Parasites: A Treatise on the Entozoa of Man and Animals / Including Some Account of the Ectozoa

by T. Spencer Cobbold

The changes in the intima are the least constant. They present all stages of progressive and retrogressive metamorphosis, from simple induration to ulceration and calcification. In the walls of the verminous aneurism one not unfrequently finds all the pathological changes exhibited by atheroma in man. Calcification is a common form of the retrograde process, and, in very rare cases, may pass on to the formation of true bone.

7. In addition to the palisade worms, one almost constantly finds a parietal thrombus contained in the aneurism. It covers the inner wall either partially or completely, being in the latter case perforated for arterial offshoots. This clot may occlude the artery, and it is not unfrequently continued into the arterial branches (peripherally) or into the aorta (centrally). Amongst the various changes that the clot undergoes, organisation of its outermost layer and softening are the most frequent. The constant occurrence of this clot is due to the presence of the worms, to the inflammation, ulcerative and regressive affection of the intima, and to the dilatation of the arterial tube.

8. The palisade worms are seldom absent from aneurisms of the horse. Their not being present is merely an accidental circumstance. On the average, nine palisade worms go to a verminous aneurism, and eleven in the horse. The highest number of worms found in one horse reached 121. Not unfrequently, also, palisade worms, or their coverings in the form of larval skins, are found in the aneurismal walls. The immigration and emigration of the palisade worms out of the intestine into the aneurism, and the reverse, take place probably, as a rule, within the arterial circulation. The path of the worm does not appear to be always the same, inasmuch as they can also wander through the peritoneal cavity. The worms found in the aneurismal walls are probably mostly only strayed specimens.

9. From a comparative pathologico-anatomical point of view, the developmental history of the aneurysma verminosum proves that a circumscribed endo-arteritis can determine the formation of an aneurism.

10. Like the worm-aneurism itself, atheroma of the abdominal arteries arises from a circumscribed acute and subacute endo-arteritis. The histological changes in the secondary atheroma of horses are perfectly analogous to those of the spontaneous atheroma of man. Idiopathic atheroma, as seen in man, does not occur any more in the horse than in the other domestic animals. Atheroma in the horse is always secondary. To be sure, one observes an idiopathic chronic endo-arteritis in many abdominal arteries of the horse, which, however, never exhibits indications of atheromatous degeneration.

11. In consequence of its position the worm-aneurism of horses is not open to physical examination, and on that account cannot be diagnosed by physical signs; moreover, it offers no characteristic symptoms. Its termination by rupture is extremely rare, the aneurisms of the abdominal aorta being more disposed to rupture than those of the anterior mesenteric artery. Of eighteen cases of known perforation, fifteen opened into the peritoneal cavity, and three into the bowel. The dangerous symptoms of the worm-aneurism are exclusively due to embolism and thrombosis of the affected artery, arising from the parietal clot. The latter becomes especially dangerous through its increasing size and the softening which often accompanies it. The absorption and shrinking of this parietal clot, be it organised or not, is materially assisted by the high pressure to which it is exposed.

12. The very marked symptoms of vascular obstruction—the sero-hæmorrhagic intestinal infarct—in embolism and thrombosis of the mesenteric arteries are easily explained by paralysis of the muscular coat of the intestine, by the absence or paucity of valves in the portal vein, by the readiness with which meteorismus (or flatus) arises, especially in herbivora, and by the loose consistence of the intestinal walls or villi.

13. The occlusion of the intestinal arteries, especially that arising suddenly, always has for its result a partial or complete paralysis of the portion of bowel which they supply. The palsy of the intestine causes the forward movement of the intestinal contents to cease, a stoppage of the fæces, a hindrance to the discharge of fæces and gas, and also that exceedingly dangerous formation of gas (within the intestinal tract) which in the herbivora is so abnormal, both quantitatively and qualitatively.

14. In embolism and thrombosis of the mesenteric arteries the symptoms during life are entirely identical with those observed in the so-called colic of horses, as has been determined by numerous observations. The partial paralysis of the bowel, which is brought on by the embolism and thrombosis of the mesenteric arteries, forms in great part the chief and leading feature of the series of symptoms known as the “colic” of horses. The palsy of the bowel which arises in this way may explain also the frequent ruptures of the digestive canal and the greater number of its changes in position. The latter are specially favored by the structure of the abdominal viscera in the horse.

15. The old changes which one finds in the peripheral branches of the anterior mesenteric artery, in the form of expired and partly absorbed embolic and thrombolic processes (pigmentation, arterial and venous thrombi), particularly in connection with those arteries which are seats of the aneurism, decisively prove that the large majority of colics resulting in recovery, so far as they do not depend upon known injuries, are caused by paralysis of the bowel from embolism and thrombosis. The sudden occurrence, course, and result of these kinds of colics also testify to their embolic origin.