Definition. Causes, excess of rich unwonted food, gastric torpor,
paresis, starvation, debility, partially ripened, poisonous seeds,
paralyzing fungi or bacteria, lead, cyanides, congestion of rumen,
chlorophyll, acrids, dry, fibrous innutritious food, lack of water,
enforced rest on dry food, over-exertion, salivary fistula or
calculus, diseased teeth or jaws, senility. Symptoms, suspended
rumination, inappetence, anxious expression, arched back, bulging
pendent left flank, impressible, no friction sounds, excessive
crepitation, hurried breathing, colics, grunting when moved, diarrhœa,
stupor, cyanosis. Signs of improvement. Phrenic rupture. Diagnosis
from tympany, pneumonia, or gastro-intestinal catarrh. Treatment,
hygienic, antiseptic, stimulants, puncturing, purgation, rumenotomy.
_Definition._ The overdistension of the rumen with solid food is
characterized by two things, the excess of ingesta which produces the
torpor or paresis which is common to all over-filled hollow viscera, and
the comparative absence of fermentation and evolution of gas. If the
ingesta is of a more fermentescible nature the rapid evolution of gas
occurs before this degree of repletion with solid matters can be
reached, and the case becomes one of tympany, but if the contents are
comparatively lacking in fermentability they may be devoured in such
quantity as to cause solid impaction.
_Causes._ Overloading of the rumen is especially common as the result of
a sudden access to rich or tempting food to which the animal has been
unaccustomed. Accidental admittance to the cornbin, breaking into a
field of rich grass, clover, alfalfa, corn, sorghum, vetches, tares,
beans, peas, or grain, or into a barrel of potatoes or apples will
illustrate the common run of causes. A pre-existing or accompanying
torpor or paresis of the stomach is a most efficient concurrent cause,
hence the affection is especially common in animals debilitated by
disease or starvation, but which have become convalescent or have been
suddenly exposed to the temptation of rich food. For the same reason it
is most likely to occur with food which contains a paralyzing element,
as in the case of the following when they have gone to seed but are not
yet fully ripened: Rye grass, intoxicating rye grass, millet, Hungarian
grass, vetches, tares and other leguminosæ, and to a less extent, wheat,
barley, oats and Indian corn. The same may come from the paralyzing
products of fungi or bacteria in musty fodder or of such chemical
poisons as lead, and the cyanides.
A catarrhal affection of the rumen, and the congestion produced by
irritant plants, green food with an excess of chlorophyll, and the whole
list of irritants and narcotico-acrids, will weaken the first stomach
and predispose to overdistension.
Anything which lessens the normal vermicular movements of the rumen and
hinders regurgitation and rumination tends to impaction, and hence an
aliment which is to a large extent fibrous, innutritious, and
unfermentable, such as hay from grass that has run to seed and been
threshed, the stems of grasses that have matured and withered in the
pastures, fodder that has been thoroughly washed out by heavy rains,
sedges, reedgrass, rushes, chaff, finely cut straw, and in the case of
European sheep, the fibrous tops of heather contribute to this
affection. Lack of water is one of the most potent factors, as an
abundance of water to float the ingesta is an essential condition of
rumination. Hence pasturage on dry hillsides, prairies or plains, apart
from streams, wells or ponds is especially dangerous unless water is
supplied artificially, and the winter season in our Northern states,
when the sources of drinking water are frozen over, and when the chill
of the liquid forbids its free consumption, is often hurtful.
Gerard attributes the affection to constant stabulation. This, however,
has a beneficial as well as a deleterious side. It undermines the health
and vigor, and through lack of tone favors gastric torpor and impaction,
but it also secures ample leisure for rumination, which is so essential
to the integrity of the rumen and favors the onward passage of its
contents. With dry feeding and a restricted water supply it cannot be
too much condemned, but with succulent food and abundance of water the
alleged danger is reduced to the minimum.
Active work and over exertion of all kinds must be admitted as a factor.
At slow work the ox can still ruminate, but in rapid work or under heavy
draft this is impossible, and the contained liquids may pass over from
rumen to manifolds conducing to impaction of the former, or
fermentations may take place, swelling up the mass of ingesta and
distending the walls of the first stomach. Similarly, cattle and sheep
that are hurried off on a rapid march with full stomachs are greatly
exposed to both tympany and impaction.
