Intestinal Hemorrhage. 323 



12. Intestinal Hemorrhage. Enterorrhagia. 



Etiology. More severe hemorrhages upon an inflammatory 

 basis are usually observed only if the inflammation has been 

 caused by an infection or by acrid caustic materials or if it is 

 complicated by ulceration. This is seen in the course of an- 

 thrax, cattle plague, hog-cholera, swine plague, distemper in 

 dogs, pyemia, septicemia ; after intoxication by caustic poisons, 

 in meat poisoning, after the administration of drastic laxa- 

 tives. Intestinal hemorrhages are frequently seen during pur- 

 pura hemorrhagica, scorbutus, and other diseases, and are due 

 more to morbid changes of the vessel walls than to a local 

 disease of the mucosa. 



Mechanical injury of the intestinal mucosa by swallowed 

 foreign bodies (fragments of bone, nails, etc.), animal para- 

 sites, echinorrhynchus gigas, taenia echinococcus, dochmius 

 duodenalis, etc., desiccated coproliths, hard substances intro- 

 duced into the rectum (end-piece of a rectal syringe), or stabs 

 produced intentionally (Sequens) may cause greater or lesser 

 intestinal hemorrhages. 



Congestion of the intestinal veins in chronic interstitial 

 hepatitis or in valvular disease of the heart, obstruction or 

 compression of the portal vein, thrombosis or embolism of intes- 

 tinal arteries may occasionally be the cause of intestinal hem- 

 orrhages. Hemorrhoids (dilatation of veins) below the rectal 

 mucosa, which is sometimes seen in dogs and horses (Utz, Eck- 

 art) also are the cause of hemorrhages from the rectum. 



As further causes of intestinal hemorrhages there may be 

 mentioned: very vascular or disintegrating tumors, especially 

 mucus polyps, intussusception, tearing of the dilated abdominal 

 aorta or of the anterior mesenteric artery after they had pre- 

 viously become adherent to the intestinal wall, finally extensive 

 burns, probably on account of the formation of eml)oli in the 

 intestinal vessels. 



Symptoms. The feces are stained with blood, or pure blood 

 may occasionally be voided through the anus. The more pro- 

 fuse the hemorrhage, the more easily blood coagTila are formed, 

 so that the voided masses may sometimes consist of coagula 

 only. This is particularly observed in hemorrhage from the 

 posterior portions of the intestines, since blood here does not 

 mix well with the already firm feces. In hemorrhage in the 

 anterior portions of the intestines, the feces are intimately 

 mixed with blood, they are tar-like, black, or even as though 

 charred, and they have an intense putrefactive smell. If the 

 hemorrhages have been only slight the feces appear pale reddish 

 or only streaked with blood; in slight rectal hemorrhages the 

 bloody streaks are limited to the surface. Defecation may be 

 very easy or it may be quite difficult, particularly if the hemor- 

 rhage is due to inflammatory conditions. 



