COLIC, ENTERALGIA, INTESTINAL SPASM.
Definition. Colicy pains from spasm, enteralgia, tympanitic indigestion, overloading of bowels, impaction, calculi, concretions, sand, foreign bodies, intestinal and arterial parasites, irritants, enteritis, catarrhal, bacteridian, protozoan, chemicals, strangulation, adhesion, volvulus, invagination, hernia, trauma of stomach or intestine, peritonitis, pleuritis, metritis, ovaritis, hepatitis, biliary calculus, nephritis, urinary calculus, neoplasms, lead poisoning. Causes of enteralgia or spasm, idiosyncrasy, nervousness, cold, wet, high condition, debility, cold, rain, dew, perspiration, fatigue, indigestion, rheumatism. Symptoms: horse—sudden attack, paws, kicks, anxious look at flank, crouches, goes down, rolls, sits, rises, shakes himself, feeds, repeats at intervals, rumbling, defecations. Complications. Diagnosis, symptoms violent, transient, completely intermittent, no fever, no tenderness; from acute indigestion by absence of faulty feed, loaded or tympanitic abdomen, crepitation, continuous pain, and of careful decubitus; from constipation by complete intermissions and freer passages; from intestinal worms by absence of fur on anus, of rubbed rump, and of parasites in stools; from verminous thrombosis by complete intermissions and absence of prostration, cold sweats and of bloody stools; from enteritis and other inflammations by absence of fever; from intestinal anthrax by the intermissions, the absence of brownish mucosa, and perhaps of anthrax from the district; from hepatitis by absence of icterus, tender hypochondrium, and fever; from kidney affections by lack of stiff, straddling gait, tender loins, stretching; from pleurisy by absence of catching breathing, tender intercostals, and friction sound; ruminants—similar symptoms except sitting up or rolling; swine—sudden starting with grunt or scream, vomiting, etc.; Carnivora—frequent moving, yelps, snapping, straining, looking at flank. Treatment: solipeds, morphia subcutem, anodynes, laxative, friction, walking, enemata, chloral hydrate: ruminants, walking, enemata, morphia, laxative; swine, morphia, laxative, antispasmodics, injections, derivatives; dog,—purgative, injections, chloral hydrate, ether, olive oil.
The term colic is loosely applied to all abdominal pains from whatever cause they may arise. It is thus allowed to embrace all diseases of the abdomen. In its more restricted sense in which it will here be considered it may be held to indicate abdominal pain without inflammation or any structural lesion.
It may however be well to note the most common causes of abdominal pain so that the distinction may be more definitely reached by a process of exclusion.
1st. Simple spasmodic colic. 2d. Enteralgia or neuralgia of the intestines. 3d. Colics from indigestion, a tympanitic, b from overloading with ingesta, c from impaction or constipation, d from calculi or concretions or from sand, or gravel taken with the food or from foreign bodies swallowed, e from worms in the intestines, f from worms in the mesenteric vessels (thrombo-embolic), g from irritants taken with the food or otherwise. 4th. Colics from structural lesions of the intestines; a from inflammation of intestine, b from bacteridian inflammation of the bowels, c from protozoan inflammation, d from chemical or other irritants, e from intestinal strangulations, f from adhesions, g from volvulus, h from invagination, i from mesenteric omental or phrenic hernia, j from strangulated inguinal, femoral ventral or umbilical hernia, k from wounds, ruptures or perforations of stomach or intestines, l from peritonitis or pleuritis, m from metritis or ovaritis, n from hepatitis or biliary calculus, o from pancreatitis or pancreatic calculus, p from nephritis, nephritic, uretral, cystic or urethral calculus, q from neoplasms affecting any of the abdominal organs. 5th. Colic due to lead poisoning.
Causes of enteralgia and spasmodic colic. Enteralgia may be defined as a neuralgic pain of the bowel which may therefore be free from spasm or any other appreciable structural or functional change. Its existence in the lower animal is necessarily somewhat problematical, as it can only be inferred from the analogy of the animal with man, and of the enteron with the superficial parts that are more frequently attacked with neuralgia, and also from the absence of visible spasmodic contractions in the bowel which has been the seat of intense pain, yet shows no inflammatory lesion. But whether this is accepted or not, the occurrence of spasm is undeniable and as both are functional nervous disorders the same causative factors will apply to both.
