Colic and Diseases of the Digestive System.1

Colic and Diseases of the Digestive System.1

57 a;eneral Brticles. COLIC AND DISEASES OF THE DIGESTIVE SYSTEM.l By GENERAL FRED SMITH, D.S.O., Di netor -Generalof tlie A 1"I"Y VelerillalY Servic...

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a;eneral Brticles. COLIC AND DISEASES OF THE DIGESTIVE SYSTEM.l By GENERAL FRED SMITH, D.S.O., Di netor -Generalof tlie A 1"I"Y VelerillalY Service.

I N the last Annual Report prominence was g iven to the important subject of colic and fatal disorders of the digestive system. During th e year which ha s since elapsed every effort has been made to enquire into the causes opera ting in the production of this peculiar class of affection, the existen ce of which amongst animals is almost entirely confined to the horse . A system of collecti ve investigation has been adopted, every case of colic o r fatal disease of the digestive system being separately reported upon, and a series of questions answered. The result of these enquiries is now presented. Speaking broadly, diseases of the digestive canal of the horse are gene rally spoken of as colic. Colic, as a matter of fact, is only a sym ptom of abdominal pain; it is present whether the affection is a simple cramp of the bowels, or whether the lesion is of a fatal character, s uch as a rupture of the intestine. It is owing to this fact that the layman gets confused in the use of a term which sometimes indicates a mild , a t other times a fatal, condition. In these returns the term" colic" is rest ricted to cases of bowel or stomach pain which recovered. All cases which died, no matter whether from inflammation, rupture, twist, or impaction, are spoken of simply as fatal disorders of the digestive canal; in this way without sacrificing accuracy we ensure simplicity. One-third of all the dea ths in the army, and over 4t per cent. of the admissions to hospital for the year, were caused by the above disorders, and day by day there were never less than seventy horses under treatment for these affections. In the presence of these facts the importance of a searc hin g enquiry into the causes needs no further co mment. During the year under review there occurred 77 7 cases of colic, and ninety·two fatal disorders of the digestive canal. The percentage of co lic on the average stren gth of horses was les,; than last year, but is st ill too high. Here are the figures for the last four years ;1905 3'37 per cent. of strength. 1906 3'79 190 7 4'35 1908 3'72"" These fig ures do not inclu de any fatal cases. , From his Annual Report.

58

The Vete r inary

:1 Menza!'

The distribution of colic by commands was as follows : Colic only. Per cent.

of ave rage stre ng th.

Scottish Command Aldershot Comman d Irish Comm a nd Eastern Command Southern Comma nd London District N orth ern Command Western Command

9'59 4'62 4' 34 4'14 3'53 2 '96 2'85 1"70

Colic and Fa tal Disorders. Per ce nt. o f average strength.

10'46 5 ' 16 4"75 4'46 3'94 3"72 3'19 1'70

In this table the great excess of colic in the Scottish Command IS very striking. Making every allowance for the error arising from the use of small numbers, it is still evident that these diseases exist in a far higher proportion than should be. Every t enth horse in th e Scottish Command was admitted during the year. Further, th e proportion of fa tal cases was the hi g hest in th e Army. The Aldershot Command has about half the admission and death ratio of the Scottish Command; the Irish, Eastern, and South ern Commands follow; th e London District furnishes a low admission rate, but a dea th rate the second h ighest in the Army. If th e colic and fatal di seases of the digestive system b e e xa m in ed by bra nche s of the Serv ice, the followin g ta ble is obtain ed :Mounted Infa ntry H ousehold Cavalry Royal Horse A rtillery Engineers Field Artillery Army Service Corps

Colic.

Fata l Disord e rs.

