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CASE OF INTROSUSCEPTED CECUM IN THE HORSE.
By Mr. W. ROBINSON, M.R.C.V.S.

Tamworth, Jan. 17th, 1845.

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My dear Sir, I HAVE sent by the train this evening a basket containing the most extraordinary morbid specimen of the large intestines I have ever met with. It appears to consist of an inverted cœcum, which by some means has become lodged within the colon. Its apex seems to have been lifted up by the power of inverted action, and passed through the common opening at its other extremity into the colon, as you will find it. The horse died this morning, shewing spasms of the bowels.

I only saw him a few hours before death. The post-mortem examination presented sufficient inflammatory mischief in the ileum and colon fully to account for his death: but for a time I could not find the cœcum, and was about to declare its absence, or the want of it, when I felt a substance in the colon, which upon opening proved to be the missing intestine. I will give you (as soon as I obtain it) a full history of this case; but trust this hurried notice will be sufficient to call the attention of the members of the Association to its singular character.

I am, in haste,

Your's very truly.

Tamworth, June 12th, 1845.

Dear Sir, I will now endeavour to give you as much of the history of the case (of introsusception of the cœcum into the colon) as I have been able to collect.

The horse which afforded the morbid specimen above alluded to, and which was transmitted to you some time back, was the property of L. Haughan, Esq., a gentleman at that time on a visit to Captain Desooun, at Drakelow-park. I have been informed that the horse had three drachms of Barb. aloes given to him on Tuesday afternoon, 14th of January; the weather being at that time frosty, with every appearance that Wednesday would not prove a hunting-day: however, a change took place in the night, accompanied with a heavy fall of rain. The next morning, Jan. 15th, the fox-hounds met at Bone Hill-house, a distance of twelve miles from Drakelow, to which Mr. Haughan rode this horse to cover, the rain falling heavily all the way.

I observed the horse on his arrival at Bone-hill was very relaxed in his bowels, and was informed he had been in that state for four or five miles on the road. On his way home the animal had warm gruel given to him, and he was fed at Tamworth.

He travelled back to Drakelow without evincing any pain or uneasiness, although his bowels were still very relaxed. On his arrival at home, and before the groom had finished dressing him, the animal shewed symptoms of spasms: he laid down, rolled over and upon his back, and appeared to suffer much pain.

The groom instantly bled him, and gave some antispasmodic mixture from this treatment he appeared to experience relief for a few hours, when the pain and general symptoms returned with increased violence. At ten, P.M., Mr. Kent, V.S., Burton, attended, and the animal was again bled by his direction, and also had given to him the agents Mr. Kent usually administers in such cases. Mr. Kent informs me that he left him, at midnight, much relieved.

I saw the horse the next day, accompanied by Mr. Friend, jun., V.S., of Walsall: he was then cool and tranquil, but I found on examination that his pulse was quick and small; mouth and tongue foul; legs cold; with a peculiar heaviness in his eyes. These obser

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vations had scarcely been made, when he again became restless, looked anxiously back to his flank and side, and, in a short time, laid down, rolled upon his back, which position he had chosen during every paroxysm. Thus he lay fighting violently with hist hinder and fore legs in the air for several minutes, with evident contraction of the abdominal muscles, and a seeming effort to expel some offending matter from the bowels. Suddenly he arose, stared wildly, and forced his head high up against the wall: after this he again became calm and easy; the pulse and respiration, which had been excessively hurried by these painful efforts, also quickly resumed their former state. He had suffered from similar attacks, and at the same intervals, since three, P.M. From this time there was a recurrence of these painful paroxysms, till death closed the scene about midnight. The post-mortem appearances I think I gave you when I forwarded the morbid specimen to the Royal Veterinary College. I dare not trust myself at this time to make any remarks upon this singular case, further than to hope it may lead to a more correct physiology of the cœcum, which from its peculiar conformation we must, I think, believe performs a more important part in the animal economy of the horse than has hitherto been allotted to it. I remain, dear Sir, Your's very faithfully,

