In pathological conditions percussion from above downwards may produce a

tympanitic sound, due to gaseous indigestion or a clear sound throughout

the greater portion of the vertical diameter suggestive of acute

gastro-enteritis with the formation of gas in the rumen, or of adhesive

peritonitis preventing the rumen from collapsing. Indigestion due to

excess of solid food, on the contrary, is characterised by a dull sound

throughout the entire region from above downwards. Percussion along a

horizontal line permits of the delimitation of certain zones which vary

a great deal in area, according to the case.

Auscultation is more instructive than percussion. Like percussion, it

may be practised throughout the entire depth of the abdomen, from the

transverse processes of the lumbar vertebræ as far as the white line,

and in a horizontal direction from the eleventh rib to the region of the

flank.

Auscultation of the upper zone enables one to detect sounds of

deglutition, gurgling sounds (glou-glou), and a sound resembling falling

water, due to the movement of solids or liquids in the rumen and

reticulum. The sounds heard vary in different cases, and depend on the

state of repletion or of emptiness of the rumen.

Auscultation of the middle zone reveals:

Firstly, a very special crepitation sound, which may be compared to the

deflagration of a handful of salt thrown on burning coal. It is believed

to result from the bursting of bubbles in the contents of the rumen

under the action of normal digestion.

Secondly, a churning sound produced by the rhythmic peristaltic

contractions of the rumen, by which the substances ingested are very

intimately mixed. By applying the ear over the flank region or by

palpation the rhythmic contractions of the rumen, two per minute in most

cases, can readily be perceived.

In practice examination of the rumen is confined to these four methods.

=Puncture.= From an exclusively scientific point of view, exploration of

the rumen also comprises analysis of the gas collected through puncture

and analysis of the liquids removed by aspiration (first stages of

gastric digestion). Normally, these gases, in the order of their

abundance in the mixture, consist of the following: Carbonic acid,

carburetted hydrogen and nitrogen.

In disease, and in most cases of abnormal fermentation, the carburetted

hydrogen is greatly in excess of the carbonic acid. In chronic

gastro-enteritis, ammonium sulphide and other offensive gases are found

in addition.

=Chemical analysis.= In the rumen the ingested food is macerated in an

alkaline liquid at a temperature of 100° to 101° Fahr. (the alkalinity

is due to the saliva). This process markedly modifies the composition of

the ingested matter. Nevertheless, the upper portion in contact with the

gas sometimes presents a slightly acid reaction, probably due to

carbonic acid. The sugary and fatty materials contained in the food

respectively undergo lactic and butyric fermentation. Only a small

quantity of the starch, however, is transferred into sugar. In the calf,

and in very young animals, the reaction of the rumen is acid throughout

the entire period of sucking. In disease, when rumination has long been

suspended and chronic loss of appetite or gastro-enteritis exists, the

reaction is generally acid. The sugars, gums, and soluble salts of

forage, roots, etc., are dissolved in the rumen, but fatty materials

undergo no modification.

The reticulum, which is the smallest of the gastric compartments, is

situated in the sub-ensiform and retrodiaphragmatic regions, extending

right and left of the middle line to a nearly equal distance. Above and

to the left it communicates freely with the rumen, to the right with the

omasum.

In practice it can only be examined in two ways: inspection and

palpation.

By inspection changes in the configuration of the ensiform region may

sometimes be detected. Such changes are rare, and must be distinguished

from congenital deformity. They sometimes accompany inflammation of the

reticulum produced by a foreign body, when the lower abdominal wall is

directly perforated by such body.

In cases of inflammation of the reticulum due to foreign bodies, abscess

formation, perforation, etc., it is possible to detect œdematous

infiltration, abnormal sensibility, fluctuation and increased heat,

etc., by manipulating the parts with the fingers or the clenched fist.

If the evidence pointing to the presence of a foreign body in the

reticulum is considered sufficient, gastrotomy may be performed and the

interior of the viscus examined with the hand, but although the

operation is possible it is very rarely practised.

=Omasum.= The omasum occupies, so to speak, a position inverse to that

of the reticulum, lying deep down on the right side, behind the

diaphragm, under the hypochondrium, and above the abomasum and

reticulum.

It is the only gastric compartment which cannot be examined, although

when impacted it may be felt on the right side.

=Abomasum.= The abomasum is lodged in the lower part of the right flank

under the circle of the hypochondrium. It extends obliquely from below,

upwards from the sub-ensiform to the sublumbar region. The smaller

curvature is turned towards the rumen on the left side; the larger

curvature is in contact with the abdominal wall. In spite of what has so

often been stated by those who have never seen it, the abomasum can be

examined and is accessible along the circle of the hypochondrium.

In adults useful information can rarely be obtained by inspection; but

in sucking calves the abomasum, if distended by indigestion,

gastro-enteritis, etc., sometimes appears prominently in the right

abdominal region. Palpation with the fingers or with the fist will

detect exaggerated sensibility, irritation, inflammation, or distension.

Percussion and auscultation furnish no very precise information. The

information obtained by the above-described examination of the stomach

is in practice amplified by a search for certain symptoms which are

usually easy to detect. They comprise:

(_a_) Suppression or irregularity of rumination. This very important

symptom suggests the degree of gravity of the digestive disturbance, and

to some extent the gravity of the general condition. Suppressed

rumination is a common symptom in many diseases, some of which are

purely digestive, though all are not. It is, however, a grave sign in

most cases.

(_b_) Eructation, which is usually frequent, may be regarded as normal

provided the exhaled gas preserves the fresh odour of grass or of the

food swallowed, like brewers’ grains, turnips, etc. Sometimes the gas is

sour, acid, fœtid, or putrid, all of which conditions indicate disease.

(_c_) Yawning is not common. It becomes frequent and attracts attention

in certain abnormal conditions; in others, again, it may be completely

suppressed.

(_d_) Nausea and vomiting are rare. Vomiting is commoner in calves, and

results from inability to digest the milk, or simply to over-distension

of the abomasum. The matter vomited by adults usually consists of partly

masticated food, and is derived from the rumen; while the contents of

the abomasum are occasionally rejected, in which case the material is of

pulpy consistence and has an acid smell.

(_e_) Digestive disturbance is sometimes accompanied by various

modifications in the breathing, such as immobilisation of the

hypochondriac region and of the diaphragm; abnormal sensibility and

reflex coughing on palpation, and, in inflammation of the reticulum due

to foreign bodies, costal respiration.

[Illustration: $1]

It is by methodically observing, grouping, and classifying the symptoms

presented that one is enabled to detect the links connecting them.

=Intestine.= The intestinal mass is contained in the right half of the

abdomen above the compartment of the stomach. The large intestine

occupies the upper zone, corresponding externally with the hollow of the

flank from the thirteenth rib to the haunch. The small intestine

occupies the middle zone from the thirteenth rib to the entrance to the

pelvis and the stifle region; the inferior zone is occupied by the rumen

and abomasum, and in pregnant females by the gravid uterus.

Notwithstanding these indications it is somewhat difficult to examine

the mass of the large intestine, separated as it is from the abdominal

wall by the =U=-shaped inflection of the duodenal loop, of which the

deep retrograde branch is in contact with the terminal portion of the

floating colon.

Inspection of the right flank furnishes no information of value in

diseases of the intestine, nor is auscultation of much service beyond

enabling one to detect the frequency, diminution, or absence of

borborygmus. Palpation alone is really of service. Practised gently and

superficially with the tips of the fingers it detects abnormal

sensibility in acute cases of enteritis; when with more energy,

palpation reveals whether the bowel be full or empty, provided that the

muscular resistance be not too marked.

=Colic.= In colic the clinical signs, their varieties, and the lesions

which give rise to them are of much more importance. When it results

from intestinal congestion _à frigore_ (due, for example, to the

ingestion of cold water), colic is usually violent, sudden, and of

relatively short duration. In other cases it is violent and prolonged

for several hours, a whole day, or even two days, and may be followed by

coma and suppressed peristalsis; it then indicates invagination,

volvulus, or strangulation. Sometimes, on the contrary, it remains dull

and is slow and continued (acute gastro-enteritis, hæmorrhagic

gastro-enteritis, etc.).

