestures to the ground. In most cases, contrary to what one would imagine, tympany is absent ; and it is only towards the end of the attack, when the case is approaching a fatal termination, that it occurs to any appreciable extent. Enemas intro. duced with a nozzle of ordinary length are not retained, but forcibly ejected almost immediately after their in- jection. Should the case be one of rectal impaction, its nature will at once be apparent directly the hand is introduced -into the rectum; and, so far as the purposes of this chapter are concerned, a consideration of its other symptoms is unnecessary. Provided the animal is healthily strong prior to the attack, and his end is not hastened by the exhibition of sedatives or violent purga- Digitized by Microsoft® 142 THE COMMON COLICS OF THE HORSE tives, the case is of a somewhat lengthy nature, and may not near its conclusion until the third or fourth day. Diagnosis.—In some cases this is remarkably simple ; in others just as difficult. After all is said and done, there can be but one absolutely diagnostic symptom, and that is the detecting, by manipulative measures in the rectum, of the offending portion of bowel. It will be seen, however, that I have carefully refrained from giving symptoms which might be truthfully de- scribed as general, from which I wish the reader to infer that such few as I have related I wish to be regarded as reasonably diagnostic. That being so, I will conclude this paragraph by simply summing them up again in brief. The continuousness of the pain, as evidenced by the state of the pulse, without definite concomitant symptoms pointing to.a more grave condition, as, for example, enteritis, twist, or rupture; the tendency to stand in a stretched-out posture, with ejected penis and quivering tail; the gradual increase in the severity of the pains if not soon relieved; the violent straining attempts at de- feecation, and the clinging, clutch-like grasp of the rectum on the operator’s arm ; the violently expulsive action of the rectum on anything introduced fey anum, and the presence in the pelvis of distended or flaccid coils of in- testine—all these are symptoms requiring careful con- sideration when summing up for a diagnosis. Without rashly venturing the opinion that these mani- festations may be relied upon to furnish a correct verdict in every case, I am, nevertheless, fully decided that many of these attacks will thus be absolutely differentiated from other forms of colic, and a corresponding improve- ment in the treatment be the happy result. Incourse of time this should lead to the report of further cases by Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE SINGLE.COLON 143 other veterinarians, and an increase of information on this particular subject should be engendered by the working upon it of more than one set of brains. Prognosis.—In a former chapter of this book I have definitely stated that any case of colic is to be regarded as serious if distended coils of intestine are to be found in the pelvis. A consideration of such cases of obstruction of the single colon as have fallen to my share leads me in no great degree to deviate from that earlier-formed conclusion. I therefore feel myself justified in advising the veterinarian to offer his client a cautious and guarded explanation of the state of affairs. Should the day fortunately arise when operative interference with the horse’s abdomen becomes a more frequent occurrence, then this particular form of colic will be the first to benefit thereby, and so yield a prognosis of a more favourable type. If the case is one of rectal paralysis, pure and simple, then the prognosis must be even more guarded still. These cases are generally insidious in their onset, and usually unaffected by therapeutic measures. Treatment.—Tahing the case of total paralysis of the vectal walls first, we may dispose of it very briefly by saying that a trial should be given to a long course of nervine tonics—e.g., strychnia, which tonic is well accom- panied by potassium iodide as a resorbent. The applica- tion of a smart blister to the lumbar region should be advised, and the patient’s daily comfort should be insured by removing from the rectum several times per diem the accumulated fecal matters. Concerning the impaction of the colon, I would, as for the other forms of subacute obstruction, advocate the adoption of purely stimulative measures; in which case the balls of ammonium carbonate and nux vomica may Digitized by Microsoft® 144 THE COMMON COLICS OF THE HORSE be administered as for the colic treated of in the last two chapters. These should again be followed up by the regular administration (every two, three, or four hours) of boli of zingib. rad. pulv. and ammonium carbonate, together with the exhibition of copious oleaginous draughts combined with ol. tereb. and ether meth., ol. menth. pip., spt. eth. nit., or any other diffusible stimu- lant that may suggest itself. Although it is not my own practice, I would also mention that a dose of aloes is not seriously contra- indicated. In fact, in this instance, there is only one argument that can fairly be advanced against it, and that is the fact that in some cases aloes does not act at all, but passes off by the kidneys. Should that happen, the veterinarian unfortunately receives no intimation thereof, and is thereby restrained (by fear of causing superpurgation) from pushing on that vigorous stimula- tive treatment which his own common-sense would immediately suggest were he only positively certain of the non-acting of the drug upon which he has placed reliance. After the expiration of ten to twelve hours, should the case show no improvement, it will be necessary to seriously consider the advisability or otherwise of ad- ministering a hypodermic dose of eserine, regarding which I have a remark to make. I do not pretend to offer any explanation of the fact, but I do most con- fidently assert that in this particular form of obstruction eserine does not show itself to its happiest advantage. To my mind that points out a satisfactory solution of what was to me at one time a serious problem. I could not understand veterinarians of experience rising to their feet at various meetings and emphatically declaring eserine to be of no value in colic cases: that it did not Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE SINGLE COLON 145 act as it was said to do. In the light of fuller experience Iam able to see an adequate reason, They had not used eserine on suitable cases. In spite of my opinion that this is not its happiest forte, however, it still remains a fact that eserine does act occasionally, even in posterior obstruction of the colon; and, after other remedies have been given a trial of from ten to twelve hours, its exhibition should no longer be delayed. The dose should not be a large one. Should it fail to act, as I have already said it may do, then the active peristalsis set up in the intestines anterior to the seat of obstruction is extremely likely to lead to a fatal lesion of the intestines or the mesenteric bloodvessels. There is, however, no risk in the administration of a small dose, say one grain. In view of what I have said concerning the likely nervous causation of this disorder, no one, I should imagine, will expect me to advocate the use of sedatives. If it were possible to do so, I would denounce their administration in even stronger terms than I have already used. I find it impossible to do so, however, and must content myself with the simple statement that their use is undoubtedly most strongly contra-indicated. If the obstruction is within comfortable reach, the veterinary surgeon should carefully knead it with the knuckles of his closed fist through the rectum, endea- vouring to crush it between his hand and the floor of the pelvis. It may, and does, cause pain, but it is also productive of good results. It goes without saying that, in addition to whatever treatment is being adopted, copious enemas should, at the same time, be freely indulged in. In fact, the ap- paratus for so doing should be left with the attendants if the veterinary surgeon is unable himself to frequently attend. The water should be used as hot as regard for IO Digitized by Microsoft® 146 THE COMMON COLICS OF THE HORSE the animal’s safety will allow, and with it should be included, at intervals, some good stimulating agent. Whether detached pieces of faces come away with the ejected water or not, the rectal irrigation should be per- sisted in, and the attendants should be firmly impressed with the idea that it is the constant warmth that tends to do good. Should all these means prove futile and the case still linger on, the long rectum-tube of Smith should be passed into the gut and, if possible, while a stream of water is passing through it, inserted for the whole of its length. Itisimportant to keep a constant flow of water, at a fairly high pressure, through the tube, in order that it may find a ready and correct road. In case the tube should not be available, a similar length of garden-hose of suitable stiffness will answer tolerably well. The only drawback to the use of the rectal tube is the need of a forced water-supply. To those resident in a country district that obstacle to a correct treatment is in most cases an insurmountable one—unless the animal is walked to the nearest market-town to the veterinary surgeon’s establishment. Finally, if all the efforts of the veterinary attendant are in vain, he may, if his position will bear the shock of a serious failure, and the age of the animal and its market value warrant him, talk to his client of operative measures. But of that more in a future chapter. Digitized by Microsoft® CHAPTER XII SUBACUTE OBSTRUCTION OF THE SMALL INTESTINES. Definition.—In spite of the fact that post-mortem records have not yet described a case of obstruction of the small intestines, I feel led, by the clinical evidence I have obtained, to give it, or at any rate the possibility of its occurrence, a place of description. Clinical evi- dence, as I hope this chapter will show, offers for our consideration a form of obstruction whose position in the intestinal tract is certainly far forward in the double colon. Whether further forward still, and obstructing the small intestines, only future records willshow. What evidence is obtainable appears to point strongly to the fact that obstruction of the duodenum does sometimes occur, and that ‘stoppage’ pains are not always to be precipitously referred to the single or double colon. The only argument against that statement is the one—‘ post mortem records have not shown it.’ Purely negative evi- dence, however, is seldom really satisfactory ; and J hope that the symptoms hereafter described will substantiate my statement that obstruction of the small intestines, most probably of the duodenum, has sometimes to be reckoned with. Causes.—Regarding the causes of colic, lam afraid I0o—2 Digitized by Microsoft® 148 THE COMMON COLICS OF THE HORSE that I have run almost to the end of my tether—or, rather have already enumerated them—and must again refer my readers to former chapters, allowing them to use their own discretion in each particular case as to which special causative factor they should give prominence to. Still, there are one or two circumstances that merit special mention. Foremost should come consideration of the duodenal S-trap. It is not hard to conceive of the possibility of this being a likely position for obstruction. Pressed, as it sometimes is, between the stomach and a distended colon, it would be remarkable if obstruction did not occur. Neither is it difficult to imagine that food im- perfectly masticated and passed on in a half-digested or acid condition from the stomach, and consequently unfit to be acted upon by the bile, should tend to stagnate in the duodenum. Following this, those morbid conditions of the liver that are instrumental in bringing about these disorders should be given attention. I, in common with many others, have noticed that prolonged feeding on rich nitrogenous foods will bring about a plethoric condition of the body that makes its first appreciable appearance in some disturbance of the liver functions. The animal becomes bilious. Congestion of the liver, or the diminished flow of bile from any cause, may, then, be put down as a factor in the production of duodenal obstruc- tion, for, with a lessened flow of bile, the digestion is imperfect, and a tendency to stasis is occasioned. Symptoms.—Almost invariably the pains that ac- company this disorder are those of an extremely dull type—even more dull than those that have already been described as dull pains. Pain of a degree there certainly is, but a certain amount of time must be given over to its Digitized by Microsoft® SUBACUTE OBSTRUCTION OF SMALL INTESTINES 1,9 consideration before it can be accurately traced to its correct source. For some days prior to the exhibition of signs of un- easiness, the animal has been heavy, has not performed his work with activity and brightness, has appeared unusually dull and drowsy. When down he lies quiet for a considerable time, and only occasionally manifests the seat of trouble by a quiet lock round at the flank. Rectal exploration reveals the presence of a few small, hard faecal lumps, which are abnormally dark in colour. The colon and such of the bowels as can be felt ave not ab- normally full, neither is there any undue fulness ov tympany of the abdomen. The pulse is raised a little beyond the normal, and is firm and full to the fingers. The tem- perature shows slight signs of febrile disturbance, and the conjunctiva is plainly stained a muddy yellow, more so, even, than is seen in that form of colic that is plainly referable to the great colon. The mouth is dry and sticky, and the odour of the breath abominably offensive, while the tongue and buccal mucous membranes are stained in like manner as the conjunctiva. It is not common, however, for the veterinary surgeon to be called in at this stage. When first he sees the case, the symptoms are more after this description : ‘The pains have become a great deal more noticeable, but still remain under the category of ‘dull.’ The getting up and down has become more frequent, although fairly long intervals of ease are even now common. The pain, when it does come on, is most intense just after the expulsion of a watery and extremely offensive purge, but rapidly subsides immediately after the first few minutes succeeding the evacuation. While the surgeon is watch- ing his case this purge may be repeated two or three times within the hour. Digitized by Microsoft® 150 THE COMMON COLICS OF THE HORSE Called in at this stage, the young practitioner, unless extremely wary, will be tempted to treat his case as one of simple diarrhoea, and administer astringents and sedatives. Needless to say, he commits a grave error. If, on the other hand, he is possessed of caution, and first explores per vectum, he will find a state of affairs there that does not fairly substantiate his first surmises. Certainly he will find the rectum, and probably also the single colon, with theiy contents, am a fluid condition. In addition, however, he will discover other portions of the intestines still containing facal matter in a state of solidity— proof positive that the purging has not been in existence for long, and equally positive proof that the purgation is not accountable for the dull pains that the carefully elicited history of the case has spoken of. Immediately on noting this, he will, if his clinical training be good, also observe that the pains the animal is showing are not of the kind that usually accompany the colic from exces- sive purging (see Chapter XVII.). There is not the tucked-up condition of the flank; there is no excessive peristalsis on auscultation; there is no great alteration in the number of respirations nor their character, and the pulse is not in that weak and fluttering condition so commonly coexistent with colic from superpurgation. Neither will the animal show desive fov the water offered him. This affords a suitable opportunity for mentioning a symptom, which, until now, has been carefully omitted. It is a well-known fact that the horse suffering from obstructive colic cannot, except in very rare cases, be persuaded to drink. In this particular instance it is almost proof that the animal is suffering from the pains of obstruction, and not those occasioned by an excessive purge. If it were the latter, he would be eagerly looking round Digitized by Microsoft® SUBACUTE OBSTRUCTION OF SMALL INTESTINES 151 on every rattle of a bucket, and, permitted, would drink to an alarming excess. If the veterinarian is of the same mind as myself, having decided that the purging is not directly account- able for the pains, he will refrain from giving the animal sedatives. ... He will treat the case purely as obstruc- tion, and persist in a solely stimulative treatment. Should he do so, he will, on his next visit to the case, have every reason to be delighted with his judgment. If it is his first case of this description, he will be quite anxious to learn whether or no the purging has stopped unaided. He is pleased to find that such is the case, and to hear that the animal has passed nothing for four, five, or six hours. Even now there may be an element of doubt, and the concerned thought is that the excreta is so thin as to be running through the bedding and so escaping notice. The dry tail does not point to it, and rectal exploration again settles the question. The interior of that bowel is quite dry, and sometimes contains chippy pieces of dried feces. And still the animal is in pain—dull pain—still peristalsis is in abeyance. The veterinarian knows now by rectal exploration and the evidence of his senses (to wit, the sight of the purging) that the last portions of the intestines—the single and double colons—are comparatively empty. The stoppage or obstruction must lie further forward. It is not likely to be in the floating portion of the small intestines; that he knows from post-mortem experience. It must, therefore, be situate in the duodenum, and the excessive biliary staining of the mucous membranes is now somewhat accounted for. Holding back from ad- ministering sedatives has left him in a position to treat his case on rational and not empirical lines. Digitized by Microsoft® 152 THE COMMON COLICS OF THE HORSE Correctly treated, the animal may begin to mend ina few hours, or the pains may last for as long as seven or eight days. Commonly it is only aday or two before the animal is, to all appearances, fully recovered. In every case I have yet seen the critical symptom ap- pears to be the voiding of a huge mass of feces (clay-like, both in colour and consistence) from the anterior end of the intestinal tract. The offensive smell from this can only be fitly described as ‘disgusting.’ From that time on- ward the pains of obstruction vanish, and after a few days’ careful dieting and nursing, the animal is out of danger. Diagnosis.—Much of the matter under this heading is often but a reiteration of facts related under the symptoms. Little thus remains for the writer but to emphasize in brief such symptoms as he regards as diagnostic. Primarily, we must consider the long period of general dulness noticed by the attendants before skilled advice is sought; the comparative absence of fulness of the abdomen as revealed by rectal exploration, and the non- appearance of tympany; the biliary staining of the conjunctiva, and the clammy, fcetid condition of the mouth, with the yellowness of the buccal membranes. These may all be regarded more or less as premonitory diagnostic symptoms, and it is not until the more notice- able colic pains come on and the offensive purge commences that the veterinarian is able to fully satisfy himself as to the correct nature of his case. The character of the purge is doubtless due to want of sufficient bile in the intestines. The bile exerts certain antiseptic effects on the intestinal contents, and when it is withheld extreme foetor of the fecal matters is a con- sequence. Thus, the fcetor may, to a certain extent, serve somewhat in locating the seat of trouble—may, in fact, in this case, be relied on as a diagnostic, Digitized by Microsoft® SUBACUTE OBSTRUCTION OF SMALL INTESTINES 153 When the purge has commenced, and the veterinary surgeon is able to accurately judge that this purge is not the actual cause of the colic, it is time he looked round for some other explanation of the pains. When, later, the purge ceases in a natural manner, without medicinal help, and the pains still remain in continuance, it is a fairly reasonabie conclusion that obstruction, in some position or other, is still to be looked for. The emptiness of the abdomen generally and the absence of tympany compel the veterinarian to place it far forward, and, admitting the fact that it is unlikely to be in the floating coils of small intestines in the left flank, the diagnosis, so far as we are yet able to settle it, is complete. We have summed up our case, and ‘duodenal obstruction,’ with congestion of the liver as a primary cause or after-complication, is the verdict. Prognosis.—I cannot say that my experience of these cases leads me to regard them at all unfavourably. They may, as I have before stated, linger on for several days, but never during that time do they offer alarming symptoms. One visits the case every four or six hours, or, should it prove protracted, twice daily, and each examination reveals the animal strong and the pulse good. The only untoward symptom of any gravity— one which I have never yet seen—would be a steady continuance and increase in the purgation. This being the case, the owner may, with every safety, be assured of a favourable issue. Treatment.—Broadly speaking, the treatment of this disorder must be conducted in two ways: Firstly, the obstruction in the intestine should be removed ; secondly, such medicines should be administered as will bring the liver to a healthy and normal condition, and so prevent a recurrence of the attack, Digitized by Microsoft® 154 THE COMMON COLICS OF THE HORSE Those who have carefully read the preceding portions of this book will see no great difficulty in carrying out the first of these directions. Again, I do not advise the administration of aloes; at any rate, not as a dependable agent. The mere fact of the bile being thrown back in sufficient quantities into the blood-stream to stain the visible mucous membranes is ample evidence that it will not be found freely enough in the duodenum to assist in che solution of the administered aloes. Assuming that the obstruction has set up such inflammatory changes as to cause a diphtheritic closure of the bile-duct, and that there is collected bile in the intestine, should calomel be given in order to hasten its expulsion? I am of the opinion that no great amount of good is to be derived from that, unless the system is at the same time helped by suitable stimulant treatment in order to first remove the obstruction. That statement brings us back again to the ammonium compounds as our sheet-anchor—again advantageously combined with nux vomica or other nerve stimulants. Consequently, for the treatment I may, with one excep- tion, refer the reader to that advised for obstruction of the double colon. The exception is the hypodermic injection of eserine. I do not believe, in this particular form of colic, its administration is called for. At any rate, any idea of using it may be safely postponed until the case has been treated on other lines for some few days. Once more, I earnestly caution the practitioner to avoid sedatives. Even when the purging breaks out he should still persist in a solely stimulative treatment, for it is not until the obstructive mass in the duodenum is removed that he may regard his case as out of danger. When, after the period of purgation (which always seems to accompany these cases), the physician has once Digitized by Microsoft® SUBACUTE OBSTRUCTION OF SMALL INTESTINES 155 obtained a normal action of the bowels, he may continue with calomel in small doses to clear the intestine of the accumulated bile. He should, at the same time, put the animal upon a course of such medicines as are known to favourably influence liver functions, and so increase the bile secretion. Probably the most suitable remedy in this case is one of the mineral acids. Before reaching the circulation, acids must pass through the liver, where they appear to set free biliary acids, and stimulate expulsion of bile from the liver and gall-bladder.!. The acid to be preferred is nitric or nitro-hydrochloric, and the following draught should be administered twice daily for three or four days: R.. Acidi nitrici dil. - . . - Bi. Aquam - - - - - - ad Oi. Misce; fiat haust. Should the practitioner decide not to administer the acid, he may, now that the obstruction is removed, employ aloes with advantage. Prescribed in 1-drachm doses once daily for three or four days, combined with ginger, gentian, or other vegetable tonics, it will exert a mild cathartic action, removing the bile from the intes- tines and stimulating the liver into activity. These attacks of duodenal obstruction, when the liver is to any great extent implicated, appear always to leave the animal in a state of great weakness and prostration— perhaps better described as want of tone and general lassitude. An easily digested diet is therefore called for, and the animal should be treated as convalescent for some considerable time. The simpler the diet, the better — bran with a few crushed oats and a liberal supply of good hay being all-sufficient. What water he 1 «Veterinary Medicines’ (Finlay Dun), p. 178. Digitized by Microsoft® 156 THE COMMON COLICS OF THE HORSE has should be medicated with 2 or 3 ounce doses of magnesium sulphate, and the kidneys may be induced to carry off their share of the accumulated effete materials by judicious doses of potassium nitrate, either in the drinking water or the patient’s food. This chapter I will conclude with a very brief account of two cases, which will serve to illustrate what I have already written. In their description I do not intend giving a daily account of the symptoms; that would take up much of my space to but little advantage. The reader will have read the symptoms of this disorder for himself, and will understand that my relation of them has been based upon these and other similar cases. Consequently, a daily record of the symptoms would be but the most fulsome repetition. Case No. i. January 30, 1902, 3.30 p.m.—The subject of this case was a five-years-old cart mare (barren). I attended the owner’s farm, some five miles distant, and received a history of general dull pains spread over the previous day. The pains had appeared somewhat worse (never violent) during the morning of this day, and were accom- panied several times by a nasty purge. This had led the owner to send for me, The pains the mare was showing did not appear to be proceeding from purgation; they were rather the ordinary dull pains of obstruction that I have mentioned so often throughout this book. To make assurance doubly sure I explored the rectum, and found that bowel containing a quantity of dirty liquid faeces, the odour of which was offensive in the extreme. Shortly after this manipulation the mare again volun- tarily evacuated a large quantity. As, however, I was unable to detect the usual symptoms of superpurgation (see Chapter XVII.), I diagnosed the case as one of ob- struction, and proceeded to treat it on those lines. I there- upon administered the balls and drench as advocated in Digitized by Microsoft® SUBACUTE OBSTRUCTION OF SMALL INTESTINES 157 Chapter IX., pp. 104 and 105, and left draughts con- taining diffusible stimulants for after administration, requesting the owner to let me know on the following day if the pains had not ceased. 4 January 31, 3.30 p.m.—My attendance was again re- quested, and I found the mare exhibiting much the same symptoms as on the previous day, with the exception that the purging had ceased since early the evening before. Accordingly, I repeated the stimulant treatment, and left further medicines of a similar nature. The case was showing no extreme urgency, and I did not propose seeing it again until the following day. Febyuary 1, 10.30 a.m—The pains had now ceased, and the mare inclined to pick daintily at a little hay. The critical discharge of a mass of clay-like, offensive- smelling faeces had taken place. I still continued the frequent administration of stimulants, now in smaller doses and combined with vegetable bitters and tonics, leaving these to be given by the farm attendants. February 2.—No visit. February 3.—Mare still convalescent, but doing well. Had several times passed normal-sized heaps of feces, healthy in colour and smell, and was now feeding fairly well. Advised the continuance of the tonics and a few days’ rest. The case subsequently did well. Case No. 2. This case, one of the most remarkable in my experi- ence, was treated some eighteen miles from home. It is astonishing to me as showing the length of time it is possible for a horse to suffer from the pains of obstruc- tion and then recover. I need hardly say that it is one of those exceptions that go to prove the rule. February 21, 1900, 12 noon.—The subject was a six: years-old cart gelding. The owner, a client of mine, came and informed me that he had a horse ill at M : I had never attended there before on account of the distance, but was persuaded in this instance, as the owner urged that the animal was a valuable one, that he was not satisfied with the treatment the horse was receiv- Digitized by Microsoft® 158 THE COMMON COLICS OF THE HORSE ing, and that he was unable to procure skilled advice nearer. On my arrival I found that the animal was being attended by one of the quacks of the old school, and gathered that he had been suffering from the ordinary pains of colic for some three or four days prior to my being called in. I could not gain much information from the empiric himself, but learned that he had been ad- ministering sedatives and aloes, I immediately insisted on having sole charge of the case, and commenced a vigorous stimulative treatment. I knew that, in addition to the obstruction, I had to fight against previously administered sedatives, and determined to run the risk of creating superpurgation by actively inciting the aloes to action. Accordingly, I administered in the form of balls the usual quantities of ammonium carbonate and nux vomica, in 1 and 2 ounce doses respectively, and the oil of turpentine and aromatic spirits of ammonia in 1-ounce doses, with linseed-oil as a draught. That done, I left the man in charge of the nursing with sufficient balls of ammonium carbonate and vegetable tonics to carry him on until the following day. February 22, 9.30 a.m.—The administered stimulants had had the effect of restarting the peristalsis that had been stayed by the sedatives, and the animal was now purging. Following a similar line of reasoning as is described under the section devoted to diagnosis, I was able to ascertain that, in spite of the purging, obstruc- tion was still present, and persisted in the exhibition of ammonium carbonate and stomachic tonics, together with draughts of ol. lini, ol. tereb., and spt. eth. meth. February 22, 6.15 a.m.—Save that the purging had now stopped, the animal was in much the same condition as in the morning, and, after administering the usual balls and draughts, I injected 2 grains of eserine sulphate under the skin of the neck. Beyond putting the animal in a little more pain, its action was unnoticeable, February 23, 9.30 a.m.—Seeing that there was still no action of the bowels, I again administered the usual draught and six of the ammonium carbonate balls, after Digitized.by Microsoft® SUBACUTE OBSTRUCTION OF SMALL INTESTINES 159 which I ventured on a further hypodermic dose of eserine sulphate. It was again unproductive of good, and I now decided to use it no more upon this particular animal, but to maintain a regular administration of such stimu- lants as could readily be given fer ovem. February 23, 6.15 p.0.—There was still no alteration in the symptoms, save that the animal had been induced to drink a little thin linseed tea. With no alteration of im- portance the stimulative treatment was continued. February 24, 9.30 a.m.—The case, to all appearances, was in the same condition as when left the evening previous. The same treatment was continued. Tiring somewhat of the case, being so far from home, and the train service wretchedly bad, I decided to see it no more that day, but left the man in charge a full supply of medicine, with instructions to desist in their administra- tion should the animal turn easier and attempt to eat. February 25 (Sunday).—No service of trains. Decided to leave the case unseen until the Monday morning. February 26, 9.30 a.m.—Animal weak, but recovered and free from pain. Feeding delicately. Appears to have suffered eight months rather than eight days. On the Sunday he had passed the usual mass of offensive dung, which had been saved for my inspection. Save the careful nursing and dieting the animal caused no further anxiety, and made an uninterrupted recovery. I have described this case with extreme briefness. Lest he should miss the point, I wish the reader to clearly understand that, at intervals of about every six hours, the horse received 2-ounce doses of ammonium carbonate for the whole of the four days I attended him, to say nothing of the frequent administration of draughts containing ol. tereb., spt. ammon. aromat., or spt. eth. meth., as my judgment led me. What the termination of the case would have been had the old empiric’s sedative treatment been continued I leave my reader to judge for himself. This concludes my somewhat lengthy description of the intestinal obstructions. Imperfect as I yet feel it to Digitized by Microsoft® 160 THE COMMON COLICS OF THE HORSE be, I hope I have now written enough to lead other observers to the more exact differentiation and diagnosis of these troublesome disorders. I also hope that the foregoing descriptions will have justified me in daring to thus arbitrarily subdivide and suggest new names for the time-honoured (yet, I venture to affirm, out-of-date) title ‘Impaction of the Bowels.’ Digitized by Microsoft® CHAPTER XIII INTESTINAL IRRIGATION IN OBSTRUC. TIONS OF THE COLON Tue subject of per anum irrigation of the intestines is of such great importance as to merit further description than the bare mention in Chapters X. and XI. Par- ticularly in the subacute varieties of colic I have been describing will it be found of value. Needless to say, it is obstructions of the colon that will be best benefited by its use. I am not referring simply to the passing into the rectum of a few pints of water with the ordinary enema syringe, but the injecting of several gallons by means of a forced water-supply, and a tube that may be inserted for at least 4 to6feet. It is again to General F. Smith that we are indebted for this further addition to our knowledge. Once or twice in this volume I have referred to im- pacted coils of intestine being found in the pelvis. Whether the obstruction be in the small colon or the large, I have no hesitation whatever in saying that forcible irrigation of the intestines with large quantities of water will do more than anything else to save the patient’s life. If the obstruction is in the small or single colon the impacted mass is comparatively small in size, usually Il Digitized by Microsoft® 162 THE COMMON COLICS OF THE HORSE about the diameter of a large cocoanut (see Fig. 11). Should the obstruction be in the large colon, its relatively larger size at once denotes that fact. When felt through the rectum, it gives to the hand the impression of a huge foetus forced close to the pelvic outlet. Unless soon relieved, cases of this description quickly put the im- plicated portion of bowel into a state of obstinate paralysis. That being so, if the usual stimulative treatment fails to give early good results, intestinal irrigation should be at once commenced, Only one or two trials will con- vince the operator of the great value of the treatment. The only apparatus really necessary is several yards of ordinary rubber garden-hose of about 4 to 2? inch in diameter, fixed to a forced water-supply. My own method of procedure, however, I will leave for the time. So far as I am able to trace, General Smith was the originator of this treatment, and that behoves me to give his case prior place. It is reported in the Proceedings of the Fifth General Meeting of the National Veterinary Association, and runs as follows : ‘F. 54, 12th Royal Lancers, a grey gelding, five years old, was admitted at 4 p.m. on April 26, suffering acute abdominal pain. He threw himself down with great force twice before means could be taken to prevent it, and to avoid a rupture of the stomach or intestines I placed him in slings, or, rather, attempted to, for he no sooner felt the sling under him than he lay like a log in it. He was lowered carefully to the ground, and quickly hobbled, and a great source of anxiety was at once removed. Before I saw him he had passed a quantity of loose faeces, and the usual medicine had been ad- ministered, but he was getting worse. The pulse was quick and small, respiration greatly increased, con- junctiva injected. Examination perv rectum revealed Digitized by Microsoft® INTESTINAL IRRIGATION 163 nothing. I at once gave morphia grs. viii. subcu- taneously, and administered aloes 3v. in solution; applied mustard to the belly, and ordered copious enemata every hour at least. He was quiet for fully half an hour after the morphia, and at 9.30 p.m. I considered I might let him rise with safety. He was still in pain, but not so acutely, was kept on his legs, hot rugs applied to the abdomen, and mustard to the legs, as they were cold. His pulse was 60, soft and com- pressible; respiration 34; temperature 102°6°; conjunc- tiva injected. He remained in pain all night. ‘ Apnl 27.—Delirious, head continually going to and fro, eyes more injected; pulse 60, very weak; respira- tion 40; temperature 103°; still in pain, has passed urine, a little flatus, but no action of the bowels; on rectal examination these are found distended with gas; continue the enemata, repeat the morphia, and constant application of hot rugs. Towards mid-day, the morphia not having the least effect, I administered ext. cannabis indice 3i., and this kept him quiet for a few hours. ‘ Evening.—Looks very wild, eyes glaring, continually throwing his head up and down and from side to side, wants to walk round the box; pulse 48, temperature 103°; 12 p.m., still in pain, repeat the Indian hemp, and give ol. lini. Oi. ; hot rugs to abdomen all night, and the usual enemata. ‘April 28, 4 a.m.—In great pain, nothing passed ; in- jected morphia grs. viii. 6a.m.: The last dose of morphia had no effect, temperature 105°6°, pulse almost impercep- tible, conjunctiva scarlet and spotted, respiration 20, very delirious and suffering great pain. Io a.m.: Gave morphia ers. xvi., it had not the least effect, wandering continuously, head to and fro, passed a few small pieces of feeces, and strains. The case is most serious, and the horse will certainly die of pain, if he does not from the impacted colon. He got worse during the day, and at 5 p.m. I gave him ext. cannabis indice 3ii., ol. lini, Oi. The hemp had, as usual, an immediate and lasting effect ; he stood quietly with his head between his fore-legs for two or three hours. The enemata administered with the ordinary pipe I considered so utterly useless, and II—2 Digitized by Microsoft® 164 THE COMMON COLICS OF THE HORSE feeling certain that the impaction was in the colon and only required to be reached, I passed my long rectum tube (kindly made for me by Messrs. Arnold and Son). I first passed it up about 4 feet, and threw in about 27 gallons of cold water—3 or 4 gallons of this remained in; what was rejected brought away a few small pieces of faeces. 11 p.m.: There is great dulness over the double colon at the epigastrium, and also in the left hypochondrium ; I believe it is in these portions where the obstruction exists; I again passed the long tube, this time 6 feet, and threw up several more gallons of cold water—a large amount of this was retained. He was kept thoroughly under the influence of the hemp, pawed occasionally, still off his head, but much quieter. ‘ April 29, 5 a.m.—Passed the long rectum tube to its full extent—6 feet—into the bowels, and threw in 13 gallons of cold water, which were retained for a long time. The horse is quieter, temperature 102°, pulse stronger, but very quick, about 60; the conjunctiva is clearer; the dull sound of the epigastrium and left hypochondrium is considerable, but a welcome loud gurgling is heard. 11.30 a.m.: Repeated the enema with the long tube; slobbering from the moath, and so weak that he has to stand with all his legs apart; the pain suffered is insignificant. 5 p.m.: Repeated the enema; temperature 100°, pulse stronger, conjunctiva clearer; am very pleased with his appearance, and confidently expect his bowels to act shortly ; give, however, ol. ricini. Oii. Stood quiet all night. The delirium entirely disappeared. April 30, 4 am —Repeated the enema; straining greatly, but passed nothing. 6 a.m.: Passage at last effected; passed a large quantity of faces, mixed with sand, gravel, and stones ; temperature 100°. During the day took a bran mash ; passed more faces, with gravel and sand, mid-day and evening. Evening: Pulse fuller, eye brighter, removed to another box and walked very tottery. ‘The record of this case need not be continued, for from this time he did well; he passed the gravel for a few days, and it then ceased; he lost so much flesh through Digitized by Microsoft® INTESTINAL IRRIGATION 165 his few days of intense suffering that it took two months’ nursing to replace. ‘The interest in this case is centred in the long rectum tube. From a considerable experience in bowel com- plaints, I came to the conclusion some time ago that if I could throw an enema into the colon I would accomplish two objects: (1) Would act directly on an obstruction seated far forward, and (2) would place the enema beyond the expelling powers of the patient, and so enable the water to act mechanically on the contents of the bowel, and also restore the tone of the gut. I accord- ingly sent to Messrs. Arnold a description of the tube I required ; it was to be 6 feet in length, made of gum elastic, the same calibre as the ordinary Read’s enema tubing, and was to fasten on to this tubing when the ordinary wooden nozzle was unscrewed ; its extremity was to be round and perforated. Messrs. Arnold sent me the exact article, which I have no hesitation in say- ing saved the life of the horse whose case I have just detailed. There is no difficulty in passing it; having been well oiled, with gentle pressure it finds its way along the course of the rectum, and when it refuses to go further no force should be used; all that is required, should it be necessary to pass it further for- ward, is to pump in a gallon or so of water, which dilates the bowel in front of it, and the passage is accom- plished. It is fair to state that I have had cases where I could not get more than half that distance up, probably owing to an irritable condition of the gut, but even in these there is an immense advantage gained over the ordinary wooden nozzle, which is only put in for a few inches. J have constantly made experiments with the ordinary apparatus on the dead subject in an erect attitude, and find that with it no enema can go moe Digitized by Microsoft® 166° THE COMMON COLICS OF THE HORSE than 4 or 5 feet into the rectum, so that for obstruction in the colon it is useless. My long tube throws an enema with ease into the single colon, and probably into the double one. If while the enema is being given the ear be applied to the left flank, the water may be heard rushing along the intestine. The tube only requires to be used in a case of obstinate obstruction from gravel, faeces, etc., to prove its great value. Before I was supplied with the instrument I now possess, I used as a substitute the tubing that is found on Read’s enema syringe, removing, of course, the wooden nozzle.’ Thus runs Colonel Smith’s report of his case. Two facts in it I wish to point out to the reader: First, the apparent uselessness of large doses of sedatives to thoroughiy aHay.pain in a serious case of obstruction, and the evident increagein alarming symptoms they give rise to. Secondly, the almost ingg@Pt53 zy AXect of the an ere. a, “Geo A result of cold water irrigation in reducing I was led myself to adopt this 4 the experience of a fatal case of ol! colon that occurred in my own, case was this: ye yoo iC a six-years-old WHE 4 to atten found her showing Epeccolic. lolon, and was con- Bes Oo) | eee De ea aitstinct impaction in all the usual symptons firmed in my opinions the pelvis. As is my sactice, I gave four balls containing ammonium @igpeemate and nux vomica, and administered a draught of ol. ini. Oi., ol. tereb. and spt. ammon. ar., of each 3il. BeYond the fact of finding the impacted coil of intestine in -he pelvis, I was unable to detect any alarming symptoms. The pulse was good and the pains not excessively violent. After watching her for some time, I injected hypodermically 1 grain of escrine sulphate, and left her for a few hours. 10.30 p.m. — The symptoms showed no abatement Digitized by Microsoft® INTESTINAL IRRIGATION 167 The eserine had failed to act. The pulse was slightly quicker, and the impacted intestine in the pelvis still present. I again repeated the ammonium carbonate balls, minus the nux vomica, and administered a further pint of oil. At the same time I injected copious warm enemas, medicated with soap liniment. June 11, 7.a.ut.—1 was disappointed to find that the case showed no improvement. The pulse had risen to 80, and the mucous membranes were becoming injected. No ease had been shown since my last visit. The case was undoubtedly becoming worse. I again repeated the balls and stimulating enemas, and injected a further dose of eserine. 12 noon,—The eserine had again failed to act, and all the symptoms were becoming gradually aggravated. There were constant straining efforts to defeecate, and enemas were quickly expelled, as clear as when injected. In my own mind I recognised a dying case, though I still persisted in giving stimulants and oil, 10.30 p.m.—Animal gradually succumbing. I had now reached the end of my tether, and, more as a forlorn hope than in any other spirit, I injected a further and larger dose of eserine—this time 2 grains. I gave the owner a fatal prognosis, and promised to call again in the morning. June 12, 7 a.m,.—The case had slowly gone from bad to worse, and the mare was now evidently dying. No further treatment was attempted, and the animal expired some time shortly after noon. I made arrangements with the owner for a post-mortem to be held the same day. Autopsy.— The knowledge gained from this was simple enough, though painful in the extreme. Every portion of the intestinal tract appeared healthy. In no part could be found feces of more than a semi-solid consistence — save, of course, the impacted portion— neither were the bowel contents abnormally excessive. The impacted intestine was quickly withdrawn from the pelvis, and turned out to be a portion of the single colon, Digitized by Microsoft® 168 THE COMMON COLICS OF THE HORSE distant some 7 or 8 feet from the anus. The obstruction was nearly round, approaching the oval, about the size of a cocoanut, and, seeing that it was composed entirely of dung, extremely hard. It presented the appearance depicted in the accompanying photograph: Fic 11.—ImpacTED PorTION oF SMALL COLON SUSPENDED BY MESENTERY. A, mesentery ; B, the obstruction; C, sacculated folds of intestine ; D, longitudinal band of intestine. No other suspicious circumstance was present. The case was Clear enough both to myself and the bystanders. Except for a few bright red patches quite near to the obstruction, the coats of the intestine were clear and clean. Remarks.—I need hardly explain to the reader how Digitized by Microsoft® INTESTINAL IRRIGATION 169 annoyed I was that the impaction was so small. In every probability, had the mare been operated on during the first day’s illness and the obstruction removed, she would have lived. Still more probable would her recovery have been if constant intestinal irrigation had been persisted in. The fatal obstruction was actually within veach of a tube that could have been passed a few feet. Had I given aloes, would the issue have been different ? I cannot whip myself with the thought that it would. Against the argument that aloes would have moved the obstruction is the fact that the contents of the whole of the intestines in front of the stoppage were in a semi- fluid state. We had, in fact, by using the oil and the nux vomica, created a purge actually washing the surface of the obstructing lump. My only regret is that I did not then know the value of the long rectal tube and a bountiful supply of water. The next case, the first in which J adopted intestinal irrigation, was followed by recovery : History.—The patient was an aged black cart gelding, used for heavy hauling purposes—coal carting. He had been at his usual work all the week until late on the Saturday afternoon. He ate his usual feeds on Sunday morning and at noon, and was found in pain about 6 p.m., when the men went to give the evening meal. Sunday, 6.30 p.m.—I found him exhibiting the following symptoms: Pain slight, but constant, and manifested by a ceaseless pawing with one fore-limb. Pulse about 68, but inclined to be fluttering and weak. He had pre- viously been rolling, but now showed no inclination to do so. Circumstances did not permit of a rectal examina- tion. So far as could be gathered from the appearance of the abdomen, there was no trouble in the large intestine. That was surmised from the complete absence of tympanites. Diagnosis was withheld until a rectal Digitized by Microsoft® 170 THE COMMON COLICS OF THE HORSE examination had been made. I administered the usual balls of stimulants, but was quite unable to get adraught down him. Left word with the owner to send him up to my own stables if he did not get easier before 9g p m. g p.m.—He was admitted into the infirmary and the rectum explored. My former surmise was wrong, for a huge mass of intensely impacted intestine—evidently the large colon—was found forcing itself right into the pelvis within 6 inches of the anus. I again repeated the balls, and failing, owing to his awkwardness, to administer a drench, gave a warm enema, containing a large quantity of turpentine liniment, in the hope that some of the turpentine would become absorbed, and so excite the bowel to action. The pulse still maintained the same number of beats, but had improved somewhat in tone. Asthe animal was now lying down, and appeared fairly comfortable, I decided to let him remain until the morning before attempting further measures. Monday, 7 a.m.—Patient still in the same condition. Administered hypodermically 14 grains of eserine sul- phate. This put him in slightly more pain for about an hour, after which he again grew easier. During the hour he passed a few small quantities of feces. This I judged was only from the single colon, for rectal exploration still revealed the presence of the impacted coil of larger intestine. 12 Noou.—Still failing to induce him to take my usual doses of linseed oil, I had no other alternative but to fall back on aloes. I administered 3 drachms only. The torpid condition of the bowels, however, promised little hope of its acting; that being so, I decided to irrigate the colon with cold water. 4 p.m.—Connected the hose with the ordinary town water-supply, and forced into the intestines per vectum several gallons of cold water. I found it impossible to estimate the exact quantity, for during the first few minutes of passing the tube there was a fairly constant flow of water outwards from the rectum; then, as the bowel in front of the injecting-tube expanded owing to the pressure of the water, and the tube found its way further in, the flow from the rectum partially ceased, Digitized by Microsoft® INTESTINAL IRRIGATION 171 until the quantity being injected must have far exceeded that dribbling out. At this period of the injecting, the ear applied to the left flank could plainly hear the water running in. What was more pleasing still to hear was a loud rumbling and disturbance of the intestines. After keeping the stream going for about ten minutes, during which time several gallons must have found a way into the colon, the tube was withdrawn. Beyond a slight shivering of the haunches, no ill effects were noticed. Indeed, the reverse was the case, for the pulse dropped to near the normal in number, and gained decidedly in tone. The animal appeared more cheerful, and even partook of a small feed. After doing so, he again showed dull pains, but the general condition was distinctly improving. The quantity of water injected could now better be estimated by the frequent evacuations made by the animal. From the time of the injection at four o’clock until as late as six or seven he passed out at frequent intervals a stream of water. At first this came away quite clear; later it was stained a muddy yellow; later still there came with it long strings of pale yellow mucus and choppy pieces of ingesta. Nothing further was done with the animal that night. Tuesday, 10 a.m.—Animal still showing dull pains. A rectal examination was again made. Even now, after the lapse of seventeen or eighteen hours, the rectum was found full of a feeces-stained fluid. The obstruction was still present, but perceptibly softer. The irrigation was repeated in the same manner, and followed by the same results. 4 p.m.— Patient decidedly easier. Repeated the irriga- tion, and administered a stimulant to promote warmth. The animal was then left for the night. Wednesday, 9 p.m.—Horse quite easy. He had eaten a good feed, and passed several heaps of faeces of normal consistence. From this time he made an uninterrupted recovery. Remarks.—The striking feature in these cases is the impunity with which large quantities of cold water may Digitized by Microsoft® 172 THE COMMON COLICS OF THE HORSE be injected without bad effects. As the foregoing case illustrates, it appears rather to be productive of good. The rise of febrile symptoms is effectually kept down, and the rectum is prevented from attaining that degree of horrible dryness that so commonly associates itself with this type of colic. If not directly reached by the in-running stream of water, the obstruction appears to become softened by the large amount of fluid remaining in the rectum immediately over it. In obstructive colics, occasioned by the accumulation of masses of undigested food, veterinarians have con- stantly bewailed the fact that the patient will not drink. Here is a ready means of pouring into his system the fluid he will not voluntarily take. In addition to the mechanical aid it gives, we have the welcome signs of active peristalsis, induced by the excitant action of the cold water on the intestine itself, Now that I know its value, it surprises me that no one seems largely to have adopted the treatment. It is not a great deal of trouble, and its beneficial results are at once apparent. Digitized by Microsoft® CHAPTER XIV THE SURGICAL TREATMENT OF INTESTINAL OBSTRUCTIONS Ar times, in his treatment of colic, the veterinarian is on the horns of a dilemma. He feels confident that he has successfully diagnosed intestinal obstruction of such a nature, and in such a position, as to render surgical interference reasonably warrantable. Should operative measures be advised early on in the case? Should expectant treatment be first adopted, and the operation be only advised as a dernier ressort ? If the first is decided on the patient may die from the effects of the operation, and the owner be accordingly annoyed. Adopting the latter procedure, the patient, in a state of rapid collapse, will not offer great possibilities of the operation being successful. Thinking so, the veterinarian has been apt to let matters rest, and it was not until 1895 that Professor Macqueen, of the Royal Veterinary College, put the matter upon a more satisfactory basis. This gentleman’s experiences, coupled with his exhaustive searches into veterinary literature, led him to the belief that penetra- tion of the equine peritoneal cavity was not so highly dangerous after all, and that operations involving that step were quite safely within the bounds of possibility. Digitized by Microsoft® 174 THE COMMON COLICS OF THE HORSE For the benefit of his brother veterinarian, Professor Macqueen converted his beliefs into undeniable facts by the performance of several interesting experiments. Horses were cast and anesthetized. Suitable antiseptic precautions were taken, and in each case a small por- tion of the floating colon was exposed. An incision was made through the bowel wall, its contents removed, the wounds sutured, and the animal allowed to recover. Reserving my remarks on its practical utility for the end of the chapter, I will allow Professor Macqueen to give the details of this operation in his own words: ‘ Materials, instruments, etc., vequived.—Four large and twelve small Turkey sponges, for use inside the abdomen and about the bowel. Twelve yards of tarlatan, cut into two-yard lengths, for packing round the bowel brought outside the wound. Four sponge cloths, for laying on abdomen and thighs to catch dust during the operation, to wipe the skin, and for rougher work outside the wound. ‘Three enamelled iron trays to hold instruments, liga- tures, and needles. Four zinc pails to hold hot water, sponges, lotions, etc. One small bucket marked in pints to measure hot water for making solutions, etc. Some 20 per cent. carbolic soap for washing hands and flank and for shaving. One aseptic scalpel and a razor. Two elbowed scissors, sharp and blunt pointed, to divide muscles, open peritoneum and bowel. Two sponge- holding forceps. Two Thornton’s T-shaped forceps to stop bleeding from skin or muscle. Two Wells’ catch forceps, and one or two spring and dressing forceps. A few straight and curved suture needles. Twenty milliners’ needles, straws No. 5, for stitching the gut. Chinese twist for all sutures—No. 1 for the gut, No. 3 for muscles, and No. 6 for the skin. A fine trocar and cannula, to puncture, if necessary, distended bowel. A Digitized by Microsoft® SURGICAL TREATMENT 175 convenient supply of hot water, and a piece of fine muslin, several layers thick, for use as a sieve for water to be used for lotions or for irrigation. Chloroform and an inhaler with sponge, and some pure carbolic acid in a graduated bottle. For dressing the wound the following should be ready: Iodoform and tannin, 1 to 3; antiseptic cotton-wool and tow; carbolized gauze; a piece of calico, 6 yards by g inches; roller bandages, and a few safety-pins. ‘ Prepavation.—The small sponges may be obtained ready for use from any wholesale druggist. They are known as Milne’s aseptic sponges. Probably the large sponges can be purchased in the same condition. I prepared my sponges in this way: After beating out the sand the sponges were placed for four or five days in cold water, which was changed daily, then transferred to a solution of hydrochloric acid, an ounce to the gallon, where they remained for twelve hours; from this they were placed under the cold-water tap, and turned about under a constant stream for an hour or two; then each was thoroughly washed in plenty of hot water, squeezed as dry as possible, and finally placed in 5 per cent. carbolic solution. ‘The tarlatan, cut into two-yard lengths, was washed in hot water containing Hudson’s powder, then thoroughly rinsed, and placed beside the sponges in carbolic. The sponge cloths were boiled, rinsed in cold water, soaked in 5 per cent. solution of carbolic, and then dried. ‘The Chinese twist was stretched by winding each skein on a bit of wood (3 inches by 14 inches), plunged in hot water, and boiled for ten minutes; then stretched again by winding on another bit of wood, and finally placed in a wide-mouthed bottle containing 5 per cent, solution of carbolic acid. Digitized by Microsoft® 176 THE COMMON COLICS OF THE HORSE ‘ The scissors, forceps, needles, scalpel, etc., should be kept together in a sheet-iron case, which may be placed on a stove or near a fire. ‘After operation the sponges, instruments, etc., must be cleansed. The sponges and tarlatan are placed together in cold water, which is frequently changed ; then the sponges are transferred to hot water containing washing soda—.4 ounces to the gallon—and left there for a day. From this they are placed under the cold- water tap, then washed separately in hot water, dried in the sun, divested of hairs, and again placed in 5 per cent. carbolic. The tarlatan is washed as before with Hudson’s powder, dried, and placed beside the sponges, For keeping sponges and muslin a 2-gallon pail, with hinged lid, will be found very convenient. The sponge cloths, after soaking in water, are boiled with soda, rinsed, and dried. The instruments are scrubbed and washed in hot water containing Hudson’s powder, dried, and enclosed in the iron case, which is then placed near a fire. ‘ Preparation fov Operation.—Before casting the horse, the flank from spine to groin and from haunch to sixteenth rib is clipped and washed. When the horse is under chloroform the flank, within 2 or 3 inches of the boundary marked by clipping, is shaved and disinfected. While these preliminaries are proceeding, the pails and trays are arranged and filled. All the solutions must be warm, and the water used in their preparation passed through muslin. Pail No.1 is filled with 5 per cent., and pail No. 2 with 2} per cent., solution of carbolic acid. The trays are filled with hot solution of the same strength as pail No. 2. The sponge cloths are placed in No. 1, and kept there until required. The sponges and tarlatan, after having been squeezed as dry as possible, Digitized by Microsoft® SURGICAL TREATMENT 17% are placed in No. 2. In one tray are placed the milliners’ needles, twelve of which are threaded with twist No. 1; another tray contains scissors, forceps, and scalpel; and the third contains reserve instruments, suture needles, and twists Nos. 3 and 6. Pail No. 3 is Position «f first incision through the skin and across the fibres of the external oblique. Dotted line marking the position of secondary wound for drainage. Fic.12~—Sre\t oF LAPARO-ENTEROTOMY (MACQUEEN’'S OPERATION). filled with hot water for rinsing hands and instruments ; and pail No. 4 is filled with boiling water, which is pro- tected from dust and allowed to cool. This water will be required to wash the bowel after suture. ‘Abdominal Incision.—The linea alba offers the least vascular and shortest route to the interior of the 12 Digitized by Microsoft® 178 THE COMMON COLICS OF THE HORSE abdomen. Through an incision of the white line any organ within the cavity can be felt, the small and large intestines in part can be seen, and to som: extent Skin, iu Cut fibres of ex- 3 % acl ternal oblique. Second incision parallel with the fitres of the internal oblique. (The fibres of the ~ transversalis ~ can be seen through the wound), Fibres of ee t internal Ne ae & MW oblique. / : Fic. 13-— OPERATION Wounp (Laparo-ENTEROTOMY). Showing the first incision through the skin and across the fibres of the external oblique. (Enlarged from Fig. 12.) portions of these viscera can be withdrawn; but the colic mesentery is too short to permit the first part of Digitized by Microsoft® - SURGICAL TREATMENT 179 the floating colon to pass through the wound. Besides, if the incision is made at this point the wound does not heal rapidly, and adhesion between its peritoneal surface and omentum or bowel is!a probable complication. In the horse, incision of the abdomen an inch or two to the right or left of the linea alba is equally objectionable. When the floating colon has to be opened, I prefer to reach the bowel through the flank (see Fig. 12, p. 177). In open- ing the flank I make three wounds before touching the peritoneum. The first divides the skin, fascia, and external oblique muscle; the second the internal oblique ; and the third the tvansversalis (see Fig. 13, p. 178). The first starts at a point 4 inches below the lumbar transverse processes, midway between the angle of the haunch and the last rib, and passes downwards and forwards for 7 or 8inches. The forward direction of this incision is opposed to all teaching, but its advantage is conceivable. The upper hind limb is unhobbled and drawn backwards. The wound gapes and exposes the internal oblique muscle, which is then cut with scissors in the direction of its fibres. A similar opening is made in the transversalis. The third wound exposes a layer of fat which is lined by peritoneum; this is pierced with the finger, and the opening is enlarged with scissors in the direction of the transversalis wound. ‘Incision and Suture of the Bewel.—So far I have only opened the bowel at the middle of the longitudinal band, where the wall appears strongest and most capable of supporting sutures (see Fig. 14,p. 180). With sharp- pointed elbowed scissors the gut can be punctured and the wound extended without the slightest difficulty. The wound is closed with sutures of prepared Chinese twist No. 1. There are many methods of suturing bowel wounds, but Lembert’s is the only one of which I hava experience. Sutures applied by Lembert’s method pass 12—2 Digitized by Microsoft® 180 THE COMMON COLICS OF THE HORSE through both the serous and muscular coats; the mucous membrane must not be punctured. The needle enters 1 inch from wound, passes through muscle for } inch, then pierces serous } inch from the edge of the wound. It is then carried across the wound, re-inserted } inch from edge, passed through muscle for } inch, and brought out + inch from the wound. A glance at the diagram (Fig.14) will enable anyone to understand the course of Fic. 14.—LEMBERT’S SUTURES (IN SMALL CoLon). the needle. The sutures are placed 4 inch apart and tied separately. The ends are shortened to within } inch from the knots. Degive has improved this method by making the sutures continuous. ‘Operation. —Cast the horse on the left side and give chloroform. Wash, shave, and disinfect the flank. Spread sponge-cloths, wrung out of carbolic lotion (5 per cent.), in front and behind area of incision. Incise skin Digitized by Microsoft® SURGICAL TREATMENT 181 and external oblique; unhobble upper hind limb, draw it backwards, and fix to a post or wall. Douche wound with warm carbolic lotion (2% per cent.), and stop bleed- ing from skin and muscle. With elbowed scissors slit internal oblique muscle in the direction of its fibres, trim the edges, and stop bleeding. Snip transversalis with scissors and extend opening with finger, taking care not to puncture fatty layer or peritoneum. Examine wound and check bleeding. Sponge with warm carbolic lotion (2% per cent.) and remove excess of fluid. When satis- fied that the wound is ‘‘dry,” rinse the hands, push the finger through fat and peritoneum, and enlarge opening with blunt-pointed elbowed scissors. Pass a large sponge, wrung out of (24 per cent.) warm carbolic solution, into abdomen, and get tarlatan ready. Pass the hand into abdomen, bring out the bowel, and hold it gently until assistant has placed pieces of tarlatan, moistened with warm carbolic lotion (24 per cent.), round the wound. This done, let the assistant take the bowel between his fingers applied like clamps, the hands resting one in front, the other behind the wound. Incline the bowel towards the horse’s thigh, and slit the free border with scissors. Remove contents and wash its mucous lining. With a fresh sponge clean the edges of the wound, and apply Lembert’s sutures. Place the stitches 4 inch apart, and insert two or three beyond the wound at each extremity. Pass all the sutures before tying any. Wipe the edges as tying proceeds, and shorten the suture ends to } inch from the knot. When the wound has been closed, pull the bowel well out of abdomen, and let assistant renew his hold. Carefully sponge off clots, hairs, and suture ends, and douche with boiled water that has been allowed to cool to about 106° F. Remove packing from round the Digitized by Microsoft® 182 THE COMMON COLICS OF THE HORSE wound, let the bowel slip into abdomen, and withdraw the sponge. Look inside, and, if necessary, pass in a fresh sponge to take up clots or fluid. Adjust the edges of transversalis wound, and excise protruding fat. Pass two or three sutures (twist No. 3) through internal oblique muscle, and sponge the surface with carbolic lotion. Re-hobble upper hind limb, and bring edges of external oblique together with a few fine sutures. Close the external wound with strong (No. 6) twist sutures passed through skin and muscle, tied in front or behind the line of union, Then slit skin and fascia downwards and backwards to 2 inches from lower end of first incision. ‘This will drain the operation wound. Sponge the surface with carbolic lotion, and let the horse rise. Dust the flank with iodoform and tannin, insert aseptic tow in drainage wound, and cover the whole with car- bolized cotton, protected with four layers of gauze. Support the dressing by winding calico round the body, and roller bandages secured with safety pins. Muzzle the horse for five or six hours, but leave his head loose. -Encourage, but do not force, exercise. For a few days restrict his diet, which ought to be somewhat laxative. Dressings should not be renewed until oozing occurs, then re-dress, but do not plug the drainage wound. The dressings might be substituted with advantage by pitch plaster or a mild blister.’ Following closely the lines advocated, Professor Mac- queen operated on (a) an aged brown pony gelding, (b) an eight-years-old chestnut pony gelding, and (c) an aged brown nag gelding, at one of which operations I had the good fortune to be present. So far as could be ascertained, these animals were healthy before the experiments. Animals (2) and (c) were allowed to live sufficiently Digitized by Microsoft® SURGICAL TREATMENT 183 long after the operations—twenty-two and thirty days respectively—to prove the success of the undertaking. They were then chloroformed to death, and post-mortem examinations made of the carcasses. In each case the result of the autopsy was gratifying. The brown pony gelding (a) was slaughtered on the seventh day following the experiment. If I remember rightly, he showed somewhat peculiar symptoms shortly after the operation. It was difficult, in fact, to say whether he was suffering from an ordinary sporadic attack of pneumonia, or whether the pneumonia was of a septic nature, caused by absorption from the operation wounds. I think that I may say the result of the autopsy on the seventh day rather justified the assump- tion that the pneumonia was sporadic in its nature, and that the operation was not the cause of it. We have here three operations of a serious nature. The end result of one may be classified ‘ doubtful,’ with a leaning towards ‘favourable’; while the remaining two may be termed in the highest degree ‘successful.’ The surgeon has shown us that, so far as the operation itselt is concerned, we have nothing to dread. Can it be turned to practical account? One case only is on record of the operation being successfully performed for the removal of a calculus or obstruction that was actually giving rise to dangerous colic. This was by Felizet in 1849. The position of the calculus was the commencement of the small colon. Several other cases are on record where the same operation has been attempted, the animal, unfortunately, dying in each instance. It appears that in each case the failure of the operation was directly attributable to its having been too long delayed. Several years have now passed since Professor Mac- Digitized by Microsoft® 184 THE COMMON COLICS OF THE HORSE queen performed these experiments. Their practical utility can only be judged of by what has transpired. So far as I am able to trace, no successful removal of an obstruction with the complete recovery of the patient has since been placed on record. Either the present-day veterinary surgeon, in spite of Professor Macqueen’s able assurance of success, is not possessed of the bold- ness of the old-time Felizet, or he has deemed the operation not exactly ‘impossible,’ but ‘ inadvisable.’ I am loth to put the paucity of recorded cases down to apathy and want of boldness, and can only conclude that the veterinarian has not seen it practicable to put the operation into every-day use. The man who first diagnoses a suitable case, after- wards operates in good time, and is rewarded by the sub- sequent recovery of his patient, will have to be possessed of an amount of foresight and will-power far beyond the ordinary. In the first place, he will have to be able to decide quickly that the obstruction he is dealing with is not likely to surrender to milder measures—surely a difficult task. Again, he must be convinced that the percentage of deaths from obstruction of the single colon is heavy enough to warrant the operation being immediately advised in each and every case that is diagnosed. The equine patient does not live long enough with obstruction to allow of any delay, no matter how short. Untoward conditions in the bowel soon make their appearance, and place its wall in an unfit state for surgical interference. If the veterinarian waits until the symptoms frighten him into the operation, he has waited too long. Coupling this need for immediate decision with the fact that nearly all veterinary operations must be regulated by strictly economic principles, it is not surprising to learn that Digitized by Microsoft® SURGICAL TREATMENT 185 a major operation of this description—one for which a large fee must necessarily be demanded, and one which will make or mar a great deal of the operator’s reputation—is severely relegated to the background of ‘possible,’ but ‘inadvisable,’ remedial measures in cases of equine intestinal obstruction. To my own mind there is only one of the intestinal obstructions described in this volume that is at all likely to warrant this extreme step being taken: that is the obstruction occurring in the small colon. That con- clusion is fairly justified by the following considerations : 1. Professor Macqueen has covertly admitted that the small colon is the most suitable bowel to operate upon, its comparatively thick longitudinal band offering a suit- able position for the incision and the after-placing of the sutures. 2. In the present state of our knowledge, the diagnosis of these obstructions is not sufficiently clear to justify us in operating unless the obstruction has been positively telt pey vectum. I have already shown, in Chapters X. and XI., that an obstruction of this size felt per vectum is most likely to be in the small colon. 3. Should the obstruction be demonstrated to exist in the large colon, we have to face two serious factors largely operating against the chances of successful surgery: (a) The extreme likelihood of the obstruction being of so large a size as to necessitate a very large incision in the bowel wall. (6) The comparative thin- ness of the walls of this portion of the intestinal tract, which would render the placing of safe sutures a matter of considerable difficulty. When all is said, the veterinarian may remember this much with safety: Whatever may be his doubts con- cerning his diagnosis, whatever anyone else may urge to Digitized by Microsoft® 186 THE COMMON COLICS OF THE HORSE the contrary, he may be perfectly assured—thanks to Professor Macqueen—that the incising of the flank and opening of the bowel (laparo-enterotomy) is attended with no grave risk in the horse—that is, if conducted strictly under modern antiseptic precautions, and with a patient still free from symptoms of collapse. As illustrative of a suitable case for operative measures, I wouid refer the reader to a reported case of Mr. E. R. Harding, M.R.C.V.S., of Salisbury : ‘Peculiarly-shaped Large Calculus in the Small Colon of a Mare.—The mare was taken ill on a Sunday. An examination was made by Mr. Harding. The large bowels were found full of faeces, and the animal showing signs of colic. The pain was not acute, and the tem- perature very little disturbed. The animal was given 2 grains of eserine without its having the slightest effect on the colic or in producing defecation. Aloes was not given, but the case treated with stimulants. During the first four days she had intervals of pain, while at other times she was quiet. At no time was the pain acute. After Tuesday the animal appeared to have no pain whatever for a week, but she ate nothing, and there was no movement of the bowels. The only medicine admin- istered was stimulants,? and warm-water injections five or six times a day. This went on for eighteen days, when the mare died during the night. A post-mortem revealed a large calculus in the colon, and showed that the actual cause of death was ruptured colon, while an enormous mass of ingesta was found in the bowels. The calculus was 34 pounds in weight, and seemed composed princi- pally of fecal matter. The animal had been in the owner’s possession four or five years, and had not been ill. before.’ There are two things that appeal to one in the report of that case. The first is the marvellous manner in 1 Veterinary Record, vol. xiv., p. 682, 2 The italics are mine,x—H. C, R. Digitized by Microsoft® SURGICAL TREATMENT 187 which it points to the advantages of a solely stimulative treatment. It would be hard to imagine an animal with obstructive colic being dosed with sedatives and then lingering on in the same manner for so long a time as eighteen days. The fact of the matter is this: The Fic. 15,—CALCULUS OBSTRUCTING SMALL Coton (Mr. Harpina’s Case). general abandonment of sedatives in veterinary equine practice would undoubtedly lead to the better diagnosis of colic troubles. I feel that it has already increased my own powers in that respect, and what it will do for me it will do for others. Digitized by Microsoft® 188 THE COMMON COLICS Of THE HORSE Secondly, one is forcibly struck by the grand oppor- tunity this subject would have afforded for operative measures if only a successful diagnosis could have been made during life. I would fain hope that in this way the future success of laparo-enterotomy lies. It may be that a long series of colic cases treated without sedatives will eventually lead to a greater and more frequent exactness in the diagnosis of these obstructions; that being done, the operation will follow naturally. This cannot be expected until a solely stimulant treatment is adopted by a large number of veterinary surgeons, and the information derived from their cases carefully chronicled. Digitized by Microsoft® CHAPTER XV INTESTINAL TYMPANY: WIND COLIC, FLATULENT COLIC, HOVEN, TYMPANITES, ETC. Definition.—That condition produced by the evolution of gases in abnormal amount in some part of the intes- tinal canal, with consequent over-distension of the portion in which it occurs. In the horse the common seats of tympany are the stomach and the large colon. The former we have already disposed of in a previous chapter, and it now remains to give a fuller consideration to this particular condition when confined to the intestines. Causes.—These I have already enumerated at length in Chapter VII. On that account, no mention here beyond a brief summary is necessary. Dietetic errors again come to the front. Probably the most common cause of all is the gorging with young herbage when the animal is first turned out in the spring after a winter in the stable. Young growing corn, clover, vetches, and foods excessively mouldy may all be regarded as dangerous. One of the worst cases I have encountered myself was brought about by the owner feeding the animal on raw potatoes. The use of new oats, wheat, and steeped foods that have been allowed to go sour, is also a common cause of this condition. Reports of cases Digitized by Microsoft® 190 THE COMMON COLICS OF THE HORSE also show this disorder to sometimes be occasioned by animals eating large quantities of mangolds, swede, turnips, or other roots. Putting to work too soon after a heavy meal, or watering and feeding too freely when exhausted, are also likely factors in its causation. A dangerous form of this derangement is often met with by those who live in marshy districts. The coarse grasses and succulent forms of herbage that flourish down by the water’s edge appear peculiarly liable to bring on an attack. When half dried, these marshy grasses seem even more dangerous still, and many a case of severe intestinal tympany is directly traceable to a meal of what is commonly known as ‘ dykeings ’— heaps of partly-dried vegetation mown from close to the water-side during the process of cleaning the drain. Williams, in his description of this complaint, says: ‘ Tympanites may arise independently of any cognizable extrinsic cause. Occurring during the process of another disease, it is always to be looked upon as indicative of a very grave condition, that the animal powers are so exhausted as to be bordering upon dissolution, and becoming amenable to chemical laws. Tympanites also occurs in obstructions of the intestinal canal from calculi, tumours, or other mechanical causes, and generally indi- cates the approach of death.”? Symptoms.—The veriest tyro cannot fail to appreciate at their true value the indications of abdominal tympany: As might be expected, the most prominent symptom is a manifest drum-like enlargement of the belly. The skin and abdominal muscles become enormously tense, and resonance is obtainable on percussion. In addition 1 In the Fens ‘drain’ is simply another word for ‘dyke,’ or artificial water-course. In no way does it signify sewer.—H. C, R. 2 «Principles and Practice of Veterinary Medicine,’ p. 555. Digitized by Microsoft® INTESTINAL TYMPANY roi to this, all the usual symptoms of ‘colic’ are well in evidence. The animal walks round and round, paws alternately with the fore-feet, and makes frantic kicks at the belly with the hind. In a mild case the tympany is plainly most noticeable in the right flank. When, however, the abdominal enlargement is great, it is difficult indeed to fix it in any particular position. When distension is extreme, rolling is not freely indulged in, and the animal lies down only with great care. Other manifestations show the pain to be extreme. The breathing is tremendously accelerated, coming and going in short, fitful gusts, broken every now and again by a short-drawn sigh. The nostrils are dilated, the pulse small, weak, and greatly quickened, and the visible mucous membranes highly injected. The temperature is commonly raised about 2° F. The ears and extremities grow deathly cold. Patchy per- spirations cover the neck, the shoulders, and the flanks, and the whole condition indicates a case of the utmost gravity. It is plain to even the most ignorant that unless the animal be given speedy relief he will soon succumb. Even now the accumulated gases are pressing heavily on the diaphragm, and seriously impeding the acts of respiration. The consequent deoxygenated and gas-poisoned state of the blood renders the bodily tone bad indeed, and points to no sign of spontaneous recovery on the part of the animal economy itself. Diagnosis.—This is simple. The abdominal enlarge- ment and the evidence it yields on percussion sufficiently point out the nature and seat of the trouble. It must be remembered, however, that tympany, when restricted solely to the stomach, will also give rise to apparent intestinal distension—the abdomen in both cases is swollen. Nevertheless, its true nature is quickly ascer- Digitized by Microsoft® 192 THE COMMON COLICS OF THE HORSE tained. When the flatulence is confined to the intes- tine, there will, of course, be an entire absence of such symptoms as I have put down as diagnostic of gastric tympany. The regurgitations of the cesophagus, the attempts at vomition, the trickling ingesta from the nostrils, and the gurgling noises in the region of the trachea, are all wanting. Should there be doubt, which I do not for a moment think possible, a rectal examination will soon dispel it. Prognosis.— Unless it be a concomitant of some more serious condition, a favourable verdict may usually be indulged in—that is, if the case is seen early. It is well, however, to hold back one’s prognosis of these cases until the operation of puncturing the bowel has been performed and its results noticed. The extreme pain, the suffocating pressure of the distended intestines upon the diaphragm, and the semi-intoxication induced by the absorption of the gases, all tend to mask the significance of the pulse and othersymptoms. Once the greater part of this is relieved by the trocar, the veterinary attendant is ina far better position to give a correct forecast. If, after this operation is performed, the pulse still con- tinues a running-down character, and the symptoms of pain do not abate, the case is to be regarded as serious. Treatment.—Taking the remedial measures in the order of their importance, I think prior place should be given to surgical interference. Considering its value and comparative simplicity, it is surprising that the operation of puncturing the bowel—technically known as ‘ entero- centesis’—should have fallen into the desuetude it did. From almost the earliest times of which we have any record it has been recommended by first one writer and then the other. Vegetius, in the fourth century, advises Digitized by Microsoft® INTESTINAL TYMPANY 193 its adoption, giving minute instructions as to the seat of the operation—in this case, the linea alba, four fingers’ breadth behind the navel—and suggesting the instru- ments to be employed. Again, I find mention of it in an old volume I have before me as I write, written by one Leonard Mascall, in the time of good Queen Bess, ane published in 1600. These are the words: ‘For a horse that is swolne with much wind in his body. Some horse with eating certaine windy meate or such herbs, will be so swolne there with as though his belly wold burst, and then he will eat no meat, but stand and hang downe his head, ready to fall, and so die, if he have not speedie help. When ye shall see any horse so, the next remedy as I can learne, is: ye shall take a sharp- pointed knife, or bodkin, and arme it so with some stay, that it go not too deep, for piercing his guts. Then strike him therewith through the skin into the body, before the hollow place of his haunch bone, halfe a foote beneath the backe bone, and the winde will come out thereat. Then if ye put a hollow quill therein (or some feather to keep it open awhile), the winde will voyd the better and so heale againe . . . this hath bene prooved the best remedie to save your horse or ox.’ In 1656 mention is made of it by Markham, and in 1776 we find it practised for the relief of intestinal tympany by Roem of Dresden. The years 1781 and 1834 reveal the operation as still in existence. Coming to more modern times, we find it revived in this country by Stewart of Glasgow, in 1836, and meet with reports of successful cases in 1877 and 1879 by T. H. Merrick of Northampton; Alexander Harthill, Louis- ville, Kentucky; and the late Captain Russell of Grantham. As a matter of fact, I think I may say with safety that it is only quite within recent years that enterocentesis 13 Digitized by Microsoft® Lyd THE COMMON COLICS OF THE HORSE has received the amount of attention it merited, and been admitted into the ranks of useful, every-day operations. Even now I am afraid that there are not a few who look upon this simple means of affording relief with a certain amount of awe. Personally, I have been in the habit of using the trocar and cannula in these cases for several years. As a result, one untoward case has fallen to my lot. The animal afterwards developed unmistakable symptoms of peri- tonitis. Fortunately he recovered. In one way the case was a lesson to me. I had, in consequence of con- stantly employing it, grown to hold the operation in a certain amount of contempt, and must confess to having grown somewhat careless as to the matter of cleanliness. That case pointed out to me the absolute necessity for a scrupulous care of the trocar and cannula. It is not sufficient to have it apparently clean—it must be anti- septically spotless. No matter what care is taken of the instrument, a rather more common sequel to this operation than the above occurs in the appearance of a small abscess at the seat of puncture. Probably even the occasional appear- ance of this small trouble would also be done away with if the spot to be punctured were first rendered aseptic, in like manner to the instrument, a procedure that the exigencies of the case do not always allow of. With regard to the seat of operation, there isa general consensus of opinion favouring the right flank, at a point equidistant from the last rib, the anterior angle of the ilium, .and the transverse processes of the lumbar vertebra. Asa matter of fact, any position in the right or left flank that offers resonance on percussion may be tapped with benefit. Preference, however, should always be given to the right, as the mere fact of the colon and Digitized by Microsoft® INTESTINAL TYMPANY 195 ceecum being fixed there renders that position always the most likely to give certain results. Failing to obtain flatus on the right side, the left should next be tried. Unrewarded by a rush of air from one spot, it sometimes happens that a second puncture in the same region, only 1 or 2 inches removed from the seat of the first, is followed by a ready and voluminous outrush. That being so, when once the surgeon has diagnosed tympany, he should not desist from his attempt to give the gases outlet until he has punctured both the right and left flanks—if necessary, in more places than one. The trocar should be at least 6 to 8 inches in length, and the cannula vary from } to 3; inch in diameter. Considerable difference of opinion exists as to the portion of intestine punctured. I do not think there is much room for doubt. In the vast majority of cases it is certainly some portion of the large colon. As illustrating the relief afforded by puncturing the bowel, I give a digest of a case reported by Mr. T. H. Merrick, of Northampton :1 ‘On July ro, about noon, I was summoned to a cart mare. The messenger informed me that she was in great pain, and very much ‘“‘ blown.” I found her to be suffering from an acute attack of tympanites, the abdomen being greatly distended. The mare was first observed to be unwell in the morning about four o’clock, when the horsekeeper went to fetch her from the field. She was in so much pain that it was with difficulty that he got her home. On my arrival the mare’s pulse was very weak and indistinct, and numbered 80 per minute; the mucous membranes were much injected ; the surface of the body and extremities cold; quickened respiration, and great uneasiness. I administered the © Veterinary Journal, vol. v., p 316. 13—2 Digitized by Microsoft® 196 THE COMMON COLICS OF THE HORSE usual remedies, but failed to give her relief; indeed, she got rapidly worse, and became so distressed and helpless that I was afraid she would fall. I therefore determined on puncturing the intestine. The accumulated gas rapidly escaped, and the abdomen quickly subsided. The relief afforded in a few minutes was most satis- factory. All symptoms of pain immediately ceased. In the course of two hours the pulse became distinct, and the mare commenced to feed.’ The usual course in the development of the abscess following this operation is well described by the late Captain Russell, of Grantham.) He says: ‘On November 20 my attention was directed to the post horse at the George Hotel, upon which I had operated for tympany on October 26, as he had lately appeared stiff in his movements and out of sorts. On my seeing him and removing his clothing, I perceived a large swelling upon his flank, about where the first puncture of the trocar had been made. On examining this swelling, I fancied I could feel deep- seated fluctuation, and feeling sure I had an abscess to deal with, I ordered it to be well fomented for a day or two to endeavour to get it to point externally. On the 23rd, however, finding it made no progress externally, I examined it with an exploring needle, when at a depth of 2 inches I came upon pus. Having made a good opening, about a quart of creamy pus escaped. The case has gone on well, and the animal was discharged to-day, December 6, convalescent.’ Having removed the gases present in the bowel, we have two other matters to consider: Firstly, the preven- tion of the further evolution of gases; secondly, the removal of the cause. The first of these is to be brought about by introducing into the bowel some form of antiseptic, or rather anti- Veterinary Journal, vol. viii., p. 4. Digitized by Microsoft® INTESTINAL TYMPANY 197 zymotic, in order to prevent further fermentation. If the colon followed immediately upon the stomach, the treatment already recommended for gastric tympany would do equally well here. It must be remembered, however, that all remedies administered per orem will first have to pass through the small intestines before they can reach the seat of mischief, and that the presence of large quantities of food in the stomach and fore part of the intestines will proportionately nullify their action. It follows from this that administration of the anti- zymotics by the mouth is not the readiest route, and that their direct injection into that part of the intestine visibly affected would be far more likely to be followed by good results. This is the method of operating: The bowel is first punctured, in the region of the flank, with an ordinary trocar and cannula. After the escape of the gases, the antizymotic determined on is injected, by means of: Toope’s injection cannula, directly into the intestine. This generally proves effectual in staying the re-forming of gas, and the further treatment of the case will run on ordinary lines. Useful antizymotics for this purpose are carbolic acid, Jeyes’ fluid, boracic acid, hyposulphite of soda, turpen- tine, lysol, etc. Probably the most simple and effective of these is carbolic acid, and it may safely be injected in 1 to 6 or 8 drachm doses, when freely diluted with water. Four drachms to the pint wiil be found a serviceable solution. When used in stronger solutions, or injected cold, it is likely to set up a somewhat alarming attack of 1 This may also be quite easily done with an ordinary smail trocar and cannula, using a Higginson’s syringe, with milking syphon attached, to inject the fluid, Digitized by Microsoft® 198 THE COMMON COLICS OF THE HORSE shivering. Jven this, however, appears to quickly pass off, and leaves no after ill-effects. In addition to its property of staying fermentation, the carbolic acid acts somewhat as a local anesthetic, and, without exerting a general sedative action, serves to allay pain in that portion of bowel with which it comes in contact. Professor O, C. Bradley, while in charge of the New Veterinary College Infirmary, reports three cases in which this treatment was adopted. Two of these I give below : 1. ‘2 p.m.— Bay cart gelding admitted. Colicky symptoms, much tympany. fPunctured, and injected 4 drachms of carbolic acid in 1 pint of water. ‘3 p.m.—Much better. No recurrence of tympany, pulse 65. ‘4 p.m,—Still improving, colicky symptoms have dis- appeared, pulse and respiration normal; continued improving.’ 2. ‘6 am.—Black cart mare admitted. Great pain, very tympanitic; pulse weak, respiration much ac- celerated. Punctured, and injected 2 drachms of carbolic acid in solution. Morphine hypodermically. ‘6.30 a4.m.—Easier. Pulse 70. ‘8a.m.—Again tympanitic and very restless. Punctured again, and injected 3 drachms of carbolic acid in 1 pint of water. ‘9g am.—-Better. Pulse 60 and stronger, respirations slower. Has stopped walking about.’ The removal of the cause is clearly to be brought about by the administration of a purgative. The fer- mentation has evidently been occasioned by the ingestion of unsuitable, mouldy, or imperfectly masticated food. The sooner this gains exit from the body the better for our patient. Personally, I am not always disposed to wait for the action of an ordinary cathartic. Having dis- posed of the gases already present, and ascertained that Digitized by Microsoft® INTESTINAL TYMPANY 199 the patient’s condition will allow of it, I prefer to inject hypodermically 14 to 2 grains of eserine sulphate. The bowels soon respond, the offending materials are quickly voided, and the patient, after the lapse of an hour, is left free from the probability of another attack. Frequently this is all that is necessary, and the need for intra-intestinal injections of carbolic acid is thus done away with. Should the eserine fail to act, and the gases commence to reaccumulate, there is then time for the carbolic acid injection to be administered. From what I have written, I do not wish the reader to infer that I absolutely discountenance the administra- tion of remedies by the mouth in this form of colic. Sooner, I consider it better to ‘have two strings to one’s bow,’ and, even whilst adopting the lines I have recom- mended, to still continue administering the usual stimulants and antispasmodics in the form of balls or drenches. Again, however, this time in company with others, I place the most severe strictures upon the use of sedatives. The cause of the tympany is the presence of fermenting materials in the intestine. There is no just reason for iocking them there by the injudicious use of anodynes. The reverse is the case, and every medicine administered, save such as is purely antizymotic in its action, should be, in some form or cther, essentially stimulative. The use of enemas is again indicated, and the patient should be well rugged down in order to promote warmth. Treated on the above lines, ordinary cases of intestinal tympany will quickly respond, and offer no great amount of anxicty. Digitized by Microsoft® CHAPTER XVI ENTERITIS: INFLAMMATION OF THE BOWELS Definition.—Colic resulting from a morbid condition ot the intestinal coats, manifested by extreme and con- tinuous pain, and characterized by its rapid course and great fatality. Regarded in the light of a simple inflammation, the term ‘enteritis’ is evidently a misnomer, so far as our knowledge of equine cases leads us. The post-mortem examination of the intestines tends more to point to the fact of its being a general bacterial infection of the blood- stream, commencing from the intestines. What draws us to this conclusion? I can better lead up to it by quoting at length from a paper by Mr. Cun- ningham, of Slateford :1 ‘What is this inflammation,’ he asks—‘this hamor- rhagic inflammation of the bowels? A favourite cob has been working hard, hé is laid off lame, and your man is very kind to him, and at night you are suddenly sum- moned to find the cob that has carried you so long, and which you know has never had a touch of colic in his life, posting on in two short hours to its end. A farmer buys a horse, young and cheap, in poor condition ; 1 The Veterinarian, vol. lix., p. 45. Digitized by Microsoft® ENTERITIS 201 he is good to it; it does well and thrives, He is proud of his bargain, and suddenly on the road it takes ill, and in a couple of hours you tell him to prepare for the worst, for though his horse will live to the morning, it will cer- tainly die. A horse passes your place with his load at nine o’clock in the morning, goes three miles, is seized, returns, and by twelve o’clock lies a carcass in your box, after a few hours’ ceaseless agony. This is worse than cholera, What is this disease? You examine the carcass, and find the veins, superficial and deep, filled with black, fluid, tarry-looking blood; the abdomen quarter full of thin, watery, dark-purple, or rusty- coloured serum; the stomach and bowels with consider- able contents, but not more than many a healthy horse in full feeding. The mucous membrane of stomach congested, and its villous portion inflamed and ercded ; the secretions sour and acid, and their contents acrid and high-coloured, Rectum not much amiss, but the cecum and colon tell another tale. Purple-looking, black, and dirty-coloured inside, thickened and swollen to 4 inch or I inch in thickness, with’ contents partly solid and partly fluid and purple-coloured, we find in them the true seat of this hemorrhagic inflammation. ‘Take a piece of healthy large intestine, examine it carefully, and you find it is about } inch thick, the muscular and peritoneal coats are firmly attached and adherent to each other, while the internal mucous is loosely attached by cellular tissue to the muscular, with a considerable amount of fat interposed, forming a sort of cushion or bed, in which the lacteals and blood- vessels may lie and ramify. All the three coats are pale and destitute of high colouring. ‘Take an inflaméd piece of large intestine, dissect it carefully. You find } or 4 inch, or even 1 inch in Digitized by Microsoft® 202 THE COMMON COLICS OF THE HORSE thickness, firm and dense, and almost hard to the feel. The peritoneal and muscular coats still adhere closely, but they are thickened and swollen, and soaked with effusion. Still, they do not appear to be acutely or actively inflamed. The mucous coat is black or dark- purple coloured, the seat of the most intense and evidently acute (or it may be passive) inflammation, but still not much thickened; its inner lining is black and dirty-coloured, studded with minute openings, while the space between the mucous and muscular layers is filled and gorged and swelled with effusion, the chief cause by far of the increased thickness of the bowel, and the effusion is clear, not dark-coloured at all; while in the peritoneal folds, connecting the divisions of the gut, lymph, watery but clear and amber-coloured, as from a pleuro-pneumonia lung, may be found in abundance. ‘If this is simple acute inflammation, where in the animal economy have we another example of such rapid, fatal, and extraordinary results in the space of a few hours from simple, pure, acute inflammation, and nothing else ? ‘Is it due simply and solely to the presence and mechanical irritation produced by large quantities of indigested material in the organs? Then, surely, a horse with a 13-pound dust-ball, or one packed with fodder beside, should be its readiest victim. But we know that such is not the case. Is embolism the cause? I believe, in one or two instances, one might be justified in saying so. Isit anthrax? I do not think the lesions justify that conclusion. Is twist or displacement the key to the mystery? I believe in some this does supply the key, and that some of the so-called cases of inflamed bowels are simply cases of twist or displacement; but, on the other hand, of the many cases I have examined Digitized by Microsoft® ENTERITIS 203 after death, in only a few, comparatively, have I been able to trace any distinct twist, intussusception, or strangula- tion.’ Causes.—Seeing that nothing is clear, we can only reason by analogy. We know that in at least one other disease such appearances as are revealed in a post- mortem of a case of enteritis are certainly caused by a bacterial invasion of the intestinal bloodvessels. We also know that the symptoms closely correspond, that the pain is just as agonizing, and that the illness is just as fatally rapid. I am referring to anthrax. When, after the experience of such a case, one meets with another in which the onset is similar, the symptoms almost identical, the issue just as much a foregone con- clusion, and the post-mortem appearances hardly distinguishable, one may be excused for referring it to a similar cause. In the first case the cause has been carefully and indisputably shown to be anthrax.! In the second, the most painstaking search fails to reveal its presence. We know that the second case is not anthrax, for the methods that revealed it once should expose it a second time, and are therefore able to assume that its cause must be a rapid invasion of the lacteals and blood- stream by some germ or other as yet undemonstrated. Allowing this to be the fact, it does not, for a moment, detract much from what other writers have put down as the usual causes. Take, for instance, such commonly quoted causes as over-fatigue, cold from exposure, and washing the belly with very cold water when the animal 1 I am able to vouch for the truth of that statement from the experience of a case that occurred in my own practice. The animal died, showing every symptom of so-called enteritis. The case was diagnosed as such and treated as such. As a result of the post- mortem, I was able to definitely demonstrate the presence of the Bacillus anthracis in the blood.—H. C. R. Digitized by Microsoft® 204 THE COMMON COLICS OF THE HORSE is heated. It is conceivable that either of these factors would tend to lower the body vitality, and that any pre- disposition there may have been would be hurried into an attack by their aid, such predisposition being the presence of the necessary virus in the intestinal tract, and some condition of the bowel wall (irritation from calculi, impaction, etc.) favouring the entrance of the germ, At any rate, whatever may be the real explanation, it is simply madness for anyone to imagine that any such trivial cause as cold, over-fatigue, etc., is sufficient per se to bring on an attack. As Williams rightly enough puts it, ‘It is very true that impaction, constipation, intussus- ception, volvulus, the presence of calculi, or the action of irritant poisons, may cause great congestion and inflam- mation of the intestinal membranes; but the disease to be described originates sw generis, and very often without the occurrence of an immediate and recognisable cause of direct irritation.’ Although in practice we are somewhat inclined to hold out to our clients the possibility of a case of ‘colic’ terminating in enteritis, I should imagine that it is simply a case of ‘ digging a large enough hole toclamber out of’ should the animal unfortunately die. Ido not think that any one of us honestly believes it likely to happen in any great number of cases. We are far more likely to inwardly admit that the case we have misdiagnosed as ‘simple colic’ is, in reality, one of twist, intussuscep- tion, etc. That being so, and taking Williams’ statement, ‘that the disease originates sw generis,’ to mean that there is some specific cause, then there is no other solution that fairly satisfies the problem save the one I have suggested —that of bacterial infection, Digitized by Microsoft® ENTERITIS 205 Symptoms.— Unfortunately, these are too well known to need any lengthy description. ‘The history of the case invariably points to the attack having been ushered in with rigors. In the language of the stable, ‘the animal is taken with a shivering fit.’ The appetite fails, the breathing becomes quickened, and the bowels show signs of commencing irritability by frequently ridding them- selves of small quantities of feces. Following this, the symptoms of abdominal pain com- mence, and, gradually increasing in intensity, remain until near the end of the case. All indications of the most severe suffering are present. The animal strikes at the belly with his feet, casts anxious and dolorous looks towards the flanks, and commences alternately rolling and rising to his feet, and sometimes biting madly at his sides. The pulse is increased in number, hard, wiry, and quick, up to 120 beats a minute, and often scarcely to be felt, except at the radial. The belly is usually normal in size—no tympanites—and appears more or less tucked up, owing to the contraction of the abdominal muscles, while pressure on it, in some cases, appears to cause pain. Profuse perspirations bathe the body, and the ears and legs grow deadly cold. All the time the pain has been continuous. No moment’s remission from suffering has eased the agonized patient and relieved the veterinarian’s mind. No second af quiet has occurred to break the dread hurrying forward of the fatal symptoms. The animal gradually grows worse and worse, and every symptom here mentioned appears to become aggravated. The countenance becomes pinched and haggard in the extreme; the sweats become slowly colder, suggesting to the touch the nearness of dissolution, and causing the hand to be withdrawn with a shudder; the visible mucous Digitized by Microsoft® 206 THE COMMON COLICS OF THE HORSE membranes are an intense livid red; the nostrils are widely dilated, and the breath coming and going in short, painful sobs. The getting up and down has resolved itself into a ceaseless circular tramp around the box; the pulse has become more imperceptible still, but yet maintains its speedy beating, and the belly is growing tympanitic. Later still, all symptoms of pain quickly subside. The bowels, so lately the seat of the most agonizing spasms, have become gangrenous, and cansequently dead to feelings of pain. The animal then stands quiet, and will even drink and endeavour to feed. The owner is pleased, and anticipates recovery. Not so the veteri- narian. He knows too well that it is but the beginning of the end. The haggard expression of the face still remains; the pulse continues thready and imperceptible; the ex- tremities are even more cold than before; the mouth is cold, clammy, and fcetid, and the body is shaking with involuntary tremors. The eyes grow amaurotic; the lips hang pendulous; the legs are widely propped apart to keep the staggering, half-unconscious brute upon his feet, and a nervous, anxious whinny greets a passing equine friend. But a short time further sees the end. The stagger gives way to an aimless blunder forward; the limbs collapse, and the tortured animal sinks to expire in con- vulsions. What was, perchance, but six short hours before a handsome specimen of the equine race, with beauty, health, and strength depicted in each line of his glossy, well-kept body, now lies a dirt-besmeared, worth- less carcass. Diagnosis.—-Once seen, I do not think that enteritis is often likely to be misdiagnosed. As a boy, J Digitized by Microsoft® ENTERITIS 207 remember committing to memory a tabular arrangement of the differentiating features of enteritis and ordinary colic. I found it in one of those old-fashioned works that, in one volume, deal with the whole ‘art and practice of farriery,’ as necessary for ‘all those who have the government of cattle.’ Somewhat too precise and over- condensed it may appear to modern minds, and yet it is not without its merits. This is how it ran: Colic. Inflammation of the Bowels. 1, Sudden in its attack. 1. Gradual in its approach, with previous indications of fever. 2 Intervals of rest. 2. Constant pain. 3. Pulse only becomes frequent 3. Pulse continuously frequent in the paroxysms of pain. but small, and often scarcely In intervals of ease is normal to be felt. in number of beats, but evi- denily fuller. 4. Legs and ears of the natural 4. Legs and ears cold. temperature, 5. Relief obtained fromrubbing 5. Belly exceedingly tender and the belly. painful to the touch. 6. Relief obtained from motion. 6. Motion increasing pain. 7. Strength scarcely affected. 7. Rapid and great prostration. Really that table offers the major points to be con- sidered when forming an opinion. To it I would add that the circumstance of the conjunctiva being so highly injected, and the fact of the pulse, temperature, and respirations all three immediately participating in the un- favourable indications, are all manifestations of a highly dangerous condition. Almost all writers appear to agree in stating that the _belly is tender to the touch. Allowing that it is, it is always difficult to judge, for one never knows how much ‘of the flinching and resentment should be put down to restiveness, Digitized by Microsoft® 208 THE COMMON COLICS OF THE HORSE After all is said, Percivall’s summing up remains as good now as on the day on which it was written: ‘The surest diagnosis between colic and enteritis,’ he says, ‘is to be found in the history of the case—in particular, in the manner of the attack, in the intermissions, in the state of the pulse, and in the progress of the case.’ Prognosis.—Once certainly diagnosed, enteritis offers but little hope of recovery. It is so commonly fatal as to warrant an unfavourable opinion being expressed in every case. In ordinary cases of colic, as, for example, impaction, irritation by calculi, diarrhoea, etc., there is no doubt that we often get a condition that properly comes under the term we are now in all probability misusing. ... We get a limited enteritis. ... The occasional slight rise of temperature in these cases is sufficient to point that out. Such of these cases as yield to remedial measures may be rightly classed as recoveries from enteritis. The name ‘enteritis,’ as signifying the disease I have been describing, has become such a well-known part and parcel of veterinary nomenclature that I have not dared to head this chapter by any other term. Had not such been the case, I should have suggested for this disorder some such appellation as ‘intestinal septic infection,’ ‘intestinal septiceemia’—%in short, any other suitable name that would have left the word ‘enteritis’ to be properly applied to those conditions it more fitly describes. That the disorder we have described 7s an enteritis, or inflammatory condition of the bowels, I do not attempt to deny. I simply maintain that its manifestations are so peculiar to itself as to point to a specific cause—that it is a disease by itself—and ought, therefore, to be given such a name as would definitely distinguish it from those comparatively minor Digitized by Microsoft® ENTERITIS 209 complaints covered by such an all-embracing term as ‘enteritis.’ The statement with which I have headed this section would then need qualification. Recovery from the limited enteritis attending other and less dangerous forms of colic is not only possible, but a matter of every-day occurrence. On the other hand, resolution in a case of ‘intestinal septicaemia,’ if I may, for a moment, be allowed to so call enteritis, will occur with about the same frequency as recoveries from the intestinal forms of anthrax. Knowing that, the practitioner will appreciate my statement, ‘enteritis offers but little hope of recovery,’ at its true value. Treatment.—I must confess myself to looking upon this as hopeless. Once established, I do not think that enteritis—at any rate the enteritis I have described—is in the slightest degree affected by anything we may pour into the animal’s body. Though not affecting the issue of the case, humanity points to a manifest duty. It should be our care to render, if possible, any aid that will mitigate the animal’s sufferings. To that end, the most potent anodynes and sedatives should be employed. Even should we succeed in inducing a state of delirious drunkenness, that is manifestly better than allowing the patient to succumb in agonizing tortures. Should the practitioner deem this advice too dogmatic, and conscientiously feel that other remedial measures should be attempted, he will find plenty to his hand in other and well-known volumes. Personally, I do not think that our knowledge of the etiology of this disorder justifies us in thrusting upon the already tortured animal drugs the action of which, in this particular instance, must be highly problematical. This is one case in which Iq Digitized by Microsoft® 210 THE COMMON COLICS OF THE HORSE we may safely take the advice of a cynic, whose name | do not remember, and ‘refrain from pouring medicines of which we know little into a body of which we know less.’ Rather should the attention of those among us who bave a natural liking for investigation be strenuously devoted to searching for a well-defined and certain cause. We may then be better directed towards devising a suit- able treatment. All this indicates most strongly that the practitioner of veterinary medicine should be quite certain of his diagnosis before he commences the merciful administration of anodynes. In spite of the most careful reasoning, and in spite of the most painstaking examination and observation, cases of colic occasionally crop up in which the symptoms are, for a time, dangerously alarming. Enteritis immediately suggests itself to the practitioner’s mind, and he com- mences the exhibition of sedatives. Before he does that, I would earnestly advise him to wait until his somewhat tentative opinion has become an absolute conviction. If he has not the courage to commence a stimulative treatment at the outset, at any rate let him adopt harmless expectant measures. Should the case turn out to be enteritis, he may confidently assure himself that anything he might have done would have been useless. On the other hand, should the alarming symptoms begin to abate, and the matter resolve itself into some more simple form of colic, he will then have the advantage of being able to push stimulative measures on a system that has not been previously placed outside the pale of hope by the undue administration of sedatives. He will find the average of his cases of so-called enteritis considerably diminish in the course of a twelvemonth’s reckoning, and, greater boon still, he will find his powers Digitized by Microsoft® ENTERITIS 2u1 of diagnosis in colic enormously on the increase. That, at any rate, has been my own experience. To my mind, it is largely this dread of enteritis, and the idea the practitioner has that he may be able to ward it off by the use of sedatives, that has tended to paralyze any forward movement towards the better differentiation and diagnosis of cases of veterinary colic. 14—2 Digitized by Microsoft® CHAPTER XVII SUPERPURGATION Definition.—That form of colic induced ty the in- ordinate action of a purgative. Referring to Chapter I., and consulting Professor Friedberger’s table, we find that this particular form of colic would come under the heading ‘ symptomatic,’ and that further classification would lead us to the fact that it is colic resulting from the administration of a poison... . We must either dub aloes ‘a poison,’ or inform Professor Friedberger that his table is incomplete, and that he has made no mention of a form of colic resulting from the administration of a harmless drug. For my own part, so far as the horse is concerned, I regard aloes as a poison. The astounding fact to me is that it has not been so called before. Williams, in his ‘ Principles and Practice of Veterinary Medicine,’ devotes a chapter to the consideration of this condition, admitting that it is of frequent occurrence, and yet not advising the more restrained use of aloes. Surely it is an astonishing thing that a drug which will commonly give rise to such dangerous symptoms as to call for a separate chapter concerning its antidotes should not be regarded as highly dangerous. Why is it that other drugs have not elevated other conditions to a Digitized by Microsoft® SUPERPURGATION 213 position of the same fatal prominence? Why is it that aloes, above all other drugs, should be singled out in this manner? Simply because it is dangerous ! If a new drug were introduced to-morrow, with only one-half of the possibilities of danger already inherent in aloes, its use would be indignantly scouted by more than two-thirds of the veterinary profession. And yet, I venture to say, there are but a very few who would dare to assail aloes in the same manner. Regarding the medico-legal questions involved in its use, Williams says: ‘The occurrence of superpurgation after the ad- ministration of a simple and moderate carthartic by the veterinarian is one of great importance. In no case where due caution has been taken, where the dose has not been more than the necessities of the case required, . . . should the veterinarian be made re- sponsible.’ Personally, I should consider a man deserving of any trouble that might accrue therefrom who systematically uses aloes in his practice without urgent calls for its administration. Physicing after grass, to get into con- dition, to remove a tendency to swelled legs, . . . all these I look upon as foolish and useless fads—practices which the intelligent veterinarian will endeavour to root out from those of his clients who are amenable to reason. Causes.—Although giving aloes the foremost position among the causative factors of this dangerous condition, it must not be forgotten that other and more simple purgatives will bring about a like result if improperly administered, or if due care is not afterwards taken of the patient. In a case of pneumonia, for instance, 4 pint of some Digitized by Microsoft® 24 THE COMMON COLICS OF THE HORSE simple bland oil—e.g., that of linseed—will be quite sufficient to cause it. Or, again, if the animal is put to work during the operation of even a simple cathartic, or is exercised too soon after its ‘setting,’ the same dire results are likely to follow. This only shows the extreme susceptibility of the horse _to the action of purgatives, and, if anything, serves to still further discountenance the common use of such a drastic purge as aloes. Symptoms.—Should the purgative act in an easy manner, but little disturbance of the system will be noticed. The pulse becomes a little weaker, less full, and its frequency increased. When the purging is about to commence the coat will be staring, and occasional tremors present themselves. The animal at this stage is nauseated, appears restless, refuses his food, and shows a slight increase in the number of respirations, Following this comes the increased action of the bowels and the evacuation of their contents. If every- thing goes well, a few hours will see a gradual return to the normal, The breathing becomes more tranquil, the pulse grows fuller and more quiet, and the appetite again returns. Should the dose have been unsuited to the patient, however, or should some adverse circumstance have been in operation, the symptoms rapidly grow more alarming. For example, if there has been any previous slight symptom of fever, if the animal is allowed to drink large quantities of cold water, or if he be exercised or over-excited in any way, an excessive action of the drug may assuredly be expected. It is not always, however, that a large dose of aloes is needed to bring this about. It is not always that any other adverse circumstance need be in simultaneous Digitized by Microsoft® SUPERPURGATION 215 operation to bring about a fatal result. It is in these last two facts that the danger of using aloes exists. Every veterinary surgeon, I might say without excep- tion, is aware of them, and he still persists in an indis- criminate use of the drug. Williams himself says: ‘Superpurgation does net always depend upon the strength of the dose. In some instances as little as 4 drachms have been followed by fatal consequences. Again, horses in an obese con- dition ... are easily acted upon by purgative medicines, and are apt to sink from superpurgation.’ Be that as it may, whether a large dose is necessary or not, or whether any predisposing circumstance at all is needed, it still remains that often the purge does not cease, but gives rise to the following and more aggravated symptoms : The appetite fails to return; the discharge becomes more fluid, more frequent, and extremely offensive, and the mucous membranes become injected. The mouth is dry, furred, and fcetid, and the respirations hurried. After each evacuation the animal shows evident colic pains, manifesting them by crouching movements, and occasionally lying down. Usually, however, he stands quiet, and only exhibits his pain by wandering round the box or pawing with one foot on the ground. The pulse has become thready, weak, and quick, and prostration becomes alarmingly evident. ‘The extremities turn cold, and the belly appears abnormally tucked up—in some cases tympanitic. Everything points to a speedy collapse. The practitioner is only too painfully aware of the danger of his case, and understands full well that the most prompt and energetic measures are necessary to combat the condition. Diagnosis.—The history of the case and the evidence Digitized by Microsoft® 216 THE COMMON COLICS OF THE HORSE of one’s own senses leads one quickly enough to the truth. More than that need not be said. Prognosis.—To a great extent this must always be guarded. Even should the pulse and other symptoms point to nothing really alarming, the practitioner. must always bear in mind the only too probable sequels of this condition. Many cases, unfortunately, end with some such serious trouble as pneumonia; others in a long and severe attack of laminitis, leaving the animal a useless cripple. Taking these as only of occasional occurrence, no one will attempt to deny the susceptibility of the horse to enteritis, That alone should lead us to endeavour to explain to the owner the risk the animal is running, and prepare his mind for the probability of the patient rapidly sinking under an exhaustive inflammation of the bowels. Treatment.—Called in at the commencement of doubtful symptoms, the best and most simple treatment is a dose of chloral. RB. Chloralhydratis - + «© © «© ©» Bi, Aq.fervens - - + + « «+ «© ad&x, Misce; fiat laust. Sig.: To be given in a pint of thick, cold gruel. It is unusual, however, for the veterinary surgeon to be summoned early. He is not called in until the symptoms have become really dangerous. He finds his patient with quick and feeble pulse, abdomen drawn up, and extremities cold. Again I advise the administration of the chloral, this time accompanied with a hypodermic injection of from 3 to 5 grains of acetate of morphia. This will tend to allay the irritability in the intestines, and induce a com- fortable sleep. At the same time the animal should be well rugged down and kept perfectly quiet. Digitized by Microsoft® SUPERPURGATION 217 _ If the flagging system appears to demand it, a stiff dose of some diffusible stimulant will be found beneficial. Ten to fifteen ounces of good brandy, or a suitable dose of spirits of nitrous ether, methylated ether, or the aromatic spirits of ammonia, will do all that is needed. The combined effects of the purging and the taking of the sedatives will sooner or later cause an intense desire for drink. Advantage should be taken of the animal’s thirst to induce him to swallow small quantities of wheaten-flour gruel or other emollient drink. This I have always found better to give cold, for oftentimes the drinking of only a few mouthfuls of something cool and refreshing will tempt the animal to pick a little solid food —a few handfuls of hay or a small quantity of corn. This will go far to bring the stomach and intestines to their normal tone, and stay the purging. Some practitioners pin their faith to opium. Unless the case is one of great urgency, I do not recommend it. Following its administration we are often immediately jumped from the extreme of violent purging to the height of absolute stasis and tympany. It is hard indeed to say which is the worse condition of the two. In conclusion, I feel it necessary to remind the reader that this chapter has not pretended to treat of acute diarrhoea arising from other causes, as, ¢.g., the ingestion of irritating or fermenting foods. In those cases the extreme sedative treatment I have recommended is not to be advised. Theaction of the bowels should not, then, be checked too rapidly. Rather, if the patient’s strength will admit, should they be aided in ridding themselves of the offending materials. No fixed rules for the treatment of ordinary purging can be laid down with any safety—so much must be left to the good sense and judgment of the medical Digitized by Microsoft® 218 TITE COMMON COLICS OF THE HORSE attendant; so much will depend upon thé history of individual cases, and the patient’s idiosyncrasies. As old Francis Clater clearly enough puts it, ‘Nothing so much distinguishes the man of good sense from the mere blunderer as the treatment of purging.’ There is no reliable ‘rule of thumb’ method in medicine. Lach case must be treated upon its own merits. Digitized by Microsoft® CHAPTER XVIII SUBACUTE OBSTRUCTION OF THE CA:CUM" Definition.—The collecting in the cecum of ingesta, abnormaily dry in consistence, together with obstinate atony of the czcal walls. While giving this definition, a few words on the history of this condition will not be out of place. Although for many years it appears to have been recognized by Continental authors and practitioners, it is only so recently as 1912 that English veterinary surgeons began to de- scribe it as a separate entity. If we may judge from the scarcity of literature refer- ring to it, then czcal impaction is far from being of common occurrence. On the other hand, it is just possible, owing to its having been so meagrely described, that it may occur with greater frequency than we are as yet aware of, and then be simply overlooked, not only evading diagnosis during the life of the patient, but also escaping notice at the autopsy. 1 As our knowledge of this condition is still so plainly in a state of flux I have deemed it wise, for the present at any rate, not tod interfere with the existing arrangement of this book by inserting this matter before the chapters dealing with the more commonly recognized conditions. The same remark also applies to the following chapters on Displacements of the Double Colon.— LC. R. 219 Digitized by Microsoft® 220 THE COMMON COLICS OF THE HORSE This latter view, I think, is the correct one. I am inclined to that belief by reason of the way in which my own knowledge of the condition came to me, Although I knew that the condition had been men- tioned, I had not myself, when publishing the first edition of this little book in 1902, ever met with a case —that is, to recognize it as such. Consequently, when dealing with subacute obstruction of the intestines, I was only able to refer to the affection briefly, and as follows : ‘The present chapter, then, is given over to a descrip- tion of all obstructions of a subacute type that occur in any position in the large or double colon, with which, until differential means of diagnosis present themselves, I include typhlitic or caecal impaction.’ These words, as a matter of fact, still stand on page 81 of the present edition. Now, however, that is all changed. If means of dif- ferential diagnosis do not present themselves with the exactness we might wish, it is at any rate quite certain that we are able fully to recognize the condition at post- mortem, especially when what we see then is read in the light afforded by the course the case has run. It is further certain that these cases run a course which, with what we now know about them, should be recog- nized during the period of the animal’s suffering. In other words, some measure of differential diagnosis is now possible, and the condition of cacal impaction must in future be described as another and distinct form of intestinal obstruction. So far as Iam able to judge, we are indebted for the furtherance of our knowledge in this respect to Professor Gofton of the Royal Dick Veterinary College of Edin- burgh. In a paper submitted at the meeting of the Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE C/ECUM 221 Scottish Metropolitan Veterinary Association, on May 4, 1g12, and published in the Veterinary Record of May 11, he deals quite fully with the condition, and in a manner which leaves no doubt at all that we have now added to the subacute obstructions of the intestines of the horse a further affection which calls for our serious considera- tion, particularly in those cases which run an extremely protracted course. With all modesty the author of that paper says: ‘It is not suggested that the condition described is new.’ Nevertheless, I would like here to assure Professor Gofton that, so far as English-reading veterinarians are concerned, it is not only new, but illuminating, by reason of the minuteness with which he describes it, and the means of differential diagnosis his particularly clear account seems to now render possible. Speaking for myself, I should like to say I should hardly have recognized this condition without the valu- able pointers furnished by Professor Gofton’s paper. They are far clearer than any others that I have been able to refer to; and, in adding a little to what he has written, I hope that this further beating of the subject may lead others also to recognize a case when they meet with it, and then to add their experiences, Causes.—At present these are obscure, but there is every possibility of further recognition of these cases clearing matters up somewhat. Professor Gofton has been good enough to furnish me with his views relating to the causative factors as applying to his own four cases. He says: ‘I attributed my cases of czcal impaction to one of two causes, but I am not able to assess the relative importance of each, nor to say how far they acted jointly. Colic cases were of great frequency in this particular stable, and they all ceased suddenly, their Digitized by Microsoft® 222 THE COMMON COLICS OF THE HORSE cessation coinciding with the simultaneous removal of what I regarded as the causal factors in operation. ‘The first was the system of watering. All the horses were watered when they returned from work at night, and before feeding. From then until they turned out to work on the following morning, they had no chance of a drink of any kind. This was altered by giving the horses the offer of a drink after feeding at night, and before feeding in the morning, in addition to the existing arrangements. ‘Secondly, molassine meal was mixed with the food when prepared. Food sufficient to serve three to seven days was prepared at one time. I think the damp molas- sine lying in the dry feed for three to seven days injuriousl y affected it. This was altered by feeding the molassine with each meal instead of mixing it and allowing it to lie for days with the dry food.’ Here, it seems, we have two definite charges laid— one against the system of watering, the other against the manner of preparation of the food. With the alteration of both of these the colic cases in this stable ceased. Now, we cannot lay the blame definitely to either the one or the other of these two likely causes. We can, however, consider the build and function of the organs concerned, and afterwards comment. In order to do this adequately I have obtained the kind permission of Major-General F. Smith to quote freely from his ‘Manual of Physiology.’ The next few paragraphs, therefore, together with the original illus- trations, are taken bodily from that work. In connection with the condition we are now discussing they should be read most carefully, for they serve in large measure to explain what we now know of the history of these cases of czecal impaction, Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE C/ECUM 223 “The Ccum has been described by Ellenberger as a second stomach. Its enormous capacity and fantastic shape have always rendered it an intestine of considerable interest (Fig. 16). To our mind, its most remarkable feature is that it is a bag, the openings into and out of which are boti found at the upper part close together. The exit, strange to say, is above the inlet, and the contents have to work against gravity in order to obtain an entry into the next intestine, the double Fic. 16.—Ccum oF THE Horse, 1N PosITION, ITS INNER FACE BEING SEEN, 1, The first (or double) coion; 2, the ileum, (Smith’s ‘Veterinary Physiology.’) colon. This is brought about by the four muscular bands on the cecum (Fig. 17), which shorten the bowel, forcing the contents upwards towards the ‘crook.’ The ileum being closed, the only available outlet is into the colon (Fig. 18). ‘Several questions suggest themselves regarding the com- munication between the large and small intestines. It is certain that, in order to get from the ileum into the colon, everything must pass into, or at any rate through, the caecum, yet we feel sure that material does not remain there long. Is Digitized by Microsoft® 224 THE COMMON COLICS OF THE HORSE it possible that the openings of the ileum and colon might be brought together so that material may pass directly from one into the other? Nothing is returned into the ileum from the czcum. There must be, in consequence, a sphincter keeping the ileum closed, for when the cacum contracts, material must cross the opening of the ileum in order to reach the colon (Fig. 18). This sphincter is furnished by the thickened condition of the wall of the ileum. We see no difficulty in Fic. 17.—ScHEMATIC ARRANGEMENT OF THE LONGITUDINAL Muscutar BANDs OF THE CCUM. Bands 1 and 2 are one, and form a complete sling for the bowel; band 4 runs from the cecum to the pelvic flexure of the colon. It is a remarkable band, and doubtless intimately connected with the mechanism which brings about the passage of material from cecum to colon. (Smith's ‘ Veterinary Physiology.’) believing that the rigid end of this tube may pass its contents practically direct into the colon, and the slightly funnel- shaped arrangement of the latter would readily admit the rigid nozzle of the ileum. ‘The contents of the czcum are always fluid, sometimes quite watery, occasionally of the colour and consistence of pea-soup, in which condition they are full of gas-bubbles, When watery, the fluid is generally brownish in colour, with particles of ingesta floating about in it. The reaction of the Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE C.ECUM 225 contents is-always alkaline. All observers are agreed on this point.! ‘The cecum is most admirably arranged as a receptacle for fluids, and though absorption undoubtedly occurs from it, and digestion of cellulose takes place in it, yet we believe its chief function is the storing up of water for the wants of the body and the digestive requirements, as it is absolutely certain Fic, 18.—THE OPENING OF THE ILEUM AND COLON IN THE C&cuUM. 1, The ileum; 2, the colon. In the figure the openings are repre- sented close together, but even when stretched apart they are less than 4 inches distant. (Smith’s ‘ Veterinary Physiology.’) that digestion in the horse can only be properly carried out when the contents are kept in a fairly fluid condition. We do not say that the caecum produces no digestive changes in the food, for we have stated that the contents are occasionally of the consistence of pea-soup, but we consider its digestive function subordinate to its water-holding one. Ellenberger 1 The writer only once found the cecum acid. 15 Digitized by Microsoft® 226 THE COMMON COLICS OF THE HORSE views the cecum as a bowel for the digestion of cellulosc, where by churning, maceration, and decomposition, this substance is dissolved and rendered fit for absorption, and he likens it to the stomach of ruminants and the crop of birds. He further considers that the caecum exists owing to the small size of the stomach and the rapidity with which the contents are sent along the small intestines. His experiments demon- strated that the entire “feed” reaches the caecum between twelve and twenty-four hours after entering the stomach, that it remains there twenty-four hours, and during that time ro to 30 per cent. of the cellulose disappears, ‘The digestion of cellulose is no doubt a very important matter, especially as we know that the poorer the food the more cellulose digested ; but we are not prepared to admit that food necessarily remains in the caecum twenty-four hours, and we believe that cellulose digestion occurs principally, though not entirely, in the colon, and, further, that it is not absolutely necessary for the material to remain in the cecum, but that it may pass on at once to the colon. The writer’s experiments on digestion have shown that ingesta may reach the czecum three to four hours after entering the mouth, and we are quite clear on the point that oats may travel some con- siderable distance along the colon in four hours from the time of being consumed, though this is regarded as exceptionally rapid. For example, a horse which had never had maize and had not tasted oats for two or three years, was fed first with 2% pounds of maize, and seventeen hours later with 4 pounds of oats. The animal was destroyed four hours from the time of commencing to eat the oats. Much maize and a few oats were found in the pelvic flexure of the colon, and a certain proportion of maize and a quantity of oats in the stomach. In twenty-one hours the small ration of 2} pounds of maize was distributed between the stomach and pelvic flexure of the colon, which is a very large area, In four hours the oats reached the same point in the bowel that the maize had arrived at. This is exceptionally rapid, but this experiment supports two points it is desired to emphasize—viz., the difficulty in getting the stomach to empty itself completely, and the rapid transit of material through the small intestines.’ Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE C/ECUM 227 Summarizing what we have learned from the fore- going paragraphs, we arrive at the following: 1. The chief function of the cecum is that it acts as a receptacle for fluids, storing up water for the wants of the body, and for digestive requirements. 2. The contents of the cecum are always fluid, some- times even watery, and never (normally) thicker than the consistence of pea-soup. 3. The cecum is a closed bag with the openings into and out of it so situated that the exit is above the inlet, and therefore necessitating the contents working against gravity to obtain entry into the colon. 