DIARRHŒA, SCOURING.
Definition. Concomitant of other affections. Causes: Congestion, effusion from small and large intestine, irritants in bowels, or blood, chill or other shock acting as reflex, cold drink and violent exercise, aqueous food, cooked, pulped; irritants, feculent concretions, parasites, fermentation products, diseased teeth, jaws or salivary glands, drink after grain, gastric hepatic or pancreatic disease, spoiled food, purgative agents in food, fever products, purgative waters, rains, dews, damp stalls, etc., fear, “washy” horses, nervous animals, root diet, œstrum, hepatic torpor, equine susceptibility. Symptoms: with root diet, with much or little bile, slight cases do not affect system, in severe cases, tympany, pawing, straining, fœtor, in infective diseases; complications, laminitis, enteritis, pneumonia. Treatment: remove or expel cause, demulcents, laxatives, anodynes, antiseptics; chronic cases, iron, bitters, antiseptics, astringents, dietetics, rest.
Definition. A frequent discharge of fluid or semi-fluid evacuations from the bowels without excessive griping or painful straining.
This is a common condition attending many diseases, rather than a specific disease of itself yet it is such a prominent feature of these various affections, and one so very characteristic that it seems well to give it a special place, even at the risk of repeating much of what must necessarily appear elsewhere.
The immediate cause of diarrhœa is a congestion of the intestinal mucous membrane and a profuse secretion into the intestinal canal. When such congestion occurs in the small intestine alone, it may be counterbalanced by increased absorption in the large, so that the secretion must be excessive to produce liquid alvine discharges. When on the other hand it occurs in the large intestine or in both large and small, the product is likely to escape in the liquid form.
In its turn the congestion of the intestinal mucosa may result from irritants in the bowels, from the presence in the blood of irritant agents which being secreted stimulate the intestinal glands to excessive secretion, and from reflex nervous action, starting from a distant point as in chilling or irritation of the skin or other organ.
Among direct irritants of the intestinal mucosa may be named a full drink of cold water especially if the horse is trotted or galloped for twenty minutes immediately after;—soft, juicy, rapidly grown green food, to which the animal is unaccustomed, as the first grasses of spring;—cooked or pulped food or ensilage in hard worked animals;—many irritant and acid plants;—accumulations of hard feculent masses in the intestines;—irritation caused by intestinal worms especially the blood-suckers;—the presence in the intestines of undigested matters, and resulting fermentations, the result of diseased teeth and jaws and imperfect mastication, of disease of the salivary glands or ducts and imperfect insalivation, of a drink of water after a grain feed, washing a part out of the stomach in an undigested condition, of disease of the stomach, liver or pancreas interfering with their proper functions; unwholesome and fermenting food like spoiled grain, or fodder, or decomposed potatoes, apples, turnips, pumpkins, carrots, cabbages, etc.;—stagnant and putrid water;—tumors, ulcers, volvulus, invaginations, adhesions and other serious lesions of the bowels may act in the same way.
As examples of the secretion of irritant matters from the blood may be mentioned almost all the different agents used as purgatives, and purgative agents accidentally taken in, these being as a rule absorbed and later secreted again on the intestinal surface, increasing the secretions in their passage:—also the morbid products of fevers which irritate the intestinal mucosa and glands as they are thrown out by them (rinderpest, lung plague, Southern cattle fever):—the purgative waters on certain “scouring lands” act in a similar way. Under the head of reflex action may be named the chills from exposure to cold rains, night dews, damp stalls or beds, and damp, hot buildings, seasons and localities. Under the head of nervous causes must be included strong emotions as excitement, fear, etc., which lead to increase of both secretion and peristalsis. Some horses are very subject to this and are known as “washy”. These have usually a slim abdomen and long loin, and scour whenever they are put to hard work. Other nervous animals with good conformation, but which fret under saddle or in harness will scour under specially severe work or under excitement. This is especially common in young colts while being “broken”, and will occasionally show in mares which are in heat. Cattle that have been on a specially succulent diet (turnips, beets, ensilage, grass) are liable to scour profusely if driven far or fast, and stock men seek to obviate this by feeding some dry bran, meal, and above all fresh dry brewer’s grains just before starting. Cows running at large when in heat are very liable to scour. An exclusive diet of turnips or beets will keep cattle in a chronic condition of mild diarrhœa, though not enough to interfere with rapid improvement in flesh. Chronic diseases of the liver by obstructing the flow of blood through the portal vein, cause intestinal congestion and predispose to diarrhœa.
