Chapter IV: Part 4

_Digestive disorder_ though starting from a different point may tend to the same end. A hyperacidity of the stomach has been observed to coincide with the malady, and by interfering with easy and normal digestion, it may stand in the way of such assimilation as is necessary to vigorous health.

_Faulty food_ operates in a similar manner. The exhausted soils, and their products deficient in alkaline and earthy salts have been already referred to; we must also note the evil effect of fibrous fodders, the main nutritive elements of which have been washed out by intemperate weather after they were cut, the rank aqueous products of wet or swampy soils, the fibrous and siliceous plants (rushes, carex, equisetums, etc.) which grow on poor, wet or soured soils, the innutritious and fermented products of beet sugar factories, and generally the spoilt food which has undergone fermentation.

_Yearly breeding_ and _constant milking_, by undermining the general health, predisposes so strongly that in many cases the affection is seen in dairy cows, while oxen and young cattle escape. The last period of gestation when the demands for the growing calf are greatest, is the period of especial danger.

_Permanent stabling_ which denies the invigorating influence of sun, exercise and pure air contributes toward the general debility and therefore, in animals that are closely stabled for the winter the spring is especially to be feared, when compulsory inactivity, poor feeding, gestation and milking have combined to reduce the system.

_Dry seasons_ have been noticed to increase the affection manifestly by reducing the supply of food.

_Course._ The affection is chronic and unless arrested by the supervention of more favorable conditions, may last for a year or more. Spontaneous recovery may set in when turned out to pasturage and open air life, and especially if a rich grain feeding is added. Without change in the conditions however, the tendency is to a fatal result.

_Lesions._ The victims of the disorder are emaciated, the fatty tissue contains a yellow serum, there is little blood, and that is thin and watery and coagulates loosely, the muscles are pale and flabby, and the gastro-intestinal mucous membrane is the seat of catarrh.

_Treatment._ To treat rationally and successfully we must adapt the measures to the obvious causes. When the soil has been scourged and exhausted, a change of pasture, and of land used for hay or soiling crops is the first consideration. If these cannot be secured then grain and seeds rich in protein, and alkaline and earthy salts should be added to the ration. Wheat bran, middlings, peas, beans, cotton seed meal, linseed meal, rapecake may be named among available resorts, or in their absence, daily doses of phosphate of lime, and sodium chloride or bicarbonate, or potash salts may be allowed, or even bone dust.

If imperfect digestion is a manifest factor, sodium chloride, or potassium chloride, calcium phosphate, iron and bitters will serve a good end. In hyperacidity, limewater, chalk, or magnesia may be given. If the digestion is torpid, hydrochloric acid with bitters may be resorted to.

Feser and especially Lemcke strongly recommend apomorphia. It is used hypodermically in doses of 2 grains for horse or cow repeated daily for three days.

=Secondary Symptoms in Wool-eating Lambs.= Lambs from two to six weeks old especially such as suck ewes with woolly udders (merino, Cotswold) first swallow the wool inadvertently, and then acquire a liking for the saline matters in the abundant yolk (merino), till finally the accumulating wool balls produce digestive and nervous disorder and a craving for the indulgence. Thus the breed must be considered in estimating the symptoms. For the same reason the wool about the hips or elsewhere soiled with salts of the urine or liquid fæces prove attractive to the victim. The proximity of other wool eaters is another cause which starts others to follow the bad example. The general conditions of debility, exhausted soil, and the absence of alkaline and earthy salts must be borne in mind. So too with prolonged confinement indoors in winter, the absence of invigorating exercise and the restriction of the animals (dams) to food which is deficient in saline matters.

Beyond the mere eating of the wool and the destruction of fleeces, the lambs do not usually suffer seriously. But if the consumption of wool is excessive the accumulating balls of the size of marbles in the stomach, and the blocking of the pylorus and small intestine, may give rise to intermittent constipations and diarrhœas, deranged digestion, muco-enteritis, mucous covered stools, loss of condition, emaciation and retarded development.

_Treatment_ consists first in the securing of a more healthy regimen. This is but one of the evils of the close winter confinement of an animal preëminently adapted to freedom and exercise. Turning out in a wide range, especially if pasture is available, is a prime consideration. The separation from the flock, of the first wool eaters, will check the propagation of the vice by imitation. Food that is defective in one or more constituents must be supplemented by that which will correct the deficiency. Salt, potassic salts and above all phosphate of lime or bone meal will sometimes benefit. May recommends the separation of the lambs from the ewes except when nursing, three times a day. Finally Lemcke claims for apomorphia the same curative effect as in other animals. The dose is 2 grains, subcutem, as in the cow and may be repeated three days in succession.

LACERATION OF THE PHARYNX.

Trauma of pharynx from objects swallowed; from whip or other
instrument in choking; lesions. Symptoms: swelling; rapidly extending;
dysphagia; salivation; retching; dyspnœa; roaring; asphyxia.
Treatment: as for pharyngitis; open pouch, suture laceration; use
antiseptics; liquid diet.

Laceration of the velum palati has been already referred to, and the remaining walls of the pharynx sometimes suffer in the same way and from identical causes. Pins, needles, and other sharp pointed bodies taken with the food sometimes perforate the walls and determine an advancing ulceration which furnishes a way for their escape externally in the region of the throat. In other cases a rigid staff, a whip, or even a probang introduced to overcome choking, is forced through the walls of the pharynx forming a pouch for the accumulation and septic fermentation of ingesta, and extensive ulcerative and gangrenous lesions.

_Lesions and Symptoms._ These depend mainly on the extent of the laceration. If there is a mere abrasion, superficial laceration or prick of the mucosa, it determines a prompt inflammation, with exudation which covers or closes the wound and a speedy healing may ensue. When, however, the whole thickness of the mucosa has been extensively lacerated and a pouch has been formed beneath it, it becomes filled with decomposing mucus and ingesta, and the resulting septic products determine ulceration, abscess, or gangrene. The result is too often a general and fatal septic infection.