4. It is certain that in order to get from the ileum into the colon everything must pass into, or at any rate through, the caecum, and yet we are assured that material does not remain there long. 5. Under normal conditions it appears quite possible that the rigid nozzle-like termination of the ileum approxi- mates itself to the funnel-shaped opening of the colon; that, therefore, the bulk of the ingesta may be passed directly from the ileum into the colon without ay entering the cecum at all. The above, I think, goes to show that this aieher does not believe that the whole of the food taken into the stomach must necessarily enter the cecum. He admits that some passes in, for it can be found, but suggests that the contents of the small intestine may be passed directly into the colon without entering the cecum, by means of the existing tap and funnel arrangement. This is entirely opposed to Ellenberger when he says that the entire feed reaches the cecum twelve to twenty-four hours after entering the stomach, and that it remains in the cecum for twenty-four hours. If the statement of Ellenberger is correct, then it does Digitized by Microsoft® 228 THE COMMON COLICS OF THE HORSE not at all fit in with the fact as observed at post-mortems, that the czecal contents are nearly always watery, and in any case never thicker than pea-soup. Moreover, if Ellenberger’s facts are correct, we should certainly expect an impacted czecum to be a far more frequent occurrence than apparently it is. If we accept Smith’s view, that the food need not necessarily enter the cecum, but may be, and perhaps commonly is, passed directly from the ileum into the colon, or if we assume for ourselves that it is passed into the czecum but is again just as regularly passed out, then it appears to me we Shall come to some understanding of cecal impaction as an infrequent but a serious abnor- mality in cases of colic. For instance, taking the view that the colon is the main receptacle for the voluminous feeds taken into the body, and assuming we have a case of subacute impaction of that viscus due toa semiparalytic condition of its walls, we begin to look back and imagine what effect such a state of affairs will have on the caecum and its functions. With the colon thus gradually filling, a stage must be reached in which no further food can enter. If food is still taken (and until actual colic pains manifest them- selves, no doubt it occasionally is), then if the food were passing through the caecum on its way to the colon a case of caecal impaction would result every time. Seeing that, as far as we yet know, cecal impaction is fatal, and of rare occurrence, then it would appear such is not the usual road of the ingesta. Taking the same set of circumstances again, but this time accepting the view that the food is passed direct from the ileum into the colon, we shall now expect to get, following the impaction, simply a condition of stasis in the ileum, and a feeling of inordinate fulness of the Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE CCUM 229 stomach which will effectually prevent the animal from taking further food; for cases of impaction of the colon sufficiently serious to thus ‘dam back’ the food are of nearly everyday occurrence. With the removal of the impaction in the colon, then, we simply get a resumption of the action of the ileum again pouring in food, the caecum all this time having been left entirely out of the equation. This it appears on the face of it is a quite reasonable explanation of what occurs in the ordinary case of im- paction of the colon, and accounts for the comparative rarity of czecal impaction. To then account for such cases of cecal impaction as do occur we should have to fall back on the not unreason- able assumption that, under the paralyzing influences exerted on the intestinal tract generally, owing to a large portion of it—the colon, to wit—being seriously impacted, the nervous mechanism controlling the apposition of the nozzle of the ileum with the funnel-shaped opening of the colon is totally inhibited. In such a case it would be easily conceivable that for a time it might blindly pour the food entering from the stomach into an entirely un- wonted direction—namely, into the czecum. In what way might the system of watering interfere with the normal functions of the cecum? Take Pro- fessor Gofton’s cases. Here the animals were allowed one long drink when coming off work in the evening. Nothing more until next morning. Would the cecum once filled in this manner hold sufficient water for the needs of digestion, etc.? We might answer, ‘ Most likely not.’ In that case such water as is necessary for diges- tion would, long before the next supply was allowed, be directed as required to the colon, even to the entire emptying of the caecum. Digitized by Microsoft® 230 THE COMMON COLICS OF THE HORSE In such circumstances it would not be difficult to understand that the nervous mechanism of the ileum might again be interfered with, and this organ again wrongly direct the food. Or, if not that, then that such portions of food as are passed along through the czecum, by reason of its excessive dryness due to the lack of the normal moisture of the parts, would again fail to pass along to the colon, and instead be tempted to stay and accumulate in the cecum. That much of this is theorizing pure and simple I am well aware. Still, the whole thing is intensely interesting, and bristles with problems that require yet a lot of elucidating. It is just as well, therefore, to sometimes give to matters such as these that amount of thought which, although it may afterwards be proved to have been wrongly directed, still helps to clear the air. If it only serves the purpose of inducing others to bring for- ward theories which may prove tenable, then it is not wasted. ; While, then, we conclude this section by again stating that the causes of cecal impaction are obscure, we still hope we have indicated that there is no reason they should not eventually be cleared up. Symptoms.—Before the exhibition of pain there is one symptom which, so far as we are able at present to judge, should be of value in assisting the veterinarian in the later stages of the case to determine accurately the case’s true nature. Professor Gofton draws attention to it as follows : ‘During the twenty-four hours immediately preceding the appearance of the symptoms of colic, the animals had a mild attack of diarrhoea at work, from which spon- taneous recovery had taken place, and after which there had been normal action of the bowels.’ Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE C©£CUM 231 This observation I have since been able myself to endorse. In the case which came under my own notice, although there was not an actual purge, the motions were abnormally ‘sloppy.’ Afterwards come the symptoms of colic and the com- mencement of the pains. These pains are not at all alarming. On the contrary, they consist entirely of those that every veterinary surgeon terms ‘dull.’ At no time, not even for a few moments, is there any mani- festation of pain that is acute. Not only are the pains of so slight a character as to lead the owner to treat the case lightly, and to neglect sending for skilled advice at the outset, but they are so excessively ‘dull’ as to lull the veterinarian himself into a state of false security. On the occasion of his first few visits he quite thinks he has an ordinary case of obstruc- tion of the colon—and the colon only—to deal with, a case that should readily yield to treatment. In spite of his treatment, he finds, to his gradually growing wonder, that the case does not alter. The animal still lingers, and the pains, still dull, continue. This very excessive dulness may eventually prove to be a point of diagnostic importance. But of that more later. All, then, that we can say is that the patient is just dull and listless. There is no desire for food, but water is not wholly refused. The pulse and respirations are little if at all altered; and the important point is that, although the patient lingers eight, nine, or ten days, or even longer, they show no alteration during the run of the case. Only for a few hours do they show sign of disturbance. That is just prior to the death of the patient, and the indications then are such as to point plainly to rupture of the intestines. Digitized by Microsoft® 232 THE COMMON COLICS OF THE HORSE At such times as the animal is on his feet there are slight pawing movements with the fore-feet, but no marked inclination to walk round the box. When down, and the animal is down for the greater part of the time, there is no wish to roll. Simply an easy, stretched-out position is maintained, with occasional lifts of the head into the flank. Assuming the case has now lasted a couple of days, we may take it that the veterinary attendant has ex- hibited a dose of aloes or other purgative. To treat- ment we have said the case does not respond. A point of importance, however, is that a response of a sort is obtained. To the aloes we get a reaction of the bowels. Not to the extent, certainly, that is seen in the average case of obstruction, but still a reaction. When more of these cases come to be reported, this again may prove another aid to diagnosis. As matters at present stand, however, it simply gives another portion of a puzzle to fit into place. The veterinary surgeon knows that aloes is at times uncertain in its action, that in some few instances in fact it does not act on the bowel at all, but is excreted wholly by the kidneys. Hesees the partial purge, deems it at any rate sufficient to put his patient on the right road, and, in his mind, sees his case well on the way to recovery. Again, to his astonishment, the pains continue. If he has not already done so, he now explores the rectum, This, so far as I am able to relate of my own experience, gives no material aid. In the one case of cecal impaction I have encountered (I hope now that I am able to recognize it to meet with others) there was an amount of straining or paining, which I knew quite well would effectually prevent any reliable information being obtained. There was in the rectum a moderate ° Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE C/ZECUM 233 quantity of feeces of medium consistence, proof that the colon was not wholly inert, and that was all. Professor Gofton, however, with four cases to which to refer, assures us that the impacted cacum is within reach, and is to be recognized by the exploring hand. In the account of one of his cases he says : ‘On a first rectal exploration the bowels, so far as could be felt, were normal, and afforded no explanation of the symptoms. On a further and more thorough examination, the upper portion of the caecum could be felt and easily recognized in the lumbar region, near the centre of the abdomen, lying mainly on the right side, but projecting a little over the middle line. The organ was unusually prominent, its walls did not yield to the hand as they do under normal conditions, and its con- tents were firm and clearly not of the natural pea-soup consistence. The full significance of this state of affairs was not grasped at first, but it soon became clear that a distended caecum, impacted with dry ingesta, accounted for the course and symptoms of the case, and that the purgative, though producing purgation, had failed to influence the condition of the cecum.’ When first reading that report, 1 was somewhat scepti- cal as to the cecum being so certainly within reach. However, a subsequent conversation with Professor Gofton quite satisfied me that, in some of these cases at any rate, such is the truth, and that, when so felt, this condition of the caecum gives incontestable evidence of the serious nature of the case. All that now remains to be said is that, even with the true nature of the case revealed, treatment at present seems to be useless. In spite of all that can be done, this constant exhibition of dull pain prevails for some seven to fourteen days. Digitized by Microsoft® 234 THE COMMON COLICS OF THE HORSE And then, quite suddenly, the end comes. Without warning the alarming symptoms associated with rupture of the intestines supervene. The pulse commences to run down, the respirations become hurried and gasping, and muscular tremors, with partial cold sweats, make their appearance. At the same time the countenance takes on that drawn, anxious expression known as ‘sardonic,’ the patient the while growing weaker and weaker, and the sobbing respirations becoming more and more ‘catchy,’ until the animal drops and dies in convulsions. It is not a pleasant ending, this; a sudden and unex- pectedly fatal one to a case the veterinarian at the outset deems simple. It is an advance in our knowledge, how- ever, thanks to Professor Gofton, that these cases may be recognized. With recognition may later happily come suggestion for improvement in treatment. Diagnosis.—The diagnosis of these cases, even if possible at all at the outset, is not going to be easy. It will, as has already been intimated, be only too easy to confound them with cases of impaction of the colon— cases which are comparatively simple. It appears, however, from what we now know, that as these cases run their course, and even before fatal symp- toms present themselves, diagnosis is going to be possible. In fact, a careful consideration of the symp- toms as just described will indicate in what way that diagnosis is to be arrived at. The first point of importance is the initial purge. This alone, if ever we come into contact with many of these cases, will be a ‘leader’ of no mean significance. It will become of even greater significance when we see that this purge is followed, not by recovery, but by a continuation of the dull pains which have preceded the Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE CCUM 235 administration of the purgative. We shall know, then, having seen the colon empty itself, that it is not to impaction of that viscus we are now to look for the reason of the pain’s continuance. We shall have our attention directed elsewhere, and that ‘ elsewhere,’ simply because the pains are of that subacute type associated with impaction of one of the large bowels, will of neces- sity be the cecum, Then will come the evidence obtained from rectal exploration. ‘A rectal examination,’ says Professor Gofton, ‘ permits of diagnosis without great difficulty, but the continuance of the dull, uneasy condition and inappe- tence after the action of the purge is not without a signi- ficance which should lead to an examination of the condition of the caecum.’ This evidence, when obtainable, will be positive. That in certain cases it will be obtainable Professor Gofton’s report makes clear. When giving mea verbal description of it, he made matters even clearer. In fact, it seems to me quite plain that we may come now to the ready diag- nosis of another interesting form of intestinal obstruction in the horse. ~ Prognosis.—This, if not wholly unfavourable, must at any rate be extremely guarded. Each of the cases re- lated by Professor Gofton terminated in rupture of the czecum, and death. In my own case the issue varied only in regard to the seat of the rupture. In this instance the first portion of the colon revealed a rent some g to 12 inches long. It would be most unwise, of course, with the very limited knowledge we yet have of this condition, to state point-blank that every case of impacted cecum ends in death. I should not for a moment be inclined to believe that. There is no reason that in every case a fatal ter- Digitized by Microsoft® 236 THE COMMON COLICS OF THE HORSE mination should ensue. On the contrary, there are many reasons for believing that resolution might just as readily occur. As a matter of fact, I fully believe that when these cases become more fully known someone will be able to come forward with the description of a case or cases, indisputable even to the feeling of the impacted cecum during life, in which recovery takes place. Treatment.—So far as we yet know, this is useless. Briefly, the treatment adopted by Professor Gofton was a dose of linseed oil followed by the administration of aloes. After the purgation ceased the bowels continued to act, although the amount of faces passed was small—a fact which was thought unimportant in view of the almost complete inappetence. To continue, we will give Professor Gofton’s own words. ‘Belladonna, camphor, and carminatives did little to relieve the continued symptoms of pain. The adminis- tration of oil in combination with stimulants produced a soft condition of the faeces and their more regular pass- age, but effected no change in the cecum. Food was offered after the first purge acted, in the shape of linseed tea, boiled linseed, bran and long hay, but was partaken of sparingly, and later not at all. The more rapidly-act- ing purges in the form of eserine and arecoline were not tried in the first case, but their exhibition in the second and third was not productive of any response, nor did they have any effect, so far as could be ascertained by rectal exploration and later by post-mortem, on the con- sistence or amount of food material in the impacted organ. ‘In the third case a method of treatment was tried which, because of its novelty, is perhaps of sufficient interest to be worth mentioning. The orthodox methods of treating impaction had been tried and had failed the Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE C4iCUM 237 experience of the two preceding cases pointed to the prob- ability of an early fatal termination, and it seemed worth while applying any method of treatment which offered a possibility, however remote, of effecting im- provement. It occurred to me that some benefit might be derived if advantage could be taken of the well-known physiological fact that the water which a horse drinks passes direct to the caecum. If the animal could be induced to drink large quantities of water, there was a possibility, small perhaps, but still a possibility, that the liquids, by permeating the mass of material impacted in the caecum, might assist in softening and loosening it, and thus aid in its removal. With this object in view a large dose of common salt was given in water. It had the desired effect so far as thirst was concerned, but its influence on the condition of the cecum, so far as could be judged by rectal examination, and subsequently con- firmed by post-mortem, was not appreciable.’ The treatment in my own case, with the exception of the novel expedient of giving the salt, was on identical lines. I was called in on September 20 and found ine animal showing the usual dull pains. There was, as in Professor Gofton’s case, a history of a slight purge a day or two previous, since when the animal had been feeding only moderately, and had still been kept at work. As the patient was an aged one, and as the pains were slight, I deemed it just a case of want of tone of the muscular walls of the colon. And further, as the animal was required to be kept at work if possible, I judgéd that a dose of eserine and pilocarpine would do all that was necessary. ‘This was given, So far as could be seen it had no effect. Therefore, on the 22nd, as the pains, still slight, continued, I refused to stay my hand longer, and Digitized by Microsoft® 238 THE COMMON COLICS OF THE HORSE administered a dose of aloes. During the next two days this certainly acted, though not to any large extent. I thought the case out of danger, and, unfortunately, allowed three days to elapse before seeing the patient again. My attendance was again requested. I still saw nothing to alarm me, and ordered light walking exercise. On September 26 this was given him, and on the 27th the animal was tied behind a cart and walked out of town to the owner’s farm some four miles distant. On his arrival he appeared to be in no worse condition than when he started. On the following morning, however (and I must say to my surprise), he was taken suddenly worse. As to what the case was now there was no doubt. The symptoms shown were unmistakably those of rupture of the intestines. A few hours later saw the end. I have laid stress on the administration of the eserine and the aloes as being, perhaps, the two most important items in the treatment. At the same time the patient received at intervals the usual stimulants as given in im- paction of the colon. In connection with this case I have one regret, and that is that I did not have the patient up at my own place. As things turned out, I did not keep that ‘ watchful eye’ on him that really I should have done. The’ necessity for this I did not see until too late. Although he was stabled not far from my home, it was one of those annoy- ing places to attend where one never saw the same attendant twice; where the patient once or twice was, without advice, moved from one box to another, and no clear record kept of the evacuations. There was no really exact history obtainable either of what the animal was doing just prior to the attack, or of what he did, in the Digitized by Microsoft® SUBACUTE OBSTRUCTION OF THE CCUM 239 way of eating, showing pain, etc., during the progress of the case. There was, in fact,a lamentable lack of intelli- gent interest, and, in plain English, I was very much misled by the muddling mismanagement of the owner and his men. Still, the post-mortem cleared matters up. The caecum was found tremendously impacted, and its contents as hard and as dry as those found in the ‘manifold’ of the ox, while the colon, as I have before mentioned, was - ruptured in its first portion. That the issue of the case would have been materially altered even had the patient received closer attention I cannot really think, The reason for regret is that I have so little to record of what would have been an unusually interesting case. General Remarks.—The foregoing pages well serve to illustrate the fact that in medicine there is no such thing as marking time. Here again, even with the com- monly-regarded simple affection of ‘colic’ we have made a further small advance. And yet, just as it will be plain to others, so it is plain to me, there are several points which with the passing of time may be considerably en- larged on. Perhaps, however, sufficient has been said to awaken interest. The record of these cases plainly enough forces one lesson home, and that is the need for a closer appreciation of the facts concerning the anatomy and function of the part implicated. Smith, in his various writings, has previously done an immense amount of work which has already borne good fruit in the way of further- ing our knowledge and improving our treatment of the intestinal disorders of the horse. It certainly appears to me that here again he has done work in connection with the physiology of this portion of the intestinal tract which is bound sooner or later to have far-reaching results. Before concluding, I would like to remark shortly on Digitized by Microsoft® 240 THE COMMON COLICS OF THE HORSE those instances, not infrequent, where cases of intestinal impaction linger on for longer than a week, sometimes for so long as fourteen days, and then recover. All of these I have hitherto judged to be cases of obstruction of the small intestines (see Chapter XII.). One is now tempted to ask: ‘ May not some of these have been cases of cecal impaction—cases where the caecum has for- tunately managed to discharge its abnormal contents ?’ It is just possible. However, we can only prove this by first accustoming ourselves to diagnose cases of cwcal impaction by rectal exploration. When we are able to do this, to definitely assure ourselves that we have an impacted cecum, and subsequently to verify that diagnosis at post-mortem, we shall be in a position afterwards, if these cases ever do end in recovery, to give a logical and indisputable account of some of such as have so ended. Further, when we are able to recognize these cases, and to know better the symptoms attending impaction of this portion of the intestinal tract, we may be able, first, by seeing such a set of symptoms, and, secondly, by putting the caecum out of the reckoning by means of a rectal examination, to come to a fuller understanding of impaction of the small intestines. I feel quite certain that the better understanding of both of these conditions is now only a matter of a short time. Digitized by Microsoft® CHAPTER XIX DISPLACEMENTS OF THE DOUBLE COLON A. Volvulus, Twist, or Torsion. Definition.— By volvulus, twist, or torsion of a bowel, we simply mean a rolling or twisting out of its normal direction. Generally speaking, this may occur in three ways. The bowel may be twisted on its own longitu- dinal axis; it may be twisted on its mesenteric axis; or neighbouring coils of gut may twist round one another. So far as the large colon of the horse is concerned, we may put the second of these on one side at once. The attachments of the colon are such that no portion of it can twist on its mesenteric axis. The meso-colon, for instance, where it spreads itself out in racket-shaped form between the second and the third portions of the bowel, is far too small to allow a portion of either the second or the third portion of the bowel to so twist. Thereafter, the close manner of attachment of the first and second to the fourth and third portions respectively of the bowel is such as to entirely preclude the possibility of this form of torsion. May any portion of the double colon twist on its own 241 16 Digitized by Microsoft® 242 THE COMMON COLICS OF THE HORSE longitudinal axis? To some extent it may. In fact, it is more than possible that it is in this way many of the cases of torsion of this bowel commence. We may explain it in this way. Assume the second portion of the bowel to be loaded with an abnormally heavy weight of ingesta, and to be making a more than ordinary muscular effort to pass it along. Under these circum- stances, the cramp-like contractions of the bowel muscles, both those of the circular coat and those of the four longitudinal muscular bands of this portion of the bowel working, perhaps at times concurrently, at others inde- pendently, may, and no doubt do, under stress of heavy work, tend to rotate the bowel on its own longitudinal axis. Some degree of torsion in this direction therefore ensues. It cannot be great, however, for the second portion of the bowel in such acase immediately begins to involve with it its attached portion—namely, the third— and the case of torsion at once becomes one of twist of one portion of bowel on or around another. This latter, twist of one portion of the bowel over another, is, I think, practically the only form of volvulus we have to consider—that is, in the case of the double colon. The degree of torsion may be from a quarter turn, to a half, three-quarter, or a whole turn (or even more). In either case, however, we have the fact that one portion of the bowel has commenced to turn round another (see Figs. 23, 24, 25 and 26). From what we know of the distribution of the colon in the abdominal cavity (see pp. 13 and 246 and Figs, 25 and 26), we are able to conceive that torsion of the united portions may occur in any position from the point of origin of the bowel in the right flank to nearly at the extremity of the colic loop, and either with or with- out removal of the pelvic flexure from its normal position. Digitized by Microsoft® TORSION OF THE DOUBLE COLON 243 It is a point of practical importance, however, that two very common seats of torsion are—(1) At the supra- sternal and diaphragmatic flexures ; (2) at a point not far distant from the extremity of the colic loop. But although torsion of the double colon has been recorded as affecting various portions of the bowel, I shall make no attempt (apart from a consideration of twist of the pelvic flexure—see Chapter XXI.) to differentiate between these different forms of displace- ment. Ido not think the time for that is ripe. Ido not consider that our knowledge of these conditions, per- plexing as they often are, is sufficiently advanced. Simply, therefore, I shall content myself with discussing the matter more or less generally, hoping in this way to do something, if only a little, to pave the way for what future observation may disclose. Preliminary Remarks.—At the outset I should like to give my reason for dealing at all with volvulus or torsion in a work having as its title, ‘The Common Colics.’ My reason is this. From my own experience I am quite convinced that the cause of death in nearly all our fatal cases of equine colic is torsion of some portion of the intestines. I am further convinced that in the very big majority of such cases the seat of the torsion is the double colon. It is, indeed, an accident unfortunately only too common. Smith, too, is plainly of much the same opinion. In his ‘Manual of Physiology,’ p. 236, he says: ‘ What is the common cause of death among horses from intestinal affections, whether affecting the large or the small bowels? There is only one answer to this, and time and careful enquiry will prove its accuracy. The answer is strangulation of the bowels, partial or complete.’ Further, on referring to vol. ii. of Cadéac’s ‘ Patho- Digitized by Microsoft® 244 THE COMMON COLICS OF THE HORSE logie Interne’—namely, that dealing with the intes, tines—we find on p. 311 the following note: ‘Palat says that twist of the colon is to twist of the small intestines as 4 to 1. Schultze has recorded 69 cases of twists of the intestines in the direction of the long axis of the organ; 56 cases were of the colon, and 13 only of the small intestine. Of a total of 618 fatal cases of colic recorded at the veterinary school of Vienna, torsion of the large colon was noticed 166 times.” ‘Jelkmann assures us that out of 192 horses dead from colic 70 succumbed to this affection (torsion), and he remarks that out of 23 autopsies on horses Io revealed displacements of the large colon.’ The truth of the matter is this: Once the veterinarian has recognized the condition, and has accustomed him- self to demonstrate it at post-mortem (which demon- stration in many cases is far from easy), he finds that deaths from torsion of the large colon are far more numerous than he has hitherto supposed. Incidentally, this ready recognition of torsion eliminates from the veterinarian’s notebook many cases that he has in all probability previously recorded as enteritis, and teaches him the fact that enteritis as a condition fey se is a thing comparatively rare. My own notice was drawn to these matters some years ago (in 1g00 and igor, to be exact), while engaged on the writing of the first edition of this little work. Until then, in common with many others, I am afraid, I was in the habit of casually dismissing as ‘enteritis’ any case which on post-mortem displayed a large area of dark coloured, livid red, or purple gut. Directly this was seen, the decision of ‘another case of enteritis’ was deemed sufficient. The existence o Digitized by Microsoft® TORSION OF THE DOUBLE COLON 245 édwist was never even called into question. This was showing a sublime disregard for anatomy, I confess ; and perhaps also displayed a certain lack of keenness in observation. Be that as it may, I relate the facts here, for subsequent experience has shown me that in these particular cases, at any rate, many veterinary surgeons, skilled in other directions, are just as sublimely casual. For two very good reasons this attitude of indifference at post-mortems on our colic cases ought not to exist. In the first place, once one has trained oneself to expect and aiterwards to unravel these cases of displacement, the making of post-mortems in cases of colic becomes, instead of an unpleasant duty, a matter of perennial interest. Secondly, I am convinced that long before one has any great number of these ‘finds’ in his notebook, there comes to him, from a sort of subconscious harking back to the phases of a case as he saw it during life, greater powers of diagnosis. Morbid condition and effect are brought nearer the one to the other. Symptoms which during the progress of the case were deemed ‘puzzling,’ perhaps, but ‘of no great import,’ stand in an entirely new light, until, in a manner he would find it difficult to explain, the practitioner eventually comes to acquire a proficiency in diagnosis that at one time he would have supposed impossible. Moreover, any knowledge we may thus gain concerning these displacements of the colon I am sure will assist us in giving a much more intelligent reading to the symp- toms exhibited in cases of ordinary subacute impaction of the same bowel. Particularly have I myself found this to be the case in instances of impaction of the pelvic flexure (see Chapter XXI.). Not only has the constant following up of my fatal cases by post-mortems led me to dis- Digitized by Microsoft® 246 THE COMMON COLICS OF THE HORSE covery of cases of torsion affecting this particular portion of the bowel, but it has enabled me to come to some measure of differential diagnosis during the life of the patient. But of that more in the chapter devoted to its consideration. Just now we are concerned only with a consideration of twists of the double colon in general. Anatomical and Physiological Facts concerning the Double Colon.—If ever we are to come to a close and real understanding of the various forms of displace- ment of the double colon, it is quite certain that a ready knowledge of the normal anatomy and of the physiology of the parts will be of the very greatest assistance to us —will, in fact, be indispensable. In a previous chapter I have already dealt briefly with the anatomy. What follows here is an enlargement on that, together with several physiological facts of the highest importance. For this I am again indebted to Major-General F. Smith, for both the subject-matter and the illustrations of this section are a direct transcript from his ‘ Manual of Physiology.” This little book already owes much to Smith’s writings, and I would like here, in addition to what I may have said elsewhere, to give that fact prominence, and at the same time to express my thanks for permission to use the material. The Colon.—‘ The direction taken by the colon of the horse is remarkable. It commences high up under the spine on the right side, its origin being very narrow, but it immediately becomes of immense size. It descends towards the sternum, and, curving to the left side, rests on the ensiform cartilage and inferior abdominal wall. The colon now ascends towards the pelvis, and here makes a curve, the bowel becoming very narrow in calibre, The pelvic flexure having been formed, the intestine retraces its steps towards its starting-point. Running on top of the previously described portion, it descends towards the diaphragm, growing gradually larger in calibre, Digitized by Microsoft® TORSION OF THE DOUBLE COLON 247 and then ascends towards the loin, being here of immense volume—in fact, at its largest diameter. It then suddenly contracts, and forms the single colon (see Figs. 19 and 20). uw Fic. 19.—THE DouBLE COLON LOOKED AT FROM ABOVE (MODIFIED FROM MULLER). 1, The first colon, the caecum being removed ; 2, the pelvic flexure, the bowel being narrow; 3, the colon suddenly enlarges ; 4, its diaphragmatic flexure; 5, the single colon. Several of the bands are seen; note also the sacculated and non-sacculated portions of the bowel. (Smith’s ‘ Veterinary Physiology.’) The object of the difference in the volume of the double colon appears to be for the convenience of its accommodation jn the abdominal cavity. Digitized by Microsoft® 248 THE COMMON COLICS OF THE HORSE ‘The double colon may, for purposes of description, be divided into four portions—the ingesta in the first and third descend, in the second and fourth ascend. It is found that Fic. 20.—PosITION OF THE C.EcuM AND DousBLE COLON ON THE FLOOR OF THE ABDOMEN SEEN FROM BELow. The point of the cecum is directed towards the sternum. The abdomen has spread open in front owing to the needful dissec- tion. It should be egg-shaped, the narrow end foremost. (Smith’s ‘ Veterinary Physiology.’) the physical characters of the contents are not the same throughout. In the first colon the food is fairly firm, and the particles of corn, etc., can be readily recognized; in the Digitized by Microsoft® TORSION OF THE DOUBLE COLON 249 second colon, the material is becoming more fluid, while at the pelvic flexure the contents are invariably in a liquid, pea-soup- like condition, and the particles of which they are composed are not readily recognized. In the third colon the material becomes firmer, but only slightly so, and bubbles of gas are being constantly given off from its surface. Inthe fourth colon, the entire ingesta are like thick soup, and the material composing them is in a finely comminuted condition, the surface being covered with gas bubbles. For the first foot or so of the single colon this condition is maintained, when quite suddenly the contents are found solid and formed into balls. ‘The remarkable suddenness of this change is invariable in a state of health, and indicates either most active absorption or that the contents are subjected to great compression. The entire contents of the colon are yellow in colour or yellowish- green, becoming rapidly brown or olive green on exposure to the air, the colour being due to the chlorophyll of the food. The contents of the colon are normally alkaline throughout ; we once, however, found them acid.’ Movements of the Intestines. —‘The movements of the intestines are brought about by the involuntary muscle com- posing its wall. This muscle in the small intestines is arranged in two sheets in a circular and longitudinal manner, while in the large intestines narrow bands of pale muscle of considerable length take the place of the ordinary longitudinal layer, and may be found on all parts where the tube is saccu- lated ; in fact, one function of the bands is to bring about the sacculated condition of the canal, an important arrangement ‘whereby economy of space is effected with no loss of surface. ‘The sacculated condition of the double colon is confined principally to the first, second, and fourth portions. The third portion, especially at the pelvic flexure, is free from saccula- tions, and the fourth portion is not so liberally puckered as the first and second. On the first colon there are four bands ; on the second colon there are also four, three of which dis- appear at the pelvic flexure ; on the third portion there is only one band; while on the fourth colon there are three (see Figs. 17 and 21). In the large intestines the longitudinal layer of fibres is confined to the muscular bands, so that the great Digitized by Microsoft® 250 THE COMMON COLICS OF THE HORSE bulk of the wall consists of circular muscle only. The longi- tudinal bands shorten the bowel, but the main work in press- ing the contents along is performed by the circular layer, The bands, in fact, are numerous where the intestine is large, and reduced in number where the bowel becomes smaller. This arrangement suggests that they may, under suitable con- ditions, produce an irregularity of pull, and we can see no other explanation of displacement of the large intestines of the horse than through the medium of these muscular bands. ‘The muscular movements of the large intestine are slower than those of the small bowels. Possibly one reason for this Flexures : Sternal Pelvic Diaphragmatic From 2" ee \ To —_ = 5 Single Caecum Se 6-—___———Y Colon 1st Colon i 2nd Colon ‘ 3rd Colon : 4th Colon Fic, 21.—SCHEMATIC ARRANGEMENT OF THE MuscuLar BaNpDs ON THE DoUBLE COLON. The colon is supposed to be opened out into a straight tube. Bands 1, 2, and 3 run from the first colon to the pelvic flexure ; one of the three actually comes from the apex of the cecum. No. 4 is the only band running the whole length of the bowel. Nos. 5 and 6 originate in the region of the third colon, and finally run on to the single colon. (Smith’s ‘ Veterinary Physiology.’) may be that the food has to remain a longer time in contact with the absorbing surface—viz., for at least forty-eight hours, and for as long as four days. The peristaltic movement of the small intestines is quite distinct from that of the large ; the one ends at the ileum, the other begins at the caecum. ‘The muscle of the intestinal wall causes the movement known as “ peristalsis,” which normally passes in the direction, stomach to rectum. Relatively quick in the small intestines, it becomes slower and more deliberate in the large; but the wave has always the one object in view—viz., to press the ingesta onward. A wave of contraction passing the reverse way—viz., in the direction of rectum to stomach—is known as Digitized by Microsoft® TORSION OF THE DOUBLE COLON 251 “ antiperistaltic.” Such a movement is considered abnormal, but in the horse, according to Colin, antiperistalsis of the small intestines is a natural condition. Some physiologists recognize antiperistaltic movements of the large intestines as being normal in certain animals, producing a to-and-fro move- ment of the contents; but it is generally thought that in the small bowels antiperistalsis is only present under abnormal circumstances. If antiperistalsis be admitted for the large bowels, we see no difficulty in extending it to the small, especially in view of Colin’s positive statement that it occurs. The peristaltic wave depends upon a something peculiar to the bowel wall, for if a piece of small intestine be experiment- ally reversed, so that the portion originally nearest the stomach is made to occupy a position farthest away from it, it is found that the peristaltic wave in the reversed segment is still in the original direction instead of in the new direction. The actual mechanism involved in a peristaltic contraction, according to Starling and Bayliss, is as follows : The circular muscle on the stomach side of the bolus contracts, while that on the far side is relaxed for some distance, so that the advancing wave drives the bolus into a relaxed portion of the bowel. If a solution of cocaine or nicotine be applied to the intestinal wall, these movements cease, from which it is argued that they are prob- ably due to local ganglia. ‘Rhythmical or pendular movements. of the small intestines were first described by Starling and Bayliss. They consist of a series of local contractions caused by the presence of food in the canal, and occur in the dog at the rate of about twelve a minute, and in the cat thirty times a minute. They have been studied by means of the Réntgen rays and a bismuth dict. Pendular movements are essentially connected with the division and subdivison of food in the intestinal canal. By means of the rays, a string of material may be seen to become suddenly segmented, each segment again dividing, and each of these again, in a perfectly definite manner, may be further subdivided. In this condition it is exposed to thorough mixing with the secretions in the intestine, and to enable the finely divided contents to be so acted upon, the bowel at the time is free from peristalsis. When acted upon, a peristalsis Digitized by Microsoft® 252 THE COMMON COLICS OF THE HORSE sweeps together all the scattered atoms, and forms them once more into astring of material. This remarkable movement is unaffected by the action of cocaine or nicotine, which have been shown to inhibit at once the ordinary peristaltic move- ments. ‘Besides peristaltic and pendular movements, another has been described in the dog much slower, but also rhythmical, which may be carried out for twenty or thirty minutes at intervals of two hours, even when the canal is empty. ‘We have been told by Colin that digestion in the small intestines of the horse is carried on by peristalsis and anti- peristalsis, the fluid travelling from stomach to ileum, and from the ileum towards the stomach, Pendular movements are of no value in the small intestines of this animal, as the entire material, until the ileum is reached, is fluid, so that there are no strings of food to be segmented. This may account for pendular movements of the bowels not having been observed in the horse. ‘Tn the first and third portions of the colon of the horse the ingesta travel by their own gravity ; in the second and fourth portions they travel against gravity, as in the caecum. As the first and fourth and second and third portions of the colon are united, the curious result follows that material is passing along each section apparently in two opposite directions. ‘The frequency of intestinal affections in the horse causes the canal to be of exceptional interest. When the caecum is found completely inverted into the colon, as if a hand had been passed through the colo-caecal opening, laid hold of the apex of the cecum, and drawn the entire bowel within the first portion of the colon, it is then that the question of muscular movements so strongly presents itself. Or, again, what is far commoner and equally fatal—viz., displacement or actual twist of the large bowel, or a complete twist of the small intestine, leaving the bowels in such indescribable com- plexity that the parts cannot be unravelled, even when removed from the body. Finally, a condition rare in the horse, prob- ably in all animals, but still well recognized, in which tele- scoping of the small bowels occurs, known as “ intussusception.” It is impossible to believe that muscular action of the intes- Digitized by Microsoft® TORSION OF THE DOUBLE COLON 253 tines is free from all blame in the production of these lesions, It is easier to understand a twist of the small intestine apart from the muscular action than it is to understand displace- ment or actual twist of the large intestine. A loop or coil of small intestine may be so distended by gas or ingesta as to become twisted, but it is more difficult to imagine either of these conditions producing twist or displacement of the large intestines, and it becomes a quesion, as we have previously said, how far the action of the muscular bands of the bowel may have a contributing influence. That great force is necessary is undoubted, bearing in mind the difficulty, if not impossibility, of restoring the parts to their position post- mortem, or endeavouring after death to reproduce the lesions experimentally.’ Causes.—A great deal has been written regarding the causation of torsion of the double colon. On first reading, much of it may appear pure theorizing. It is theory, however, based on what is known of the anatomy of the bowel, and plausible, not only to the extent of being possible, but extremely probable. In the first place it seems to be a fact that displace- ments of the colon occur much more frequently in animals of the heavy or lorry type than in those of lighter breeds, And this fact is easy of explanation. The comparatively more voluminous build of the bowel in the larger breeds, and the fact that the colon is so largely filled with water and often with abnormal quantities of indigestible food, are factors that tend first to tympanitic conditions and later to displacement. ‘That the colic loop in particular should be liable to displacement is readily explained when we remember (a) the variation in size of its com- ponent parts (notably the small dimensions of the third portion as compared with the second), and (0) the fact of its extremely free and unattached position in the abdomen. As I have explained in a previous chapter, ‘We have here a bowel several feet in length, of voluminous build, Digitized by Microsoft® 254 THE COMMON COLICS OF THE HORSE and designed to carry enormous weights of ingesta, with a heavy and unattached end. Devoid of mesenteric or other stay to hold it in position, this heavy end is free to - move at will in the abdomen. This must, one would think, lead at times to trouble which could easily be referred to displacement.’ There can be no doubt that at times it does, and that this cause alone is often a factor determining either tor- sion of the pelvic flexure (see p. 300) or twist, partial or complete, in the neighbourhood of the suprasternal and diaphragmatic flexures. The late Professor Walley, in commenting on the ‘ pre- eminent liability of the colic loop to torsion,’ remarks on the fact that it is usually the receptacle of a large quantity of semifluid material, leaving us to infer, for he does not actually say so, that this weighting of the free end is responsible in large measure for its deviation from the normal position. This cause may be, and I should say nearly always is, assisted in operation by disordered muscular action of the bowel; but that point I will deal with later. For the present it will be better to consider further the part played by the build of the bowel itself in determining these displacements. In the main this will deal with the see-sawing or rolling of the third portion over the second, or the second portion over the third, according as the twist is from left to right or from right to left, and will be concerned principally with torsion at the suprasternal and diaphragmatic flexures. For the views regarding this, and the way in which the occurrence of torsion in this situation is explained, I am indebted to the work of Cadéac; and the whole thing may perhaps be rendered more intelligible if we resort to the use of diagrams, Digitized by Microsoft® TORSION OF THE DOUBLE COLON 255 Referring first to the course normally taken by the colon, p. 246, and then expressing it diagrammatically, a transverse section of the abdomen in front of the base of Fic. 22..-DIAGRAM ILLUSTRATING THE RELATIVE POSITIONS OF THE NorMAL DouBLE CoLon. This is viewing the supposed section from behind, and shows 1, 2, 3, and 4—the first, second, third, and fourth portions respectively of the bowel. The black dots a, a, indicate the glands and vessels on the inferior face of the first and fourth portions. Similar dots b, 6, indicate the glands and vessels on the superior face of the second and third portions. R, Right side of abdomen; L, left side of abdomen. the caecum will give some such picture as that illustrated in Fig. 22. With this diagram before us, we may then follow Cadéac’s explanation of twist from left to right. It is in this direction, he assures us, that torsion of the double Digitized by Microsoft® 256 THE COMMON COLICS OF THE HORSE colon generally occurs, and this, he says, is due to the anatomical distribution of the bowel. In this way: The second portion of the bowel being larger than the third, and containing a greater weight of ingesta, tends to roll (in either direction, H. C. R.) on the third. Thus, if the animal lies on the left side, the second portion, heavily weighted with ingesta, glides between the abdominal wall and the third portion, coming eventually to lie on the left side instead of on the right side of the abdominal cavity. This of necessity causes the attached third portion to move over the second from left to right. If, when this has happened, the animal then gets up sharply, the bowel » by the movement is helped to maintain its abnormal position, and twist, incomplete—that is to say, twist of half a turn—has occurred. This we may again express diagrammatically, in which case we have the state of affairs depicted in Fig. 23. When compared with Fig. 22, it will be noted that the second and third portions of the colon have changed places. Not only have they changed places, but the superior face has become the inferior, as will be noticed from the changed position of the glands 8, J. At autopsies the fact that the distal half of the colic loop has thus turned upside down may be noticed if, im- mediately on laying back the abdominal flaps, and before disturbing any of the intestines, careful examination is made of the course of the bowel. Smith draws attention to this in the following words: ‘In conducting the post-mortem examination in cases of this kind, after the flaps of the abdominal walls are laid back (the animal lying on his spine with his legs in the air), note carefully the course of the large bowels, using both hand and eye. ... Asan example of this I give the following: If, on opening the abdomen, a wide Digitized by Microsoft® TORSION OF THE DOUBLE COLON 257 muscular band is seen running on the plain, unpuckered face of the double colon, it may be predicted that the bowel is twisted, though to all appearances it may seem Fic. 23.—DIAGRAM ILLUSTRATING THE POSITION OF THE Four DIVISIONS OF THE DOUBLE COLON WHEN INCOMPLETE TwIsT —THAT IS, TWIST OF HALF A TURN—HAS OCCURRED FROM Lert To RIGHT, I, 2, 3, and 4, The first, second, third, and fourth portions, respec- tively, of the bowel; a, a and 8, b, the vessels and glands ; R, right side of abdomen; L, left side of abdomen. The arrow in the diagvam indicates the direction of the twist. to be in its normal position. The muscular band and plain, unpuckered surface tells the tale. This is found on the upper surface of the intestine (the animal in the I Digitized by Microsoft® q 258 THE COMMON COLICS OF THE HORSE standing position) and not on the lower, and if found there, the bowel must be twisted for it to be exposed.’ This will be more readily understood if reference is now made to Figs. 19, 20, and 22, illustrating the normal course of the bowel. Again, under certain abnormal conditions of weighting of the bowel—as, for instance, when, owing to irregularity of digestion, the third portion is impacted and heavy while the second is comparatively empty—_twist may occur in the opposite direction. Under these circumstances, if the animal lies on his right side, the third portion of the bowel may glide between the abdominal wall and the second portion, and torsion occur from right to left. The state of affairs would then be represented by Fig. 24. Were it not for the arrow indicating the direction of the twist, this diagram might be taken to represent equally well twist from left to right, as in Fig. 23. The distal half of the colic loop has again turned upside down: with the autopsy made with the patient on his back, the plain, unpuckered surface of the bowel is again exposed ; and again the superior face of the latter half of the colic loop has become the inferior, as instanced by the position of the vessels and glands 8, b. , At the actual autopsy, however, the direction of the twist is quite apparent if careful examination is made of the bowel in the neighbourhood of the suprasternal and diaphragmatic flexures; for one is led to it by being com- pelled to twist the second and third portions of the bowel in the opposite direction in order to make them occupy their normal positions in the abdomen. Moreover, it will be noticed at once, immediately on laying back the abdominal flaps, that the third portion crosses the second— 1 Proceedings of the Fifth General Meeting of the National Veterinary Association. Digitized by Microsoft® TORSION OF THE DOUBLE COLON 259 that it is, with the animal on his back, on the top instead of alongside the third, and that it is directed from left to right across the abdomen. It will immediately be noticed, too, in this case of incomplete twist, or twist of Fic. 24.—DIAGRAM ILLUSTRATING THE POSITION OF THE Four Divisions OF THE DouBLE COLON WHEN INCOMPLETE TwisT —THAT 1S, TWIST OF ONLY HALF A TURN—HAS OCCURRED FRoM RicuT To LEFT. I, 2, 3, and 4, The first, second, third, and fourth portions, respec- tively, of the bowel; a, aand 4, b, the vessels and glands; R, right side of abdomen ; L, left side of abdomen. The arrow in the diagram indicates the direction of the twist. half a turn, that the vessels and glands are exposed (see 8, 8, Fig. 25, and compare this with the bowel in its normal position in Fig. 22). On the other hand, if the twist is from right to left (see Fig. 26), then it will be noticed that the first third or Digitized by Microsoft® 260 THE COMMON COLICS OF THE HORSE yy My ) y SS Ta PT {MW Fic. 25.—THE DousLe Coton 1n Twist oF HALF a TURN FROM Lert To RIGcut. This represents the positions taken up by the second and third portions of the double colon in the case of incomplete twist from left to right at the suprasternal and diaphragmatic flexures. (The autopsy made with the patient on his back.) 1, First portion of colon; 2, second portion of colon; 3, third portion of colon; 4, the cecum; 5, diaphragmatic flexure ; 6, suprasternal flexure; 7, pelvic flexure; 8, vessels and mesenteric glands; S, sternum; k, right side of abdomen; L, left side of abdomen. so of the third portion of the double colon is lying beneath, and is more or less hidden by the extremity of the first and the commencement of the second portion. Thus far we have considered the colon twisted at the Digitized by Microsoft® TORSION OF THE DOUBLE COLON 261 Fic. 26.—TuHE DouBLE CoLon 1n Twist oF HatF A TURN FROM Ricut to Lert, This represents the positions taken up by the second and third portions of the double colon in the case of incomplete twist from right to left at the suprasternal and diaphragmatic flexures. (The autopsy made with the patient on his back.) 1, First portion of colon; 2, second portion of colon; 3, third portion of colon; 4, the cacum; 5, meso-colon; 6, supra- sternal flexure; 7, pelvic flexure; 8, vessels and mesenteric glands; S, sternum; R, right side of abdomen; L, left side of abdomen. suprasternal and diaphragmatic flexures, and twisted to the extent of half a turn only. On referring to the various diagrams, and thinking the Digitized by Microsoft® 262 THE COMMON COLICS OF THE HORSE matter over, one will readily understand that in the case of a complete twist—that is to say, twist of a whole turn— the appearances at first sight, and before the intestines are disturbed, will suggest that twist has not occurred at all, the various portions of the bowel seeming to occupy their normal positions. This, as a matter of fact, they do, but only because the degree of twist is greater. In other words, the bowel has rolled over a second time in the same direction, bringing its various faces into somewhat their original positions, but rendering the incomplete twist a complete one. That twist, and a bad form of it, has occurred is in such a case rendered evident by the changes in the bowel wall caused by strangulation, which changes are confined to the second and third portions. Referring to this matter of incomplete and complete twist Cadéac says: “In the case of twist of a half turn, the colon being ex- posed, one notices that the vascular face of the second and third portions of the bowel is not in apposition with that of the first and fourth—the superior plane has become the inferior. “In complete torsion the vascular face has returned to its original position, ... the degree of rotation being a complete circle. Strangulation occurs at the point where torsion has taken place. One can see there an anzmic band, pale or rather white, which marks the division between the normal bowel and that which is hyperemic or hemorrhagic through stasis. The twisted portions are studded with hemorrhages in the form of sanguino- lent suggillations, or with blackish-red blots of variable size. ‘The meso-colon is infiltrated with coagulated blood and serum ; it is gelatinous and tumified, and its normally thin structure changed in appearance by the occurrence Digitized by Microsoft® TORSION OF THE DOUBLE COLON 263 therein of large swellings, and by brownish and blackish- red discoloration. ‘The intestinal wall, extremely tender, is infiltrated with blood. The contents of the twisted or strangulated portion consist of a reddish-brown pulp, or of blood, brownish in colour. Sometimes the intestinal wall is necrosed, and the mucous membrane shows a blackish green coloration with erosions. ‘Anterior to the constricting band (which band, we may mention, is simply the tightened wall of the bowel itself at the seat of torsion, H. C. R.), the intestinal wall appears thinned, owing to distension, and is deprived of blood. ‘ These different changes vary very much, according to the degree of torsion and the length of time it has been in existence.’ Thus far we have dealt with just the free distribution of the colon itself as a circumstance conducive to dis- placement; and the sum total of the argument advanced is that the build of the bowel alone renders it peculiarly liable to torsion. But what is the actual cause? The answer to that is, A combination of causes, chief among them being that of disordered muscular action. The long muscular bands, with which we have seen the colon is liberally supplied, must play an important part in determining displacement. That these muscular bands are extremely powerful there can be no doubt. Did we wish for assurance on that head, then we need only to consider the enormous weights of ingesta the bowel is called upon to deal with. Even under normal conditions of health, light feeding and easy digestion, with no demand on the bowel muscle for undue effort, the force exerted by these bands must be great. When labouring under abnormal Digitized by Microsoft® 264 THE COMMON COLICS OF THE HORSE conditions, as, for example, when attempting to deal with an overloaded state of the bowel (overloading probably to the extent of impaction of some portion of it), then the force exerted must be enormous. Failing to dislodge the impaction, what more likely than that the violent contractions thus brought about result in doubling over the bowel. Smith is fairly emphatic with regard to this point; and his remarks are so in agreement with my own views that I quote them here. He says: ‘The actual mechanism which brings about twists of the large and small intestines is disordered muscular action, and disordered muscular action is the result of disordered nervous action... . In the case of the large intestines the muscular action must be capable of causing the bowel to perform a revolution more or less complete, and in this way reversing its position, We cannot attempt to indicate the exact disordered action which occurs; this question would require to be worked out on the living subject. The colon is most liberally sup- plied with bands (see Figs. 19, 20, 21), and it does not appear to us to be beyond the bounds of reasonable possibility that these play a most important part in the production of displacements. The cause of the dis- ordered nervous action which leads to this, may, from its physiological interest, be briefly dealt with. Apart from obvious errors in feeding, the most common cause of derangement of the muscular action of the digestive canal is work. It is this which accounts for the majority of of colic cases occurring towards the end of the day, the frequency with which the seizure occurs at or shortly after work, especially that of an exhausting nature, and the practical absence of colic among non-working horses.’1! 1 Smith, ‘Manual of Physiology,’ p. 237. Digitized by Microsoft® TORSION OF THE DOUBLE COLON 265 Smith here, in addition to disordered muscular action, discusses work as a cause. In a former article of my own" I have before laid emphasis on the intimate manner in which are connected these two things—namely, twist of the double colon, and work. There I remarked: ‘The veterinarian will learn that there is a history of a previous day’s heavy labour, and that the oncome of the symptoms dates from the early morning following that labour. This is of grave significance, for we may take it that displace- ment of the bowel either took place during some violent muscular effort of the day before, or that, soon after the ravenous feeding at the conclusion of the day’s work, tympanitic conditions of the bowel and consequent undue spasmodic movements of its walls have brought about a fatal change in its position.’ Stress was laid on this by the late Professor Walley when he said:? ‘ The attendant symptoms may not be developed or observed for several hours after the occur- rence of the accident which has given rise to them. I am satisfied that in many cases a horse receives displace- ment or partial torsion of the colon when at work, and does not evidence any decided symptom, not even colic, for hours; in fact, not until the congestion of the intes- tines becomes pronounced, and the small intestines and stomach become tympanitic.’ With both Smith and Walley I agree. Torsion of the colon may occur during heavy labour. I think, however, this last statement needs qualifying. It does not neces- sarily imply that heavy or even exhausting work, if of a vegulay nature, is alone sufficient to cause mischief. There must be something more than that. For instance, in 1 Journal of Comparative Pathology and Therapeutics, vol. xxiv., p. 306. 2 Veterinary Journal, vol. ix., p. 396. Digitized by Microsoft® 266 THE COMMON COLICS OF THE HORSE the two cases I relate on p. 305, it will be noticed that not only had the animals to shift a heavy load from a standstill, but had to do so up a sharp and greasy incline. The slipping and sliding attempts thus made, with perhaps an occasional pitching forward on to the nose, and sudden violent efforts to recover equilibrium, are the dangerous factors, and certainly would serve to throw the weighted end of the colon into abnormal positions. A history of such work, therefore, must be looked upon with suspicion when read in conjunction with fatal or suspiciously fatal symptoms. Under such circumstances twist or torsion of the colon may, and no doubt often does occur while the animal is actually at work. Speaking for myself, however, I must say that I do not think this is at all the wswal way in which twist of the double colon occurs. I regard the heavy and ex- hausting work not as an actual cause, but simply as a predisposing factor. In this way: After a day of heavy labour, the horse comes in ravenously hungry. He hastily bolts his food. Impaction of the bowel or tympany, or both, result. Torsion then occurs (a) either through the mere mechanical action of the gas in the interior of the bowel, (0) or as the result of the powerful contractions of the muscular bands in their attempt to deal with the impaction or the gas, as the case may be. While, therefore, I agree with Walley and with Smith that torsion of the colon sometimes occurs while the animal is actually at work, I nevertheless wish to point out that in my opinion it far more often takes place sub- sequently, and in the manner I have described above. Symptoms.—I am satisfied from my own experience that cases of incomplete torsion, such as those illustrated Digitized by Microsoft® TORSION OF THE DOUBLE COLON 267 in Figs. 25 and 26, are far more common than those cases where the torsion is complete. I will therefore consider the symptoms as relating to incomplete torsion first. Ignoring the more or less general signs of colic, I will endeavour to dwell on such points as are special to the condition with which we are dealing. Called in toa case of colic torsion, the veterinarian usually finds the animal in pain that is constant. At any rate, if periods of ease are shown at all, they are what we may term ‘ compara- tive.’ There is no stretched-out, comfortable pose, with the semi-somnolence seen in impaction. In what periods of quiet that do occur, as exhibited by freedom from movement, the animal maintains the standing position. Even then, a careful watching of the respirations and examination of the pulse, followed by a general inspection of the patient, will reveal the fact that the condition is still serious. For instance, the breathing is laboured and spasmodic, and the pulse, although early in the case bounding and full, is slowly becoming weak, quick, and compressible. The temperature is raised to 103° or 104° F., and the mucous membranes are injected. More ominous sign still—patchy perspirations break out about the body, and are disagreeably forced on one’s notice when taking the pulse in the axilla. A further grave symptom, and one of use in diagnosis, is the occasional passing of feces, abnovmally soft. The italics here are important. We sometimes get the same irritable emptying of the last portion of the colon, and also of the small colon, in cases of colic impaction, when such impaction is situate anteriorly in the bowel. What is passed in cases of impaction, however, és of normal con- sistence. If it deviates from that at all, it is towards abnormal firmness—well-shaped dung-balls, showing the rounding given to them by the sacculations of the single Digitized by Microsoft® 268 THE COMMON COLICS OF THE HORSE colon, and covered on occasions by thick strings of mucus from the bowel lining. What is passed in the early stages of torsion is best described as rather sloppy ov oily. Rectal examination reveals, instead of the open and ‘ ballooned ’ state of the bowel we have come to associate with impaction, a spasmodic condition of its walls that renders any extensive exploration difficult. Accompanied by moaning grunts, and violent expulsive efforts on the part of the patient, the rectum exerts a clinging clasp round the inserted arm with such force as to almost cramp the fingers. Waiting for the stronger of these expulsive efforts to subside, a further exploration becomes possible. And then, during the patient’s cessation from straining, the hand discovers, thrust close to the pelvic opening, a gas-distended coil of bowel—the tympanitic pelvic flexure. This was referred to by Walley as ‘ the resilient tumour of intestinal torsion or displacement,’ and was likened by him to a greatly distended bladder. That it is the pelvic flexure is definitely ascertained by noting its shape, and by following up the bowel and feeling for its longitudinal muscular bands. Once these are felt, then the fact that one is dealing with the displaced colon is assured. Jelkmann and Moller both of them refer to this means of definitely determining the pelvic flexure.? The late Professor Walley also mentioned the same thing.? In addition to this abnormal position of the pelvic flexure, rectal examination revehls an additional symptom of importance. Quite distinct from the colon, above, and usually to the left, can be felt a tightened band running from above downwards and forwards. This is the 1 Moller’s ‘ Veterinary Surgery’ (translation by Dollar), p. 287. 2 Veterinary Journal, vol. xxx., p. 395. Digitized by Microsoft® TORSION OF THE DOUBLE COLON 269 twisted and tightened rectal mesentery, and, grasped through the rectal walls, it feels for ali the world like a piece of tautened wire. Pressure on it causes pain. These two symptoms, the presence close to the pelvic opening of the tympanitic flexure, and the occurrence of the tightened mesenteric band, may be taken as almost positive signs that twist has taken place. Connected with this, however, is a point to which I should like to draw the reader’s attention. In displace- ment of the pelvic flexure alone, that is uncomplicated by torsion at the suprasternal or diaphragmatic flexures—a condition which I shall discuss in Chapter XXI.