Finally, colic of the latter character may, in addition, be accompanied

by icterus, in cases of retention of bile, biliary calculi, hepatitis,

etc.

=Anus.= Examination of the anus is easy. Simple inspection reveals its

presence or absence, and consequently the existence of congenital rectal

atresia, which is somewhat common in calves and colts. Digital

exploration is, however, sometimes useful, for in occasional cases an

anus may exist, which externally appears normal, but terminates in a

sac, the rectum being closed by a membranous partition.

Nothing is easier to recognise than tenesmus; it occurs in cases of

profuse diarrhœa, diarrhœa of calves, and dysentery in newly-born

animals.

[Illustration: $1]

=Rectal exploration.= Exploration of the rectum is a last and most

valuable means of confirming the diagnosis in all visceral diseases of

the pelvis and abdomen. To utilise this method to the full, the rectal

pouch should first be thoroughly emptied by the free use of enemata, the

subsequent examination being made with great care. The animal’s hind

legs being secured, the operator smears his hand and forearm with some

fatty substance, and, forming the fingers into a cone, introduces them

with gentle pressure through the anus, the palm of the hand being turned

downwards. Passing the hand gently along the rectum, the operator will

be able to distinguish the conical posterior pouches of the rumen, the

loop of the duodenum, the mass of convolutions of the small intestines

and of the colon, etc. Next, he will examine the vagina, uterus,

bladder, ureters, kidneys, aorta, and the pelvic and sublumbar lymphatic

glands. He may be able to recognise distension of the rumen with food,

twists of the intestine, herniæ, mesenteric or diaphragmatic

invagination or volvulus of the bowel, etc.

In other cases he may be able to discover lesions of the kidney, of the

uterus, of the broad uterine ligaments, of the ovaries, or of vessels.

In all cases it is desirable to make a methodical and complete

examination, whatever the primary object may have been. Such an

examination may be carried out as follows: The operator having

introduced his hand into the rectum, begins by examining the state of

the pelvic organs, the rectum, base of the vagina, the body and horns of

the uterus, the bladder and the lymphatic glands and ligaments of the

pelvis.

By laying the hand flat in the rectum and pressing gently downwards the

anterior border of the pubis may be felt, somewhat more deeply placed.

The rectum is then thrust slightly to the right, and the ascending

branch of the right ilium, as high as the sacro-iliac articulation, and

the lower surface of the sacrum, are directly examined; lastly, the hand

is directed towards the left, gliding down the left ilium, and returning

to the point of departure. In this way the state of the pelvic floor, of

the arteries, veins, and lymphatic glands, etc., the degree of mobility,

tension, or fulness of the uterus, as well as the condition of the broad

ligaments, are all ascertained.

Still more deeply placed, and at the extreme limit to which the arm can

be introduced, will be found some or all of the above-mentioned

organs—viz., the small intestine, large intestine, kidney, etc.

=Defæcation: Examination of the fæcal material.= The character of the

fæces is very important in certain diseases; _e.g._, diarrhœa assumes a

varying importance, according as the discharges are of an alimentary,

serous, mucous, or sanguinolent type, and are slight, temporary,

intense, profuse, or continued. In other cases defæcation is slow,

becomes difficult, and various degrees of constipation exist. Defæcation

may be completely suppressed, as in invagination or strangulation of the

intestines; on the other hand, one may observe diarrhœa, dysentery

(microbic or sporozoic diarrhœa), and intestinal hæmorrhage. The last

named may be of varying degrees of acuteness, from the passage of simple

drops or streaks of blood, distributed over almost normal excreta, to

the passage of unchanged blood in liquid jets or in clots.

=Macroscopic examination.= Macroscopic examination takes cognisance,

firstly, of the quantity (40 to 80 lbs.), consistence (firmness or

softness), colour (olive green, blackish green, greyish black, sooty, or

tarry) and odour (normal, fœtid, putrid, etc.) of the fæces.

Sometimes the excreta are moulded and covered with glairy mucus, or

contain such abnormal products as undigested food (a sign of chronic

diarrhœa), false membranes, false membranes due to pseudo-membranous

enteritis, fibrinous clots, or parasites like liver flukes, tæniæ and

strongyles.

=Microscopic examination.= Microscopic and bacteriological examination

is sometimes useful; and even when macroscopic examination has revealed

nothing, it is possible to detect the presence of the eggs of parasites

like flukes, strongyles, hooked worms, etc., the presence of sporozoa

(as in intestinal coccidiosis) and of specific microbes, as in the

diarrhœa of calves, etc.

It is only by the synthesis of methodically collected signs that one

finally succeeds in exactly diagnosing the numerous diseases which may

affect the intestine: intestinal congestion, invagination, volvulus,

intestinal strangulation (mesenteric or diaphragmatic herniæ, etc.),

atresia of the anus, acute or hæmorrhagic enteritis, or intestinal

helminthiasis.

=Liver.= The liver is situated in the right sublumbar region. It is

fixed behind the diaphragm and under the hypochondriac region, and

extends from the ninth to the thirteenth rib. It can be examined by

palpation through the last intercostal spaces and behind the thirteenth

rib. In health it is difficult to pass the fingers sufficiently under

the hypochondriac circle to reach the liver; but in case of morbid

hypertrophy it extends more or less beyond the last rib, and palpation

between the last ribs sometimes reveals abnormal sensibility.

Percussion better than palpation enables one to delimit the space

occupied by the liver, particularly towards the back, where there is no

interposed layer of lung. Percussion is especially useful in detecting

hypertrophy due to cancer, tuberculosis, echinococcosis of the liver,

etc., or hepatic atrophy. In isolated cases icterus may exist,

confirming the conclusions otherwise arrived at.

=Pancreas.= The pancreas is situated rather deeply in the right

sublumbar region, below the kidney, behind the liver, above the floating

colon, and within the duodenal loop. It is therefore very difficult to

examine; moreover, the diseases which affect it are still little

understood.

The point most prominently brought forward by this demonstration of the

topographical anatomy and semiology of the digestive apparatus is the

difficulty of accurately diagnosing digestive diseases in the ox when

one confines oneself to a superficial examination. To have any chance of

arriving at an exact diagnosis, methodical and thorough examination is

indispensable. Given this condition, accurate diagnosis becomes

possible, despite all difficulties.

CHAPTER I.

DISEASES OF THE MOUTH.

STOMATITIS.

=Definition.= By stomatitis we mean inflammation of the buccal mucous

membrane. Stomatitis may be simple—_i.e._, due to accidental causes, to

varying local forms of irritation, or to wounds; or, on the contrary, it

may be specific, of infectious origin, like the stomatitis of

foot-and-mouth disease, gangrenous coryza, cattle plague, etc.; or,

finally, it may be of toxic origin, like the stomatitis of mercurial

poisoning.

Here we shall only study the simple forms of stomatitis, the gangrenous

stomatitis of calves, and mercurial stomatitis. The others will be

noticed in speaking of the diseases of which they form one of the

symptoms.

SIMPLE STOMATITIS.

=Causation.= Simple stomatitis of bovine animals is often due to feeding

with rough forage, or forage containing prickly or spiny plants, like

thistles, sea holly, eryngo, etc. Sometimes it follows prolonged

irritation by rough teeth, premolars or stumps, or accompanies the

shedding of the temporary molars. Ingestion of irritant plants like

nettles, certain specimens of the orders _Labiatæ_ and _Umbelliferæ_,

leaves covered with vesicant insects, cabbage and turnip leaves infested

with aphides, oil beetles, etc., or the swallowing of hot liquids, may

also, though more rarely, produce it. Finally, in grave diseases of the

digestive apparatus, the buccal mucous membrane may secondarily become

affected.

=Symptoms.= The primary symptoms are usually represented by ptyalism and

a certain difficulty in grasping food. In other cases the mucous

membrane appears slightly dry for some time before salivation sets in.

On introducing the fingers into the animal’s mouth some elevation of

temperature may be noted, and on direct inspection the non-pigmented

regions are seen to be abnormally vascular, a fact which has earned for

this form of stomatitis the names of “erythematous” and “erysipelatous

stomatitis.”

