r LIBRARY NEW YORK STATE VETERINARY COLLEGE ITHACA, NEW YORK Digitized by Microsoft® SF 959.C6U is" """""'"■"'"''' Colic in the horse. 3 1924 002 958 852 DATE DUE ""'-: «' 1 U "- A 1 ? a 1 l«^ K X ^^ '*^> A-hO^ ft PT fl n UtI \ 3 Idba — ^j> ./ .« C/ 7~'-<;.^ ^^ ,^„ y Xl/* C~ ~-Tt ■^■■- H(it" 4^7*C ^S- '• GAYLORD PRINTED IN U S A. Digitized by Microsoft® This book was digitized by Microsoft Corporation in cooperation witli Cornell University Libraries, 2007. You may use and print this copy in limited quantity for your personal purposes, but may not distribute or provide access to it (or modified or partial versions of it) for revenue-generating or other commercial purposes. Digitized by Microsoft® COLIC IN HORSES. D. H. UDELL. Digitized by Microsoft® iH ^' ^'"''■^Q'i ,„v;v(.ui'.r' sr 176 ' - ', Annual Eepoet of the c 4;. COLIC IlSr THE HOESE.- INV c -/, '' D. H. Udael Departjnent of Medicine. In a restricted sense the term ccilic means pain in any part of the stomach or intestines. It is not the name of a disease, though usually defined as such (Eeeks, Wall), but a secondary symptom induced by comjjression of the ends of the sensitive nerves through spasmodic contractions of involuntary muscles of the intestines (Hutyra & ilarek, Kothnagel). Spasmodic contractions of in- voluntary muscle fibres of other organs also induce colic pains (uterus, bladder, urethra, gall duct). This article does not include so-called "false colic" (pain in the peritoneum, spleen, etc.) or so-called " symptomatic colic " (infectious diseases, poisons, pri- mary gastro-enteritis). Eecently there has been some criticism of the customary use of the term colic. Hutyra and Marek in particular call attention to the absurdity of its retention in classifications from either a clinical or a scientific standpoint. They maintain that there is no reason for the retention of a single ^vord to cover all the diseases of a region of such importance ; that such a custom has a tendency to lead to a similar uniform treatment for unlike diseases, and that in the light of our present knowledge and methods of differential diagnosis its use in classifications is now unjustified. Classification and occukeence. The following classifica- tion includes only those diseases of the alimentary tract to which the term colic as used in strict sense may be applied. It excludes poisons, complications of infectious diseases, infectious diseases affecting princij^ally the digestive tract, and primary gastro-enter- itis (sym])tomatic colic of Eroehner). Since all colic is sympto- matic the term is not free from objection. A. Cataeehal and Eitnctional Indigestions. 1. Catarrhal SjMsm of the Small Intestines (spasmodic, chill- ing, nervous, rheumatic colic). Thirty-five 'pev cent, of clinical eases (H.&M.). " 2. Acute distentions, a. Gastric distentions (gastric indiges- tion, overfeeding, tympany). Eleven to twenty-one per cent, of * Presented at the Second Annual Conference for Veterinarians, Itliaca, N. Y., Jan. 1909. Digitized by Microsoft® State VETEraxAEv College. 177 clinical cases (H. & M.) ; 18 per cent, of 834 autopsies bad gastric rupture (Wall) ; 10 per cent, of 1,487 clinical cases in the Berlin clinic, one-third of which were primary (Behren). b. Intestinal gaseous distentions (flatulent colic, tympany). Two to fifteen per cent, of clinical cases (H. & M.) ; 3 per cent, of •■834 autopsies (Wall). 3. Intestinal Accumulations and Impactions (food, feces). a. Small intestines. Forty-four per cent, of 722 clinical cases ■(Behren) ; 3 per cent, of 834 autopsies (Wall). In 109 cases of primary intestinal impaction at the Budapest clinic in 1906-07 the ileum. was involved in 13, the duodenum in 3. In 386 fatal ■cases in the Berlin clinic during 1897-1906 the ileum was involved in 96, the duodenum in 13, the jejunum in 2. b. Large intestines. Thirty-two per cent, of 722 clinical cases (Behren); 1. 5 per cent, of 834 autopsies (Wall). In the 3S6 autopsies at the Berlin clinic the colon was involved in 185, the -caecum in 80, and the rectum in 10. In the 109 cases at the Buda- pest clinic the colon was involved in 90, the caecum in 3, and the Tectum in 1. B. DlSPLACEMEJN'TS, ObSTEUCTIOKS AK"D StEICTUEES. 1. Volvulus and Torsion occur in from 2.5 to 5 per cent, of all ■clinical cases (H. & M.). In the years 1892 to 1906 it comprised 4.1 per cent, of 61,248 cases of colic in the Pnissian army; 1.92 per cent, were volvulus of the small intestine, 2.06 per cent, torsion ■of the colon, .13 per cent, torsion of the caecum. In the same period it comprised 33. S ^per cent, of 7,458 lautopsies; 15.8 per ■cent, of the small intestines, 17 per cent, of the large. It com- prised 38.2 per cent, of 83-4 autopsies (Wall). It is most common in military and draft horses (H. & M.), and is usually found in the terminal end of the ileum (Behren). 