In the milder forms there are only the common indications of a moderate pharyngitis. In the more severe form, the throat swells at first on the lacerated side and later all around. This swelling soon fills the intermaxillary space and extends over the face and the entire head. From the first, deglutition is extremely difficult or impossible, liquids are returned through the nose and saliva flows abundantly from the mouth. Retching is not uncommon and saliva mixed with alimentary matters is discharged by the nose (solipeds) or mouth (other animals). The swelling of throat and head has a doughy, œdematous feeling, it is very tender, and soon causes rattling, wheezing breathing, roaring, dyspnœa and asphyxia.

_Necropsy_ shows the general œdematous exudate, the laceration of the pharyngeal walls, and the collection of debris and pus in the lacerated cavity. The pus may have extended between the muscles following the course of the gullet and trachea as far as the chest. Extensive patches of necrosis may also be shown. _Treatment._ In the slighter cases the ordinary treatment for catarrhal pharyngitis is demanded. In the more severe the lesions are so redoubtable and their progress so rapid that a fatal result is virtually inevitable. As a desperate resort the septic pouch may be opened from without, its contents removed, the pharyngeal wound sutured if possible, and a thorough irrigation with antiseptics (acetate of aluminium solution) employed at frequent intervals to check if possible the septic process. The animal should be fed with well boiled milk or other liquid which will not add to the fermentation, and this may be given through a stomach tube, or by the rectum when deglutition is impossible.

PARALYSIS OF THE PHARYNX

From nervous bulbar lesion, or toxic from the pathogenic bacteria.
Transient or permanent and fatal. Symptoms: dysphagia: liquids
expelled by nose or enter lungs. Inhalation pneumonia. Facial palsy.
Roaring, laryngeal thrill. Atrophy. Gangrene. Treatment: remove cause:
combat bulbar hyperæmia and cephalic congestion: cold: derivatives,
electricity: blisters: antiseptics.

This has been described as a rare affection, yet it is often a marked symptom of cerebro spinal meningitis, and has been observed in infectious pneumonia, and influenza of the horse (Cadeac, Palat) as well as in rabies, and traumatic injuries of the brain.

The existence of the condition usually implies disease of the bulb at the roots of the vagus and glossopharyngeal nerves, or swellings affecting these nerves or the sympathetic along its course. The morbid condition may be transient in which case a speedy recovery may follow, or it may be permanent and end fatally.

_Symptoms._ Swallowing is impossible and the animal refuses food and drink or if the latter is forced on him it is rejected by the nose or mouth when the head is lowered or still worse, it enters the larynx and descends into the lungs. The larynx innervated by the same trunks is usually involved and the alimentary solids and liquids determine gangrenous bronchitis and pneumonia, with labored breathing, fœtid breath and violent dyspnœa. In other cases the facial nerve is involved, the nostrils and lips are flaccid on one or both sides, and the eyelids and ears may droop. There may be snuffling breathing from the closure of the alæ nasi, or roaring from the approximation of the arytenoids and vocal cords. If the affection is unilateral the difficulty of breathing is greatly diminished and even deglutition may be effected with some effort. There is usually, however, the obvious unilateral paralysis of the face, and especially of the larynx, with the distinct thrill, during inspiration, conveyed to the finger placed on the larynx.

Complications in the form of gangrene and atrophy of parts supplied by the same nerves, or those adjoining the pharynx, have been recognized in different cases.

_Treatment._ This must depend on the obvious cause of the affection. If due to an infectious disease the first attention must be given to that. If due to tumors or abscesses pressing on the nerves they may be removed. If there is bulbar hyperæmia or effusion attention must be devoted to derivation and other means of combating that. Cephalic congestion and heat may be met by cold applications. Derivation toward the bowels may be secured by eserine, pilocarpin or physostigmine administered subcutem. Reabsorption of exudate may be sought by pilocarpin, or diuretics—the latter administered by the rectum. Electricity in weak current may be tried when the acute febrile symptoms have moderated, accompanied by hypodermic injection of strychnia (2 grs.). Frictions around the throat with essential oils or even a cantharides blister may be used to advantage. Antiseptic washes may be injected into the mouth,—vinegar, boric acid, borax, sulphite of soda. Finally the animal must be nourished by rich gruels and soups given by the rectum, or in the smaller animals by the stomach tube.

TUMORS OF THE PHARYNX.

Varieties of neoplasms. Malignant invade adjacent and distant parts.
Symptoms: sore throat; stertor; dyspnœea; dysphagia. In cattle,
lymphadenoma, tubercle, actinomycosis. Cause cough, ptyalism,
discharge, fœtor, dysphagia. Dogs and pigs vomit. Treatment: medical;
surgical.

Tumors of the pharynx are not common in the _horse_ yet they occasionally appear as either primary or secondary neoplasms. They are of various kinds, as, epithelioma (Labat, Mathis), carcinoma (Casper, Dupuy, Mathis), sarcoma (Siedamgrotzky, Johne), lipoma (Fricker), cystoma (Degive) and melicerous (Lesbre). The malignant forms tend to invade the surrounding tissues and spread widely into the nose, palate, tongue, pharyngeal glands, and, secondarily, into the small intestines. The simple tumors like the lipomata and fibromata tend to detach themselves and hang by a pedicle (see pharyngeal polypi). The same is true of the melicerous cyst which originating in an obstructed mucous or salivary duct projects as a mass as large as a hen’s or pigeon’s egg into the fauces or pharynx.

_Symptoms._ There are symptoms of intense sore throat with stertor continuous or intermittent, increasing to dyspnœa at intervals or on exertion. In case of pediculated tumors these attacks correspond to the displacement of the tumor into the glottis. Deglutition is difficult or impossible, liquids or even solids returning through the nose, mixed with mucus and at times tinged with blood. Nasal discharge and ptyalism are present.

In =cattle= pharyngeal tumors may be of the same nature as mentioned for the horse, but they are far more frequently lymphadenoma, and above all tubercle or actinomycosis. Zimmer found that of seventy-three such tumors fifty-four were actinomycosis.