'46 pe r ce nt. 1'13 3'30 3 '93 5'21 8 '07

·23 per cent. '88 '1 3 ' 79 '45 '89

The low colic percentage of the Mounted Infantry is a point of importance, and th e question suggests itself whether cobs are so liable as horses. It certainly appears that draug ht horses are more liable than riding horses, but this point can only be decided by extended enquiry. The monthly preva lence of colic has been studied, a nd though considerabl e variation occurs from month to month , ye t July stand s out as the worst m onth of th e year. If th e year be divided into six warm months, April to September, a nd six cold months, October to March, it is found th a t more cases of col ic occur during th e warm t~an during the cold month s. The seasonal influence is, howeve r, much more marked' in the in cidence of fat al cases ; there are m ore fatal cases during the summer, July a nd September furnishing th e t wo months of highest mortality .

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The explanation of the higher admission and mortality rate in summer is that colic and fatal disorders of the digestive system are not entirely brought about by water or food, but that work is a factor. To this point we shall return. For years it has been known that colic is more frequent at certain hours of the day; in consequence the influence of the time of day in the production of colic has been carefully observed in the whole of the 777 colic cases and ninety-two fatal cases of disease of the digestive system recorded during the year. These results are of the greatest practical importance; they demonstrate in the daily life of the horse what may be described as a colic storm, which lasts sixteen hours. This begins at 5 a.m. and ends at 9 p.m., the height of the tempest being reached between 4 p.m. and 6 p.m. The disturbance snbsides at 9 p.m., and from then until 5 o'clock next morning there is comparative calm, lasting eight hours. Thus, there is in the life of horses a colic day of sixteen hours. The cause of this we must now attempt to arri ve at. The events of the colic day which alone can have any influence in the production of the disease are water, food, and work; the events of the non-colic day (night) are rest, and practically no food. Evidently water, food, and work are far more concerned in colic production than rest and abstinence. The water a hor se drinks does not stop in the stomach, for the latter is so small it could not contain it; the fluid as it is drunk passes in at one end of the stomach and out at the other, and travels to a special receptacle by means of a tube 72 ft. in length; this tube is the small intestine, and the water takes from five to fifteen minutes to travel its whole length, while it takes food at least five hours to travel the same distance. A thirsty horse may drink as much as 3 or 4 gallons of water, and this mass sweeps through the stomach and small intestines, in the latter carrying in its rush everything before it. With the above fact before us, it becomes an important point to determine the proportion of colic cases which occur before and after watering. This is shown in the following table;Culi c cases Fatal

Attacked be fore watering .

Attacked aft er watering.

19'43 per cent.

80'57 per cent. 69'57

3°'43

The significance of "watering" is here very marked; over 80 per cent. of the colic cases are attacked after the horse has been " watered."

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The VeterinalJ I '.Journal.

It is now important to see how far this is maintained throughout the twenty-four hours. For this purpose we have divided the day into eight groups of three hours :C OLI C CASES

Before wa te r

I

4

7 10 I

4

7 10

a.m. to 4 a.m.

" " " " " p.m. " II

. "

"

" " "

7 10 I

4

.

" p.m. "

7

II

10

II

I a.m.

After wa ter

F ATA L CAS ES

Befo re

Aft e r

wat er

wa t er

0

6

o

2

26

19

14

10

12

83 11 3

7

36 10

60 3 0

5

119 19 1

6 o o

82

o

23 4

17

0

5

IT

5

The table shows that from 4 a.m. to 7 a.m. both colic and fatal cases were more li able to attack before than after water, but that may be due to the fact tbat the large majority of horses would be watered after 7 a.m. From 7 a.m. to 10 a.m. the influence of water is very marked, seven times as many cases of colic occurring "after" as compared with " before" watering. The fatal cases at this period still show an excess among those that have not watered over tbose that have. From 10 a.m. to I p.m. there are three times as many cases of colic " after" as " before " water, and for the first time there are more fatal cases among the watered as compared with the unwatered horses. From I p.m. to 4 p.m. there are eleven times more colic cases among the" watered" horses; from 4 p.m. to 7 p.m. four times as many; from 7 p.m. to 10 p.m. twenty-seven times as many; and from 10 p.m. to I a.m. seventeen times as many. Strange to say, among tbe fatal cases not a single horse was attacked" before" watering after I p.m. in the day. The irresistible conclusion from these observations is tbat "watering " exercises an enormous influence over the production of colic and fatal disorders of the stomach and intestines. The question is, How does it act? To this the only reply is that its action must be mechanical, sweeping out the imperfectly digested contents of the stomach, which conseq~ently set up irritation. Under natural conditions a horse is practically always eat in g, and the small size of tbe reservoir known as the stomach explains the necessity for this. H e will eat nearly throughout the whole day and night, broken only by extremely short periods of sleep, and he drinks when he feels thirsty. Under the conditions of domestication he has to eat, but more particularly drink, at those times when it is convenient to give it. He cannot always be feeding, as he is required for work, and the food he should tak e twenty-four hours to consume is compressed into the working day