In speaking of dry, fibrous food and lack of water as factors, we must
avoid the error of supposing that succulent or aqueous food is a sure
preventive. In a catarrhal condition of the rumen or in a state of
debility, impaction may readily occur from the excessive ingestion of
luscious grass, wheat bran, potatoes, apples, turnips, beets, or
cabbage.
Finally defects in the anterior part of the alimentary tract may tend to
impaction. Salivary fistula or calculus cutting off the normal supply of
liquid necessary for rumination, tends to retention and engorgement.
Diseased teeth and jaws interfering with both the primary and secondary
mastication has the same vicious tendency. Old cows, oxen and sheep in
which the molar teeth are largely worn out, suffer in the same way,
especially when put up to fatten or otherwise heavily fed. In this case
there is the gastric debility of old age as an additional inimical
feature.
_Symptoms._ These vary with the quantity and kind of ingesta also to
some extent with the previous condition of the rumen, sound or diseased.
They usually set in more slowly than in tympany. On the whole the
disease appears to be more common in the stable than at pasture. The
animal neither feeds nor ruminates, stands back from the manger, becomes
dull, with anxious expression of the face, arching of the back and
occasional moaning especially if made to move. The abdomen is distended
but especially on the left side, which however hangs more downward and
outward and tends less to rise above the level of the hip bone than in
tympany. If it does rise above the ilium this is due to gas and it is
then elastic, resilient and resonant on percussion at that point. The
great mass, and usually the whole of the paunch is nonresonant when
percussed, retains the imprint of the fingers when pressed, and gives
the sensation of a mass of dough. The hand applied on the region of the
paunch fails to detect the indication of movements which characterize
the healthy organ. The ear applied misses the normal friction sound, but
detects a crepitant sound due to the evolution of bubbles of gas from
the fermenting mass. This is especially loud if the impaction is one of
green food or potatoes, even though the gas remains as bubbles
throughout the entire fermenting mass, instead of separating to form a
gaseous area beneath the lumbar transverse processes.
The respiration is hurried, labored and accompanied with a moan, the
visible mucosæ are congested, the eyes are protruded and glassy from
dilatation of the pupils, the feet are propped outward, and the head
extended on the neck. There may be signs of dull colicy pains, movements
of the tail and shifting of the hind feet, in some cases the patient may
even lie down but never remains long recumbent. There may be occasional
passages of semi-liquid manure, though usually the bowels are torpid and
neither passages nor rumbling sounds on the right side can be detected.
When moved the animal usually grunts or moans at each step, and
especially when going down hill, owing to the concussion of the stomach
on the diaphragm. In cases due to green food the irritation may extend
to the fourth stomach and intestines and a crapulous diarrhœa may ensue.
The temperature remains normal as a rule. The disease is more protracted
than tympany, yet after several hours of suffering and continual
aggravation the dullness may merge into stupor, the mucosæ become
cyanotic and death ensues from shock, asphyxia, or apoplexy.
_Course. Termination._ Many cases recover in connection with a
restoration of the contractions of the rumen, the eructation of gas, in
some rare cases vomiting or spasmodic rejection of quantities of the
ingesta, and the passage of gas by the bowels. This may be associated
with a watery diarrhœa, and loud rumbling of the right side, which may
continue for twenty-four hours or longer. With the subsidence of the
diarrhœa there comes a return of health, or there may remain slight
fever, inappetence, suspended or impaired rumination, dullness,
listlessness, and a mucous film on the fæces. This indicates some
remaining gastro-enteritis.
In some instances there is rupture of the diaphragm with marked increase
in the abdominal pain and the difficulty of breathing. In others there
is a laceration of the inner and middle coats of the rumen so that the
gas diffuses under the peritoneum and may even be betrayed by an
emphysematous extravasation under the skin.
_Diagnosis._ From tympany this is easily distinguished by the general
dullness on percussion, the persistence of the indentation caused by
pressure, the outward and downward rather than the upward extension of
the swelling, and the slower development of the affection.
It is far more likely to be confounded with pneumonia, which it
resembles in the hurried, labored breathing, the moans emitted in
expiration, in the dullness on percussion over the posterior part of the
chest, it may be even forward to the shoulders, and in the cyanotic
state of the mucosæ. The distinction is easily made by the absence of
hyperthermia, and of crepitation along the margins of the nonresonant
areas in the lungs, by the fact that the area of chest dullness covers
the whole posterior part of the thorax to a given oblique line, and by
the history of the case and the manifest symptoms of overloaded stomach,
not with gas but with solids. From gastro-intestinal catarrh it may be
distinguished by the more rapid advance of the symptoms and by the
absence of the slight fever which characterizes the latter.