If the stomatitis is due to local multiple irritation, such as results

from spines and prickles in the food, the abnormal vascular appearance

is confined to the neighbourhood of the abrasions or punctures, and the

affected regions are of very varying size. In some cases, principally as

a consequence of trifling local irritation and of burns of the first and

second degree, blisters of varying size may develop and break, leaving

behind ulcerations, which, however, always heal rapidly. The aphthous

non-contagious stomatitis mentioned by certain authors seems most

probably to pertain to this class.

=Diagnosis.= The diagnosis is usually easy, and a little attention to

the accompanying symptoms is sufficient to avoid confusion with the

various forms of symptomatic stomatitis.

=The prognosis= is favourable.

=Treatment= is based on removal of the determining cause, if this can be

recognised, withdrawal of rough forage, removal of sharp points on the

teeth, extraction of stumps, etc. As a rule, recovery follows rapidly.

It can be hastened by washing out the mouth directly, or by means of a

syringe, with water containing honey, vinegar, decoctions of brier

twigs, oak bark, barley or rice. This treatment is completed by

supplying nourishing gruel and food demanding little mastication.

CATARRHAL STOMATITIS IN SHEEP.

“The more delicate buccal mucosa in these animals would render them more

subject to inflammations, but this is more than counterbalanced by the

mode of prehension of aliments, not by the tongue, but by the

delicately-sensitive lips, and further by the daintiness and care with

which these animals select their food. The =treatment= would not differ

materially from that prescribed for the ox.” (Law’s “Veterinary

Medicine,” Vol. II. p. 15.)

[The treatment referred to consists of simple astringent and antiseptic

washes, borax given in the drinking water, or mixed with honey or

treacle and smeared occasionally on the tongue. Washes of sodii

hyposulphis or sulphis, or even weak solution of carbolic acid, may be

used after the irritant cause has been removed. Vinegar or diluted

mineral acids may be used alternately with decoctions of blackberry bark

or other vegetable astringents. When there are symptoms of gastric

disorder a laxative, followed by vegetable bitters and other tonics, may

be prescribed. Foreign bodies—thorns, wire, etc.—fixed in the tongue,

cheek, or palate should be searched for and removed at the first

examination of the patient.]

NECROSING STOMATITIS IN CALVES.

=Definition.= This name is applied to a special stomatitis, which in

very young animals produces superficial necrosis of more or less

extensive areas of the buccal mucous membrane, and sometimes of

subjacent parts.

The disease, although somewhat rare in France, has been mentioned by

Lafosse and well studied by Damman and Lenglen.

=Causation.= Its cause is still imperfectly understood. Some regard it

as a consequence of insufficient nourishment, of disturbance resulting

from dentition, of general exhaustion, and of bad hygienic conditions.

These explanations are scarcely sufficient, however, and at the present

time there is a tendency to regard it as a complication of primary

grave, debilitating diseases, like the diarrhœa of calves, omphalitis,

omphalo-phlebitis, etc. Moussu has never seen it apart from omphalitis,

and he considers the lesions due to the action of the bacillus of

necrosis. Infection occurs through the umbilicus becoming soiled by

contact with the litter.

The early symptoms consist in loss of appetite, congestion of the mucous

membranes, and salivation. Early examination of the buccal cavity

reveals the presence everywhere, except on the palate, of whitish-grey

or yellowish patches, whose aspect is markedly in contrast with that of

neighbouring parts. These are fragments of the mucous membrane

undergoing necrosis. They are numerous, are surrounded by a narrow

inflamed zone, and may be from ½ inch to 1 inch in diameter.

Necrosis advances rapidly, and extends throughout the thickness of the

mucous membrane; the slough soon becomes delimited and separates. The

odour of the mouth is then absolutely fœtid, and the saliva appears

streaked with pus and blood.

The ulcerations exhibit a livid base, and show no tendency to heal.

Necrosis extends in depth, and affects the muscles, tendons, and even

the periosteum and the bones. The teeth are frequently loosened.

Grave complications, such as pharyngitis, broncho-pneumonia, infectious

enteritis, and septicæmia soon appear, and the animals are carried off

by septic infection and intoxication in a few days—at the longest in a

week.

=Diagnosis.= The diagnosis is only difficult at first; and, at a later

stage, the only mistake possible is that of confounding the condition

with a very grave attack of aphthous stomatitis. Local sanitary

conditions are sufficient to secure the avoidance of this error.

=Prognosis.= The prognosis is extremely grave; the disease usually

results in death; recovery is exceptional. Very luckily the disease

seems to become rare in direct proportion as the hygienic conditions of

cattle breeding and keeping are improved.

=Treatment.= Curative treatment always appears to be ineffectual when a

grave primary disease has already enfeebled the animal before necrosing

stomatitis appears. In those cases where the stomatitis constitutes the

primary condition, attempts should be made as far as possible to cleanse

the wounds. The buccal cavity should be thoroughly washed out, and the

wounds then cauterised with solution of carbolic acid of 6 per cent.

strength, nitric acid of 10 per cent. strength, hydrochloric acid of 7

to 8 per cent. strength, or chromic acid of 20 per cent. strength.

This local cauterisation is performed with a tampon of cotton wool fixed

to a handle; for necessarily it is impossible to apply any dressing

whatever of a permanent nature. The cauterisations may be repeated twice

a day. The stump of the umbilical cord should never be forgotten, for it

sometimes contains a mass of necrotic tissue the size of a man’s thumb.

It should be thoroughly cleansed and the wound plugged with a mixture of

iodoform and boric acid.

This treatment will not avail unless the functions are stimulated by

rich food that can be easily masticated and digested, and by giving milk

of good quality, or boiled milk, eggs, meat-powder, cooked beans, etc.

Aromatic infusions and hay tea containing coffee and small quantities of

alcohol or tincture of quinine are also of service.

MYCOTIC STOMATITIS IN CALVES.

_Thrush. Muguet._

“This is a form of stomatitis manifested by a raised white patch on the

mucous membrane and determined by the presence of the _Oidium albicans_

(_Saccharomyces albicans_), a cryptogam discovered by Berg in 1842 in

thrush in children. It is closely allied to the _mucor_, and attacks

only the young and feeble. The white crust consists of epithelial cells

intermingled with an abundance of the white mycelium and oval spores of

the fungus. Andry in his artificial cultures found that it was pearly

white when grown on gelatine, dirty white on potato, and snow white on

carrot.”

=Symptoms.= “Buccal mucosa, red, congested and tender, shows here and

there white curdy looking elevations, or red erosions caused by the

detachment of such masses. These bear a strong resemblance to the crusts

seen on this mucosa in rinderpest, but are easily distinguished by the

absence of the attendant fever, and by the discovery, under the

microscope, of the specific microphyte. The eruption may extend to the

pharynx and œsophagus and interfere fatally with deglutition, but

usually it merely renders sucking painful and is not serious.”

=Treatment.= Cleanse and disinfect the sheds, “and invigorate the young

animals by sunshine, free air and exercise. Locally ... borax, which

arrests the growth of the parasite, whether in artificial cultures or in

the mouth. The powder may be rubbed into the sores, or it may be mixed

with ... molasses and used as an electuary. As substitutes boric acid,

salol, thymol, potash chlorate, or Condy’s fluid may be used.” (Law’s

“Veterinary Medicine,” Vol. II. p. 36.)

ULCERATIVE STOMATITIS IN SHEEP.

The name of ulcerative stomatitis of sheep has been given to a disease

which is characterised by the appearance of a pultaceous deposit on the

surface of the buccal mucous membrane and later by the development of

ulcerations and of vegetative growths.

=Causation.= The cause is imperfectly understood. In certain years the

disease appears to attack lambs at the time of weaning, but it may also

affect flocks of animals as old as fifteen or eighteen months, two

years, or even more. It is contagious, and may extend to one-half or

two-thirds of the entire number in the flock. Full-grown and old animals

appear to be immune.

It was formerly thought, _à priori_, and in consequence of the character

of the buccal deposit, that the disease was identical with thrush, and

that the lesions were produced by _Oidium albicans_. Neumann in 1885

declared, however, that he could not find the fungus in question in

scrapings from the mucous membrane.

Moussu had similar negative results in the experiments he made during

1894, when he examined both young and old animals belonging to flocks in

the departments of Berry and of La Brie.