W. J. T. Morton, Esq., R.V.C.

W. ROBINSON.

Mr. Simonds. In this interesting specimen, for which we are indebted to Mr. Robinson, we perceive the body of the cœcum to be introsuscepted, or turned within itself, so that the peritoneal covering forms the lining membrane of the sac, while the displaced intestine occupies the interior of the colon. Intussusception, or this abnormal change of position in the intestines, often results from a reverted peristaltic action, which generally is preceded by spasmodic contractions of the muscular coat of the intestines. In colic a reverted action is by no means unusual, and by it, perhaps, we could account for the state of parts now before us. But, before arriving at any conclusion with regard to morbid appearances, it is always right to take a retrospective view, and ask

ourselves what is the normal function of the organ we find diseased. Now the base of the cœcum is continuous with the cœcum caput coli, forming here a blind pouch; from this part its apex extends, forming another blind pouch. The cœcum, therefore, forms a sac at both extremities, but has a free communication with the colon by a large opening. From the peculiarity of its shape, it would appear that the ingesta which travels to its apex has to be returned from thence into the colon by a motion of its muscular coat, somewhat analogous to reverted peristaltic action. Now spasm, fortunately, is seldom found to attack the large intestines, but none can question that in this disease inordinate and long continuous muscular contraction takes place; and as the cœcum has normally a double kind of peristaltic action to perform, this action under the influence of such a disease becomes greatly increased: hence probably the cause of this singular inversion. The thickened condition of the coats of the cœcum also deserves some notice. The apex, which part it is fair to presume was first inverted, has its parietes much increased by infiltration of blood between its coats, while that part of the gut which is continued towards the cœcum caput coli becomes less and less dense. Such thickening is the consequence of congestion, and the variations it presents are dependent on the longer or shorter periods that such congestion has existed.

The symptoms which the animal in the first instance exhibited are said to be similar to those observed in gripes; and although no treatment can be expected to afford relief in a case of this nature, yet, to enable the practitioner to form a correct diagnosis, every peculiar symptom becomes of importance in these cases of abdominal disease. It happens that a similar instance occurred some years ago in my practice; and, in order that the symptoms may be compared in these cases, I will briefly relate the particulars. The subject was a black pony. One evening the animal, after returning from work, was attacked with abdominal pain, which was supposed to arise from gripes, and this was rendered the more likely by his having partaken freely of cold water at a stream a short distance from home. Some remedies of a stimulating nature were given, but, these affording no relief, I was requested to attend.

I found the animal in much pain and very restless, lying down,

rolling on his back, then quickly rising again; he looked round at his side; the abdomen was tympanitic; the pulse full, and rather increased in number. These symptoms, however, are generally present in spasm; but accompanying them there was a peculiarity which attracted my attention. When the animal got up, instead of shaking himself as horses commonly do when suffering from spasmodic colic, this pony would raise his head, thrust his nose into the rack, and remain in that position for several minutes, breathing stertorously during the time. Then the pain would recommence with greater acuteness; he would now turn his head towards the abdomen, bite at his flank, and once more lie down, and roll upon his back; but I soon found that his manner of lying down was devoid of the recklessness that characterises spasm, having an appearance not only of consciousness but of care. My opinion was, that some acute affection of the stomach caused these symptoms, and, as sedatives failed to afford any relief, and the patient was gradually becoming worse, I gave the owner but little hope of his recovery. In two days he died. The post-mortem examination shewed all the viscera healthy, with the exception of the cœcum, the apex of which was inverted six or eight inches, and much strangulated. The history of the case now under consideration is at present somewhat imperfect, but Mr. Robinson has promised to send us full particulars at his earliest convenience, and then we shall learn whether any similarity existed in these two cases with reference to the symptoms which the animals evinced. Of course, I do not conceive that they are strictly pathognomonic. We know that different animals express the same feeling by different signs; yet often we may trace a similarity when the disease arises from the same cause. Between inversion and enteritis the duration of the disease will often give us some clue to a correct diagnosis; and I can easily conceive that, with an inverted cœcum, as spasm does not originate in inflammation, the horse may survive three or four days: but in enteritis death usually takes place in eight-and-forty hours.

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