ACUTE CATARRHAL ENTERITIS IN SOLIPEDS.
Definition. Causes: Irritants swallowed, debility, improper, insufficient food, congestions, parasitisms, impaired innervation or circulation, iced water, chills, perspirations, fatigue, hot, damp weather, overfeeding, cryptogams, bacteria, newly harvested fodder, septic, or fermented food, leafy fodder, toxins, stagnant, septic water, lack of pepsin, muriatic acid and bile, diseased teeth or jaws or salivary glands. Lesions: Gastritis, congestion of small intestine and colon, in striæ, thickening, ecchymosis, ulceration, necrosis, excess of mucus with pus, villi, follicles and glands swollen. Symptoms: Fever, high colored urine, costiveness, coated tongue, red eyes, inappetence, sluggishness, emaciation, weakness, unthriftiness, colics, rumbling, diarrhœa; or more fever, suffering, anorexia, icterus, hurried breathing, pleuritic ridge, arched back, tender abdomen, rumbling, flatus, diarrhœa, critical or bloody, anxiety, debility, prostration, collapse. Prognosis. Treatment: In mild cases, careful diet, and laxatives with antiferments, in severe cases, laxatives, anodynes, antiseptics, demulcents, stimulants of peristalsis, enemata, counter-irritants, fomentations, compresses, mustard, in profuse diarrhœa antiseptics, anodynes, demulcents, calomel and chalk, bismuth, astringents, boiled flour or starch, gums. Dieting during convalescence.
Definition. Inflammation of the intestinal mucosa.
Causes. Irritants of all kinds taken in with food, or as medicine or otherwise and acting on the mucosa. Debilitating conditions (chronic disease, starvation, overwork, close indoor life) which lower the tone of the system at large, and local debilitating conditions like coarse, dry, fibrous, innutritious food, congestions, parasitisms, impaired innervation and troubles of the circulation are strongly predisposing. Drinking iced water may operate by lowering the tone of the intestines but seems to habitually act rather by inducing reaction and congestion. Chills of the surface, especially when perspiring and fatigued, act in the same way. The relaxation and atony attending on long continued hot weather, predisposes to enteritis, but is doubtless even more injurious by the abundance of ferments which it propagates in food and water.
Overfeeding and stimulating aliments thrown on an alimentary canal in such an atonic condition become especially hurtful. The injury, however, comes most commonly from food that contains an excess of cryptogams or bacterial ferments or from water similarly charged. Newly harvested fodders in which the microbes are still in a state of vigorous life, when added to the poisonous principles in certain immature seeds (leguminosæ, gramineæ, etc.); fodders that have undergone fermentative changes (rotten potatoes, turnips, musty hay or oats); fodders that are leafy and harbor an excess of microbes (alfalfa, sainfoin, cowpea, clover) are especially dangerous at times. If musty or otherwise altered they often contain besides, dangerous toxins.
In taking into account the fungi and microbes in spoiled foods, we need not give exclusive attention to the particular species of microbe present. An extended observation shows that the same ferments may be present in the dry, well cured, wholesome fodder, and in the musty or spoiled specimen, the main difference being in the excess found in the latter case as compared with the former. With the excess too, there is always present a large amount of toxins, ptomaines and other more or less poisonous products, which, acting on the intestinal mucosa or even on the system at large, tend to reduce its vitality and to lay it open to the attacks of bacteria which had otherwise remained perfectly harmless. Porcher and Desoubry, Achard and Phulpin and Wurz have shown experimentally that intestinal microbes can enter the chyle and blood from even a healthy bowel. The streptococcus of pneumoenteritis equi of Galtier and Violet appears to be a common fodder and intestinal microbe, which has become pathogenic, because of its excess or on account of a lack of resistance on the part of the animal. In the same way the various intestinal cocci and the common colon bacillus may become pathogenic when the normal antagonism of the bowels and their contents is lessened.
In the same way stagnant and septic water may be harmless to one animal of great vigor and good tone and pathogenic to another which lacks these qualities; or the excess of the ferment and its toxins may overcome the natural resistance of the animal. The lack of the natural antiferments of the intestine, pepsin and hydrochloric acid, on the one hand and bile on the other, will also conduce to multiplication of the microbes and their products, so that they can successfully attack the mucous membrane.
Other accessory causes operate more or less, thus any impairment of the process of mastication, through diseased teeth or jaws tends to the escape of undigested food through the stomach, as a specially favorable culture media for the microbes, and irritants of the mucosa.
Lesions. As the disease very often implicates the stomach (gastro-enteritis), the usual lesions of gastritis will be seen. Most commonly the lesions are best marked in the small intestine, and again in other cases in the colon, but usually there is more or less change in all parts of the intestinal canal. The small intestine is almost devoid of aliments and the mucosa deeply congested in patches or striæ, with at points thickening, softening so that it crushes under the finger, hemorrhagic discoloration, and even ulceration, and necrotic changes. It is covered with a layer of mucus, thin and mucilaginous or thick and glutinous, containing many granular and pus cells. The villi are swollen, the follicles of Lieberkuhn puffed up, and the agminated and solitary glands widely dilated, filled with exudate, and surrounded by an area of congestion. Proliferation of small, round cells has produced embryonic tissue in the mucosa and especially between the glands.