In addition it has been suggested that the disease affects badly

cared-for and badly fed lambs, and subjects suffering from “watery

cachexia.” This seems correct in many cases, and Moussu has seen

ulcerative stomatitis decimate flocks which had previously been attacked

with intestinal helminthiasis and verminous broncho-pneumonia; but, on

the other hand, in the environs of Melun he saw it in animals which had

previously been quite free of disease and were kept under perfect

hygienic conditions.

The conditions in which animals are reared, the use of common drinking

ponds, and the method of supplying flocks with food, are the chief

causes of the distribution of the disease.

=Symptoms.= The symptoms consist in loss of appetite, or rather in

difficulty in grasping and masticating food, wasting, a certain degree

of dulness, and salivation. Somewhat later one often sees appear on the

free margin of the upper and lower lips an eruption of small

vesico-pustules, which quickly become covered with yellowish-brown

crusts and bleed on the slightest touch. The lips swell, become

sensitive and painful, so that examination of the cavity of the mouth

should be made with care. The mucous membrane is then seen to present a

very varying number of greyish-white or greyish-brown points, each of

which is due to the destruction of the epithelium and to the production

of a pultaceous deposit, which can very readily be removed, leaving

uncovered superficial ulcerations, which bleed if very lightly touched.

These ulcerations are of irregular shape, and are distributed most

freely over the gums, the internal surface of the lips and cheeks. The

palate and tongue are only invaded in the last stages. Still later one

notes, instead of these ulcerations and as a consequence of

abnormalities in the process of repair, reddish-violet turgid

vegetations varying in size from that of a millet seed to that of a

pepper-corn or even of a small mulberry.

The total duration of the disease varies with its degree of intensity.

In favourable cases it may not exceed eight to ten days; in grave cases

it continues for fifteen to twenty days. Recovery is usual when the

subjects are vigorous and well-nourished lambs, or well-kept sheep,

previously free of disease. On the other hand, Moussu has noted a

mortality of 15 to 20 per cent. in thin animals of bad bodily condition

and already depressed by verminous broncho-pneumonia and intestinal

helminthiasis. When the attack is about to prove fatal, complications

such as gastro-enteritis, resulting from septic infection or

intoxication, and accompanied by fœtid diarrhœa, often make their

appearance.

=Diagnosis.= The diagnosis presents no difficulty, the characteristics

of this stomatitis being entirely different from those of the aphthous

form. The claws are never affected, and there is no lameness.

=Prognosis.= In this connection the practitioner will do wisely to avoid

committing himself, and to closely study the conditions under which the

disease has developed. In all cases the appearance of fœtid diarrhœa

must be regarded as of very unfavourable augury.

=Treatment.= The first precaution to take consists in separating all the

healthy animals in the flock, and placing them in a non-contaminated

spot.

The diseased are then treated one by one; each day the buccal cavity is

washed out with boiled water or with a solution of borax or boric acid.

After each washing the ulcerations should be touched with tincture of

iodine or with some other rather active antiseptic solution. Finally it

might be useful, and would be of value, to add to the gruel or water a

small quantity of common salt and of salicylate of soda at the rate of

15 grains to the pint.

GENERAL CATARRHAL STOMATITIS IN SWINE.

=Causes.= “Swine suffer from simple stomatitis when exposed to thermal,

mechanical, or chemical irritants. Such irritants comprise food that is

too hot, or is hard and fibrous, or which contains spikes and awns,

capable of entering and irritating gland ducts or sores, or food which

is fermented or putrid, food or medicine of an irritant character. The

habit of catching and holding swine with a running noose over the upper

jaw, and the forcing of the jaws apart with a piece of wood in search of

the _Cysticercus cellulosa_ are further causes. In several specific

infectious diseases inflammation of the mucous membrane, with eruption

or erosion, is not uncommon. This aphthous fever is marked by vesicular

eruption, muguet by epithelial proliferation and desquamation, hog

cholera and swine plague by circumscribed spots of necrosis and erosion.

Patches of false membrane are not unknown, and local anthrax, tubercle,

and actinomycosis are to be met with. Inflammation may start from

decaying teeth.”

“=Symptoms= resemble those in other animals, refusal of food, or a

disposition to eat sparingly, to select soft or liquid aliments, to

swallow hard materials half chewed, or to drop them, to champ the jaws,

and to seek cold water. Accumulation of froth around the lips is often

seen, and the mouth is red, angry, dry, and hot, and exhales a bad

odour.”

“=Treatment= does not differ materially from that adopted in other

animals: Cooling, astringent, antiseptic lotions, honey and vinegar, and

in case of spongy or eroded mucosa, tincture of myrrh daily or oftener.

Soft feeding, gruels, pulped roots, ... and clean water should be

constantly within reach. In case of ... indigestion a laxative, followed

by vegetable tonics, will be in order.” (Law’s “Veterinary Medicine,”

Vol. II. p. 17.)

ULCERATIVE STOMATITIS IN SWINE.

“This is the scorbutus of Friedberger and Fröhner, the glossanthrax of

Benion.”

=Causes.= “It has been attributed to insufficient or irritant food, to

damp, close pens, and to chronic debilitating diseases, and all these

act as predisposing causes. In gastritis and in infectious fevers like

hog cholera, swine plague, and rouget (hog erysipelas) the spots of

congestion and petechiæ on the buccal mucous membrane may become the

starting points for ulcerative inflammations. These conditions appear,

however, to be supplemented by infection from bacteria present in the

mouth or introduced in food and water, and, as in the case of other

domestic animals, the most successful treatment partakes largely of

disinfectant applications.”

=Symptoms.= “Loss of appetite, grinding of the teeth, champing of the

jaws, the formation of froth round the lips, fœtor of the breath,

redness of the gums and tongue, and the formation of vesicles, or white

patches, which fall off, leaving red, angry sores. These may extend,

forming deep unhealthy ulcers, with increasing salivation and fœtor. As

the disease advances the initial dulness and prostration become more

profound, and debility and emaciation advance rapidly. Unless there is

early improvement an infective pharyngitis or enteritis sets in,

manifestly determined by the swallowing of virulent matters from the

mouth, and swelling, redness, and tenderness of the throat, or colics

and offensive black diarrhœa, hasten a fatal issue. Rachitis may be a

prominent complication, as it seems in some instances to be a

predisposing cause.”

=Treatment.= “Isolate the healthy from the diseased, and apply

disinfection to all exposed articles and places. Employ local

antiseptics as in other animals. Sulphuric or hydrochloric acids, in

fifty times their volume of water, or tincture of iron, chlorate of

potash, or chloride of ammonia, or borax have been used successfully.

Bitters and aromatics have also been strongly recommended.” (Law’s

“Veterinary Medicine,” Vol. II. p. 29.)

MERCURIAL STOMATITIS.

This form of stomatitis possesses certain distinguishing characters, and

develops after severe or trifling mercurial poisoning.

=Causation.= Sheep sometimes suffer from mercurial poisoning as a result

of the use of baths containing corrosive sublimate or mercurial ointment

for acariasis or other cutaneous parasitism. Animals of the bovine

species seem predisposed to the disease as a consequence of their

special sensitiveness to the action of mercury, which is not shared by

other species.

Mercurial poisoning may occur accidentally, but is usually the result of

some attempt at treatment. Any preparation containing mercury or

mercurial salts may produce it. In domesticated animals it most

frequently results from the action of the ordinary mercurial blister or

mercurial ointment of the pharmacopœia, or again of calomel. Sometimes

it follows the use of mercurial salts in uterine douches, or in lotions

used to wash out large abscess cavities or wounds.

The application of blisters or of anti-parasitic dressings, or

infriction with grey ointment over extensive surfaces, favours this

intoxication. It may result from direct local intra-cutaneous

absorption, from vapour given off by mercurial applications obtaining

entrance into the body through the broncho-pulmonary and digestive

tracts, from vapour given off by metallic mercury (as in ships’ holds),

or from ingestion of mercurial compounds licked off the skin, as

certainly occurs. Hitherto in all discussions, even the most recent, on

the mechanism of poisoning, partisans of different views do not appear

to have given sufficient attention to these now clearly proved facts.