The _symptoms_ are wheezing breathing, cough, nasal discharge, ptyalism, bleeding from the nose, fœtid breath, difficult deglutition attended by cough and rejection of the ingesta through the nose, and the presence of a solid body in or on the pharynx which may be manipulated from without or within and tends to increase in size.

In =dogs= there are the same general symptoms with vomiting. The vomited material is usually remasticated and swallowed. The swelling in the pharynx can be felt from without, or seen through the open mouth. The tonsils are usually enlarged. Pressure on the pharynx or gullet produces instant regurgitation.

_Treatment_ consists in the removal of the tumor when possible. Malignant growths and multiple tumors are not favorable for treatment. Actinomycosis can be treated throughout by iodides, or these may supplement the surgical measures. In the short-faced animals an ecraseur, or a wire-snare passed through a tube may be employed. (See pharyngeal polypi).

ESOPHAGITIS. INFLAMMATION OF THE GULLET.

Causes: Alimentary and therapeutic; parasitic and accidental
traumatisms; mechanical irritants; acrids; caustics;
parasites—gongylonema, coccidia, spiroptera. Extension inflammations.
Lesions: hyperæmia; epithelial degeneration and desquamation; erosion;
petechiæ; suppuration; fibroid contraction; sacculation; polypi.
Symptoms: dysphagia, difficult deglutition; eructation; cough; upward
wave motion in jugular furrow; colicy pains; probang arrested; fever.
Treatment: liquid or semi-liquid food; for caustics, antidotes; cold
water; ice; antiseptics; derivatives; open abscess; potassium iodide.

_Causes._ This usually arises from injury to the mucous membrane and in the milder forms remains confined to this structure. In the more severe, it extends to the muscular coat and even to the periœsophagean tissues. The causes may be divided into alimentary and therapeutic irritants; parasitic or accidental traumatisms; and extension of inflammation from the pharynx or other adjacent part.

Among _irritants_ taken as food, may be named hot mashes, bolted by a hungry and gluttonous horse, and temporarily arrested in the gullet by reason of the resulting irritation of the mucous membrane. In other cases, coarse fibrous fodder is bolted without previous mastication, and scratches and abrades the œsophagean mucosa leading to transient or progressive inflammation. In other instances diseases of the teeth, jaws, temporo-maxillary joint, or salivary glands prevent the necessary trituration of the food, and it is swallowed in a rough, fibrous, or even a dry condition. Again the impaction of a solid body (turnip, apple, potatoe, egg) or of a quantity of finely divided grain or fodder so as to obstruct the lumen of the gullet, is an occasional cause. The density of the epithelium reduces these dangers to the minimum, yet a too rough morsel, or an undue detention of the less irritating material will determine hyperæmia and even inflammation and infective invasion. Acrid and irritant vegetables in the food are less injurious when thoroughly insalivated, as their contact with the œsophagean walls is then very slight and transient.

_Irritant and caustic chemical agents_ given for therapeutic purposes, attack the mouth, pharynx and stomach, more severely than the gullet through which they are passed with great rapidity. In some cases, however, the agent will adhere by reason of its powdery, gummy or balsamic character and will then act as a direct irritant. Solutions of caustic alkalies (weak lye) given to correct acid gastric indigestion in the horse, and ammonia to remedy tympany in cattle, when insufficiently diluted, will dangerously attack the œsophagean mucosa.

_Parasitic irritation_ is not so common here as in other parts of the intestinal canal where the contents are longer delayed and are passed with less friction, yet certain parasites are found in this region and may even produce considerable irritation. The gongylonema of the thoracic œsophagean mucosa of ruminants and swine are apparently harmless. The psorospermia of the œsophagean muscles of the same animals are alleged to cause œdema of the glottis, asphyxia and epilepsy. The spiroptera microstoma of the horse has in one instance known to us caused extensive denudation of the muscular coat within a foot of the cardiac end of the gullet. Finally we have found bots hooked on to the œsophagean mucosa close to the cardia, causing much irritation and spasm. The spiroptera sanguinolenta is often present in chambers hollowed in the œsophagean mucosa of the dog.

_Traumatic causes_ appear in the form of contusions and bruises from without, but much more frequently from foreign bodies, and probangs operating from within. The use of a whip or of a rope without a cup-shaped end for the relief of a choked animal. Short of the occurrence of laceration this often produces contusion and abrasion which results in local inflammation. Even the too forcible dislodgment of a solid body by a probang of approved pattern, may bruise and scratch the gullet when the seat of violent spasm. Pins, needles, wire, thorns and other sharp bodies are liable to do serious damage during their passage in an ordinary bolus and when they transfix the mucosa violent infective inflammation may ensue.

_Extension inflammations_ from the throat, and from phlegmous, abscesses, tumors, etc., in the jugular furrow need only be mentioned in this connection, as the primary disease will be clearly in evidence.

_Lesions._ These are usually circumscribed when due to a traumatic injury and extended when caused by caustics or irritants. The affected section is swollen, and surrounded by some serous effusion. When the muscular coat is involved it is often paler than normal, and microscopically shows extensive granular and fatty degeneration. The mucosa usually sloughs off its epithelial layer, sometimes over an extensive area (thoracic portion, Renault; whole gullet, Bertheol), and the exposed raw surface is of a deep red or violet. When the epithelium is not shed, it is infiltrated, swollen and friable breaking down under the slightest manipulation. Petechiæ and slight blood extravasations are abundant, and diffuse suppuration is not uncommon. In traumatic injuries necrosed areas are found in the muscular and mucous coats. Strictures, dilatations, and polypoid growths are liable to follow as sequelæ.