2. Incarcerations comprise 1 to 1.5 per cent, of clinical cases, and 5 to 13 per cent, of autopsies (H. & ISL) ; 21.5 per cent, of ■854 autQjDsies (Wall) ; 1.56 per cent, of 64,248 clinical cases, and 12.8 per cent, of 7,458 autopsies in the Prussian army. Hernias of the diajDhragm and mesentery, the foramen of Winslow, and fibrous bands are the usual seats of compression. 3. Intestinal obstruction is relatively rare. Three-tenths per •cent, in the Prussian army in 15 years; at Budapest from .2 to .7 per cent, ©f colic; 1 per cent, of 854 autopsies (Wall). Digitized by Microsoft® 178 Annual Eepoet of the 4. Intestinal stricture is rare, about the same as obstruction (H. & il.) ; .9 per cent, of 854 autopsies (Wall). According to Behren cicatricial stenoses of the ileum are very common and a frequent cause of food accumulations. C. THEOJrBOSIS AND E:\rBOLISM. In the clinics at Berlin and Dresden and in the Prussian army thrombotic infarcts are found in the intestinal walls in 5 to 6 per cent, of horses that have died of colic. In Budapest the per cent, is 32, while in Stockholm, where the water is filtered, Wall found the infection in only 1.2 per cent, of 854 autopsies. The affection is widely variable in distribution and is more common in the country. D. GASTEO-ENTEPaTIS. Wall found enteritis in 1.2 per cent, of autopsies. A comparison of the observations of different writers shows greater uniformity of expression in the groups where the fatalities- are high, and where the diagnoses are verified by autopsies. In those forms of indigestion where recovery is the rule and the cases- are diagnosed by clinical symptoms there are wide variations in the diagnosis. For example, in group A Hutyra and Marek include 50 to 80 per cent, of all colic under the first two headings, while Froehner and Behren include TG per cent, of 723 clinical cases under group 3. It is not probable that such differences occur under conditions that are so similar. This apparent discrepancy is due partly to the absence of distinct lines of demarcation between the diseases of group A, partly to difiiculty in determining the exact nature of the primary affection. Since this discrepancy has little influence on the treatment it is of no great clinical importance. Etiology. 1. Anatomical and physiological predisposition is usually regarded as an important element in the etiology of colic. It is doubtless true that the horse is subject to more dietetic irregu- larities and imperfections than any other animal, but the relative importance of such predisposition is not easily determined. The horse is more sensitive to irritation and responds more quickly to pain than most domestic animals. The stomach of the horse is small when compared with the bulk of food eaten, and the food itself receives very little mastica- tion before it is swallowed. The normal capacity of the stomach is about ten quarts. In one hour a horse may easily eat five quarts Digitized by Microsoft® State Veteeinaey College. 179 of oats and five pounds of hay, to which must be added five to ten quarts of glandular salivary secretions and perhaps as much more water. Usually the food enters the left sac of the stomach where the salivary digestion continues and gradually passes into the pyloric end where it receives peptic digestion. With medium grade distention the pylorus relaxes and the food passes into the duodenum. Food and water may also pass directly into the duo- denum under conditions which favor fermentation and indigestion. Interference with the normal evacTiatinn of the stomach predis- ] loses to grave results, since overdistentinn appears not to stimidate the vomiting centers of the horse as in most animals. Conditions, then, which favor unphysiological distention and relaxation of the stomach wall are especially dangerous. The small intestines are suspended in a long mesentery, tand volvulus occurs in about 2 per cent, of clinical cases. The duo- denum is restricted in its movements by a short mesentery and through its relation to the fixed mesenteric attachment. Food accumulations on the right side at the point of curvature toward the left are not rare. In the ileum accumulations are common directly in front of the ileo-caecal opening. The terminal end of the ileum is restricted in freedom of movement through its short mesentery and its fixed attachment to the caecum, while the ileo- caecal opening is small and directed towards a mass of relatively dry and bulky residue. Froehner and Behren maintain that the most important predisposing factor is the extraordinary amount of continuous work required of the ileum in forcing the residue through an opening smaller yet than its own diameter into the dry caecal contents. They also attribute food accumulations to ■cicatricial stenoses of the ileum, and mention its strong muscular devcloi^ment and consequent