The conclusion to be drawn is that in animals of the bovine species

mercurial preparations ought to be used with caution, and that even

under such conditions stomatitis may appear. Finally, it should be

remembered that all lesions of the kidney indicated by albuminuria and

other signs, and all lesions of the liver, favour poisoning by checking

or preventing the elimination of mercury by the kidney, or by

interfering with its transformation in the hepatic cells.

=Nature.= Regarding the essential nature of stomatitis, it would appear

(according to the work carried out in 1890 by Gallipe on mercurial

stomatitis in man), that we should regard it as a septic stomatitis, and

not as a primary toxic stomatitis. The mercury absorbed by the body not

only produces salivation, but a very important change in the chemical

composition of the saliva. The vitality and toxicity of the saprophytic

microbes normally present in the buccal cavity appear greatly to

increase, and although only the most trifling erosions may exist in the

mucous membrane, true intra-mucous inoculation takes place, and forms

the point of origin for septic stomatitis.

It has been found that it is not even necessary to have lesions in the

buccal mucous membrane; in fact, this is the weak point in the theory

emitted. Nor is a modification in the chemical composition of the saliva

sufficient; for when a mixture of iodine and the iodides, for example,

is being given, the saliva is chemically modified, and yet stomatitis,

properly so-called, does not occur.

What seems most probable is that mercurial stomatitis is a

toxi-infectious stomatitis, in the development of which mercury acts

primarily by its toxic effect on the salivary glands, whose secretion it

modifies, and on the buccal epithelium, the renewal of which it checks.

Infection of the mucous membrane is thereby favoured, even in the

absence of any previous lesion, and stomatitis develops.

=Symptoms.= The symptoms consist in abundant salivation with discharge

from the mouth, suggesting the existence of foot-and-mouth disease. In

grave cases the saliva appears streaked with blood, even from the

beginning. The buccal cavity exhales an intense fœtid odour which,

during the following days, becomes more marked; the mucous membrane is

pale in colour, and coated with a greyish exudate. The mouth is hot and

sensitive, the gums are swollen, reddish-violet in colour, and painful.

Alveolar periostitis soon sets in, the teeth become loose, and

mastication is rendered impossible, especially as the inflammation

causes the tongue to swell and lose its mobility. These symptoms are

unaccompanied by fever.

In the last stage ulcerations and local necroses appear on the gums, on

the inner surface of the lips and cheeks, and around the commissures of

the lips. The patients are almost unable to feed, rapidly lose flesh,

become anæmic, and die from septic infection. The temperature is often

below normal.

A toxi-infectious gastro-enteritis, with fœtid, blood-stained diarrhœa,

is grafted on the primary stomatitis. Complications in connection with

the respiratory, circulatory, and urinary apparatus appear, and the

patients die in a condition of absolute exhaustion.

Naturally this termination is not inevitable; trifling cases of

poisoning, and even grave forms, when properly treated, may, and should,

recover.

=Diagnosis.= The diagnosis is mainly based on the history, except in

cases of accidental and unsuspected poisoning.

=Prognosis.= The prognosis is grave, for even when the disease does not

prove fatal the animals remain anæmic and exhausted for long periods.

=Treatment= should principally be directed towards combatting the local

complications. When poisoning is due to external applications of mercury

or its salts the skin should be washed with soap and water, and

afterwards dressed with a soluble sulphide, which renders the mercury

insoluble. The mouth should frequently be rinsed with boiled water, with

decoctions of barley or marsh-mallow, with a 30 per cent. solution of

boric acid or alum, or with a 1 to 2 per cent. solution of salicylic

acid.

Fully grown cattle receive daily doses of 1¼ to 2 drams of chlorate of

potash internally. This drug appears to owe its favourable action to the

fact that it is partly eliminated by the salivary glands. Lastly, with

the idea (which may, perhaps, be illusory) of minimising and checking

the bad effects of the mercury introduced into the body, certain

practitioners have recommended the administration of eggs, flowers of

sulphur (2½ to 5 drams), sulphate of iron (1¼ to 2½ drams), and of

iodide of potassium (1¼ to 2½ drams), drugs which are alleged to form

insoluble compounds with mercury.

GLOSSITIS.

The term “glossitis” is applied to all inflammations of the tongue,

whether superficial or deep seated. These inflammations may result from

trifling causes, in which case they are termed “simple, acute, or

chronic glossites”; or, on the other hand, from well-recognised causes,

like tuberculosis or actinomycosis, in which case they receive the name

of “specific glossites.” Here only ordinary glossites are investigated,

the others being more particularly described in chapters specially

reserved for the description of the primary diseases of which these form

symptoms.

SUPERFICIAL GLOSSITIS.

This condition is characterised by lesions in the mucous membrane or in

the immediately subjacent tissues, deeper seated structures not being

involved.

The causes are similar to those of simple stomatitis, and as in animals

of the bovine species the tongue is the principal and almost the only

organ of prehension, it is particularly exposed to the chance of injury.

As mechanical injury done by rough fodder first makes its effects felt

on the tongue, superficial glossitis is often due to the action of sharp

or prickly plants like furze, wrestharrow, thistles, sea holly, etc. The

glumes, awns, and spikelets on certain plants play a similar part.

Caustic medicinal draughts, hot drinks, and sharp points on the molar

teeth may also produce the disease without the rest of the buccal mucous

membrane being involved.

=Symptoms.= These are extremely simple. There is, first of all, some

difficulty in grasping the food and some diminution of appetite, which,

however, is more apparent than real, the digestive organs acting well.

The second symptom consists in moderate salivation without special

characters.

The local symptoms alone are characteristic. The mucous membrane

covering the tongue appears red, swollen, locally inflamed, and painful.

The inflamed areas are usually located on the free part near the frænum

or opposite the molar teeth.

Thorns, foreign bodies, awns or spikelets of rough grasses can often be

seen implanted in the tongue, and if the disease has existed for a short

time, little ulcerations may not improbably be discovered.

=Diagnosis.= The characteristics of this superficial glossitis are

sufficiently marked to allow of easy diagnosis, and to prevent it being

confused with the lesions of actinomycosis or tuberculosis or with the

extensive desquamation which accompanies foot-and-mouth disease.

=Prognosis.= The prognosis is never grave. Recovery occurs in six to

eight days, provided the primary cause be removed.

=Treatment= consists in avoiding the use of rough food, in removing

foreign bodies implanted in the mucous membrane or in rasping rough and

irregular teeth. For the rest, as in stomatitis, mere attention to

cleanliness suffices. The mouth is washed out with boiled water, boric

acid solution, mixtures of vinegar and water, or with water containing a

small percentage of alcohol.

ACUTE DEEP-SEATED GLOSSITIS.

This disease has also been termed parenchymatous and interstitial

glossitis, because all the deep-seated tissues, including the muscles

and connective tissue layers are involved in the inflammation.

=Causes.= The disease may be due to a neglected attack of superficial

glossitis, to some grave microbic infection, or to excoriation and

ulceration of the mucous membrane. Very often it is of traumatic origin,

and is due to violent traction on the tongue by herdsmen or others when

administering draughts of their own composition. This traction causes

rupture of the muscle and slight interstitial hæmorrhage.

=The symptoms= develop somewhat rapidly. Whilst at first the animal

shows difficulty in grasping food, it is soon totally incapable of doing

so. The tongue loses its mobility, is no longer protruded from the

mouth, and swallowing becomes so painful that salivation sets in. On

direct examination the tongue is found swollen, thickened, immobile,

painful, and occupying the whole of the oral cavity, sometimes

projecting beyond the region of the incisors, and preventing the mouth

being closed. Inflammation may become so intense that the point of the

tongue hangs out of the mouth. It becomes blackish, bleeding, swollen,

and excoriated by contact with foreign bodies or simply with the row of

incisor teeth. The saliva becomes fœtid, blood-stained and purulent, and

contains large quantities of broken down epithelial cells. It is not

uncommon to note more or less extensive necrosis.

=Diagnosis.= The diagnosis of this form of glossitis presents no

difficulty, for if under certain conditions it may resemble, for

example, the glossitis of actinomycosis, it differs essentially from

that disease by its rapidity of development, by its complications, and

also by the absence of the specific ray fungus.