—there is also to be felt in the pelvis a similar gas-distended coil of bowel. This time, however, it is a coil of the small intestines, and wot the pelvic flexure, for the latter in this case is displaced downwards and out of reach, It is a matter which complicates the making of a correct diag- nosis, and I shall discuss it later under that section. For the time being, however, we may leave it out of the equation, and at this stage simply say that a gas-distended coil of bowel in the pelvis, no matter what portion of the intestine it may be, is a sign of serious displacement, if not of actual torsion, and always a symptom of the utmost gravity. Recognizing its serious nature, the veterinarian at this point may halt in its examination and enquire more closely into the history of his case. The information he gains thereby is significant, and, although I have already dealt with it under the section devoted to Causes, it is of sufficient importance to mention again. He learns that there has been heavy and exhausting work on the day previous. He hears that the animal afterwards came in and partook of his usual feed with all, if not more than, his usual avidity. He learns, too, that the oncome Digitized by Microsoft® 270 THE COMMON COLICS OF THE HORSE of the symptoms he is now presented with occurred only some several hours after such feeding. If he has had experience of these cases before, he is now sufficiently alarmed. He becomes further alarmed when he sees the persistence of four other symptoms which I shall next endeavour to describe. These are— (t) A peculiar crouching movement prior to lying down ; (2) the continuance of the pain when in the recumbent position ; (3) the expression of countenance ; (4) a gradu- ally increasing pallor of the conjunctival and buccal mucous membranes. The ‘crouching’ movement in these cases is most noticeable. Quite suddenly in his hurried walk of pain . the animal will lean to one side, bending low to the ground as though to drop, and then just as suddenly re- cover himself to continue his hurried walk. This is done, not once, but repeatedly, until to the veterinarian, anxiously waiting to see what pose the animal will assume when down, it seems that he will never take the floor. Finally he goes down, and we then get evidence of the continuance of the pain. A stretched-out position on the side is not maintained. More often than not he sits in the manner of a dog alert, with fore-limbs stretched straight in front of him. Another marked symptom then presents itself. I can best describe it by saying that one has often seen a dog lying thus, when suddenly startled, make a sudden movement to rise, and then, when only half-way up, as though reassured, just as suddenly sub- side. This the animal does continuously while down. The third symptom, a peculiarly haggard expression of the face, although very evident to the practised veter- inarian, is not easy to describe. I can best indicate it by likening it to the expression a man wears with badly Digitized by Microsoft® TORSION OF THE DOUBLE COLON 271 knitted brows. There is an abnormal wrinkling of the upper eyelid, and with that what appears to be on the part of the animal an agonizing knowledge of something more grave within him than mere acute pain. I have seen the same haggard and despairing look on the faces of animals suddenly disembowelled in accident. The fourth symptom, a gradually increasing pallor of the buccal mucous membrane and of the previously-in- jected conjunctiva, is one which, when once he has seen it, the veterinarian will come to recognize as grave in the extreme. It indicates only too plainly the fatal change that is occurring in connection with the blood-supply of the bowel—a point to which I shall refer again in the section on Diagnosis. Accompanying this pallor of the mucous membrane is a peculiar viscid condition of the saliva I find it hard to describe. It lies in strings and sticky smears on the tongue and adjacent parts, and is of so thick a consistence as to suggest scraping as the only means of removing it. The odour of the breath, too, is abominably offensive, and is in itself a sign of grave functional disturbance. Unless something unforeseen now occurs (as, for example, the sudden change in position of the resilient tumour in the rectum—a point which I refer to again in Chapter XXII.) the case hastens on to a fatal termina- tion. A gradual filling of the colon and regurgitations of both fluid and gas in the cesophagus make themselves plainly heard, a visible distension of the cesophagus being observable with each eructation. Muscular tre. mors begin to make their appearance. Tympany becomes pronounced. The patchy sweats become more profuse and cold, the pulse grows even more quick and weak, and the breathing more laboured, sobbing, and spas- modic. The animal’s gait, froma studied walk, becomes Digitized by Microsoft® 272 THE COMMON COLICS OF THE HORSE an aimless blunder, as he stumbles forward and always forward, until death, with some degree of suddenness and with no antecedent period of ease, closes the scene. This is the usual run of the symptoms in a case of torsion that is incomplete. One other point of impor- tance, however, remains to be noted. It is the fact that the case lingers on for so long as from twelve to eighteen hours. The importance of this point lies in its value in diagnosis, and I shall refer to it more fully later (see p. 281). When torsion is complete—that is, when the bowel has made a whole turn on itself —then the symp- toms are much more violently marked. This will be readily understood when we remember that in incom- plete twist we have venous strangulation only, while in complete twist we get arterio-venous, or complete, stran- gulation, In this latter case not only are the symptoms more violent, but they are developed with a marked degree of suddenness, Although the veterinary surgeon is not usually in attendance early enough to note it, there is at the outset the same irritable emptying of the uninvolved portion of bowel, following which the fatal symptoms come on at an alarming pace. At the very commencement the pulse is bounding and almost incompressible, and the visible mucous mem- branes are highly injected, The pains are agonizing and persistent, and can be checked not even by the most heroic exhibition of sedatives. Marked muscular tremors are early in evidence, profuse perspirations bedew the body, and there is an early exhibition of the haggard and despairing cast_of countenance. The whole attitude of the patient, in fact, and exclusive of anything gained by a close examination, is at once indicative of rapidly approaching dissolution. It is true that the case may _ Digitized by Microsoft® oo Fb TORSION OF THE DOUBLE COLON 27 linger on for from four to six hours, sometimes, perhaps, for even eight. Seldom, however, is it longer than that. The case just rapidly runs its course, until, after a short period of apparent ease just prior to death, the animal drops and dies in convulsions. The period of apparent ease is, of course, due to the animal standing quiet, and to all appearances free from trouble, when, owing to extensive gangrene of the twisted bowel, all sensation therein is dead. ' Diagnosis.—It is not the condition of complete twist, but that of incomplete, which will call for the veterin- arian’s skill in diagnosis. I shall, therefore, consider that first. At the outset I would say that a close study of the symptoms will enable the veterinarian to diagnose these cases with comparative accuracy. It is worth noting, however, that diagnosis of the condition in its quite early stages is byno means easy. Indeed, it is very often difficult. At the very commencement, therefore, it is well to admit to ourselves what these difficulties are. In the main the difficulties encountered in forming our diagnosis lie in the fact that the plainly fatal symptoms are developed only gradually. On a first visit, unless the observer is particularly alive to the significance of quite little things, nothing grave may be noted. The colon, twisted to the extent of causing venous strangu- lation only, does not cause pain sufficiently severe to alarm. The fact that early in the case the pulse is full and bounding, as in an ordinary case of impaction, becoming weak and compressible only with the progress of the case, is not a circumstance conducive to the making of a correct diagnosis at an early stage. The irritable passing of the faces may be read for normal evacuations, while the manner in which the patient stands, apparently quiet and free from pain (the 18 Digitized by Microsoft® 274 THE COMMON COLICS OF THE HORSE existence of the latter being evident only to a man of some experience), may suggest that nothing serious is to be looked for. These are difficulties, however, that the veterinarian in course of time learns how to surmount. As he ripens in experience, he comes to approximate these apparently misleading manifestations at their true value. He knows that the pulse, although now full and strong, may quickly become weak and compressible, and learns not to rely on that alone. Gradually he comes to distinguish between the irritable passing of the very small quantities of feces induced by grave mischief ‘ further forward,’ and the evacuation of a quantity, small perhaps, but of normal appearance and consistence, and accompanied by the more or less normal movements and attitudes of the patient suffering from subacute impaction only. Neither is he misled by the periods of apparent ease. He sees the animal standing quiet, perhaps, but he reads plainly enough by the ‘catchy’ movements in the flank, by the coming and going of the patchy perspirations, and by occasional changes in the character of the pulse, that pain is stillin existence. All little things, granted. But all significant. ; Here it is that the history of the case as we have referred to it when discussing the causes and symptoms gives the observer help. He learns that there was a long stretch of heavy labour on the day previous, gathers that there was subsequent hearty feeding, and hears that not until the early morning following was there manifestation of pain. That excessive muscular action on the part of the bowel in dealing with an impaction has been in existence appears to him more than likely, and prompts the veterinarian to be on the alert for torsion as the cause of the symptoms he now sees. Digitized by Microsoft® TORSION OF THE DOUBLE COLON 275 Rectal examination then carries the diagnosis a step farther. It reveals the condition of affairs we have described under the symptoms—namely, the clinging clasp of the rectum on the inserted arm, the tightened rectal mesentery, the presence of a gas-distended coil of intestine thrust up against the exploring hand, and forcible efforts on the part of the patient at evacuation. Such symptoms as these are not met with in just ordinary cases of impaction. It is plain indeed that serious dis- placement or even actual twist has occurred. Now, however, comes a point of considerable diffi- culty. At any rate, it has been a difficulty with me. It is the matter of diagnosing rightly the significance of the gas-distended intestine in or near the pelvis. The difficulty arises in this way. In the main this chapter deals with incomplete twist of the double colon at its suprasternal and diaphragmatic flexures—a form of twist which, as we shall afterwards show, is sometimes amenable to treatment. In passing, it deals also with complete twist of the same bowel, an affection which runs so short a course, and is so palpably patent, as to in no way confound our diagnosis. It so happens, though, that we are not allowed to confine our attention to these two conditions alone. If we were able to do that, then the matter would be comparatively simple. But a further form of incomplete twist—namely, torsion of the pelvic flexure, forces itself on our notice, and simply has to be taken into our calculations if we are to diagnose our case correctly and afterwards to attempt treatment. By torsion of the pelvic flexure I mean a doubling or bending over of the extreme end of the colic loop (see Chapter XXI.). In these cases the pelvic flexure is doubled down out of reach. No portion of the colon can be felt. In fact, in many instances, rectal examination Digitized by Microsoft® 276 THE COMMON COLICS OF THE HORSE reveals an abdomen apparently empty—no distended bowel of any description within reach. With the pelvic flexure thus out of reach, and the abdomen apparently empty of distended bowel, displace- ment of the pelvic flexure can very often be correctly diagnosed. In such a case, indeed, the matter is an easy one (see record of Case I., Chapter XXI.). But it some- times happens, with the pelvic flexure thus displaced, that a coil of small intestine comes to take its place. This quickly becomes distended with gas, and, by the paining efforts of the patient, is forced right up into the pelvic cavity. Here it can be readily mistaken for the pelvic flexure itself (see record of Case II., Chapter XXI.). In other words, in at least two instances of torsion we meet with this resilient tumour or gas-distended portion of bowel forced right up to and sometimes into the pelvis. These two instances are—(1) Torsion of half a turn at the suprasternal and diaphragmatic flexures—the cases we are particularly considering ; and (2) torsion of the pelvic flexure—both of them forms of incomplete twist, and both of them showing more or less identical symptoms. How are we to distinguish the one from the other? It is im- portant to be able to do this, for in the one case we may attempt treatment with some hope of ultimate success, while in the other treatment is out of all question. There are two ways in which this may be done: The first method is to pay attention to the form, and particularly to the position of the tumour. The tumour met with in torsion of the pelvic flexure (in this case dis- tended small intestine) is neither so large nor so round to the touch as the distended flexure itself. Moreover, and this point I regard as important, it is forced not only up to the pelvic brim, but actually within the pelvic cavity and close up to the rectum, rendering exploration difficult Digitized by Microsoft® TORSION OF THE DOUBLE COLON 277 in the extreme. Now, in semitorsion at the suprasternal and diaphragmatic flexures, with the distended pelvic flexure itself constituting the tumour, we find the said tumour occupying the position where normally the pelvic flexure should be—namely, just on the pelvic brim, and to the left sooner than to the right side. I¢ és not forced vight into the pelvis. And this latter, which I have itali- cized, is just what we might expect. For this reason: With semitorsion at the suprasternal and diaphragmatic flexures, there is necessarily some degree of shortening of the colic loop, which shortening is sufficient to prevent even the violent paining of the animal forcing its end— namely, the flexure—into the pelvic cavity. The second way in which distinction may be made is to pass the hand in front of the tumour and feel for the longitudinal muscular bands of the colon. When they can be felt, then the question as to whether we are dealing with the pelvic flexure or simply with a portion of the small intestine can no longer be in doubt. Tautened by the torsion, one or more of them may be distinguished and even grasped by the exploring hand. Needless to say, this is the more certain method ; and when the bands can be felt in this tightened and twisted condition, then torsion of the colon can be diagnosed without risk of error. Indeed, there are observers (notably Moller! and Cadéac’) who describe in some detail the way in which, by manipu- lation of these bands, torsion from left to right may be distinguished from that in the direction of right to left. I must confess that I have not yet succeeded in doing this myself. In some degree I believe I have been handi- capped by the unwieldy size of the organs of the large Shire animals in which the whole of my cases in this dis- 1 Moller, ‘Operative Veterinary Surgery,’ p. 287. 2 Cadéac, ‘ Pathologie Interne,’ p. 333. Digitized by Microsoft® 278 THE COMMON COLICS OF THE HORSE trict of Spalding occur. Manipulation in animals so large is exceedingly difficult. As, therefore, I have no directions of my own to advance, I shall quote here the instructions given by the two authors I have mentioned. Moller says: ‘ The longitudinal bands can be distinctly felt, and-show, not only that we have to deal with the colon, but also in what direction torsion has occurred. When the bowel is in its proper position, they run nearly parallel with the long axis of the body ; but in twists, a change in their course is distinctly appreciable. In tor- sion towards the right they run backwards and inwards: in torsion towards the left, backwards and outwards. According to Jelkmann, the rectal mesentery, whose fixed border can be felt far below the lumbar vertebrz, appears greatly stretched, and in right rotation does not pass per- pendicularly downwards, but towards the left, and pressure on it causes the animal pain. ... Careful examination of the bands of the colon seems to me of more importance in diagnosis, and no doubt can exist as to the presence or direction of the torsion if they can be discovered; but the posterior bands of the cecum, which can be distinctly felt when the latter is distended with food, must not be mistaken for those of the colon. Such an error is avoided by remembering that the cecum runs from the outer angle of the right ileum in a bow directed backwards, and ends near the left stifle.’ Cadéac says: ‘ Failing functional diagnostic signs, a rectal exploration enables one to determine the direction in which torsion has occurred when the second and third portions of the double colon have made a half turn only. In this matter one prompts oneself by ascertaining the position occupied by the muscular bands, the vessels, and the glands. These together form a kind of guide-line by which we may recognize not only the fact that torsion Digitized by Microsoft® TORSION OF THE DOUBLE COLON 279 has occurred, but also the precise direction of it. The right hand introduced into the rectum commences to pal- pate the distended pelvic flexure, and then follows the muscular bands, now become plain to the touch, for they are stretched tight by torsion. In this manner one finds, say, the muscular band of the third portion of the bowel directed from below to above, from before to behind, and from without to within. ‘This indicates torsion from left to right of the third portion of the bowel upon the second.’ Of the direction taken by the bands in the case of tor- sion of half a turn from right to left, Cadéac says nothing. In either case, however, he informs us that in the event of half a turn only, whether it is torsion to the right or torsion to the left, the line of lymphatic glands and blood- vessels along the bowel has taken up a superior position. Following that, he is careful to explain that when torsion occurs to the extent of a whole turn, this manipulation tells us nothing ; for the simple reason that when complete twist has occurred, the glands and vessels, by proceeding further in the direction of twist, have come eventually to occupy their normal position. Read casually, this would at first sight appear to altogether negative the value of this method of examina- tion. But it does not. It simply means that while, by manipulating the glands, we can ascertain the direction of twist in the case of incomplete torsion, we are unable to do so when the torsion is complete. By this time the veterinary surgeon should realize definitely that he is dealing with a case of incomplete torsion of the bowel. In fact, he may at this stage com- municate something of his summing up to the owner, at the same time guarding his opinion, after the manner explained under the section on Prognosis. Should he Digitized by Microsoft® 280 THE COMMON COLICS OF THE HORSE have doubt, however, then that doubt does not linger for long; for the passing of every hour shows a gradual increase in the severity of the pains, and the oncome of other and more disquieting symptoms. Foremost among these is the increasing pallor of the conjunctiva and buccal mucous membrane. The dread significance of this symptom in incomplete twist is referred to by Walley in the following words: ‘ In these cases, in which there is only venous obstruction, the blood is constantly being pressed into the veins from the arteries, and as it cannot escape by ils natural channels, the former become dis- tended with blood to their utmost limits, and, the pressure continuing, the fluid parts of the blood are finally forced through the walls of the capillaries into the intestinal cavity, into the peritoneum, and into the submucous and subserous tissues, the denser portions of the blood and the red corpuscles accumulating in the obstructed veins. In many instances the walls of the capillaries give way, and extravasations result. The culmination of all this is death by internal hemorrhage, the intestine acting the part of a sponge, through which the life-blood of the animal is gradually drained and squeezed into the peritoneal and intestinal cavities, and the connective tissue of the bowel. Hence the diminution in colour of the injected membranes, the failure of the pulse, and the progressive emptying of the jugulars.’ It is now, too, that tympany occurs; when the use of the trocar and cannula furnishes us with a valuable piece of evidence. The evacuation of the gas gives no relief from pain, and with the issuing from the cannula of the last of its volume, there bubbles from the mouth of the in- strument a thick, blood-tinged, light coffee-coloured dis- charge—almost pus-like in appearance—the inflammatory discharge from the bowel wall. This is conclusive Digitized by Microsoft® TORSION OF THE DOUBLE COLON 281 evidence that gangrene has commenced—a fact we were previously inclined to acknowledge to ourselves on account of the,odour of the escaping gas, an odour which perhaps can best be described as ‘ putrid.’ With these last two grave symptoms to weight the balance—namely, the deathly pallor of the visible mucous membranes, and the gradually increasing tympany (a tympany which the use of the trocar relieves only tem- porarily) the veterinarian no longer merely suspects twist. His suspicions have become certainties, and his diagnosis is complete. In fact, he may now communicate his opinion to the owner in language no longer tentative, and with a tolerable certainty of being able to demonstrate the torsion at the autopsy. In the case of complete twist diagnosis is not nearly so difficult to arrive at. The grave nature of the case is only too apparent at the very outset. The rapidity with which the symptoms are developed; the intensely agonizing character of the pains at the very commence- ment; and the full bounding pulse and highly injected mucous membranes, are all sufficiently alarming and indicative. Evidently the case is one of torsion of some portion of the bowel. Even then it may be summed up to the owner in the one word ‘twist.’ In addition to this, the veterinarian notes the persistence of the high colour of the mucous membranes—no ten- dency at all to pallor, but on the contrary a continuation of as high a state of engorgement of the vessels as it is possible to get. He makes the mental note ‘complete strangulation.’ Complete strangulation necessarily means complete torsion, and his diagnosis is arrived at. Rapid, one would think, and liable to error. But, if they are wanted, there are still other indications—namely, the pro- fuse baths of perspiration, the muscular tremors, the Digitized by Microsoft® 282 THE COMMON COLICS OF THE HORSE rapidly filling pulse at the submaxillary, and the quite early exhibition of the sardonic cast of the features. They all serve to render sure even more sure. But after all is said, the great point is the progress of the case. Even to the veriest beginner the rapidity with which it hurries along allows no time for doubt. The whole thing comes on so suddenly, and so suddenly posts on to the end, that the symptoms are as it were thrown at one in their entirety. There is no mistaking their import. Does he wish to differentiate it from enteritis, then there is one point to which he may be referred, and-that point is the fact that in enteritis proper, such an enteritis as we have described in Chapter XVI., there is a history of the attack having been ushered in with rigors or a ‘ shivering fit.’ - This is not the case in twist. Prognosis.—When we are dealing with the slowly progressive symptoms of incomplete torsion, then our prognosis must of necessity be guarded. For this need for caution there are two reasons. In the first place the slow way in which the diagnosis has to be built up leaves room for error the while it is being done. Secondly, even when we feel quite clear that twist has occurred, even when we certainly recognize one or more of its usually fatal indications, we still cannot be sure that some sudden turn in the case—a turn we cannot possibly foresee—is not going to quickly change its whole aspect. I refer to the possibility of spontaneous reduction (see Chapter XXII.). Prognosis, then, must still be guarded. In such a case the owner should certainly be warned, and warned seriously. His animal is more than likely to die. At the same time it is wise to explain to him what we ourselves know of this possibility of reduction, not so much with the idea of holding out hope, but-that we may Digitized by Microsoft® TORSION OF THE DOUBLE COLON 283 be able, should reduction fortunately occur, to point to its happening, and refer to our previous explanation. Do we leave this explanation until the event, then it is far more likely to appear a shifty wriggling from a nasty situation than a truthful exposition of the facts. In the case of complete torsion, of course a prognosis may be given at once. Needless to say, it is a fatal one. Treatment.—At first sight it would appear that any treatment for twist would be useless. And in the case of complete twist it certainly is. In such an instance the only thing that can be done is to attempt to relieve the animal’s sufferings by administering huge doses of seda- tives, Even this, however, seems to accomplish but little towards the desired end; and really, where we are quite sure of our diagnosis, the most humane treatment is a charge of shot, or the administration of chloroform with the mask pushed to the point of poisoning. When we come to consider the condition of incomplete twist, however, then not only are we justified in attempt- ing treatment, but we may do so with the not unreason- able assumption that some few cases will recover, owing to the bowel effecting its own reduction (see Chapter XXII.). How can we best aid the bowel tothat end? I certainly do not think it will be by giving sedatives. In these cases, therefore, I again advocate the line of treatment to which all along through this book I have given prom- inence — namely, the administration of stimulants, as opposed toa treatment that is purely sedative. It may, and does, cause additional pain. At the same time, it is on occasions productive of results that a solely sedative ‘treatment could only hinder. The very thing to which we are to look for any chance of the bowel’s spontaneous reduction—namely, the action of its powerful muscular Digitized by Microsoft® 284 THE COMMON COLICS OF THE HORSE bands—is at once rendered of no account by the paralyzing influence of the sedative. These cases alone furnish another and a weighty argument in favour of the general adoption of a stimulant treatment in cases of equine colic. Certainly here it seems to me that to blindly administer the sedative is as wrong as it is possible to be. Better, surely, to administer stimulants in order to conserve the animal’s fast-failing energies, and then to make some such attempt at mechanical reduction as we shall now describe. According to Moller? it was Jelkmann, who at the National Science Congress at Bremen in 1890, first drew attention to the manual reduction of torsions of the colon. Moller himself, after repeated experiments on the dead subject in the standing position, speaks of the operation in very favourable terms, and quotes cases which clearly enough convey the fact that torsion of the colon is not only thus to be treated, but is to be treated successfully. Cadéac, in vol. ii, of his‘ Pathologie Interne,’ also refers to the operation, but appears to be relying on the descriptions of Jelkmann and Moller rather than quoting experiences of his own. The point, however, is that he agrees as to the possibility of the operation being successful. Dollar’s translation of Moller, in which this operation is discussed and described, has been in circulation now for close on two decades. During that time I do not remember to have seen a report of a case by an English veterinarian in which Jelkmann’s operation has been successfully performed. If such has been published, then I have missed it. Anyhow, the point to which I wish to draw attention is that references to this operation, if any, have certainly been but few. This is not surprising when one considers the following facts: (1) That diag- 1 Moller, ‘Operative Veterinary Surgery,’ translation by Dollar Digitized by Microsoft® TORSION OF THE DOUBLE COLON 285 nosis is difficult, and skill therein only to be attained by repeated failures and careful checking of the data obtained at post-mortems ; (2) that the operation is one of some magnitude, necessitating not only a very clear understand- ing of the various conditions to be dealt with, but also a large amount of manual dexterity and strength; (3) that it is somewhat likely to be fought shy of for the reason that it suggests to the uninitiated onlooker an ‘aimless groping in the dirt’—the more so when such groping ends, as it oftentimes must, in failure. But before the operation the surgeon will, if he is tactful, imbue the on- looker with a little of his own enthusiasm by means of a few brief but well-chosen explanations, and give him an intelligent interest in what is going forward. At any rate, as I have remarked on an earlier page of this book, the surgeon should not neglect to undertake any procedure which is calculated to benefit his patient. That there are difficulties in the way of the operation I admit in the foregoing paragraph. I must further admit, after several years’ experience of these cases of incomplete colic torsion, that it is only during the last few years that I have come myself to see how many of these difficulties may in course of time be surmounted. In other words, although I have had many failures, I have on several occasions, while attempting this manual reduction as described by Jelkmann and Moller, met with success. Moreover, what success I have had has been more than sufficient to prove to me the correctness of the observations of these authors, and the value of the directions as summed up by Moller. These latter, therefore, I shall quote here. ‘Treatment is commenced by giving a clyster of lukewarm water in order to clear the rectum as far as possible, and to obtain sufficient room for inserting the Digitized by Microsoft® 286 THE COMMON COLICS OF THE HORSE hand. Jelkmann inserts the left hand, presses forward towards the left abdominal wall, and endeavours to thrust the left portion of the colon [i.e., the combined second and third portions, H. C. R.] with the convolutions of the rectum forwards from this point towards the middle line of the abdomen. Once the bowel is brought into this position, Jelkmann passes the hand slowly upwards, when the colon falls back over it into its normal position; he considers that the convolutions of the rectum, displaced towards the left lower abdominal wall, having been thrust upwards, leave room for the colon to return to its normal position. My own experi- ments tend to support this explanation. ‘I replaced a left rotation of the colon in the following way: After emptying the rectum, the right hand was introduced, and discovered the bands of the colon run- ning from in front backwards and outwards, or towards the left. I now employed the bands of the colon lying above to bring about reposition. Whilst the hand in the rectum was strongly adducted, I laid its volar surface or the fingers against the bands, and after repeated care- ful attempts, finally succeeded in drawing these so far towards the right that the colon again took up its position parallel with the middle line of the body. As I had discovered by my experiments on dead animals, in torsion towards the left the bands of the lower section of the bowel [the combined second and third portions, H.C. R.] offer a purchase for retroversion. After effect- ing this, the pelvic flexure of the bowel, until then filled with gas, at’ once collapsed, the symptoms of colic dis- appeared, peristaltic action, which had almost com- pletely ceased, again set in, the small frequent pulse altered its character, and half an hour later the recovery of the animal could be foretold... . In support of Digitized by Microsoft® TORSION OF THE DOUBLE COLON 287 what has been said, I append the following case from my own practice. ‘On June 8, 1890, I was called to see a heavy cart- horse which had been suffering from colic for twenty hours. There was moderate but continued restlessness ; the animal lay down frequently, but soon rose again, moved about in various directions, and showed all the symptoms of obstruction of the bowel. The pulse was 65 per minute, small and weak ; the mucous membrane dirty red; respirations thirty, and shallow; the flank moderately distended with gas; peristalsis occasionally slightly audible at the right side; general perspiration. Defecation had been in abeyance for twenty hours, only three hard portions of dung having been passed, the appetite had decreased during the same period, and drink was only taken in small quantities. Exam- ination fey anum discovered the pelvic flexure of the colon greatly distended with gas, which caused it to be pressed towards the posterior wall of the pelvis. On the outer surface of the colon a tense cord could be felt, which passed from above downwards and inwards, from behind upwards and outwards, A similar cord passing in the same direction could be detected on the inner surface of the colon; the urinary bladder was only partially filled. ‘ The hand introduced into the rectum was laid in the above-described manner against the outer cord, and after several attempts it was found possible, by very considerable exertion, to move the bands of the colon towards the middle line of the abdomen. Active peris- talsis and passage of gas at once followed, after which firm excreta were passed. The restlessness decreased, and after a short time entirely disappeared, whilst the pulse recovered its normal condition, and the mucous mem- Digitized by Microsoft® 288 THE COMMON COLICS OF THE HORSE brane lost its redness, In an hour the pain was entirely gone.’ Having given Moller’s description of the operation, I should like now to make a few observations of my own, and to give very shortly my own experiences in this matter of reduction. As I have already intimated, I have met with success. I wish I could say I had met with success in the same percentage of cases as have other writers.1 That, however, I am unable to do. Often my efforts have been attended by failure. Some- times this failure to effect reduction has been through a mistaken diagnosis, as, for instance, when the twist has been shown afterwards to have been at the head of the colon, instead of at the suprasternal and diaphragmatic flexures. When favourable results are obtained, how- ever, they are so strikingly apparent to the. onlooker, and so eminently gratifying to the surgeon, that one readily forgets all the disappointment engendered by the cases that are unsuccessful. Moreover, those cases that are successful sufficiently point out the road for further advance in the same direction, and give promise to the operator of further success still as he gains confidence and gathers experience, If I am to be quite frank, then I must admit to not being able, even now, to reckon up the direction of the torsion by manipulating the muscular bands of the bowel and noting the way in which they lie. Myself I seem to have derived more help from noting the tightly-stretched rectal mesentery and its altered direction. This does not mean that I think diagnosis by recognizing the muscular bands is impossible, or that I wish in any way 1 Jelkmann, for instance, appears to be able to effect reduction in every case diagnosed, Vide p. 286, Dollar’s translation of Moller’s ‘Veterinary Surgery.’ Digitized by Microsoft® TORSION OF THE DOUBLE COLON 289 to discount what has been laid down by Jelkmann and Moller. It simply means that I have not been able to diagnose the direction of the twist in this way myself, partly, I think, for the reason I have mentioned before— namely, that my patients are nearly always among the big and unwieldly Lincolnshire Shires. That there was ‘something in the operation,’ however, was forcibly brought home to me some time ago when treating a nine months’ old foal. The case, after going through all the phases of incomplete twist, being taken with what was apparently just ordinary impaction, treated first by the owner and then by myself, lingering on for longer than forty-eight hours, with a gradual exacerbation of the symptoms, and finally commencing to show the usually fatal signs of a failing pulse and pallid mucous mem- branes, accompanied by constant straining attempts at defecation, suddenly yielded to manual interference. The case is particularly stamped on my mind, as it happened to be the first in which I performed a rectal examination with any idea at all of doing something to relieve the trouble. On the occasion of my first visit I detected per vectum the gas-distended pelvic flexure, and the tightened rectal mesentery, conditions so indicative of these cases of incomplete twist. I thereupon pro- ceeded, as I always do, with the administration of stimulants, hoping each time that I afterwards made a visit to find that some alteration in the unfavourable dis- position of the viscera had taken place. That, however, was not to happen. Hour after hour elapsed with the patient growing steadily worse. One expedient after the other was tried, including frequent hot-water enemata, and three doses of eserine and pilocarpine. The owner, only a man in a small way, was growing more and more anxious. I myself, seeing no change at all in the 1g Digitized by Microsoft® 290 THE COMMON COLICS OF THE HORSE patient save a gradual increase in the gravity of the symptoms, grew anxious also. The gas-distended flexure and the band-like tightening of the rectal mesentery could still be felt—their position not altered in the slightest. In addition, the increasing tympany of the abdomen was growing alarming. Plainly enough I saw that unless something more was done the case could only have one end, and that a fatal one. + Giving some intimation of what I was about to attempt, but holding out no hope of recovery, I inserted my right arm into the rectum as far as I could possibly reach, Iwas unable to detect the muscular bands of the bowel, but discovered that the inflated flexure could be pushed forward, only, however, to immediately follow the withdrawn arm until it regained its former abnormal position pressed right up close to the pelvic opening. Unable to ascertain the direction of the twist, but deter- mined to try something, I made up my mind to thrust back the pelvic flexure, and at the same time to push it upwards and then over—first over to the right, and then, if unsuccessful, over to the left, hoping that pushing further in the direction of twist, should I unfortunately do so, would not make matters worse, and trusting that when force was exerted in the opposite direction (namely, in the direction that would reduce the torsion) the bowel by the contraction of its muscular bands would help somewhat, and that a favourable change in its position would ensue. This latter happened, and I can best describe the sensation given to the inserted arm by likening it to the feeling one experiences when on replacing an everted uterus, the latter finally ‘swims out ’ to take up itsnormal position. That something had been accomplished for the benefit of the patient was almost immediately apparent. Before I had had time Digitized by Microsoft® TORSION OF THE DOUBLE COLON 291 to wash and roll down my sleeves flatus was expelled in large volumes fey anum, and the tympany of the abdomen, before so marked, began visibly to decrease. More than that I did not stay to see. This was in the evening. On the following morning the patient was well and feeding. A further case I can call to mind occurred in a heavy Shire gelding. He was brought to me early one evening, and the history elicited was that he had been at heavy work on the day previous, carting stone. In the early hours of the day following he was found by the atten- dants to be unwell. He refused his morning feed, and commenced to exhibit dull pains. These gradually increased during the day, and with all the attendant symptoms of obstruction of the bowels in evidence. When, at about 5 p.m., he was brought to me, the symptoms of incomplete twist that we have once or twice repeated were well marked. Particularly noticeable was the sobbing breathing, and the extreme pallor of the mucous membranes, to say nothing of the weak and thready pulse. Moreover, rectal examination revealed the tympanitic flexure close to the exploring hand, and the presence of the stretched and tightened band, pre- sumably the rectal mesentery, which I have before likened to a tautened wire stretched across the abdo- men, in this case running from behind forwards and downwards. Again I administered the usual stimulants, including a dose of eserine, but attempted nothing in the way of manual interference until later in the evening. At 10.30 p.m. I decided, as in the previous case, to attempt movement of the distended flexure. Preparatory to that, especially as the paining attempts of the animal at defecation rendered manipulation difficult, I punctured Digitized by Microsoft® 292 THE COMMON COLICS OF THE HORSE the distended bowel per vectum, afterwards using the trocar in the right flank and relieving the abdominal tympany still further. As in the preceding case rotation of the flexure (this time attempted in one direction only— namely, from left to right) immediately effected a change for the better in the before evil disposition of the viscera. No passing of flatus was this time noticeable, a circum- stance which I accounted for by remembering that I had first reduced a great deal of the tympany with the trocar. The other alarming symptoms, however, began to sub- side, tympany did not again occur, and the following morning found the patient free from pain, and feeding. In neither of these cases do I pretend to have given any- thing elaborate in the way of instructions as to procedure, I do not yet feel sure enough of my ground. Simply, I have given a brief account of them just as they occurred tome. I hope that by doing so, exaggerating none of the advantages, and minimizing none of the attendant difficulties, that I may influence those who have not yet done so to pay special attention to this operation of manual reduction in cases of colic torsion. To say the least of it, the operation is an extremely interesting one, and even to only attempt it is to gain much in the way of valuable information. But apart from its interest the thing hasits utilitarian side; for I am certainly convinced that in very many cases it is the one and only way of saving the patient’s life. One or two quite practical points in the procedure I would like to emphasize before concluding. They are these: Frequent enemata of hot water thrown into the rectum during the early stages of the case very much help the surgeon in his attempt at reduction later on. In this way not only are the posterior portions of the bowels emptied and cleansed, but there is also engendered a Digitized by Microsoft® * TORSION OF THE DOUBLE COLON 293 certain amount of ballooning of the rectum, rendering manipulation less difficult. It is a point of practical importance, too, to remember that reduction is far easier if the case is allowed to go for a few hours before mani- pulation is attempted. The more violent of the expul- sive efforts of the patient have then subsided, the inserted arm is not nearly so soon affected with cramp, and there is far less risk of inflicting injury on the interposed rectal walls. If attention be paid to these points, and, above all, to a close consideration of the regional anatomy, then one can certainly promise the operator much in the way of results that will fill him with gratified astonishment. Digitized by Microsoft® CHAPTER XX DISPLACEMENTS OF THE DOUBLE COLON—Continued B. Flexion Definition. — Save for one instance? I can find no reference to this condition in English veterinary litera- ture. It is important, however, to give it consideration, if only in a brief chapter; for it is a form of intestinal displacement, the recognition of which serves to throw light on what would otherwise be instances of death from obscure causes in cases of equine colic. The French express it by the word ‘coudure,’ and the most suitable equivalent that comes to my mind is the term ‘flexion.’ By this I wish to indicate a ‘peymanent bend’ of some portion of the bowel. It is entirely distinct from torsion or twist, and can best be described diagrammatically as in Fig. 27. The dark lines indicating the bowel walls show a flexion or bend at B, while the dotted lines mark the course the bowel should normally take. We know, of 1 Smith, in his article on ‘Some Fatal Diseases of the Digestive Canal of the Horse,’ discussed before the Fifth General Meeting of the National Veterinary Association in 1887 gives it mention.— H.C. R. 204 Digitized by Microsoft® FLEXION OF THE DOUBLE COLON 295 course, that under peristaltic movements these so-called flexions or bends of the bowel are in constant process of make and unmake. The condition only becomes patho- logical when from some cause or other it becomes per- manent. When the condition becomes permanent, then there is formed at what we may call the elbow of the bend a sort of wrinkling or puckering of the bowel wall. This wrinkling or puckering in turn forms a prominence in the lumen of the bowel (see the point marked +). This prominence alone, apart from any paralysis of the bowel wall, tends to cause stasis of the ingesta, and occlusion. Causes.—So far as they relate to flexions of the Fic. 27,—FLEXION oR BEND OF THE INTESTINE. A A, Lumen of the bowel; B, position of the flexion. double colon I recognize three main causes—viz., pres- sure on the bowel from without ; local paresis of the wall; and traction. The best instance of pressure that comes to my mind is the pressing of an over-loaded stomach on the suprasternal and diaphragmatic flexures. This needs some little explanation ; and I recollect one case in particular which will serve to illustrate it. The subject of the case, a heavy cart mare, exhibited during illness all the symptoms associated with subacute ob- structive colic. In spite of treatment she died. At the autopsy there was nothing at all to account for death except this peculiar condition of bending of the bowel— no torsion or twist of any portion of the intestine, and not Digitized by Microsoft® 296 THE COMMON COLICS OF THE HORSE even limited enteritis so far as could be judged from the appearance of the bowel walls. The flexion revealed, however, was somewhat remarkable. The stomach, filled and distended to its utmost with dry ingesta, was pressing heavily against the suprasternal and diaphrag- matic flexures of the colon. The result of this was that not only were the said flexures flattened out and ob- literated, but that what were originally the convex faces of the bowel in this position had now become the con- cave, In commenting on pressure as a cause Cadéac says: ‘The suprasternal and diaphragmatic flexures of the double colon are sometimes straightened out and directed towards the diaphragm, where they become engaged between the anterior face of the stomach and the posterior face of the liver and the diaphragm. The flexures are then squeezed and flattened by the hard and distended stomach, which organ they embrace after the manner of a cravat.’! In such cases as these, associated with the pressure, is the further cause of local paresis. The bowel wall, that portion of it pressed into an abnormal position and held here by the over-distended stomach, must, as the case lingers on, to a large extent lose its normal nerve tone. That, in its turn, means obstruction at the affected spot. And then, deadened by the continued pressure, and after- wards by the paralyzing toxins elaborated by the im- prisoned ingesta, the bowel eventually comes to lose entirely that action of alternate contraction and expansion which we know as peristalsis, and which is so necessary to the maintenance of its vital functions, In other words, the end result is a fatal stasis of the ingesta. The other cause of flexion to which I have referred is 1 Cadéac, ‘ Pathologie Interne,’ vol. ii., p. 308, Digitized by Microsoft® FLEXION OF THE DOUBLE COLON 297 ‘traction.’ Probably the best example of this is to be found in those cases where an impacted pelvic flexure is found forced right into the pelvic cavity, taking up the position normally occupied by the bladder. In such an instance we then have not only the condition of impaction to deal with (see Chapter X.), but again a condition of abnormal flexion in an anterior portion of the bowel. This is the way in which it occurs: We know that normally the pelvic flexure lies close within our reach near to the pelvic brim. When impacted, there is always a tendency for this weighted end of the colic loop to be forced backwards by the paining attempts of the animal at defeecation. Ordinarily, the paining of the animal (the pains in this condition not being exces- sive or violent) serves only to impinge the impacted flexure on the pelvic brim. On occasions, however, it is thrust further back still, until, as we have just now said, it comes to occupy the pelvic cavity. This thrusting back of the weighted end of the loop means a pulling on and an obliterating of the supra- sternal and diaphragmatic flexures.1 And in such in- stances, unless this is recognized, and the impacted flexure is repelled and made to take up its normal position in the abdomen, then it means that so long as this ab- normal position of the impacted pelvic flexure is allowed to continue, so long is dangerous flexion in existence at points just anterior to the suprasternal flexure and posterior to the diaphragmatic flex ure. Symptoms and Diagnosis.—T hese may conveniently be discussed together, for there is really but little to add to what has already been said in other portions of the book. It is evident, for instance, that the symptoms will be those of ordinary subacute impaction of the bowel, as 1 Cadéac, ‘ Pathologie Interne,’ vol. ii., p. 307. Digitized by Microsoft® 298 THE COMMON COLICS OF THE HORSE described in Chapter IX. For these, therefore, the reader may be referred to that chapter. In discussing the causes, however, we mentioned one point which again presents itself when dealing with diagnosis. When the impacted pelvic flexure is present in the pelvis, then it is fair to assume we have a condition of flexion in connection with the suprasternal and diaphragmatic flexures. Prognosis and Treatment.—For the whole of this the reader may again be directed to Chapter IX., with just the additional remark that when an impacted pelvic flexure is found in the pelvis, then, in addition to the administration of the usual purgatives and stimulants, it should be part of our treatment to place it back into the abdominal cavity in order to relieve the abnormal flexion we know its false position must be causing anteriorly. General Remarks.—As we said at the commence- ment of the chapter, this condition of flexion or abnormal bending of some portion of the bowel becomes of especial interest when we are conducting autopsies on cases dead of subacute obstructive colic. Unless we are prepared for the possible existence of such a condition, it may easily be overlooked, and the real cause of death remain obscure. In other words, when an animal has suc- cumbed, showing nothing but the dull symptoms of subacute colic during the whole of the illness, and the autopsy reveals nothing in the way of torsion, enteritis, or other pronounced lesion, then one, unless he is cogni- zant of this condition, is apt to be left in wonder as to what the actual cause of death could have been. It is then that a knowledge of this condition helps one out. Either a pronounced bend, or ‘kink,’ as I have seen it elsewhere described, is found in a position where such should not be, or one of the normal flexures is discovered Digitized by Microsoft® FLEXION OF THE DOUBLE COLON 299 straightened out or obliterated, either condition offering a solution of what would otherwise have remained a mystery. That the bend, flexion, or kink, has been a permanent one, is judged from the fact that the ingesta at the affected part is collected into a hard unyielding mass, in some instances, in fact, maintaining an outline actually elbow-shaped, just as would a plaster-cast of the lumen of the bowel, thereby indicating plainly enough the evil disposition affecting the bowel during life. Similarly, when a normal flexure is found straightened out, the packed ingesta at this point by its shape suffi- . ciently points out that the condition was in existence prior to death. Digitized by Microsoft® eer CHAPTER NXI DISPLACEMENTS OF THE DOUBLE COLON—Concluded C. Torsion of the Pelvic Flexure: Its Diagnosis, and Differential Diagnosis between that Con- dition and Simple or Subacute Impaction of the Same Portion of the Bowel Definition.—Torsion affecting the extreme end of the colic loop, thus involving the last third of the second division, and the first third of the third division of the bowel. So far as my experience goes, I have found torsion of this portion of the bowel always of the incomplete variety— just a mere doubling or bending over of the flexure. Causes, Symptoms, and Diagnosis.—These, as relating to incomplete twist of the colon in general, have been fully described in Chapter XIX. It often happens, however, that torsion or displacement as affecting the pelvic flexure alone may be diagnosed. In order to draw attention to this I recapitulate here something of what has been said in Chapter XIX., concluding with what I believe to be a further important matter—namely, the means we now possess of differentiating between torsion of the pelvic flexure and its mere impaction. 300 Digitized by Microsoft® TORSION OF THE PELVIC FLEXURE 301 From what has already been set out under the symp- tomatology of incomplete twist in Chapter XIX., it will have been noticed that much depends on the history of the case. When with such a history as we have there described we meet with symptoms of gravity—notably the spasmodic contraction of the rectum during explora- tion, the continuance and gradual increase in severity of the pains, the irritable passing of small quantities of loose faeces, the weak nervous pulse, the raised tempera- ture, the patchy sweats, and the agonized expression of countenance—-then we may be tolerably certain that twist has occurred. It is another matter to locate it. Sometimes, however, it may be correctly referred to the pelvic flexure after some such manner as this: In such a case as we are considering we may at once put twist_of the small intestine out of the reckoning by saying that in these cases the pain, vapid in its oncome, is so insistent and so agonizing, abdominal distension so rapid and so marked, the sweats profuse to a degree of becoming quite early in the case a perfect bath, and the position of the patient when down so often dorsal, as to give to the veterinarian in a few short hours a fair inkling of the true nature of the attack. Similarly, with complete twist of the colon—which cases of complete twist always occur farther forward in the colic loop than the pelvic flexure—the rapid oncome of the pain, the profuse sweats, the highly injected mucous membranes, the early exhibition of the sardonic grin or haggard expression, and the rapid posting on of the case to its end, all are indications which leave no room for doubt. We may therefore sum up as follows: Our case is not twist of the small intestines—the symptoms are being unrolled far too slowly. If only for the same reason, Digitized by Microsoft® 302 THE COMMON COLICS OF THE HORSE and apart from the evidence afforded by the other symp- toms as described in Chapter XIX., it is not complete twist of the colon. ... And yet twist we have decided is the condition with which we are dealing. Eliminating the other possibilities as we have done, it can only be some form of incomplete twist, and that of the double colon. But of what portion of it? Here the presence or absence of the “resilient tumour”’ in the pelvis comes to our aid. If on exploration we meet with the emptiness of the abdomen described ina previous chapter, then we may take it as certain that displacement of the pelvic flexure has occurred. The point may here be raised that displacement has occurred merely as a result of torsion elsewhere (say, at the diaphragmatic flexure, or at the head of the bowel) and that the pelvic flexure is thereby ‘pulled back’ from its normal position, and is not itself actually the subject of twist. Now this ‘ pulling back’ of the pelvic flexure can only occur to any great extent in cases of complete twist of the bowel, and in these instances we get a cutting oft of the blood-supply to the half or to the whole of the colic loop, according to the position of the twist. In either of these events we get a train of symptoms de- pending on strangulation and rapid gangrene of the distal portion of the loop, which train of symptoms we have, but a paragraph or two back, referred to. But this particular set of symptoms we have decided is not in evidence. We have quite made up our minds that the symptoms shown are those of incomplete twist only— and yet the pelvic flexure is missing from its normal position, Just what does this mean? Asked that question, we may sum up as follows: We have here a case of intestinal torsion; we have Digitized by Microsoft® TORSION OF THE PELVIC FLEXURE 303 succeeded in negativing that it is twist of the small intestines ; we have also negatived the fact that it is complete twist of the colon; we have gone further and decided that it is incomplete twist of the latter bowel, and that in this particular case of incomplete colic twist there is the absence from its normal position of the colon’s free end. All this can but mean that the pelvic flexure is displaced, and that such displacement is responsible for the patient’s condition, In this way our diagnosis is complete, and that a successful diagnosis may be made in this manner I am quite convinced. That I am not alone in this opinion I know from the following words of Major-General Smith: ‘I lay particular stress upon the absence of the large intestines from the left flank when the pelvic flexure is displaced. This symptom enabled me on one occasion to arrive at a successful diagnosis.’ ‘There remains one other point for consideration. I have already pointed out that although the pelvic flexure may be. displaced and the actual cause of the mischief, matters may be complicated by our discovering in the pelvis a gas-distended coil of small intestine (see Chapter XIX., p. 275. This may readily be mistaken for the inflated pelvic flexure, especially when we are greatly hindered in exploration by the violent straining of our patient. In such a case the veterinarian may excusably fail to make an accurate diagnosis. The admission of this, however—one of the many difficulties in our way—does not detract from the truth of my conten- tion that some cases of pelvic torsion may be diagnosed. I am particularly anxious to press this point, if only that it may be the means of enabling others to experience the pleasure of thus accurately defining their case during life, and afterwards verifying the diagnosis at post- Digitized by Microsoft® 304 THE COMMON COLICS OF THE HORSE mortem. For when once we are able to do this, if only in isolatedi nstances, and at post-mortems always care- fully checking the errors we unavoidably make, we must come eventually to a greater understanding of these troublesome conditions, upon which so much yet remains to be written. Differential Diagnosis between Torsion and Simple Impaction of the Pelvic Flexure.— With his case before him and with such help as I have been able to give, I do not think the veterinarian should experience any great difficulty. In the first place the history of the illness will give him material assistance ; and in this connection too great a stress cannot be laid on the fact that the case of torsion is the one where the urgent symptoms develop in the early hours of the morning, and appear to be consequent on some more than ordinarily severe hauling effort during the labour of the day before. On the other hand, when one is called in during the late forenoon, afternoon, or evening, more par- ticularly when the history points to no labour more severe than steady work, and that on regularly full rations, then usually we need fear nothing worse than the simple case of impaction (see Chapter X.). The observation of the symptoms gives further help, and for purposes of ready comparison may conveniently be put into tabular form as follows: IMPACTION. TwIsT. See Chapter X. See Chapter XIX. 1. Periods of ease manifested 1. Constant pain, exhibited by by the patient maintaining a continual crouching movements, sleepy, stretched-out positionon and marked disinclination to lie the floor, for quite long periods. down. The dog-like attitude when down, and the frequent twinges of acute pain then shown, as described in the text. Digitized by Microsoft® TORSION OF THE PELVIC FLEXURE 305 ImMPaAcTION. See Chapter X. 2. Pulse full, and normal in number of beats, except during the paroxysms of pain, 3. Respirations deep and reg- ular, only becoming quickened and catchy during pain, 4. Temperature normal. 5. No straining on rectal ex- amination. Rectum ‘ballooned.’ No marked spasmodic contrac- tion of its walls. 6. Rectal examination reveals the presence in the pelvis of the Twist. See Chapter XIX. 2. Pulse constantly quick, and slowly progressing to a running- down character. 3. Respirations short, catchy, and laboured; may be termed ‘sobbing.’ 4. Temperature raised to 103° F, 5. Marked straining on rectal examination, with spasmodic clasping of the bowel on the inserted arm. 6. The pelvic flexure is alto- gether missing from its position ingesta-packed pelvic flexure. near the pelvic brim. In conclusion, but without belittling any other of the evidence, each portion of which forms a link in our chain of reasoning, I would remark on the importance of the information gained by rectal examination. When we find pey vectum the knee-shaped, ingesta-packed portion of bowel as described in Chapter X., it is conclusive evidence of impaction of the pelvic flexure. Similarly, when careful exploration fails to reveal the pelvic flexure in its normal position near the pelvic brim, the evidence is just as conclusive that we are dealing with a case of pelvic displacement. Two Recorded Cases of Torsion of the Pelvic Flexure.—As the report of an actual case is always interesting, I give below two cases of torsion of the flexure which occurred in my own practice. They are interesting not only as concerning torsion of the flexure alone, but may be read in connection with the description of incomplete twist as given in Chapter XIX. 20 Digitized by Microsoft® 306 THE COMMON COLICS OF THE HORSE Case I.—Suwbject, a three-years’-old cart gelding. History—Jwly 27.—On this day the animal was at work carting manure from a crew-yard out into the fields. The ‘pull-out’ from the yard was moderately stiff, and was greasy with the wet portions of the dropped manure. In the evening the horse was quite well, and ate his usual feeds. July 28.—In the early morning of this day the gelding was to all appearances quite well, and partook of a moderate feed of green lucerne. At 7 a.m. he was taken with sharp colic pains. To these the owner at first paid little heed, deeming them due to an ordinary attack of spasmedic colic, thinking that natural relief would perhaps soon follow. At 9 a.m. the owner saw that such was not likely to happen, and himself came to request my attendance. At 10 a.m. I reached the farm and found the animal in the field, at the end of a long halter, walking round and round the attendant in charge. Even before actually reaching the animal I saw that the case was a serious one. The pains were continuous and violent, and the exhibition of the peculiar ‘ crouching’ movement referred to on p. 270 was most marked. Patchy sweats bedewed the body, and the haggard expression of countenance so common in our fatal cases of colic was well in evidence. That the case was. hopeless I was convinced just on a cursory examination, but proceeded to handle the animal and make a more careful investigation before giving an opinion. The pulse was full but quick; and the visible mucous membranes injected, though not greatly. Respirations were hurried and sobbing, and the temperature 103° F. Rectal examination gave confirmatory evidence of the grave nature of the case. The bowel clung round the Digitized by Microsoft® TORSION. OF THE PELVIC FLEXURE 307 arm with the tenacity of strongly exerted voluntary muscle, rendering further examination difficult, and call- ing for great care in order to avoid rupturing the organ. Contents of the bowel were few, oily, and soft. There was no dryness, so marked a feature in cases of ob- struction.! There was no distended bowel in the pelvis, and no portion of the colon could be felt, or at any rate dis- tinguished. The animal was now given his head and allowed to do as he liked. Instead of wandering off into the field (the quite usual thing under these circumstances when the case is one of simple obstruction only) he commenced boring with his head into first one bystander and then another, not roughly, but as though seeking ease. He could, in fact, only be kept from doing this by the re- peated use of the whip. Finding that, try as he would, we were insistent on keeping him off, he walked a few yards away, still exhibiting the crouching movement already described, to eventually throw himself to the ground. That the pain was continuous was still quite evident even now he was down. No ease was obtained in the recumbent position. Instead, he lay with his forelegs extended in front of him, and continuously exhibited the alternate half rise, half fall, on which I have laid stress as being very nearly symptomatic of incomplete twist. Treatment.—lIn the full knowledge that nothing could be done, and that only death would ensue, an attempt 1 In this connection note the remarks of Major-General Smith : ‘The bowels have usually in the first instance acted. In other words, the rectum has emptied itself. . I saw one case of pelvic flexure twist where profuse diarrhoea was “‘preseat Sean the whole period of the attack,’ Digitized by Microsoft® 308 THE COMMON COLICS OF THE HORSE was made to relieve the pain by administering a heavy dose of morphia and atropine. Prognosis.—Early death from displacement of the intestines, in all probability the large colon.* At 2 p.m, all grave symptoms markedly more pro- nounced. The pulse was wiry and evidently running down. The patchy sweats were now cold, and the pains were still continuous. Patient decidedly weaker. At 6 pm. death occurred with no period of ease before it. Autopsy.—This revealed a remarkable twist of the double colon. As the abdomen was slowly opened the first noticeable abnormality was that the caecum failed to protrude. Even with the opening completed, and flaps of the abdominal wall deflected, the cecum was not to be seen. The first portion, and about two-thirds of the second portion of the double colon were lying in their normal positions next the floor of the abdomen. The end of the second portion and the commencement of the third (that is to say, the whole of the pelvic flexure) were turned over from right to left and downward and forward (the carcass in the dorsal position) so that the point of the pelvic flexure was hidden from sight, a dis- tended part of portion number two (the middle third of it) 1 It should be noted that this case is recorded just as it stands in my notebook, without addition or alteration of any kind. This was in 1908, before I felt quite so certain as I do now that twist of the pelvic flexure could be diagnosed. Even then, no doubt the absence of the pelvic flexure from its normal position ought to have led me to a correct decision, It will perhaps be interesting to the reader to hear, too, that the prognosis, fixing upon the large colon as the seat of the trouble, was given, as a proof of what a careful examination would do for one, to an assistant of mine who accompanied me, and who afterwards with me verified the diagnosis at post-mortem. Digitized by Microsoft® TORSION OF THE PELVIC FLEXURE 309 seen to be running in a transverse manner across the abdomen. The abnormal position taken up by the bowel will be better understood by a reference to Figs. 8, 9, and 10 on Pp. 124, 126, and 127, Fig. 8 representing the normal colon, and Figs, g and 1o the particular case of twist I have just related. Case II.—Swbject, a ten-years’-old cart mare. History—A ugust 4.—During this day the mare was at work carting manure from one of the yards. As in Case I. the ‘ pull-out’ from the yard was steep and try- ing. The mare was last seen at 9 p.m. At this time she was turned out into a field for the night, to all appearances quite well. August 5, 5 a.1.—The mare was discovered in the field, rolling about in pain, and with marks on her head and hips which denoted that she had been rolling for some time. She was brought up into the yard for treat- ment. At 7.30 a.m. I was in attendance. Again, just as in Case I., I was able to see almost at a glance that the case was hopeless. All grave symptoms—haggard ex- pression, troubled pulse, intensely injected membranes, sobbing respirations, and patchy perspirations—were in evidence. The abdomen, although slightly so, was not greatly tympanitic, and the rectum, instead of cling- ing tightly to the inserted arm, was rather inclined to be open, or ‘ ballooned,’ two facts which I regarded as some- what favourable in themselves, but altogether over- balanced by the weight of the symptoms. of gravity. When down, too, the mare at times appeared fairly quiet. Rectal examination also revealed the presence in the bowel of a small quantity of soft feces, and gave me what Digitized by Microsoft® 310 THE COMMON COLICS OF THE HORSE I took to be the pelvic flexure of the colon in its normal position. Diagnosis.—This I gave as twist of the double colon, perhaps only partial, and probably at the suprasternal and diaphragmatic flexures. My diagnosis I arrived at in this way. I hkuew that the fatal signs of twist were all of them present. I thought I discovered the pelvic flexure in its normal position, and, therefore, excluded that. 1 knew that it was not complete twist of the bowel that had occurred for the reason that (although grave) the symptoms were insufficiently rapid to point to it. I further deducted ‘incomplete’ twist from the com- parative absence of tympany. Fixing the point at the suprasternal and diaphragmatic flexures was in some measure trusting to the law of chance, for, in my experi- ence, twist of the head of the colon does not occur so frequently as in other positions. Just how far this diagnosis was right will appear when we describe the autopsy. Treatment.—This was wholly expectant. No seda- tives were given, for I hoped the partial twist I had diagnosed might yet, in a manner which I shall discuss in the following chapter, effect a spontaneous reduction under a stimulant treatment. This included eserine and pilocarpine. 12.30 p.m.—I was told by the attendant that the mare had been much easier and quieter. He held the opinion that she was improving. It was plain to see, however, that nothing but a fatal prognosis could be given. Pain was still continuous. The pulse, taken every now and again, at intervals of a few minutes only, varied from as low as 80 to as high as 120 beats per minute—was, in fact, still ‘troubled.’ The respirations, 28 per minute, were still sobbing, and the expression still was haggard Digitized by Microsoft® TORSION OF THE PELVIC FLEXUKE 311 One good passage of faeces had taken place. This was within an hour of the administration of the eserine and pilocarpine. Since that nothing save the passage of a little flatus. 6 p.1.—I could detect no change, only that the mare was weaker, August 6, 4.15 a.m.—Death occurred. I was informed of this by a messenger, and was also told that from the time of my last visit in the evening previous the mare had grown steadily worse, that eventually she lost all control of her actions, and that she died in agony with no previous period of ease. Autopsy.—Contrary to what I had expected, this re- vealed displacement of the pelvic flexure. What, during the rectal examination I had taken to be the pelvic flexure was a greatly distended coil of small intestine forced into the pelvis. The pelvic flexure itself, as in Case I., was doubled downward and forward (the carcass again in the post-mortem position on the back) the end of the flexure being out of sight beneath the second and third portions of the bowel and a quantity of small intes- tines. So like was this to the condition found in Case I. that no photograph was taken. The abnormal position the pelvic flexure took in the abdomen will, I think, be sufficiently understood from reference to Fig. 28. In Case I]. there was marked discoloration of the bowel, although not sharply defined. In this instance there was nothing of the kind marked. This last note is of importance. It indicates that Case II., so far as strangulation of the bowel went, was not so complete a twist as Case I., and, although ending fatally, serves to show the value of the favourable symptoms noted during the life of the patient—namely, the passing of the flatus and comparative absence of abdominal distension, together Digitized by Microsoft® 312 THE COMMON COLICS OF THE HORSE with the absence of spasmodic contracting of the rectal walls. It will be noted, too, that this animal lived on for nearly twenty-four hours, as against the twelve or ( wget