_Symptoms._ These usually manifest themselves from two to four days after the operation of the cause. There is much difficulty in deglutition, the effort to swallow either solids or liquids causing acute suffering, with extension of the head on the neck and strained contraction of the facial muscles. If the liquid succeeds in passing the pharynx, it is arrested at the seat of inflammation and regurgitated through the nose and mouth, or in solipeds through the nose only. This takes the appearance of emesis even if nothing actually comes from the stomach. The animal shakes the head violently, breathes hurriedly, and has fits of paroxysmal coughing. A wave extending from below upward along the jugular furrow and followed by nasal discharge is a marked symptom, as the violence of the inflammation increases. Uneasy movements of the limbs, pawing and lying down and rising, indicate the existence of colic, and this is aggravated by the administration of anodynes or antispasmodics by the mouth. In cattle, rumination is arrested, froth accumulates around the lips, the rumen becomes tympanitic, and colicy movements appear. Oftentimes a swelling extends upward in the jugular furrow, and even in its absence, pressure with the fingers along the furrow will often detect an area of tenderness with or without local swelling. Fever with more or less elevation of temperature, is a general symptom. There may be wheezing breathing or loud stertor. The passage of a probang is arrested by the swelling or spasm at the diseased part and when withdrawn may be covered with pus or fœtid _debris_. In the horse a small probang may be passed through the nose.

_Treatment._ In a slight congestion at the seat of a recent obstruction and which tends to renewed obstruction, little more is necessary than to restrict the feed for a few days to soft mashes so that irritation of the sensitive surface, spasm and the arrest of the morsel may be obviated. Plenty of pure water or of well boiled linseed or other gruel should be allowed.

In cases in which the obstruction is still present in the gullet, its removal by probang or looped wire is the first consideration, to be followed by the measures mentioned above.

In case of the swallowing of a caustic agent, no time should be lost in giving an antidote. For the mineral or caustic organic acids, lime water, magnesia, or other bland basic agent is demanded. For caustic alkalies or basic agents, bland acids, such as vinegar, citric acid, or even a mineral acid very largely diluted will be in order. In both these cases and in that of caustic salts, albuminous and mucilaginous agents, eggs, linseed tea, slippery elm, gums, and well boiled gruels are indicated. To these may be added small doses of laudanum when the irritation is great. Iced drinking water, iced milk, or iced gruels are often soothing to the suffering animal, and cold compresses, snow or ice applied along the jugular furrow is often valuable. To counteract the septic developments on the affected mucous membrane, chlorate of potash, boric acid, salol, naphthalin, naphthol, pyoktannin, or even weak solutions of phenic acid or creolin may be used. In the slighter forms of inflammation or when the acute form threatens to persist, an active counter-irritant of mustard or cantharides may be applied along the jugular furrow.

In case of abscess, as manifested by fluctuation following a hard, indurated, painful swelling, a free incision should be followed by frequent injections of antiseptic lotions or by the packing of the cavity with such bland antiseptics as salol, boric acid, or iodoform on cotton.

As inflammation subsides, potassium iodide may be given, both as an antiseptic and a resolvent, to counteract the tendency to fibroid contraction and stricture of the gullet.

SPASM OF THE ŒSOPHAGUS. ŒSOPHAGISMUS.

Causes: nervous disorders or lesions, pharyngeal, œsophagean, or
gastric disease, œsophagean parasites, choking, tumors, ulcers, cold
drinks. Symptoms: extended drooping head, working jaws, frothing,
pawing, attempts at swallowing, alkaline regurgitation, cries, rigid
gullet, tenderness. May be paroxysmal with intervening dullness.
Treatment: by sound; by removal of obstruction; by antispasmodics.
Embrocations. Tonics.

_Causes._ This has been noticed as a concomitant of certain diseases of the nervous centres, such as rabies, tetanus, or epilepsy, and those of the pharynx or stomach. Cadeac has seen it in connection with stricture, and the present writer has observed it as a result of larvæ of œstri hooked on to the mucosa above the cardia. It is an important factor in most cases of choking, and may depend on tumors, ulcers, or even cold beverages. Animals with a specially nervous organization are particularly subject to it and it may thus be an hereditary family trait. It has been especially noticed in solipeds and calves.

_Symptoms._ A feeding animal suddenly ceases to eat, extends the head on the neck, drops the nose toward the ground, moves the jaws constantly, froths at the mouth or lets the saliva drivel to the ground, moves the fore feet uneasily pushing the litter under the belly, makes efforts at deglutition during which, waves may be seen to descend along the jugular furrow, followed by regurgitation and discharge of the liquid as by emesis. The act is often followed by a slight cry. Manipulations of the left jugular furrow detects the gullet as a firm, rigid cord, unless when liquids are passing as above, and auscultation reveals a rattling or gurgling noise as if in jerks. Pressure on the gullet is often very painful, increasing the spasm and rigidity, and causing the animal to cry out. Wheezing breathing may attend the discharge of saliva through the nose, and violent paroxysms of coughing may be caused by the entrance of this liquid into the larynx.

In the majority of cases no food is swallowed and nothing but saliva is disgorged, which together with the absence of an acid odor distinguishes this from true vomiting. In an exceptional case of the author’s, occurring in a colt, the animal continued to masticate and swallow green food which gradually filled the whole length of the gullet, practically paralyzing it. In ordinary cases a small sound can usually be passed into the stomach. In cases of obstruction, however, by a solid morsel, or by an accumulation of soft solids, the probang will enable one to detect the condition. The acute symptoms may occur in paroxysms of a few minutes in length, between which, the animal remains dull and disspirited until the new attack supervenes. Recovery is at times as sudden as the onset, though there remains, for a length of time, liability to a relapse. Cadeac has seen a succession of such attacks which extended over a year and a half.

_Treatment._ In many cases the passage of a probang or sound, will, by the mere distension of the gullet, overcome the local spasm, though it may be necessary to repeat the operation several times. In case the sound causes much pain the end of the instrument may be well smeared with solid extract of belladonna, and after passing this as far as the obstruction a short time may be allowed, before its passage is again attempted. In case obstruction by soft solids has taken place, the passage of the wire loop will serve to break up the mass and even to draw it up toward the mouth.

The administration of antispasmodics is the next indication. Chloroform or ether by inhalation or in solution in water, chloral hydrate as an enema, morphia or atropia hypodermically may be used according to convenience. Bromide of potassium and other antispasmodics given by the mouth, too often fail to pass the obstruction and thus prove useless, except in the intervals of the spasms.