=Prognosis.= The prognosis is grave, not only on account of the possible

complications, but also because the animals are unable to feed and

therefore lose flesh with very great rapidity.

=Treatment.= The first steps in treatment are in the nature of local

disinfection, in order to prevent general infection. The mouth therefore

should be washed out five or six times per day with boiled water,

followed by antiseptic injections until improvement commences. Solutions

of boric acid or borax (3 per cent.), chlorate of potassium (2 to 3 per

cent.), or salicylic acid (3 to 4 per cent.), are useful, but the free

employment of 1, 2, or 3 per cent. solutions of chloral is even

preferable.

With the idea of protecting the organ from external injury, Lafosse

formerly suggested the use of a suspensory bandage for the tongue, fixed

to the base of the horns by small bandages. Guittard recommends

scarification of the free part, and the application of a support

perforated at the bottom to allow the blood, saliva, pus, etc., to

escape. In spite of careful attention the disease may last from two to

three weeks.

CHRONIC GLOSSITIS.

This form of disease has also been termed “sclerosing glossitis” and

“non-actinomycotic wooden tongue,” because it is anatomically

characterised by induration of the tissues, and because apparently it

resembles true “wooden tongue,” with which it was confused until within

the last few years. Imminger in 1888 and Pflug in 1891 described two

forms. The first, termed “superficial sclerosing glossitis,” is said to

be the more frequent, and most commonly affects young animals suffering

from irregularities in dentition. It seems due to a superficial acute

glossitis assuming a chronic form. The submucous connective tissue in

time undergoes hyperplastic changes, so that the tongue at first becomes

swollen and afterwards absolutely rigid. One never finds ulcerations or

actinomyces.

=Diagnosis.= A close examination will always enable the case to be

diagnosed at the first visit, or under any circumstances after a short

time.

=The prognosis= is very grave, because the animal has the greatest

difficulty in grasping and masticating food, or may even be unable to do

so. Patients lose flesh very rapidly, and end by dying of hunger.

=Treatment= is of little service. The administration of iodine, the only

drug which appears indicated, has proved of very questionable value.

Economically, it is better to slaughter the animal.

* * * * *

The second variety is rare, and has been termed “deep-seated sclerosing

glossitis.” It is simply a chronic form of ordinary deep-seated

glossitis. The layers of connective tissue separating the muscles are

represented by very hard, inelastic vertical partitions. As a

consequence, the whole tongue becomes indurated and more or less

completely immobile. In this condition, again, there is neither

ulceration nor actinomyces.

=Diagnosis.= The diagnosis necessitates a careful examination. In the

living animal it is very difficult to establish a distinction between

this and the preceding form, though after death the task becomes much

easier.

=The prognosis= is grave, complete restoration of the parts being

impossible.

=The treatment= differs in no respect from that given in the preceding

instance. It is of little value.

* * * * *

Imminger and Pflug have also described a deep-seated nodular sclerosing

glossitis, characterised anatomically by the existence in the depth of

the tongue of fibrous nodules, varying in size between a small nut and a

fowl’s egg. The tongue is only slightly increased in size.

This disease may perhaps be due to actinomycosis.

CHAPTER II.

DISEASES OF THE SALIVARY GLANDS, TONSILS AND PHARYNX.

PAROTIDITIS (PAROTITIS).

The term “parotiditis” indicates an inflammatory condition of the

parotid gland. Of this disease several forms exist. The disease is

termed simple when due to accidental causes or infections, specific when

resulting from some special disease germ like the ray fungus.

Anatomically, these diseases consist in inflammation of the glandular

parenchyma and connective tissue stroma which surrounds the acini.

ACUTE PAROTIDITIS.

=Causation.= The causes of acute parotiditis are varied. Mechanical

violence or contusions (due to collisions with fixed bodies, horn

thrusts, or blows from the ox-goad) may produce it, the glandular

parenchyma and connective tissue separating the acini or the

peri-glandular tissue being torn, crushed, lacerated, and often also

directly infected in consequence of the injury. Ascending infection

through the medium of the salivary ducts represents a second possible

cause of the disease.

Finally, parotiditis may, in some cases, constitute only a localisation

of a general disease. It seems a fact that in rare circumstances

parotiditis may assume an epizootic character, and attack a large number

of animals in a particular stable or in neighbouring stables; and if,

under these circumstances, we are unable to blame the food (which has

not been done), we are forced to admit the influence of infection and

contagion.

=Symptoms.= Whatever the cause, the symptoms are generally well marked.

In many cases the first indication of the disease is apparent or real

want of appetite, always complicated with difficulty in swallowing, and

often accompanied by trifling fever.

Salivation, resulting from irritation of the gland and inability to

swallow, becomes abundant, and at once draws attention to the buccal

cavity and adjacent parts. Inspection of the patient then reveals the

existence in the parotid region of a diffuse swelling, which on

palpation is found to be hot and painful, and to occupy the whole of the

parotid region between the lower jaw and the upper extremity of the

neck. The lesion is usually unilateral, but occasionally bilateral.

Parotiditis may terminate in resolution, suppuration, or necrosis. The

suppuration may either be simply subcutaneous and extra-glandular, or

may involve a portion of the salivary gland and of the parotid lymphatic

gland in addition.

Necrosis is exceptional, though Moussu saw double and total gangrene of

both parotids, complicated with septicæmia, in the animal, of which a

sketch is given herewith.

[Illustration: $1]

If the disease is due to violent injury by a foreign body, traces of a

wound may be found, but it is often useless to search for these, even

when the parts have been pricked with a sharp goad. When the

inflammation has resulted from ascending infection of the salivary

ducts, exaggerated sensibility may sometimes be detected throughout the

whole length of Stenon’s duct, particularly at the point where the duct

crosses the jaw. There is always marked difficulty in moving the head,

particularly towards the side, and sometimes in a vertical plane. The

head is extended on the neck, and is held stiffly in such a way as to

suggest the possibility of tetanus. Some observers have described as an

important symptom marked swelling of the orifice of Stenon’s duct. It is

certainly difficult to detect, and furthermore is of no great

significance.

=Diagnosis.= Although diagnosis is easy, it is a difficult matter to

detect the point of origin of the disease. The salivation and difficulty

in swallowing might seem to suggest pharyngitis, a condition which

sometimes exists simultaneously. The distinction between this disease

and the forms of chronic parotiditis, or tumour formation in the parotid

(due to actinomycosis, lymphadenoma, melanoma), is also easy, on account

of the slow development of the last-named conditions. The only condition

liable to be confused with that under consideration is abscess of the

subparotid gland.

=Prognosis.= The gravity of the disease varies greatly. When

inflammation is slight, resolution usually occurs in eight to fifteen

days. The onset of suppuration is announced by renewal of the fever, by

more marked swelling, which becomes localised at a given point, and by

the existence of deep or superficial fluctuation. Care, however, is

required to detect the last named.

Necrosis may occur suddenly when the infecting organism is specially

virulent, and may affect one-third, one-half, or the whole of the gland.

The prognosis then becomes extremely grave, and if diagnosis has not

been prompt and treatment energetic, death may follow in a short time

from septic infection.

=Treatment.= Unless some well-marked sign foreshadows a complication,

treatment should be directed to ensuring resolution. Bleeding has been

recommended; its good effects, however, are open to doubt, though one

cannot entirely forbid it. All practitioners agree in recognising the

value of vesicant applications. The affected parts may be freely dressed

with an ointment containing 2 per cent. each of pulverised tartar emetic

and bichromate of potash, with the ordinary cantharides blister, or even

with a weak mercurial blister, provided that the animals can be

prevented from licking the wound.

Some practitioners prefer vesicants prepared with cantharides and croton

oil. Whatever be the vesicant chosen, it is best after three or four

days to apply emollients of slightly antiseptic character, such as

ointments containing camphor, boric acid, salol, etc. When abscess

formation is recognised the abscess should be opened as early as

possible. Some precautions are necessary to avoid injuring important

nerves and vessels; in dealing with a deep-seated abscess it is

necessary to use the knife for dividing the skin alone, to seek the

abscess by blunt dissection with the finger or with round-pointed

scissors, and to open it with a similar instrument. The cavity should

then be freely washed out with a warm antiseptic solution—3 per cent.

carbolic solution, or 1 per cent. iodine solution, etc. If necessary a

drain composed of iodoform gauze can be inserted, or a counter-opening

made.