In some nervous animals, especially high bred horses and dogs, there is undoubtedly an idiosyncrasy which shows itself in a special susceptibility of the nervous system. In such animals an exposure to cold or wet, or the presence of a local irritant which would have been without effect under other circumstances, lights up the nervous disorder and produces an explosion, it may be as spasm or it may be as nervous pain. Animals that are kept under the best care, that are least accustomed to exposure and neglect, that are highly fed, and maintained in high spirits and are impatient of control are more susceptible than those that become inured to change and exposure, yet are kept in moderately good condition. On the other hand the subject which has become debilitated by overwork, underfeeding, exhausting disease, or the generation in the system of some depressing poison is likely to show a similar nervous susceptibility, so that at the two extremes of plethora and nervous susceptibility, on the one hand, and anæmia and neurasthenia on the other, we find a corresponding tendency to nervous disorder under comparatively slight causes. Thus it happens that a drink of ice cold water, an exposure to a cold blast or a drenching rain or a heavy night dew may seem to be the one appreciable cause of the trouble. If the animal has been perspiring and fatigued the attack is more likely to occur. In other cases a slight indigestion unattended by impaction or tympany, or the ingestion of an irritant which on another occasion, or in another animal would have been perfectly harmless, will induce a violent nervous colic. In some instances the attack is supposed to be of a rheumatic nature the causative action of the cold giving color to the theory.
Symptoms. The attack usually comes on suddenly especially if it has followed on a drink of cold water or a cold exposure.
Solipeds. The horse leaves off feeding or whatever he may have been engaged in, paws with his fore feet, moves uneasily with his hind ones or kicks with them, one at a time against the abdomen or out backward, he looks back at the abdomen with pinched, drawn, anxious countenance, bright anxious eye, and dilated nostrils, he moves uneasily from side to side of the stall or box, crouches for a few seconds with semi-bent knees and hocks and then throws himself down violently with a prolonged groan. When down he may roll from side to side over the back, and struggle in various ways, he may start to rise, sit for a moment on his haunches, then go down and roll as before. Or he may get up, shake himself and resume feeding as if entirely well. Soon the spasms reappear, suddenly as at first, and after a time subside as before. Thus the disease proceeds, each succeeding paroxysm diminishing in violence until they permanently subside, or increasing until the animal dies worn out with shock, suffering and exhaustion. If the paroxysms are severe the skin is usually bathed more or less in perspiration. Usually the peristalsis continues more or less, a rumbling is heard in the bowels and more or less fæces are passed in small solid balls or semi-liquid.
The course of the disease is usually rapid and followed by recovery. When prolonged it may become complicated by volvulus, invagination, indigestion or even enteritis.
Diagnosis. The characteristic symptoms are the suddenness of the onset, the extreme suffering during the paroxysm, the reckless manner in which the animal throws himself down, the intermissions with complete absence of pain, the natural condition of the pulse and temperature in the intermissions, the comfort with which the patient shakes himself, and the absence of all abdominal tenderness, manipulation and friction seeming to give relief rather than discomfort.
In the colic of acute indigestion there is the previous excessive or unwholesome meal, or the full drink after feeding; there is tympany, or a loaded state of the abdomen proving flat on percussion, there may be crepitation on auscultation, there is continuous pain with exacerbations (not complete intermissions), and there is rather a careful mode of lying down.
In intestinal constipation or other obstruction, fæces may be passed at first in small pellets coated with mucus or they may be at first passed freely but in steadily lessening quantities until they stop altogether. The pain is constant but worse at one time than another and in case of external hernia the swelling will be visible.
In helminthiasis there is the general unthriftiness, irregular appetite, frizzled broken hair on the base of the tail, a fur of dried mucus around the anus and the presence of parasites in the droppings.
In verminous thrombosis, to the symptoms just named there are added the reckless method of throwing himself down, hyperthermia, constancy of the pain, rapidly running down pulse, cold sweats, and profound prostration. When blood is passed per anum it is all the more significant.
In enteritis or peritonitis the hyperthermia and the constancy of the pains are sufficiently pathognomonic.
In intestinal anthrax there are the dusky brownish yellow mucosæ, the marked prostration, the hyperthermia and the constancy of the suffering. There is also the fact that the region is subject to anthrax and bacilli may be present in the blood.
In acute hepatic disease there is hyperthermia, dusky or icteric mucous membranes, great tenderness when percussion is made over the short ribs, and sometimes lameness of one shoulder (usually the right).