Fomentations of the lower border of the neck with warm water, and frictions over the region of the gullet with camphorated spirit, essential oils, ammonia, or in calves with oil of turpentine, often contribute to relieve the spasm.

Finally after the severity of the attack has passed, a course of bitter tonics and above all of nux vomica will fortify the system against a relapse.

PARALYSIS OF THE ŒSOPHAGUS.

Causes: nervous lesions and disorders; arytenectomy; over distension;
stricture; parasites. Symptoms: dysphagia; regurgitation; cough;
dyspnœa; hard packed gullet. Inhalation pneumonia. Lesions. Treatment:
remove cause; liquid food; dilatation; nerve sedatives and stimulants;
electricity; counter-irritants.

_Causes._ This has been noticed in a number of cases in solipeds, and attributed to central nervous lesions, cerebral concussion (Straub), encephalitis (Hering, Bornhauser), paralysis of the fore extremities (Meier), pharyngeal paralysis (Puschmann). Möller has seen it several times consequent on arytenectomy, while Dieckerhoff and Graf have seen it occur without any clearly defined cause. In a case referred to above, the present writer found it connected with the attachment of larvæ of œstri in the lower end of the gullet. Stricture and impaction may be a further cause.

_Symptoms and lesions._ There is more or less interference with deglutition, culminating in complete inability to swallow, and the rejection of morsels of masticated food by the nose. Cough may also occur from the descent of food toward the lungs, with more or less dyspnœa and oppression of the breathing. Manipulation along the left jugular furrow, detects the œsophagus as a prominent hard, rope-like mass which fills up the groove unduly. When death occurs rapidly the gullet is found gorged with masticated food throughout its entire length. In certain instances gangrenous pneumonia is found, the result of the penetration of food into the bronchia. In other cases there are lesions of the medulla oblongata, or of the vagus or glossopharyngeal nerves or their œsophagean branches.

Death usually results from obstruction, inanition, or, in case the paralysis is partial, from pneumonia or exhaustion.

_Treatment._ First remove or correct the existing cause of the disease. Impaction may be broken up by the use of the wire loop, or pincer probang; parasites may be expelled by passing a cupped probang; the impactions following arytenectomy can be obviated by feeding gruels, milk and other liquid foods only, and from a bucket set on the ground; stricture may be dilated by the use of graduated sounds; and nervous diseases may be dealt with according to their specific nature in each several case. When any definite cause of this kind has been overcome the persistent use of strychnia, subcutem, or by the mouth, may be effectual in overcoming the paresis of the gullet. Hypodermic injections are best made along the left jugular groove, and frictions, stimulating embrocations, and galvanic currents may be employed with excellent effect.

ŒSOPHAGEAN TUMORS.

Forms of neoplasm in gullet of horse, ox, sheep, pig, dog. Symptoms:
dysphagia; eructation; vomiting; bloating; cough; dyspnœa; stertor;
fœtor; palpitation. Treatment.

These have been often noticed in the lower animals. In the _horse_ have been noticed _melanoma_ (Olivier, Röll, Kopp, Besnard, Pouleau), _fibroma_ (Dandrieu, Dieckerhoff), Carcinoma (Chouard, Lorenz, Cadeac, Laurent), epithelioma (Blanc, Lorenz), Leiomyoma (Lucet, Lothes), cystoma (Caillau, Legrand), mucous cysts (Lucet).

In =cattle papilloma= is especially common, having been noted by _Johne_, Mons, Fessler, Schütz, Lusckar, Gratia, Beck, Cadeac and Kitt. =Tubercles=, and =fibroid masses= with cystic purulent centres are not uncommon. =Actinomycosis= is also frequent, sometimes hard and warty and at others soft and vascular.

In the =Sheep=, Dandrieu found between the muscular and mucous coats a hard tumor as large as a hen’s egg, the removal of which put a stop to a persistent choking. In both =cattle= and =sheep=, swellings from =coccidiosis= are common; in =cattle= and =swine= from =gongylonema=, and in =sheep= from =filaria= (Harms) or =spiroptera= (Zurn).

In =pigs=, =fibroma= is met with in the walls of the gullet (Raveski) and in =dogs= =fibroma=, =papilloma=, and the tumors of spiroptera.

_Symptoms._ The coccidia and spiroptera usually cause few symptoms or none, but neoplasms usually develop symptoms of obstruction, dysphagia, eructation, vomiting, and all the indications of choking according to their seat. These do not come on suddenly and recover as in simple choking, but even though there may be periodic obstructions, spasms and paroxysms, there is a slow, progressive advance as the neoplasms increase. Stertorous or mucous breathing, cough, dyspnœa and fœtid exhalations are common, the symptoms may be aggravated when the head is bent, and the tumor may even be felt on palpation of the throat or left jugular furrow. In ruminants tympany occurs after feeding.

_Treatment_ is surgical and consists in the removal of the tumors by incision and ecraseur or otherwise. Thoracic œsophagean tumors are usually inoperable.

IMPACTION OF THE CROP. INGLUVIAL INDIGESTION.

Gallinaceæ and Palmipeds. Causes; Overfeeding after privation;
fermentation; lack of water; green food in geese and chickens; food
containing paralyzing element. Symptoms; dull; motionless; erect
plumes; drooping wings and head; gapes; ejects liquid from bill; firm
cervical swelling. Treatment; manipulation; incision; surgical
precautions. Convalescent feeding.

The cervical dilatation of the œsophagus known as the crop is well developed in all granivorous birds, (Gallinaceæ, etc.;) and like the macerating cavities of the ox (first two stomachs) is subject to overdistension and paralysis. In the palmipeds (ducks, geese) there is no distinct crop but in its place the cervical portion of the gullet has a fusiform dilatation, and under given conditions this may be also the seat of impaction.