Co//c and Diseases

0/ the

Dt"g-esti'l'e System ,

6[

of twelve hours. The arrangements necessitated by having to place horses in stables are not suited to the peculiarities of the animal's digestive apparatus, which demands little and often. When we see the nosebag being put on the horse in the streets the moment he comes to rest, we ha ve no difficulty in recognizing that the principle of " little and often" is being intelligently carried out. But water is not the whole explanation of colic and fatal disorders of the digestive system, for 20 per cent. of colic cases and 30 per cent. of fatal cases occur before watering. Work as a cause of colic and fat al digestive disorders is quite undoubted; whether its effects are produced in consequence of work suspending digestion, or whether it be due to the actual strain of work acting mechanically on the digestive canal, cannot be stated, but the fact is undoubted; 76'8 per cent. of the horses attacked with colic were known to have worked on the day of attack, and 23 per cent. were idle. Strange to say, practically the same proportion was observed among the fatal cases; 76 per cent. had been or were at work, and 24 per cent. idle. If the working day of the army horse be ta ken as extendin g from 7 a.m. to I p.m. we should expect, if work were a factor in the production of the disease, to find m ore cases of colic occurring in the working than in the non-wo rking day; but as a matter of fac t it is not so. Between 7 a.m. and I p.m. 273 mi xed cases of digestive disorder occ urred, while from I p .m. to 7 p.m. 398 seizures took place. Yet it may well be th at disturban ce set up by work in the mornin g :night not develop until the afternoon, especially if th ese proce sses were of a che mi ca l n ature. Further, th e major part of the colic and fatal cases occur in the late summer, the period of man ceuvres, when afternoon wo rk would be takin g pl ace. The seasonal prevalence of colic mi ght also be explained by the amount of water consumed, but we believe it supports the view that work i~ a fac tor, the only difference between the summer and winter life of the army horse being that he does more work in the former. Our impression is th a t draught horses are more liabl e to colic and fatal di sorde rs tha n riding horses, and the figures ava ilable this year support that view. If extended enquiry should prove this to be the ca se, it still furth er st rengthens the case against severe musc ular work as a cause. There is equally good reason for b elieving work to b e an important ca use of fat a l cases of the digestive system .! Yet again, when sub· I T hese Llt al cases are rem arkable for the peculiari ty of th e le sion. The stomach of the h orse bu rsts as if s truck by a sh ell , o r the intes tines ru pture just as if th ey had been del iberate ly to rn by hand . More rem arka ble still, th e howels tie th emse lves in a knot of such co mp lex it y tha t even at josl-JJlorlem examination th ey frequ ent ly cannot be u nt ied. In no other an imal than the h0 rse h ave such les ions been descri bed.