In disease of the urinary or generative organs the stiff or straddling gait, tender loins, and the frequent stretching as if to urinate, are nearly pathognomonic.
In pleurisy the hyperthermia, the transient duration of the colic, and the tenderness on manipulating the intercostal spaces will usually differentiate.
Ruminants. In cattle, as in the horse, the symptoms of spasmodic colic are restlessness, constant movement, looking round at the flanks, wriggling of the tail, uneasy lifting of the hind feet, kicking at the abdomen, and abruptly lying down and rising again. The animal does not roll on the back nor sit on the haunches. Fæces may be passed in small quantity or entirely suppressed, and there may be a slight tympany of the paunch.
Swine. The animal is attacked abruptly, starts with a grunt or scream, moves around uneasily, lies down, rolls, gets up, and repeats the motions. Vomiting is not uncommon, and the belly may be tense, tympanitic and even tender. The bowels may be confined or relaxed.
Carnivora. The colicy dog is very restless, changing from place to place, sitting on his haunches, lying down curled up, starting up suddenly with a yelp, and repeating the restless movements. He looks anxiously at his flank, sometimes bites at it, and cries plaintively. The bowels are usually torpid, and defecation effected with straining.
There are distinct intermissions but these are cut short by a new accession of pain.
The attack is usually transient and ends in recovery.
Treatment. Solipeds. For nervous colic the hypodermic injection of sulphate of morphia (2 grs.) is very effective. This will commonly bring relief in less than five minutes. Should there be no effect at the end of this time it may be repeated with advantage, but should a second dose fail, it is well to resort to other measures. Eserine and barium chloride are contraindicated as being liable to increase the spasm, and if there is no irritant to expel there is no object in their exhibition. The old prescriptions of laudanum and turpentine; laudanum and ether; sweet spirits of nitre with belladonna, or hyoscyamus, and other stimulants and narcotics are of little avail as they are not absorbed from the horse’s stomach and cannot operate until they have reached the duodenum. If given at all, their action may often be hastened by injecting them into the rectum.
When the morphia fails it is the safest treatment to give a moderate dose of aloes or other laxative, in combination with extract of hyoscyamus or chloral hydrate. This takes time to pass into the duodenum, and be absorbed and secreted anew in order to have its full effect, and therefore it may be necessary to keep up a moderate action of the morphia as a palliative. In four hours, however, at the latest, the aloes can be counted on to bring permanent relief. This appears to come as soon as the active principles have been absorbed, the nauseating effect operating at once on the overexcited nerve centres. The action is more perfect still when a free secretion has been started from the intestinal mucosa, and the circulation and innervation in the intestinal walls are essentially changed. This measure which was long successfully practiced and advocated by the late Joseph Gamgee, is even more perfectly adapted to the colics of indigestion and irritation, of impaction and fermentation. There are of course cases of complete obstruction in which it must fail, but it is probably the most successful method for colicy affections in general.
In addition to the above, other methods of correcting the disordered innervation are available. Active friction of the abdomen with straw wisps is often effective, also fomenting the abdomen with hot water. Simply leading the animal around acts as a nervous derivative, and may be employed to prevent his dashing himself down so suddenly as to injure himself. Then copious injections of warm water soothe the rectum, solicit its peristalsis and by sympathy affect the other intestines in the same way. They may often be made more effective by the addition of antispasmodics (extracts of belladonna or hyoscyamus or chloral hydrate).
In all cases a soft bed should be provided to secure the animal against injury in his sudden reckless movements.
Ruminants. Simple spasmodic colic is usually transient and may be successfully treated by driving around, giving copious warm water injections, and using morphia subcutem. Frictions to the abdomen with straw wisps, or with oil of turpentine should be tried. Should these fail there is a presumption of further trouble and no time should be lost in giving a laxative (Glauber salts) 1 to 2 pounds, or castor oil 1 quart, with antispasmodics and stimulants as for the horse.
Swine. The antispasmodic treatment may be tried on the pig, but usually it is well to give a purgative at once in combination with the narcotic. Castor oil 4 ounces, laudanum ½ drachm, or jalap 2 drachms, and extract of hyoscyamus 20 grains in electuary. Warm injections and embrocations to the abdomen are desirable.
Dog. It is usually well to give a purgative at once (jalap ½ drachm) with 10 to 20 drops laudanum according to size. Copious injections of warm water and a warm bath may follow. Chloral hydrate 20 to 60 grains, may be exhibited by the rectum; also ether 1 drachm, in olive oil.