_Causes._ The impaction may result from overfeeding when the bird has been starved, or when it suddenly gains access to food of a specially appetizing kind and to which it has been unaccustomed. The crop like every other hollow viscus is rendered paretic by overdistension. Then the food undergoes fermentation still further distending the cavity, affecting the brain by reflex action, and paralyzing the vagus and its peripheral branches in the lungs, heart, stomach, liver, intestines, etc. When the food is dry as in the case of beans, peas, bran, farinas, it may be a simple firm impaction which the muscular walls of the crop are unable to break up or move onward. When green food is taken there is often superadded the additional evil of active fermentation from the great number and activity of the bacterial ferments contained in it and the soft aqueous fermentescible nature of the food (See _tympany in ruminants_). Dupont states that young geese led out to fresh spring grass may lose two-thirds of their number in a few hours from such overloading and that some species of _Carex_ and cynodon dactylon are particularly injurious. Chickens also gorge the crop with clover, etc. In all such cases, plants that contain a paralyzing principle like lolium temulentum, ripening lolium perenne, chick vetch, etc., are to be specially dreaded. (See Trichosoma Contortum).

_Symptoms._ There are first dullness and sluggish movements, followed by indisposition to move, the bird standing in one place with ruffled feathers and drooping wings, and at intervals, projecting the head forward with open beak and in some cases a little liquid is rejected. If the bird is now caught and examined the crop is found to be firmly distended, and more or less compressible or indentable according to the nature of the food impacted. In most cases and especially if the food has been green or aqueous, there is a certain resiliency from the presence of gas outside the solid impacted mass.

_Treatment._ This must be in the line of seconding the physiological efforts of regurgitation which is a normal and common act in birds. The duck which has gulped a mouse half-way down the cervical part of the œsophagus will readily disgorge it when he finds it impossible to pass it further. The carnivorous birds often reject by vomiting the indigestible debris such as feathers and bones, after all the more soluble parts have been disposed of in the stomach. The pigeon even feeds its young by disgorging into their open bills, the semi-digested food and milk from its crop. Following these indications we must break up the contents of the crop by manipulation and force them in small masses upward into the bill and downward to the proventriculus. The rejection by the bill may be further stimulated by introducing the finger into the fauces to rouse the reflex active emesis. Usually the crop can be quickly and satisfactorily emptied in this way.

When this proves impossible there remains the operation of direct incision through the walls of the crop and the evacuation of its contents. This can be done by a pocket knife or even a pair of scissors. The crop is punctured in its lower part and the incision is continued upward as far as may be necessary to allow the escape of the contents. Usually half an inch will suffice. Then the crop is squeezed so as to press the contents through this opening and it is emptied by a process of enucleation. If the contents are fibrous it may be necessary to employ forceps to dislodge the material. The empty crop may be washed out with tepid water, any food attached to the raw edges of the wound must be removed and the skin stitched accurately together. The wound rarely fails to heal by first intention. To avoid stretching it, the food for a day or two should be restricted to milk, gruels, or a little soft mash.

Lerein notices jaundice as a sequel of impacted crop, and recommends treatment by sulphate of soda in the water.

TYMPANITIC INDIGESTION IN THE RUMEN. BLOATING.

Definition. Susceptible Genera. Causes; gastric paresis, overloading,
cold, fear, exhaustion, poisons, fermentescible food,—new grain,
leguminosæ, frosted vegetables, ruminitis, foreign bodies in rumen,
microbian ferments. Symptoms, abdominal, general. Gases formed under
different aliments—carbon dioxide, marsh gas, hydrogen sulphide,
nitrogen, oxygen. Lesions, rupture of rumen or diaphragm, compression
or rupture of liver or spleen, petechiæ, congestion of lungs and right
heart, of cutaneous and cerebral vessels. Prevention, avoid
indigestible and fermentescible aliments, correct adynamic conditions,
tonics, avoid injurious ferments, make alimentary transitions slowly.
Treatment, exercise, bath or douche of cold water, rubbing and
kneading, rope round abdomen spirally, gag in mouth, dragging on
tongue, movement of a rope in fauces, probang, stimulants,
antiseptics, alkalies, ammonia, oil of turpentine, oil of peppermint,
alcohol, ether, pepper, ginger, soda, potash, lime, muriatic acid,
carbolic acid, creosote, creoline, sulphites, kerosene, chloride of
lime, chlorine, tar, common salt, hypochlorite of soda, magnesia,
eserine, pilocarpin, barium chloride, colchicum, lard, trochar, Epsom
salts, rumenotomy. Treatment of diseased gullet, mediastinal glands,
stomach or intestines.

_Definition._ The condition is a combination of paresis of the rumen and gaseous fermentation of its contents. The initial step may be the paresis or in the more acute forms the fermentation.

_Genera susceptible._ While all ruminating animals are subject to this disorder, it is much more frequent in cattle and sheep than in goats.

_Causes._ It commences in _paresis of the rumen_ in the weak, debilitated, convalescent or starved animals which are suddenly put on rich, and appetizing food. Hence it is common in animals that break into a cornbin, a store of potatoes, a field of growing corn or small grain, or that are turned out on green food in early spring. Cadeac maintains that paresis of the rumen is the essential cause in all cases, while the nature of the aliments ingested fills a secondary and comparatively insignificant rôle. According to this view the torpid stomach can neither relieve itself through regurgitation for rumination, nor expel through the œsophagus the constantly evolving gas which therefore distends the viscus to excess. In support of this view may be adduced the occurrence of tympany through fatigue, fear, cold, enlarged (tubercular) mediastinal glands pressing on the gullet and vagus, obstruction of the œsophagus by a solid body (choking), impaction of a morsel of solid food in the demicanal of the calf as noticed by Schauber, and the cessation of the normal vermicular movements of the rumen in connection with inflammation of its coats, or extensive inflammation elsewhere or finally of fever. Even in paralysis of the stomach by poisons like lead, tympany may be a result. Cadeac attributes tympany following the ingestion of green food wet with a shower, or drenched with dew, of frosted potatoes or turnips, or of iced water, to the paralyzing action of the cold on the rumen. This view is manifestly too extreme, as the bloating occurs often after a warm summer shower, or after the consumption of potatoes and other roots and tubers which have been spoiled by frost but which are no longer at a low temperature when consumed.