Symptoms. In the mildest form there is hyperthermia, thirst, insensible loins, scanty, high colored urine, costive bowels, a few small pellets only being passed at a time, hard, dry and covered with a mucous film, hot, clammy mouth, coated tongue, with redness along the edges and tip, yellowish red eyes, impaired appetite, dull, sluggish habit, a tendency to hang back on the halter, and a steady loss of flesh and increased dryness and unthriftiness of the coat. Slight, intermittent colics occurring especially after meals and attended by loud rumbling of the bowels are marked features. This may be followed by slight relaxation of the bowels and recovery in about a week, unless it should become complicated by intestinal indigestion or impaction, or should merge into the acute form.
In the more intense forms all symptoms are aggravated. There is anorexia and even refusal of water, dullness and prostration are well marked, the head carried low, and the gait is unsteady. The mouth is hot with tenacious mucus, and a fœtid odor; the tongue is furred and red at the tip and margins, the eye is sunken, the conjunctiva icteric, the face pinched, and the pulse accelerated. Hyperthermia may reach 104° F. Breathing may be almost normal, or with fever, may become rapid and accompanied by a pleuritic ridge on the flank. The back is slightly arched and rigid, the belly drawn up and tender, after meals it may be tympanitic, and colics set in or are aggravated, pawing, uneasy movements of the hind limbs, and lying down to rise again shortly, with frequent looking at the flanks being noticeable.
Defecations are at first abundant and coated with mucus, later the balls are small and scanty and expelled with much effort. From the first the everted rectum is of a very deep red. Toward the end of the first day or later the intestinal rumbling increases, flatus passes freely, and diarrhœa may set in and prove critical. This usually indicates disease in the colon and tends to recovery; it may be entirely absent if the inflammation is confined to the duodenum, the effused liquid being re-absorbed from the cæcum and colon. If the diarrhœa should prove critical there is a return of appetite and spirit, the fæcal discharges become firmer and recovery takes place in a week. If, however, the diarrhœa becomes more profuse and bloody, the colics more intense, the eyes more sunken and hopeless, the face more pinched and anxious, and the temperature reduced to or below the normal, with great weakness and debility, the near approach of death may be feared. This state of collapse may be further marked by extreme coldness, or dropsy of the limbs, increased icterus, hurried breathing and rapid loss of flesh.
A prominent icterus indicates implication of the liver from the ascent of the infecting germs through the bile ducts, or the passage of microbes or their products or both through the portal vein. In either case it is a serious complication.
Prognosis. In its uncomplicated form the disease is not very fatal to vigorous, mature horses, though more trying to the young. If infective germs or their products implicate the liver producing marked jaundice, or if the general system is poisoned by the microbes or their toxins, producing marked depression and prostration the danger is enormously enhanced.
Treatment. In the mildest cases a limitation of the food to moderate bran mashes, and a dose of ½ lb. of sodic sulphate, with salicylate of soda (3–4 drs.) or bismuth will usually suffice.
In severe cases, at the outset, while constipation exists give 3 or 4 drs. of cape aloes, or ½ lb. Glauber salts or ½ pint olive oil, combined with 2 drs. of extract of hyoscyamus or belladonna and 3 drs. salicylate of soda. This serves to deplete from the inflamed vessels and the whole portal system, to soothe suffering, to expel much of the offensive and infective matters from the bowels, and to check fermentation in that which remains. They should be given with, or followed by mucilaginous liquids like solutions of slippery elm or gum arabic, flaxseed tea, or well boiled farinaceous gruels.
Pilocarpin, 3 grs., or eserine, 2 grs., or both have been recommended and may be resorted to when action of the bowels is urgently demanded. They need not supersede the other laxatives. In manifest impaction of the large intestines, salts, aloes, pilocarpin and eserine may form an effective combination.
Copious enemata with mucilaginous liquids or warm soap suds should be given at frequent intervals.
Counter-irritants and derivatives to the abdomen are most important. Hot fomentations may be persisted in for an hour at a time, or a damp compress around the abdomen covered closely by dry blankets and held in place by elastic circingles. Mustard pulp made with cold water rubbed in against the hair and at once covered by paper and a thick blanket is often of great value as drawing blood and nervous action to the skin and relieving the suffering intestine.
In all cases the diet and drink must be carefully supervised. A little thoroughly scalded wheat bran, or farina, and decoctions of flaxseed, farinas, slippery elm or mallow, or a solution of gum arabic will refresh the animal without overloading the digestive organs or favoring further fermentation.
In case of the onset of diarrhœa which threatens to prove excessive and persistent, the giving by mouth and anus of antiseptics and anodynes with mucilaginous agents may be resorted to. Calomel may be given in 10 grain doses twice daily mixed with five times the amount of chalk. Or 2 drs. each of nitrate of bismuth and salicylate of soda and ½ oz. of laudanum may be given three times a day. Or quinine, 2 drs. and nux vomica 10 grs. may be added to the above. A choice may be made of other anodynes, (hyoscyamus, belladonna), antiseptics, (salol, chloral, naphthol, naphthalin, creolin), and bitters, (gentian, calumba, cascarilla).
Antiseptic and even astringent injections must be given, and well boiled farinas and mucilaginous agents may be given by the mouth. Wheat flour boiled for several hours; starch prepared with boiling water as for the laundry, (1 pint); gum arabic, or slippery elm may suffice as examples.
The patient should have a dry comfortable box and warm clothing according to the season of the year. He must be kept for a week on linseed gruel or other equally simple demulcent agent and brought back to his customary food by slow degrees.