Diirerential Diagnosis. Treatment. 451 



extension of the alxlomou is usually caused only hy bloatint>- of 

 the large intestine. 



Percussion of the abdomen hardly assists in arriving at a 

 diagnosis. 



The intestinal sounds are of greater prognostic than diag- 

 nostic value. The absence of peristalsis in certain portions of 

 the intestines cannot be determined from the behavior of the 

 intestinal sounds, because, unless quite feeble, the latter are con- 

 ducted from one spot to all parts of the abdominal wall. If, 

 however, the sounds are persistently more frequent, and loudest 

 over certain sections of the abdomen, one may conclude that the 

 intestines of this region are in a condition of energetic per- 

 istalsis. 



Complete constipation, coming on simultaneously with or 

 soon after restlessness, speaks for obstruction or paralysis of 

 the intestine; the absence of these symptoms at the l)eginning 

 does not, however, exclude these affections. Retarded defeca- 

 tion, and even complete constipation, is ol)served also during the 

 later course of disease of the stomach. Marked straining at 

 defecation is observed most commonly in diseases of the rectum 

 and in peritonitis. The character of the feces assists in some 

 cases in arriving at a diagnosis. 



Rectal examination furnishes the most valuable data and it 

 should never be neglected. There is not a single reason in 

 favor of its neglect and many cases can be diagnosticated cor- 

 rectly on the basis of a proper rectal examination. 



To make a careful rectal examination one should first inject two or three 

 quarts of lukewarm water into the rectum; this relaxes the rectal wall and makes its 

 internal surface slippery. Before introducing the hand the neighborhood of the 

 anus is inspected anil tumors, parasites or blood are noted if present. The oiled or 

 greased hand is introduced by overcoming the resistance of the rectum with the 

 fingers closed into a cone. It is then advanced carefully until the arm has been 

 pushed in as far as the elbow; while this is being done one can ascertain, 

 by palpating the rectal wall, whether the latter has been torn. The hand then 

 progresses in the direction of the thorax to find out whether the rectum is empty 

 (obstruction). Then palpation is made through the rectal wall in order to examine 

 the urinary bladder, the two abdominal rings (in mares the ovaries), the accessible 

 portions of the small and large intestines, the posterior or mesenteric root, the poster- 

 ior, upper portion of the spleen, the left kidney and, in horses that are not too large, 

 the anterior mesenteric root and the vessels contained in it. A man of medium size 

 is able, in not too large horses, after introducing the arm up to the shoulder, to 

 palpate the anterior portion of the left kidney and from there downward and 

 laterally a spherical segment of the abdominal cavity. If possible the examination 

 is made on the standing horse. Very restless horses must be first quieted by an in- 

 jection of morphine or by choral hydrate, or they must be restrained. 



Treatment. In order to avoid serious errors, treatment 

 must always be directed against the underlying disease, which 

 has either been determined with certainty or at least with good 

 probability. The variable nature of the causes of colicky pain 

 excludes any uniform method of treatment; it is, however, al- 

 ways advisable to take the patients to a roomy closed place well 

 littered with dry straw, to prevent reckless throwing down and 

 impetuous rolling partly by narcotic means, partly by proper 