In the case of partial necrosis, all the necrotic tissue must be

carefully removed, injury to vessels, which would favour septicæmic

infection, being avoided. Afterwards free antiseptic irrigation should

be employed several times per day.

In necrosis of the entire parotid extirpation may seem indicated; but

the greatest prudence is demanded, for the operation is extremely

serious and delicate.

CHRONIC PAROTIDITIS—PAROTID FISTULA.

When a case of acute parotiditis is not treated, and does not end in

suppuration, it is usually succeeded by chronic inflammation and fibrous

induration of the gland. Any obstruction of Stenon’s duct, whatever the

originating cause (foreign bodies like wheat awns, oat grains, calculi,

etc.) stops the flow of saliva throughout the excretory apparatus, and

produces over the entire parotid region a doughy swelling, which might

seem to indicate the existence of indolent parotiditis. The collections

of liquid thus produced have improperly been termed “salivary

abscesses.” If ascending infection fails to occur, or if infection is

unimportant and does not lead to suppuration, a relatively painless

chronic parotiditis develops, and in this case movements of the head and

mastication and deglutition alone are impeded.

The salivary ducts, however, may become so distended that the main

superficial collecting duct undergoes softening, and the skin covering

it becomes ulcerated, just as would occur had a true abscess formed.

Under such circumstances the skin soon yields and a salivary fistula is

established.

=The symptoms= consist in swelling or induration of the gland,

interference with movement of the head and with mastication; the whole

developing slowly without pain or fever.

The distinction of this condition from actinomycosis of the parotid may

sometimes present some difficulty until a fistula develops.

=The prognosis= is grave, because there is no hope of normal conditions

being restored.

=Treatment.= Treatment often proves unsuccessful. Should the condition

have resulted from an obstruction, it is first necessary to attempt the

removal of such obstruction, whether it be a foreign body or calculus,

and so to re-establish the normal channel for the saliva. Local

stimulation may be tried, though in cases of fistula without much hope

of success. Smart blistering of the parts surrounding the opening and

firing in points have been recommended; but rather than persist in

prolonged treatment of doubtful value, it is often better to prepare the

animals for slaughter.

INFLAMMATION OF THE SUBMAXILLARY SALIVARY GLAND.

Inflammation of the submaxillary gland is rare in the ox. As in the

horse, it is usually caused by the penetration of foreign bodies, such

as glumes or awns of grain, fragments of straw, thorns, etc., into

Wharton’s duct.

The difficulty in grasping food and the restricted movement of the

tongue are the first symptoms to attract attention. On examination, the

region of the “barbs,” usually on one side, appears injected, swollen,

inflamed, and sensitive.

The submaxillary space is effaced by the swelling of Wharton’s duct; the

corresponding submaxillary gland is doughy and painful on pressure. The

symptoms rarely become more threatening than this.

=The diagnosis= presents no difficulty.

=The prognosis= is favourable.

=Treatment= consists primarily in removing the obstruction from the

duct. Steady pressure from behind, forwards along the course of the

duct, may sometimes cause the foreign body to be ejected into the mouth,

along with a jet of offensive saliva. The distended and inflamed duct

soon becomes emptied, and all the symptoms rapidly diminish. In other

cases, when the obstructing body is firmly fixed in position, it is

necessary to open the duct within the mouth by a stroke of the bistoury.

TONSILITIS IN PIGS.

“Acute and chronic forms are seen. The former has the general causes and

symptoms of pharyngitis—fever, dulness, a disposition to lie with head

extended and buried in litter, drooping ears, watery eyes, indifferent

appetite, painful deglutition, and sometimes vomiting. Mouth red and

hot, breath fœtid, tonsils swollen, their alveoli filled with

muco-purulent matter or with fœtid cheese-like masses. Cough at first

dry and hard, later loose and gurgling.

In chronic form there is general swelling of the tonsils with distension

of follicles by above-mentioned putty-like masses, which are often

calcareous. These are due to the proliferation of microbes, which find

in these alveoli a most favourable field for their propagation. The

affection usually ends in recovery, but may go on to grave local

ulceration and general infection.

=Treatment.= Astringent antiseptics to buccal mucous membrane.

Electuaries of honey or treacle and borax, sal ammoniac, chlorate or

permanganate of potash and externally stimulating embrocations to the

skin of the throat. In some cases solutions of iron chloride or tincture

of iodine may be used with advantage and as a wash for the mouth and

fauces. Attend to general health. If constipated give Glauber’s salt or

jalap, ... and elimination through the kidneys must be sought through

the use of nitrate of potash or other diuretic.” (Law’s “Veterinary

Medicine,” Vol. II. p. 46.)

PHARYNGITIS.

Inflammation of the mucous membrane of the pharynx is less frequent in

the ox than in the horse, a fact probably due to its less sensitive

character in the ox and to differences in the methods of working oxen.

=Causation.= The causes are numerous and varied; and although local

microbic infection undoubtedly plays the most effective part in the

development of the disease, it is none the less certain that external

influences are of considerable importance. For this reason chills,

sudden variations in temperature, sudden arrest of perspiration, and

currents of cold air have always been invoked as causes. Cruzel thinks

that the ingestion of ice-cold water in winter is sufficient to produce

acute pharyngitis. The action of rough forage may of itself explain the

development of pharyngitis in animals constantly kept indoors under

excellent hygienic conditions. In such cases the disease may be regarded

as of traumatic origin. Furthermore, it is necessary to mention direct

injuries of the mucous membrane caused by clumsy examination,

awkwardness in passing the probang, and attempts on the animal’s part to

swallow sharp foreign bodies, which scratch, tear, lacerate, or

penetrate the mucous membrane and become fixed in it.

Finally, another series of causes, and not the least important, remains

to be considered—viz., the forced administration of irritant substances

like ammonia, tincture of iodine, oil of turpentine, very hot liquids,

etc.

To sum up, the four great series of causes consist in direct irritation,

intra-pharyngeal wounds, variations in temperature, or primary or

secondary microbic infections.

=The symptoms= are characteristic. They consist in loss of appetite,

difficulty in swallowing, consequent on the condition of the pharynx,

and fever, which is often marked from the first. Pharyngeal dysphagia

can easily be distinguished from that due to injury of the œsophagus,

inasmuch as it occurs on the first attempt to swallow.

Urged on by hunger, the animal grasps food, which it chews and attempts

to swallow, but immediately allows it to fall back into the manger, or

ejects it by a painful coughing effort. In the case of liquids, even of

lukewarm drinks, the same accident occurs, the food or liquid being

returned by the nostrils. Slight salivation results from this difficulty

in swallowing. The animal’s attitude is similar to that in parotiditis.

The head is held stiffly, extended on the neck, in order to avoid

compressing the region of the pharynx, and can only be moved slowly and

with much pain. There is no apparent swelling of the parotid region, but

on manipulating or pressing on the gullet the animal sometimes manifests

the very acute tenderness of the parts by coughing and endeavouring to

thrust away or to kick the examiner. Finally, examination of the mouth

sometimes shows reddening and excessive sensibility of the soft palate

and of the pillars of the fauces.

These symptoms often assume a more alarming character, or are

complicated by others; in fact, the condition very rarely stops at

pharyngitis, but is usually accompanied by inflammation of the larynx,

of the soft palate, and of the naso-pharynx. The whole throat is then

inflamed; the nose and sometimes the eyes discharge, and there is

difficulty in swallowing, interference with respiration or noisy

respiration, and intense fever.

=Diagnosis.= The diagnosis presents no difficulty, the symptoms

mentioned being easy to identify, whether the condition be simply

inflammation of the pharynx or be of a more extensive character.

Nevertheless, cases occur where the symptoms are alarming, but in which

one might hesitate between the diagnosis of ordinary acute sore throat

and the sore throat which ushers in gangrenous coryza. A definite

expression of opinion must then be deferred to a later date; for one

cannot be absolutely certain whether or not the other signs of

gangrenous coryza will appear.