mechanical injury through contrac- tion on sharp roughage as a predisposing cause. Keference is made by both authors and by the Berlin Pathological Institute to the frequency of cicatricial stenosis in the ileum. In the large intestine the seats of predilection for impaction are in the caecum, the left ventral part of the colon including the pelvic flexure, and the right dorsal part of the colon (stomach-like dila- tation ) . In each of these three locations a bulky dry residue must be carried upward in a sac-like dilatation and then forced through a i^hysiological constriction in the alimentary canal. In addition the right dorsal part is firmly attached to the abdominal wall and pancreas at its base, while the exit into the small colon is not only Digitized by Microsoft® 180 Annual Eepoet of the small but bent at a right angle. The colon is largely unsupported and torsion occurs in about 2 per cent, of clinical cases. Throm- bosis and ejiiholisni of the anterior mesenteric artery and its branches are peculiar to the horse. 2. Dietetic errors are the most important primary causes of indigestion. T'sually the cau'io is to be found in the poor quality of the food and the following arrangement from Hutyra and Marek indicates the principal defects : Indirjesiible (corn, rye, coarse straw). Swells rapidly (new clover, peas and beans). Cohesive (chopped hay and straw with corn or barley meal or bran ) . Ferments (young wilted clover or alfalfa, beets and potatoes, heating grass or new hay, green roughage of any kind when fol- lowed by an abundant drink). Damaged (mouldy grain or roughage). Frozen or hot feed. Overfeedinej of a good quality of grain or roughage is not a com- mon cause of colic. Irregular feeding, however, or rapid hard work immediately after a heavy feed, frequently seen in hack and livery horses, is an important etiological factor. Dieteitic errors may induce catarrhal conditions that lead to intestinal spasms, to atony (overdistentions), or impactions with the corresponding danger of a subsequent rupture or displacement. 3. Defective reflexes (cold, heat, fatigue, hunger). Xormal peristalsis is maintained reflexly through mechanical irritation of the mucous membranes by the food, the activity in general being in proportion to the roughness of the fodder, though toi) much roughage may induce atony (straw). Physiologically there is no peristalsis in an empty intestine, while pathological sus- pension occurs when the muscular contractions are weakened or suspended by overdistension with gas or when the volume or weight of the food is too great. Cold promotes peristalsis reflexly through stimulation of the skin and the atmosphere thus maintains a certain tonus of the body during life. In the horse colic curves often correspond t» atmospheric extremes. The reflex action of cold is to induce vasoconstriction ami increase the tone of the vohmtary and invol- untary muscles. When increased tonus (tension) is abnormally prolonged fatigue dccurs so that a return to normal atmospheric environment is followed by a general relaxation, which is supposed Digitized by Microsoft® State Veterinary College. 181 to favor food stasis and accumulation. This usually occurs after the animal is brought to the stable and the charts of Wall prepared at Stockholm show an elevation of the colic curve on the days follow- ing wind and rain. Relaxation is thought to be due to resorption of the products of fatigue (autointoxication). Hunger seems to cause relaxation through deficient cellular nutrition. Overwork with subsequent fatigue has a similar effect on the reflexes and it is probable that diminished heat radiation on liot humid days with few currents of air is responsible for the intestinal hyperemia and colic so common in summer (retention of the products of oxida- tion). High temperatures diminish the stimulation of the skin and reflexly induce vasodilatation and diminished peristalsis with a corresponding tendency to food accumulations and impactions. Klimmer draws attention to the inappetence of intestinal conges- tion, and the frequency of cerebrospinal congestion (heat stroke) in hot humid atmospheres. The extent to which reflex overexcitation or overdepression is a predisposing cause of functional indigestion is not readily deter- mined. Contributors to general medicine seem inclined to regard them as important factors and their conclusions are strongly sup- ported by clinical experience. The general practitioner soon learns to recognize colic weather even in the absence of a theoretical knowledge of atmospheric relations. It remains for future investi- gations to determine to what extent reflex stimuli affect intestinal secretions and sensations as well as motion. 