_Treatment._ Slight cases may be treated by hygienic measures only.
Walking the animal uphill, injections of cold water, friction on the
left side of the abdomen to rouse the rumen to activity, antiseptics as
in tympany to check further fermentation, and stimulants to overcome the
nervous and muscular torpor, may be employed separately or conjointly.
When it can be availed of, a rubber hose may be wound round the abdomen
and a current of cold water forced through it.
When further measures are demanded we should evacuate any gas through
the probang or a cannula, as in tympany, and thus relieve tension and
then resort to stimulants and purgatives. Common salt 1 ℔. is of value
in checking fermentation, and may be added to 1 ℔. Glauber salts in four
or five quarts of warm water. A drachm of strong aqua ammonia or 2 oz.
oil of turpentine and ½ drachm of nux vomica may be added. Bouley
advocated tartar emetic (2 to 3 drachms), and Lafosse ipecacuan (1 oz.
of the wine) to rouse the walls of the rumen, and more recently
pilocarpin (ox 3 grs.), eserine (ox 2 grs.) and barium chloride (ox 15
grs.), have offered themselves for this purpose. The three last have the
advantage of adaptability to hypodermic use, and prompt action. The
repetition of stimulants and nux vomica may be continued while there
appears any prospect of restoring the normal functions of the paunch,
and when all other measures fail the only hope lies in rumenotomy.
=Rumenotomy.= The warrant for this operation is found in the entire lack
of movement in the rumen, the absence of eructation, the cessation of
rumbling and motion of the bowels, and the deepening of the stupor in
which the patient is plunged. The longer the delay and the deeper the
stupor and prostration the less the likelihood of a successful issue
from the operation. The animal is made to stand with its right side
against a wall, and its nose held by the fingers or bulldog forceps. If
judged necessary a rope may be passed from a ring in the wall in front
of the shoulder around the animal to another ring behind the thigh and
held tight. Or a strong bar with a fulcrum in front, may be pressed
against the left side of the body, and well down so as to keep the right
side fast against the wall. A line may be clipped from the point of
election for puncture in tympany down for a distance of six inches. A
sharp pointed knife is now plunged through the walls of the abdomen and
rumen in the upper part of this line, and is slowly withdrawn, cutting
downward and outward until the opening is large enough to admit the
hand. The lips of the wound in the overdistended stomach will now bulge
out through to the wound in the abdominal walls, and three stitches on
each side may be taken through these structures to prevent displacement
as the stomach is emptied and rendered more flaccid. A cloth wrung out
of a mercuric chloride solution may be laid in the lower part of the
wound to guard against any escape of liquid into the peritoneal cavity.
The contents may now be removed with the hand, until the organ has been
left but moderately full. Two or three stable bucketfuls are usually
taken, but it is by no means necessary nor desirable that the rumen be
left empty, as a moderate amount of food is requisite to ensure its
functional activity. As a rule at least fifty pounds should be left.
Before closing the wound and especially in cases due to dry feeding, it
is well in a tolerably large animal to introduce the hand through the
demicanal to ascertain if impactions exist in the third stomach and to
break up these so far as they can be reached. This done, the edges of
the wound in the stomach are to be carefully cleansed, washed with the
mercuric chloride solution and sewed together with carbolated catgut,
care being taken to turn the mucosa inward and to retain the muscular
and peritoneal layers in close contact with each other. It will usually
be convenient to cut first the two lower stitches through the abdominal
walls, and suture from below upward. When finished the peritoneal
surface of the gastric wound may be again sponged with the mercuric
chloride solution, together with the edges of the wound in the abdominal
walls. Finally the abdominal wound is sutured, the stitches including
the skin only or the muscular tissues as well. The smooth surface of the
paunch acts as an internal pad and support, and with due care as to
cleanliness, antisepsis and accuracy of stitching, it is rare to find
any drawback to continuous and perfect healing. It is well to restrict
the animal for three days to well boiled gruels, and for ten days to
soft mashes in very moderate amount lest the wound in the paunch should
be fatally burst open before a solid union has been effected.