Prognosis. Treatment. 371 



quent, and recurrences often occur. In obstipation of the cecum 

 the reappearance of defecation does not always indicate im- 

 provement, because masses of desiccated feces may remain be- 

 hind in the cecum. If complications have already occurred there 

 is no hope for recovery, except in secondary dilatation of the 

 stomach, which can be treated successfully. 



In the Budapest Clinic the mortalitv for different years ranges between 3 to 

 10%. 



Treatment. To remove accumulated masses of feces from 

 the large gut, those which can be reached manually from the 

 rectum should be evacuated, then a rectal injection of a large 

 amount (30-40 qts.) of lukewarm water should be given, being 

 allowed to run in under a low pressure. The injected water is 

 partly soon expelled, but Dammann and Marek have shown 

 experimentally that in horses without ol)stipation the fluid may 

 travel up to the middle or even to the beginning of the colon, 

 and that it may therefore be expected to produce softening of 

 the feces in obstipation. Cold water is not well adapted for this 

 purpose because it stimulates the intestines to contract and to 

 prevent the progress of the fluid inward. The injection of a few 

 quarts is of no avail, because the fluid will then irrigate only the 

 posterior portion of the rectum. Accumulations of feces in the 

 cecum or in the small intestines cannot be influenced even by 

 very large quantities of water. The injections (which are not 

 usually successful by themselves) must be repeated several 

 times. 



In order to soften the masses of feces which are situated 

 more towards the stomach and to stimulate peristalsis, neutral 

 salts in large doses should be administered (250-500 gm.), or 

 aloes (30-40 gm.), according to Hohne, even 50 gm., or castor oil 

 (300-500.0 gm.) with one-half to one quart of neutral oil, or with 

 50-70 gm. of ether. In cases w^hich are not very grave, abundant 

 defecation and speedy recovery are usually observed after 

 the administration of these drugs. In grave cases, how- 

 ever, the rectal injections and the administrations of the above 

 drugs must be supported by medicines which stimulate the in- 

 testinal muscularis to strong contractions. Not earlier than 

 half a day after the rectal injection, or after the salts or castor 

 oil have been given (in obstipation of the ileum, however, after a 

 few hours), one should administer subcutaneously eserine (0.06- 

 0.08 gm.), with pilocarpine (0.15-0.25 gm.) or with arecoline 

 (0.05-0.08 gm.). These applications do not only stimulate the 

 intestinal muscularis but they increase the intestinal secretions 

 and make the mucosa more slippery for the expulsion of the 

 masses of feces. Without such preliminary softening, the above 

 named drastic means may produce rupture ; this might particu- 

 larly occur if eserine alone is used in somewhat large doses. 

 It is necessary to watch the animals carefully after the use of 

 the above drastics because they intensify abdominal pains, and 

 the horses must be prevented from reckless throwing and roll- 



