Improvement may be recognized by the termination of the paresis, the lessening of the abdominal tension, the return of the rumbling in the abdomen, the passage of fæces and flatus, and of urine and by general relief.
Lesions. In case of death the overdistension of the intestines and abdomen is the most marked lesion, the composition of the gas varying with the nature of the ingesta and the duration of the illness. Carburetted hydrogen compounds abound as a rule in the early stages, while carbon dioxide predominates later. Pinner found 49 per cent. of carburetted hydrogen, 8 per cent. of carbon dioxide, and 42 per cent. of nitrogen.
The contents of the large intestines are usually in considerable amount and in an undigested condition. The walls of the distended bowels are greatly attenuated and may show congestion, petechiæ, or rupture. Rupture of the diaphragm is not uncommon. Congestion of the lungs, but especially of the skin and superficial structures of the body, and of the brain are natural results of the expulsion of blood from the abdominal cavity.
Treatment. The desiderata are: relief from existing gaseous tension; arrest of further fermentation; and the restoration of the vermicular movement of the intestine.
The two first indications may sometimes be successfully met by stimulants and antiseptics. Formerly, mild cases were successfully treated by oil of peppermint and oil of turpentine in oil, and a free use of enemata. A more modern resort is a large (virtually soporific) dose of chloral hydrate (1 oz.) given in solution. This is at once a powerful antiferment and an antispasmodic. It is moreover highly volatile and in the heat of the stomach is readily passed on into the duodenum and absorbed. Employed early it not only checks the production of gas, but it relaxes the whole intestinal tract and allows the free passage of accumulated gas which passes off rapidly per anum.
But in severe cases the gaseous distension is too great to hope for relief by such measures and puncture of the cæcum or double colon is the only hopeful resort. This is made with a small trochar and cannula not more than ¼ inch in bore, which is inserted at the point of greatest resonance. The point usually advised, as in the ox, is the centre of the space circumscribed by the last rib, the ilium and the transverse processes of the lumbar vertebræ. A better plan is to percuss and puncture the point where the drumlike resonance is greatest. The higher the puncture the more promising as the cannula is less likely to be blocked by the ingesta which accumulates in the lower part of each viscus. The cannula may be left in place for some time to keep the bowel flaccid and allow time for the restoration of its contractile functions. The cannula may be utilized to inject antiferments (chloral) and peristaltic stimulants (eserine, pilocarpin, barium chloride). In cases in which puncture is not imperative these agents may be used hypodermically, eserine 1½ gr., pilocarpin 2 grs. or barium chloride 7 grs.
Enemata of soapsuds, with or without stimulants prove effective in emptying the floating colon and soliciting the action of the large intestines generally and the passage of flatus. Friction of the abdomen and walking exercise are desirable. After recovery a restricted diet, laxatives and bitters serve to restore the lost tone of the alimentary canal.
ACUTE INTESTINAL INDIGESTION WITH IMPACTION OF THE LARGE INTESTINES IN THE HORSE.
Definition. Causes: dessication of ingesta in colon, sacculation, constriction at pelvic flexure, debility, ill health, local peristalsis, diseased teeth, jaws or salivary apparatus, excess of food, heating grain, hard fibrous indigestible fodder, green leguminosæ, privation of water, inactivity, verminous aneurisms, tumors, strictures, obstructions. Symptoms: colics after meals, becoming more severe, tension and firmness of right side, sitting on haunches, stretching, small, hard, dry coated stools, obstruction felt on rectal exploration, frequent attempts to urinate, tympany. Course: six hours to six days or more, signs of aggravation and improvement. Lesions: large intestines tympanitic, impaction often at pelvic flexure, or other constriction, adherent mucosa has thick mucus or blood, is discolored, friable, necrosis, perforation, liquid contents of distended bowel in front, rupture, invagination, volvulus. Treatment: laxative diet, injections, aloes, pilocarpin, eserine, barium chloride, chloral hydrate, morphia, henbane, belladonna, puncture, cold or oleaginous enemata, empty or knead rectum and colon, cold compress, electricity, friction, laparotomy.
Definition. This is an impaction and obstruction of the colon, and usually of the pelvic flexure with dried and badly digested alimentary matters.