Of the various domestic animals horses are the most liable to superpurgation, from an undue dose of aloes acting on the very large colon and cæcum. Hence the importance of using such an agent carefully in the young, fat or debilitated especially, of the avoidance of cold drinks or exercise to excess after the aloes has been given, and of keeping from work during its operation or immediately after.
Symptoms. These are of all degrees of severity from the frequent pulpy evacuations of animals fed exclusively on roots, (beets, turnips, potatoes), to the excessive and almost constant discharge of a dark colored liquid mingled with more or less mucus. The discharge may be of a light color and fœtid, indicating deficiency of bile, or of a dark yellowish brown and odorless.
Slight diarrhœa does not affect the appetite nor general health, nor check improvement in condition. In the more severe and continued forms there is loud rumbling in the abdomen, loss of appetite and condition, a rapid small pulse, accelerated breathing, pallid mucous membranes, sunken glassy eye, and increasing debility even to an unsteady gait. Distension of the abdomen with pawing and other indications of abdominal pain may appear in bad cases. In the milder cases due to simple irritation and congestion there is no tenesmus, no excess of mucus, no formation of bubbles or froth in the stools, as occurs in active intestinal fermentation and dysentery. In symptomatic cases on the other hand there are superadded the marked symptoms of intestinal inflammation, or fermentation, and the fæces become putrid and offensive, which they do also in the different infectious diseases (influenza, contagious pneumonia, rinderpest, lung plague, hog cholera, swine plague, canine distemper, fowl cholera), when the toxins and waste matters of the food and decomposing tissues are being thrown off by the bowels.
Diarrhœa may be complicated with other diseases and especially in the horse with laminitis.
In mild cases it tends to a spontaneous recovery, and is followed by some slight costiveness, and if this should prove extreme there may be some danger of complicating sequelæ such as indigestion, enteritis, pneumonia or laminitis.
Treatment. The first consideration for the practitioner is to discover if possible the immediate cause of the diarrhœa. If this is found to reside in some infectious or other disease aside from the bowel, the attention must be directed to that even more than to the diarrhœa. If it depends on an overdose of some purgative agent or of acrid purgative plants taken with the food, any further laxative is to be avoided, and yet astringents and other agents which tend to lock up the offending material in the alimentary canal must be equally guarded against. An abundance of mucilaginous and demulcent liquids (mallow, flaxseed gruel, boiled starch, etc.) may be given both by the mouth and anus, to sheathe and protect the irritable mucous membrane and to dilute and carry off the irritant contents. Moderate doses of opium may be required to allay the violence of the spasms and peristalsis, but this should not be pushed to the extent of locking up the irritants. Sometimes antiseptics (naphthalin, salol) are useful to check fermentation, and pepsin may be given to assist digestion.
In ordinary cases due to the presence of an irritant the first object must be to relieve the bowels of this, and the second to soothe the irritated mucous membrane. A laxative is usually all that is required, but it must be a mild one so as not to add to already existing irritation. Olive or castor oil are to be preferred as a rule (horse and ox 1 pint; sheep and swine 4 ounces; dog ½ ounce), alone or with a moderate dose of laudanum. Or rhubarb or aloes may be substituted if desired. A dose of whisky or brandy, or oil of turpentine will often do much to allay the secretion and peristalsis. These should be followed by moderate doses of flaxseed gruel, or solution of slippery elm or mallow, or simple well boiled gruels.
If the discharge persists after the laxative has had time to operate, these mucilaginous agents may be replaced by solutions of boiled starch, or of gum arabic, and small doses of calmatives such as laudanum (horse or ox 1 ounce, sheep or pig 2 drachms, dog 20 drops), or prussic acid or cyanide of potassium (30 drops of the acid or grains of the salt for horse or cow). Sub-carbonate of bismuth, chalk, and carminatives and antiseptics may also be given. According to the indications the practitioner must combat persistent intestinal fermentation, or a relaxed adynamic condition of the intestinal mucosa, or general weakness and exhaustion, with such agents as seem best adapted to the individual case.
Chronic cases will demand the exercise of much judgment. After a gentle laxative, salts of iron (sulphate, chloride) and pure bitters may be given with antiseptics. Or vegetable astringents (catechu, kino) with freshly burned charcoal and essential oils (peppermint, cloves, cajeput) may be employed. In some instances calomel and chalk (1:12) will serve a good end. In others silver nitrate, or arsenite of copper succeeds. Quinine, nux vomica, pepsin, may be used to improve tone. The diet is usually all important. Well boiled gruels, boiled milk, arrowroot, pulped or scraped raw flesh may be demanded in different cases. The patient should be kept at perfect rest, and all excitement avoided.