4. Displacements and obstructions are nearly all secondary mechanical complications and careful autopsies show that in many cases of volvulus there is an impaction posterior to the displace- ment. In eighteen cases of volvulus examined by Behren he failed to find food accumulations in only three. In a series of 1G3 dis- placements food' obstructions or impactions were present in 81 per cent. (Pilwat, Behren). Unequal filling and weight of intestinal loops, excessive peristalsis, rolling from pain, and anatomical rela- tions previously mentioned are generally considered to be prom- inent causes. Intestinal ohstructions in the horse are usually due to calculi, less frequently to fecal balls, parasites or foreign bodies. Intestinal stenosis or stricture is said by most observers to be uncommon although the Berlin Pathological Institute reports its very frequent occurrence. Pathogenesis. Gaseous formation in indigestion. Normally the gaseous material in the intestine is absorbed by the blood Digitized by Microsoft® 182 Annual Kepoet of the (oxygen, carbon dioxid) or is passed off. Catarrhal or other con- ditions that cause intestinal hyperemia restrict resorption and promote tympany. Bacterial fermentation with the formation of marsh gas, carbon dioxid, and fatty acids takes place promptly in all forms of indigestion, suppressed peristalsis and atonic condi- tions being ideal for the inci'ease of bacteria, toxic products and gases. Increased distension from the formation of gas finally leads to atony or complete paralysis of the intestine, and in many cases to intense and continuous pain. Pain (colic) is due to tonic contractions of the intestinal mus- culature. It is doubtful if neuralgia of the intestinal nerves (enteralgia) ever ocurs, while increased peristalsis is not painful. The pathogenesis or reflex effect of pain is as follows: the force of the heart is at first increased from stimulation of the vagus, followed by weakness due to paralysis. The respiration is at first stinndated, but finally the animal becomes dyspneic from a subse- quent paralysis. Vasomotor constriction is followed by dilatation. The voluntary and involuntary muscles undergo clonic contractions with evacuation of feces, gas and urine. Persjjiration is increased from stimulation of the sweat centers. The sensorium is deranged and the animal appears to be blind and without feeling. There are two apposing reflexes in prolonged severe jDain ; paraly- sis clue to paralysis of the heart and vasoconstrictors, and general excitement. With intense jDain the paralysis may be so marked that the animal is unable to stand. With relaxation of the pain a period of sopor follows, the animal is exhausted. The reflexes may be slight or intense according to the degree of pain. Asphyxia. Fermentation with the formation of gas may increase the abdominal pressure until dyspnea is marked and the blood overladen with carbon dioxid. With a marked decrease of the oxygen in the blood, reflex excitation is followed by depression and finally by paralysis of the circulatory and respiratory centers. The reflexes of asphyxia and pain are practically identical, but the treatment is different. Bupturc is liable to occur when the animal throws itself; death from putrid intoxication usually following within twenty-four hours (Wall). As a rule the animal lives only a few minutes after ru])ture of the stomach. Displacements cause intense pain from pressure, and a marked venous congestion that soon. leads to rapid transudation which may even cause death from loss of blood. Digitized by Microsoft® State Veteeinaey College. 183 Intoxication. The general effect of resorption is to cause a putrid intoxication. The toxins are resorbed by the lymph and blood and pass to the liver. The hemoglobin of the red blood •corpuscles passes freely into the plasma (varnish color), while changes in the cells of the vessel walls cause petechiae and €cchymoses in the serous membranes. Degeneration of the muscle of the intestine predisposes to rupture ; irritation of the heat cen- ters causes elevation of the temperature and an increase in the frequency of the pulse and respiration. Finally the temperature becomes subnormal, paralysis of the circulatory and respiratory •centers develops and death ensues in one to two daj^s. When the resorption is insufficient to cause death the local reaction is more pronounced and local inflammation may develop. In the presence of extensive passive hyperemia of the intestines gangrene is more liable to develop than inflammation. Symptoms. In all forms of colic a consideration of the condi- tion of the pulse, the peristalsis, the temperature, and the conjunc- tival mucous membrane- is of primary importance in the deter- mination of the gravity of the disease. In some cases a com- parison of the general symptoms is our only index to the exact •character of the aft'ection, while dexterity and experience in the physical examination of the abdomen, especially