Attempts have been made to estimate the time taken in the formation of a calculus by allowing a ring for each feed and successive deposit therefrom (Fürstenberg, Colin). Thus a calculus of 14 pounds with 720 layers, it was estimated could be formed in one year at two feeds per day. More definite evidence was found in the case of Pastore in which a coin with the mint mark of 1847 was found as the nucleus of a calculus the size of the fist in 1848.
Lesions. Formed in the most spacious parts of the colon and cæcum, calculi usually rest there for a length of time without visible injury, and it is only when they are moved onward and get arrested at a narrow part of the gut (pelvic flexure, floating colon, rectum) that they cause appreciable trouble. Yet it is claimed that by their weight they drag upon the yielding walls of the bowel, causing dilatation and attenuation, weakening the peristalsis and predisposing to rupture. The compression of the vessels also tends to anæmia and atrophy. In the case of rough crystalline calculi the mucosa is subjected to attrition, irritation, and inflammation. The more serious and urgent trouble is that of obstruction of the narrower portions of the colon and rectum, which may be absolute and persistent, leading to rupture and death or a fatal inflammation on the one hand, or may end in recovery on the other, in connection with a displacement onward or backward of the calculus as the result of peristalsis or anti-peristalsis.
Symptoms. These are intermittent colics, each reaching a climax and followed by a sudden recovery as the calculus is displaced into a more spacious part of the colon. A significant feature is the complete obstruction, fæces being passed for a short time at first and then suddenly and absolutely stopped. Coincident with this are tympany, violent colics, straining, rolling, sitting on the haunches, perspirations, anxious countenance, and all the symptoms of obstruction.
Diagnosis is never quite certain unless the practitioner with his oiled hand in the rectum can detect a hard stony mass obstructing the pelvic flexure of the double colon with a tense elastic distended bowel immediately in front of it, or a similar hard obstruction of the terminal part of the floating colon with a similar distension in front of it. The pelvic flexure may usually be felt below and to the right at the entrance to the pelvis, and the floating colon above, under the right, or more commonly the left kidney. Calculi in the more spacious parts of the double colon or in the cæcum are inaccessible to manipulation. The feed (bran, ground feed) will be suggestive, as will the occupation of the proprietor (miller, baker).
Treatment. This is rather a hopeless undertaking. No effective solvent of the calculus can be given, and purgatives usually increase the danger by increasing the peristalsis and dangerously distending the bowel above the point of obstruction. It is true that this is sometimes followed by a temporary recovery the calculus being loosened and falling back into the dilated portion of the bowel. Less frequently the increase in the peristalsis forces on a moderately sized calculus to complete expulsion. It is a desperate though sometimes successful resort. A more rational course of treatment is the dilation of the bowel back of the obstruction by copious mucilaginous, soapy or oleaginous enemata. Trasbot suggests CO2 produced by injecting sodium bicarbonate and tartaric acid. This may be seconded by the hypodermic injection of barium chloride or of atropia. When the calculus is lodged in the floating colon or rectum it may be possible to reach it with the hand and extract it at once. The last resort, is by laparotomy for the removal of the calculus. One such successful case is on record in which Filizet removed a calculus as large as an infant’s head. In other cases the horses failed to survive. Desperate as the resort may be it is not to be neglected in a case of undoubted calculus, solidly impacted and of such a size that its passage is impossible. A fatal result is imminent, and even if the present attack should pass off it can only be looked on in the light of an intermission, so that there is practically nothing to lose in case the result should prove fatal. Anæsthesia and rigid antiseptic measures should of course be adopted.
FOREIGN BODIES IN THE INTESTINES OF SOLIPEDS.
Sand, pebbles, earth, lime, nails, pins, needles, coins, shot, cloth, leather, rubber, sponge, tooth, bone, wood, twine. Symptoms: as in intestinal indigestion or calculi, or sand or pebbles in fæces; peritonitis, phlegmon. Lesions: congestion, catarrh, ulceration, abscess, needles may travel to other organs. Treatment: laxative, enemata, or as for calculi.
All sorts of foreign bodies are taken in with food and water and find their way to the intestines. Sand from drinking from shallow streams with sandy bottoms, from browsing on sandy pastures where the vegetation is easily torn up, or from feeding grain from sandy earth will sometimes load the intestines to an extraordinary extent so that such horses will pass sand for some weeks after leaving the locality. Small stones and gravel are taken in in the same way or from the habit of eating earth or licking crumbling lime walls. Nails, pins, needles, coins, shot, pieces of cloth, leather, caouchouc, sponge, and even a molar tooth and a piece of a dorsal vertebra have been thus taken. Recently the author saw a small twig of hard wood transfixing the pylorus and duodenum with fatal effect. In another case were balls of binding twine which had been taken in with the fodder on which it had been used.
The symptoms are usually those of intestinal indigestion or calculi. In some cases, however, they are peculiar, thus there may be a constant passage of sand, there may be indications of peritonitis, or there may form a phlegmonous swelling of the abdominal walls in the abscess of which the foreign body is found.
Lesions. Pechoux found 56 lbs. of a brownish earth in the cæcum and colon. Congestion and ulceration of the intestines are common, with occasionally abscess. All the lesions that attend on or follow obstruction may be met with. Boullon saw a remarkable case of the ingestion of needles in which these bodies were found in the small intestine, liver, pancreas, diaphragm, kidney and lung.