The Veter/llary .707tr7lai. mitt ed to the te st of the figme s availab le, very little s upport is given. During wha t we have spoken of as th e workin g day, 7 a.m. to I p.m ., twenty ·nine fa ta l cases occ urred, while twenty· eight were attacked durin g th e non-workin g da y. On th e other hand, as just pointed c ut, th e m·a jo rity of fa tal cases occur in the late s ummer, at a time when afternoon work is being perform ed. Very few fatal cases are attacked between 7 p.m. and 4 a.m. Thi s is nat urally a peri od of repose. On the oth er ha nd, there is qui te a violent outburst between 4 a.m. an d 7 a .m., the chief int ensity of which is between 6 a .m . and 7 a.m. This cannot be due to wo rk, thoug h it might b e due to water. The figures of the 4 a.m. to 7 a.m . outburst are very re markabl e ; out of a mi xed total of sixty-nine cases which occ urred during that hour no less th a n twenty-four pro ved fa tal, whil e out of 264 mixed cases seized between 4 p.m. and 7 p .m. only twenty-three proved fa tal. Any ex pl a na tion of th e remarkabl e ou tbreak between 6 a.m. and 7 a.m. can not for th e present be attempted . On an a verage there are four time s as m a ny fat al inte stinal as stoma c h ca ses, b ut the proporti on between in tes tin a l a nd stomach troubl e g rows less and less as the day advances. For ins tance, in th e mornin g the proportion is 8 int estine to I stomach; at midday 3"S in t estin e t o I stomach; a nd in the evening 2·4 intestine t o I stom ach. The tables w hich are a pp ended to the repo rt show that the fat al cases incl uded: sto mach a ffec ti ons IS (rupture 14, impaction I), enteritis 13, volv u lus 18 , ventral herni a 2, intu ss usce ption 4, impaction of in testine 3, st r angulat ion 10, rupture of int estin e 14, calculus 3, di a rrh c:ea 1, peri toniti s 7, rupture of li ve r I , entozoa 1. I n attempting to deal with th e q uestion of prevention, we must con sid er th e three main feature s in th e life of th e horse, viz., water, food, and work. By wate rin g horses more fre q uently, say four instead of three tim es a da y, less will be con s umed a t a tim e, a nd if our reasonin g is sound thi s should be producti ve of benefit. Bu t unl ess we ado pt th e system of a lways keeping water before the horse, it appears impossi bl e to avoid washin g a portion of one o r more meals ou t of th e stomach. l It is certai nly a void ed at morning water, a period when, unfort unately , althou g h th e c hann el is clear, many horses drink very littl e . It is just possible a t midday water to avoid washing out portion s of the morning feed, b u t it seems impossible to avoid it in th e evening . If it is not I Since this was writte n th e Com mandant , Mounted Infant ry, in fo rmed me he always keeps water by his cobs. H ow fa r does this expla in thei r comparative immun ity to col ic .?

Colic and Diseases

0./ the

D ig-estive System,.

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avoided, then it appears possible that horses become tolerant of the process of imperfectly digested material being washed into the intestin es, otherwi se it is difficult to explain why 96 per cent. of the animals escape a whole year without a n attack of abdominal pain. An d so with feeding; a twenty-four hours' supply ha.s to be given in twelve hours, and safely conducted through a small bag incapable when cram med of holding more than on e-fifth of the total daily ration . That it does not fail more often is somewhat surprising, but the adaptability of the body is one of its stron g fea tures. The principle of " little and often " embraces the golden rule in feedil~g horses. The colic of work may ye t be shown to be due to the inter va ls between feedi ng bein g too grea t, or the large amount of water consumed. Durin g a long march, or a long day 's operations, " littl e and often .. should be practised ; horses shou ld be watered as frequently a s possibl e and fed, if for only fi ve or ten minutes at a time . This will enable an animal to get through much of the day's ration without an undue accumulation for the evening, and no ill consequences need be expected when work foll ows a li ght feed. The cab horse in this ma tter forms an excellent g uide; he should be followed in preference to th e racer or hunter. Mo re colic cases occur on a W ednesday an d fewer on a Sunday. Wednesday is a half-holiday, and the excess of colic on this day mig ht mean want of care o r want of supervision, but S aturd ay is also a halfholiday and no excess is shown on this da y. On S unday we should naturally ex pec t fewer cases if the previous reasoning we have brought forward is sound, but the number of observa tions are at present insufficient to admit of any definite conclusions being drawn. There are certain horses liable to colic, i.e., greedy feeders, " wind suck ers," or a nimals th e bowels of which contain for eig n bodies, sa.nd, calculi, &c . ; but aft er every possible cause has been exhausted there are still 70 per cent. of fat al cases of the di gestive syste m for which no primary cause can be assigned, nor discovered on post-mortem examin a tion.