by means of rectal examination, is our most reliable method of making an exact clinical diagnosis. Catarrhal spasm of the intestine represents the simplest and mildest form of colic. The pain often develops suddenly, con- tinues from ten to fifteen minutes and then relaxes for a time. The peristalsis is active and the pulse, respiration and temperature are nearly normal. Defecation occurs frequently and diarrhoea may be present. Recovery within a few minutes to five or six hours is the rule unless there should develop a secondary volvulus. Acute distentions are more severe. Primary gastric distentions usually develop soon after eating. The stomach contents may •consist of gas, or a uniform mixture of gas and fermenting food, ■or an impacted mass of dry food (corn meal, fibrous roughage). The pain is intense and continuous and the horse may roll and plunge violently. The pulse is usually 60 or above, the respiration is increased, even dyspneic, and the temperature is normal or slightly elevated at first. The conjunctival mucous membrane is injected, j^erspiration abundant. One of the most characteristic symptoms is the presence of undulating movements up the jugular Digitized by Microsoft® 184 Annual Eepoet of the groove (eructation) as well as retching and vomiting. The vomited food as expelled from the nose or mouth has a sour penetrating odor. The stomach tube is readily passed and the stomach contents- may or may not be discharged through it according to their con- sistency ; usually one notes a sour odor at the end of the tube. The frequency of the eructation also depends on the consistency of the stomach contents. The abdomen is only slightly enlarged^ peristalsis is usually suppressed or absent and defecation is sup- pressed after a short time. Eectal examination may reveal some tympany of the small intestines, especially in the duodenum just posterior to the anterior mesentery (small horse). In cases of marked tymp)any of the stomach it is said that the blind end of the stomach or the base of the spleen may be paljDated in the region of the left kidney or the external angle of the ileum. Mild case& may resiDond to simple treatment and show only general symptoms- of colic, but severe cases must be given prompt relief as fatal comiDlications develop early (rupture of the stomach or diaphragm). Intestinal gaseous distention is characterized by abdominal! tympany that develops soon after eating, though horses with rigid abdominal walls may not show marked abdominal enlargement even in severe cases. The intensity of the pain is usually propor- tional to the amount of fermentation and gas. The pulse is rapid and often weak, the respiration is always dyspneic (asphyxia) and the temperature may be normal or slightly elevated. The- mucous membrane shows diffuse redness (paralysis of the circu- latory and respiratory centers, decomposition of the blood front putrid intoxication) or venous congestion. Peristalsis is normal at first, afterwards suppressed or one may hear tinkling sounds.. On rectal examination the abdomen is found distended in all its- ]iarts so that palpation is impossible. Secondary distention of the stomach is of frequent occurrence. AccnmnJaiions and impactions cause diverse symptoms accord- ing to the seat in the large or small intestines. Primary food accumulations in the small intestine usually develop soon after eating, the symptoms develop quickly and the progress is rapid. The rectal examination is negative or one may palpate a cylindrical swelling about the size of a man's arm directed transversely across the abdominal cavity at about the plane of the anterior border of the left kidney (TI. & 11. ). Anorexia is complete from the begin- ning. The pulse and respiration gradually increase, peristalsis Digitized by Microsoft® State Veteeixaey College. 185 a)id defecation are suppressed. Secondary gastric distention is present in about 50 per cent, of cases and secondary rupture of the stomach may occur. Eupture of the intestine itself is not rare. In other cases sepsis and intoxioation from resorption of putre- factive gases supervenes with cori'csponding heart weakness, fever, depression and marked diffuse rediress of the conjunctival mucous membrane. I Impactions in the large intestine present more definite symptoms with the possible exception of impaction of the right dorsal part of the colon (stomach-like dilatation). In most cases the diagnosis can be made by rectal examination alone. Defecation is partially suppressed for several days and finally becomes complete, mild colic then develops, characterized by rather long intervals of freedom from pain. Finally the colic is more continuous but is rarely intense. The patient frequently assumes an attitude like that of a horse when urinating. The abdomen may be normal in size and like most forms of colic the