_Tympany_ may also start from the ingestion of certain kinds of _food_ which are _in a very fermentescible condition_. Green food, especially if the animal has been unaccustomed to it, is liable to act in this way. Clover and especially the white and red varieties, lucern (alfalfa), sainfoin, cowpea and other specially leafy plants, which harbor an unusual number of microbian ferments, and which contain in their substance a large amount of nitrogenous material favorable to the nourishment of such ferments are particularly dangerous in this respect. All of these are most dangerous when wet with dew or when drying after a slight shower, partly no doubt at times by reason of the chilling of the stomach, but mainly because the ferments have been stimulated into activity by the presence of abundance of moisture. Drenching and long continued rains are less dangerous in this respect than the slight showers and heavy dews, manifestly because the former wash off a large portion of the microbes, which under a slight wetting multiply more abundantly.

Frosted articles act in a similar way, partly when still cold by the chilling and paralyzing of the stomach, but cold or warm, by reason of the special tendency of all frozen vegetables to undergo rapid fermentation when thawed out. This is true of green food of all kinds when covered by hoarfrost, of turnips, beets, potatoes, carrots, apples, cabbage, etc., which have once been frozen, and of frosted turnips and potato tops, though, in the case of the latter agent, a narcotic principle is added.

In the case of Indian corn, the smaller cereal grains, and certain leguminous plants (vetches, tares, peas, beans) which have the seed fully formed but not yet quite hardened nor ripened, there is the double action of a paralyzing constituent and an aliment that is specially susceptible of fermentation.

Inflammation of the rumen, already quoted as a cause, may be determined by hot as well as cold food, by irritant drugs and poisons, and by narcotico-irritant and other acrid plants in fodder or pasture. In the same way the inflammation caused by the introduction of foreign bodies into the rumen, such as nails, tacks, needles, pins, wires, knife blades, and masses of hair or wool may at times cause tympany.

The two main causative factors, of paresis of the rumen on the one side and of specially fermentescible food and a multiplicity of microbian ferments on the other, must be recognized as more or less operative in different cases, and in many instances their combined action must be admitted. The tympany is the symptom and culmination of a great variety of morbid causes and conditions, and its prevention and treatment must correspondingly vary.

_Symptoms._ The whole left side of the abdomen being occupied by the rumen, its distension leads to an uniform swelling of that side, differing from that caused by simple excess of solid ingesta in being more prominent high up between the last rib and the outer angle of the ilium, and in giving out in this region a clear tympanitic or drumlike resonance on percussion. It has also a tense resiliency, like that of a distended bladder, easily pressed inward by the finger but starting out to its rotundity the moment the pressure of the finger is withdrawn. The distension caused by overloading with solids bulges out lower down, is not resonant but dull or flat when percussed, and yields like a mass of dough when pressed retaining the indentation of the finger for some time. The swelling of tympany, when extreme, rises above the level of the outer angle of the ilium and even of the lumbar spines on the left side, and if no relief is obtained the right side may undergo a similar distension.

Auscultation detects an active crepitation over the whole region of the rumen, finer in some cases and coarser in others, according to the activity of evolution and the size of the bubbles of gas. The crepitation is especially coarse and loud in fermentation of green food, and of spoiled potatoes or other tubers or roots.

In all acute or severe cases, there is anorexia, suspension of rumination, and the normal movements of the compressed bowels seem to be largely impaired, though the anus is protruded and a little semi-liquid fæces or urine may be expelled at intervals. The breathing is accelerated, short, and labored. The nostrils are dilated, the nose extended, the face anxious, the eyes bloodshot and the back arched. Froth may accumulate around the lips, or the mouth may be held open with the tongue pendent. Sometimes a quantity of gas may suddenly escape with a loud noise, but without securing permanent relief. The heart beats are violent and accelerated, the pulse increasingly small and finally imperceptible, and the visible mucous membranes are congested and cyanotic. Pregnant females are very liable to abort.

When the right flank as well as the left rises to the level of the lumbar spines death is imminent, and this may take place as early as fifteen or thirty minutes after the apparent onset of the attack. Death may result from nervous shock, from suffocation, or from the absorption of deleterious gases, or from all of these combined.

In the less acute cases the animal may live several hours before the affection terminates in death or recovery. As a rule he stands as long as he can and finally drops suddenly, the fall often leading to rupture of the diaphragm or stomach, to protrusion of the rectum, or the discharge of ingesta by the mouth and nose.

In still slighter cases relief comes through vomiting or more commonly through frequent and abundant belching of gas, the swelling of the flanks subsides, rumbling of the bowels may again be heard, and usually there is a period of diarrhœa.

_Gases present._ When the rumen is punctured before or after death so as to give exit to the gas in a fine stream it proves usually more or less inflammable, the lighted jet burning with a bluish flame. The usual inflammable ingredients are carbon monoxide, hydrogen carbide (marsh gas) and hydrogen sulphide, yet the relative proportion of the gases varies greatly with the nature of the food and the amount of gas evolved, carbon dioxide being usually largely in excess. The following table serves to illustrate the variability:

─────────┬─────────┬─────────┬──────────┬─────────┬─────────┬───────── │ │ │ │Lameyran │ │ │ │ Gmelin, │ │ and │ │ Gas. │Pflüger. │ from │Lassaigne.│ Fremy, │ Vogel. │ Raiset. │ │ clover │ │ from │ │ │ │ │ │ clover. │ │ ─────────┼─────────┼─────────┼──────────┼─────────┼─────────┼───────── CO │ 60–80│ 5│ 29│ 5│ 27│ 74.23 CO │ 28–40│ │ │ │ │ CH │ │ 15│ 6│ 15│ 48│ 23.46 HS │ │ 80│ │ 80│ │ O │ │ │ 14.7│ │ │ N │ │ │ 50.3│ │ 25│ 2.22 ─────────┴─────────┴─────────┴──────────┴─────────┴─────────┴─────────