peristalsis is suppressed. Rectal examination reveals a distended intestine of a semi-solid or firm consistency. The colon may fill the entire left half of the abdomen. The left inferior part is recognized by the presence of sacculations and longitudinal bands, the left upper part is smooth and enlarges as the hand is carried forward. Both are united by the pelvic flexure which may be found in the pelvis. The right dorsal part in front of the caecum is difficult to palpate ; it may be reached in small horses. The caecum is easily reached in the upper part of the right flank where it is recognized as la roundish enlargement about the size of a man's head, smooth on the surface and firm in consistency. Occasionally one may be able to palpate the two longitudinal bands. In impaction of the caecum one may find tympany at its base and in the terminal attached portion of the ileum. Impaction of the small colon is easily recognized on rectal examination in the region of the left flank. Volvulus of the small intestines frequently escapes a positive clinical diagnosis. A provisional diagnosis is reached by consider- ing the intensity of certain general symptoms, the findings of a rectal examination, and the duration of the disease. Tympany develops rapidly as the deranged circulation suspends the absorp- tion of gases and fermentation aids in their development. Loops of distended small intestines are found in the posterior part of the abdominal cavity. The pulse is very frequent and weak, finally imperceptible, the heart impulse is increased and the temperature Digitized by Microsoft® 186 Annual Eepoet of the usually elevated. These severe general symptoms develop within one or two hours after the intestine is displaced, while their development in food accumulations and other obstructions takes place more slowly. In seventy-five cases observed by Behren death took place in ten to twelve hours. The cause of death is sepsis and asphyxia. Torsion of the colon induces the same severe and rapidly develop- ing symptoms as volvulus of the small intestine and incarceration. On rectal examination the left half of the colon is found to be very tympanitic so that it often fills the entire left abdominal region. Torsion of the, left colon is recognized by the spiral direction of the longitudinal bands. In torsion to the right the spiral has a left anterior direction, in left torsion the spiral has a right anterior direction. According to Behren a certain degree of distension must be present to recognize with accuracy the differ- ent parts of the large intestine. In general the course is very rapid, though like volvulus and other displacements it is usually secondary and the intense symptoms are liable to develop only after the animial has heen sick for several hours. In 70 cases ob- served by Behren death took place within C to 12 hours. Gastric rupture presents the same severe clinical picture. Pain may suddenly cease but the general attitude ; pulse 100 and im- perceptible, subnormal temperature, and the intense diffuse red- ness of the mucous membranes indicate the gravity of the case. On rectal examination one finds no resistance in the upper ab- dominal region. Death occurs within a few minutes to a few hours. Rupture of the diajjhrar/m presents the sam* series of rapidly developing severe general symptoms. It is characterized by intense dyspnea. Incarcerations within the abdominal cavity seldom present dis- tinct differential symptoms. The general symptoms are those of displacements. In general the tympany is less than in torsion and volvulus. This statement does not apply to strangulated hernias. TJirombo-emholic colic may be diagnosed in small horses by palpation of the anterior mesenteric artery. One may be able to palpate the thrombus and to recognize the deranged pulsation. Eepeated attacks of colic that develop with exercise in horses that receive regular care and proper food is sufficient evidence to arouse suspicion. Rectal examination is usually negative, and tympany is slight or absent. In this affection the general symptoms of colic are somewhat diverse. Digitized by Microsoft® State Veterinaey College. 187 Treatment. In all colic due to primary indigestion the funda- mental O'bject is to evacuate the alimentary tract. In those forms that are not too severe or persistent the rapid subcutaneous purgatives (eserin, arecalin, pilocarpine) which act reliexly through the nervous system have proven very satisfactory. Evacuation is prompt and in one or two hours the effect of the drug has passed. Since they are powerful depi-essants they should be used with caution whenever the general symptoms of colic are severe (weak pulse, depression, suppressed peristalsis, diffuse redness of the conjunctival mucous membranes, tympany and fever). In such cases the effect of one or two doses may be highly satisfactory, but in the absence of relief they should not be con- tinued. In the treatment of food accumulations in the small in- testines Behren gives first .75 of a grain of arecalin. If this produces no result he follows it in one-half to one hour with the same amount of eserin. He assumes that the food is softened and loosened by the action of the arecalin on the glands and that the effect of the eserin on the musculature induces peristalsis and promotes evacuation. If the impaction still persists he resorts to aloes. Agents that act directly on the alimentary system (aloes, oil, salts) are less depressing and their effect is more certain and pro- longed, though not so prompt. Peristalsis may be promoted reflexly by cutaneous irritants over the abdominal wall or by cool rectal injections. Abundant rectal injections of slightly saline warm water introduced slowly, or slow walking exercise, assist in the relief of impactions of the colon. Tlie stomach tube is perhaps our most valuable recent addition to the therapeutics of colic. It affords relief in most cases of acute primary distension of the stomach, or distensions secondary to in- testinal indigestion. It seems to have been first adopted for general use in the clinic at Budapest where for several years it has been used exclusively in the treatment of primary acute gastric distensions. Marek reports recovery in 81 out of 85 cases in 1906. The Marek tube is somewhat larger than the one ordinarily used in America. Behren speaks favorably of its use in about 250 cases in the Berlin clinic. The tube is easily passed through the mouth and when the stomach is tympanitic relief is usually prompt. Impaction of food requires injection of warm water followed by siphonage, this may have to be repeated several times to loosen an impacted mass, while in secondary tympa,ny it may be necessary to pass the tube at frequent intervals. Digitized by Microsoft® 188 Annual Eepoet of the Fermentation with the formation of poisonous gases and toxins may be restricted with creolin given in half ounce or ounce doses every few hours. Some prefer lactic acid given in doses of 2 to 3 drams. Whenever intestinal tympany causes discomfort it should be relieved with the trocar. Usually this is accomplished through trocarization of the caecum in the right flank, in some cases how- ever it may be necessary to trocarize both flanks in order to release the gas. With a small trocar and surgical cleanliness the opera- tion is safe. The writer has always passed the trocar at the point where distention appeared to be most marked. Pain when prolonged and intense should be controlled with narcotics. Chloral per os or rectum and fluid extract of Cannabis Indica injected into the jugular vein are widely used. Morphine is still employed though many clinicians are positive in their assertions that it is uncertain in the relief of pain in the horse, that it is directly opposed to the evacuations of the bowels, and that in some cases it induces overexcitation. During acute attacks of pain the animal may be walked slowly to prevent rolling or throwing. Hot applications, or counterirritants like mustard or ammonia liniment, tend to relieve pain, promote peristalsis, and overcome the effects of an early intoxication (drowsiness). Displacements within the abdomen rarely respond to treatment. Torsion of the left colon has been treated with varying success by difl'erent clinicians. At present rotation of the animal in the direction of the torsion, las in torsion of the uterus, is receiving some attention. Forssell rejDorts 17 recoveries out of 18 torsions of the colon. Hutyra and ilarek question the accuracy of his diagnoses and report uniform failure of treatment in their own cases. Bchren reports success in only one of four attempts and he also questions the accuracy of the diagnoses of some writers as revealed by their clinical descriptions. Since torsion of the colon occurs in only one to two per cent, of clinical cases of colic, reports of its frequent successful treatment are subject to critical examination. Horses suffering from colic should be kept in a box stall with plenty of straw, the back and abdomen should be covered with a blanket and food and water withheld. In the preparation of this paper the following writers have been freely quoted. Digitized by Microsoft® State Veteeinaey College. 189 rKiEDBEEGER und Feoehkee. — Spezielle Pathologie und Therapie der HaiTstiere. HuTYBA und Maker. — Spezielle Pathologie und Therapie der Haustiere. Professor James Law. — Veterinary Medicine. SvEN Wall. — Die Kolik des Pferdes. Doctor Beheen. — Die Kolik des Pferdes. Monatshefte f. praktische Tierheil- l^unde, XXII Band, 3 Heft. Oslee's Modern Medicine. Digitized by Microsoft® Digitized by Microsoft® Digitized by Microsoft® Digitized by Microsoft® Digitized by Microsoft®