The most elaborate observations on this subject are those made by Lungwitz on the different aliments kept in closed vessels at the body temperature, and on similar agents fed for days as an exclusive aliment to oxen provided with a fistula of the rumen for purposes of collection. He found carbon dioxide to be the predominating gas in all cases, but that it was especially so in extreme tympanies and varied much with the nature of the food. The following table gives results:

Percentage of CO_{2}.
Buckwheat (Polygonum fagopyrum) 80
Alfalfa (Mendicago Sativa) 70–80
Clover (Trifolium pratense) 70–80
Meadow grass 70–80
Indian corn (Zea Maïs) 70–80
Spurry (Spergula arvensis) 70–80
Hay of alfalfa or clover 70–80
Oats with cut straw 70–80
Yellow Lupin (Lupinus luteus) 60–70
Vetch (Vicia sativa) 60–70
Oats cut green 60–70
Potato tops 60–70
Potatoes 60–70
Meadow hay 60–70
Leaves of beet 50–60
Leaves of radish 50–60
Cabbage 40–50

The marsh gas varied from 16 to 39 per cent., being especially abundant in cases of abstinence. It should, therefore, be in large amount in the tympanies which accompany febrile and other chronic affections. Hydrogen sulphide was found only in traces, recognizable by blackening paper saturated with acetate of lead. Oxygen and nitrogen were in small amount and were attributed to air swallowed with the food. In the work of fermentation the oxygen may be entirely used up.

_Lesions._ These are in the main the result of compression of the different organs, by the overdistended rumen. Rupture of the rumen is frequent. The abdominal organs are generally bloodless, the liver and spleen shrunken and pale, though sometimes the seat of congestion or even hemorrhage. Ecchymoses are common on the peritoneum. The right heart and lungs are gorged with black blood, clotted loosely, and reddening on exposure. The right auricle has been found ruptured. Pleura, pericardium and endocardium are ecchymotic. The capillary system of the skin, and of the brain and its membranes, is engorged, with, in some instances, serous extravasations.

_Prevention._ This would demand the avoidance or correction of all those conditions which contribute to tympany. In fevers and extensive inflammations, when rumination is suspended, the diet should be restricted in quantity and of materials that are easily digested (well boiled gruels, bran mashes, pulped roots, etc.,) and all bulky, fibrous and fermentescible articles must be proscribed. In weak conditions in which tympany supervenes on every meal, a careful diet may be supplemented by a course of tonics, carminatives and antiseptics such as fœungrec oxide of iron, hyposulphite of soda and common salt, equal parts, nux vomica 2 drs. to every 1 ℔. of the mixture. Dose 1 oz. daily in the food, or ½ oz. may be given with each meal.

Musty grain and fodder should be carefully avoided, also mowburnt hay, an excess of green food to which the stock is unaccustomed, clover after a moderate shower, or covered with dew or hoarfrost, frosted beet, turnip, or potato tops, frosted potatoes, turnips or apples, also ryegrass, millet, corn, vetches, peas with the seeds fairly matured but not yet fully hardened. When these conditions cannot be altogether avoided, the objectionable ration should be allowed only in small amount at one time and in the case of pasturage the stock should have a fair allowance of grain or other dry feed just before they are turned out. Another precaution is to keep the stock constantly in motion so that they can only take in slowly and in small quantity the wet or otherwise dangerous aliment.

When it becomes necessary to make an extreme transition from one ration to another, and especially from dry to green food, measures should be taken to make the change slowly, by giving the new food in small quantities at intervals, while the major portion of the diet remains as before, until the fæces indicate that the superadded aliment has passed through the alimentary canal. Another method is to mix the dry and green aliments with a daily increasing allowance of the latter. Some have avoided the morning dew and danger of fermentation by cutting the ration for each succeeding day the previous afternoon and keeping it in the interval under cover.

_Treatment._ Various simple mechanical resorts are often effective in dispelling the tympany. Walking the animal around will sometimes lead to relaxation of the tension of the walls of the demicanal and even to some restoration of the movements of the rumen with more or less free eructation of gas. The dashing of a bucket of cold water on the left side of the abdomen sometimes produces a similar result. Active rubbing or even kneading of the left flank will sometimes lead to free belching of gas. The same may be at times secured by winding a rope several times spirally round the belly and then twisting it tighter by the aid of a stick in one of its median turns.

A very simple and efficient resort is to place in the mouth a block of wood 2½ to 3 inches in diameter and secured by a rope carried from each end and tied behind the horns or ears. This expedient which is so effective in preventing or relieving dangerous tympany in choking appears to act by inducing movements of mastication, and sympathetic motions of the œsophagus, demicanal and rumen. It not only determines free discharge of gas by the mouth, but it absolutely prevents any accession of saliva or air to the stomach by rendering deglutition difficult or impossible. A similar effect can be obtained from forcible dragging on the tongue but it is difficult to keep this up so as to have the requisite lasting effect. Still another resort is to rouse eructation by the motions of a rope introduced into the fauces.

The passing of a hollow probang into the rumen is very effective as it not only secures a channel for the immediate escape of the gas, but it also stimulates the demicanal and rumen to a continuous eructation and consequent relief. Friedberger and Fröhner advise driving the animals into a bath of cold water.

Of medicinal agents applicable to gastric tympany the best are stimulants, antiseptics and chemical antidotes. Among stimulants the alkaline preparations of ammonia hold a very high place. These, however, act not as stimulants alone, but also as antacids and indirectly as antidotes since the alkaline reaction checks the acid fermentation which determines the evolution of the gas. They also unite with and condense the carbon dioxide. Three ounces of the aromatic spirits of ammonia, one ounce of the crystalline sesquicarbonate, or half an ounce of the strong aqua ammonia may be given to an ox, in not less than a quart of cold water. Next to this is the oil of turpentine 2 oz., to be given in oil, milk, or yolk of egg. But this too is an antiferment. The same remark applies to oil of peppermint (½ oz.), the carminative seeds and their oils, and the stronger alcoholic drinks (1 quart). Sulphuric or nitrous ether (2 oz.) may be given in place. Pepper and ginger are more purely stimulant and less antiseptic. Other alkalies—carbonate of potash or soda, or lime water may be given freely.