When there is only difficulty in swallowing one might _à priori_ suspect

traumatic injury of the mucous membrane, with or without the presence of

a foreign body. It is also necessary to bear in mind the possibility of

difficulty in swallowing being occasioned by reflex irritation without

local lesions, originating in enlargement of the retro-pharyngeal

lymphatic glands as a consequence of tuberculosis or other disease.

=The prognosis= is favourable; even without treatment acute pharyngitis

usually tends to recovery in eight to twelve days, and rarely becomes

complicated. Nevertheless, some reserve ought to be exhibited in cases

of pharyngitis due to the action of rough forage, the removal of the

cause being here indispensable to any improvement. Similarly in cases of

pharyngitis due to foreign bodies having penetrated the mucous membrane,

which are chiefly characterised by inability to swallow, the disease may

continue for a very much longer time than above indicated, unless the

foreign body is discovered and removed. Inflammation is limited to a

zone surrounding the point of implantation. It extends more deeply with

movements of the foreign body, and may end in the formation of an

abscess. Of this variety is Hopsomer’s remarkable case, in which a

darning-needle finally obtained exit through the submaxillary space, in

which it had caused the formation of an abscess.

=Treatment.= The treatment is the same whether we are dealing with a

simple acute pharyngitis or with a more widely distributed inflammation.

It consists in smartly stimulating the region of the throat with

mustard, cantharides oil, or ointment, or with an ointment containing 2

per cent. of tartar emetic and of bichromate of potash, and then

covering the parts with a flannel hood. This mode of treatment seems

preferable to that recommended by German authors—viz., the application

of cold compresses to the throat, the administration of cold gargles,

etc. Moderate bleeding, to the extent of two or three quarts, has the

great advantage, as in all similar cases, of lowering the temperature.

This treatment may, if necessary, be completed by the internal

administration of 3 to 5 drams of Kerme’s mineral (oxysulphuret of

antimony) in electuary, according to the animal’s size. Medicated

inhalations diminish local irritation, render swelling less painful, and

facilitate the separation of false membranes and the discharge of

adherent mucous secretions.

The ordinary food should be replaced by cooked roots, lukewarm drinks

and gruels, all rough fodder being prohibited.

If difficulty in swallowing alone continues, the operator should examine

the mucous membrane of the pharyngeal cavity with the hand, in order to

discover and remove any foreign body which may have become implanted

there.

PSEUDO-MEMBRANOUS PHARYNGITIS IN CATTLE.

In addition to the above acute forms of pharyngitis, a

pseudo-membranous, croupal, or pseudo-diphtheritic pharyngitis has been

described in the ox. It is due to polymicrobic infection, and is

characterised by the formation of false membranes on the pharyngeal

mucous membrane. The condition seems to be a pharyngitis of exceptional

intensity, varying markedly from the classic type and being most nearly

related to severe sore throat, laryngitis, gangrenous coryza, etc.

It rarely attacks aged cattle, but is readily transmissible to calves

and young stock. Cadéac failed to inoculate it on guinea-pigs and

rabbits. Damman succeeded with sheep and with rabbits, the latter dying

in twenty-four hours after inoculation with hæmorrhage at the seat of

puncture. Löffler hypodermically infected mice and produced extensive

infiltration of the abdominal walls, and often of the peritoneum,

surface of the liver, kidneys and intestine, on which formed a thick

yellowish exudate containing the organism.

=Causes.= Löffler found filaments of a long delicate bacillus about half

the thickness of the bacillus of malignant œdema. The bacillus did not

grow in nutrient gelatine or in sheep’s blood serum, but readily grew in

blood serum of the calf. Cadéac gives as predisposing causes: sudden

chills, rapid alterations of temperature, inhalation of irritant

vapours, suppression of cutaneous secretion, swallowing irritant

liquids, and injuries.

=Symptoms.= The nasal membrane is reddened, thickened and covered in

patches with false membrane, causing snuffling and wheezing breathing.

The throat is tender and swollen, cough is frequent, gurgling, and

followed by expulsion of false membrane, muco-pus and some blood. Shreds

of false membrane adhere to the nose and lips. Other symptoms are:

fever, accelerated pulse, dark mucous membranes, haggard countenance,

mouth open, hanging tongue, stringy salivation, and constipation or

diarrhœa.

The disease runs a rapid course, and death may occur in twenty-four

hours. Recovery may be equally rapid, but often convalescence is

protracted.

=Lesions.= Intense congestion of mucosæ of nose, mouth, pharynx, larynx,

and bronchi, with here and there patches of false membrane, which may be

soft or tough, according to the duration of the attack. The deep surface

of the false membranes is blood-stained; and, according to Preitsch,

false membranes sometimes occur in the œsophagus, rumen, and omasum,

which in consequence may show patches of ulceration.

=Treatment= (as for the horse). This includes poultices,

counter-irritants, laxatives, febrifuges, alkalies and antiseptics.

Inhalations of medicated vapour, warm water to which has been added some

antiseptic—carbolic, lysol, creolin, camphor, sulphurous acid; or for

calves, iodoform, oil of turpentine, calcium sulphide, silver nitrate,

coal tar. To detach the false membranes ipecacuanha and potash chlorate,

or soda sulphate, or magnesia sulphate may be tried. Papayin and pepsin

have been suggested as appropriate remedies. Anyodnes—digitalis,

belladonna, morphia and aconite—may be useful. Tracheotomy is indicated

as a last resort.

PSEUDO-MEMBRANOUS PHARYNGITIS IN SHEEP.

Roche-Lubin states that this is common in flocks as a result of moving

the sheep in dusty enclosures. The dust is supposed to excite the

intense croupous inflammation of the mucous membrane. The disease has

been noticed in spring in young lambs shortly after weaning. Damman

states that he transmitted the disease to the sheep from the exudate of

the calf.

=Symptoms.= Frothy salivation with constant movements of the jaws,

viscid nasal discharge, difficult deglutition, panting, snuffling

breathing, throat swollen and very tender, frequent cough, discharge of

exudate. The head and neck are extended, the eyes dull, appetite is

lost, the mucous membranes are red or cyanotic, and the animal appears

weak and listless. As respiration becomes more difficult the mouth is

held open, the tongue is protruded, and with each cough shreds of false

membrane are expelled. Death from suffocation is not uncommon.

=The lesions= are not different from those seen in the calf.

=The treatment= is similar to that for the calf. Tepid drinks containing

hydrochloric acid, or sulphate of soda (1 lb. to 50 sheep) in the

drinking water, has been recommended. Fumigation with sulphurous acid or

chlorine may be tried. Small numbers may be treated by swabbing the

throat with solution of sodii hyposulphis or weak caustics and

antiseptics.

* * * * *

In young and in adult pigs pseudo-membranous pharyngitis is often only a

manifestation of pneumo-enteritis. It therefore calls for no special

description at this point. No exact investigation of the organisms which

produce these forms of pharyngitis with false membrane formation has

been made in veterinary surgery. We only know that these diseases are

not true diphtheria due to “Klebs’ bacillus.” Treatment should be very

energetic from the commencement, but otherwise it differs in no respect

from that ordinarily adopted.

Tonics and stimulants, like alcohol, wine, coffee, etc., are indicated.

[The following account of the disease is summarised from Law’s

“Veterinary Medicine,” Vol. II.]

“Pseudo-membranous pharyngitis has long been recognised as a contagious

disease of swine, attacking especially swine kept in herds or in close,

insanitary pens. Young pigs are more liable to attack than older

animals, perhaps, owing to the older animals having suffered the disease

in early life.

Modern observation shows that pharyngitis with false membranes is common

in swine plague, and the present tendency is to refer all such cases to

that category. It is, however, altogether probable that the occurrence

of local irritation, with the addition of an irritant or septic microbe

altogether distinct from that of swine plague or hog cholera, gives rise

at times to this exudative angina. Certain it is that septic poisoning

with the food is not at all uncommon in the hog, in the absence of these

infectious diseases.

=Symptoms= are those of sore throat, with much prostration, a croaking

cough, yellow discharge from nose and mouth, and marked muscular

weakness. The tongue, tonsils and soft palate are red, swollen, and

studded with patches of false membrane. The identification of swine

plague may be made by the history of the outbreak, the number of animals

affected, the tendency to pulmonary inflammation, the enlarged lymph

glands, the presence of the non-motile bacillus, which does not generate

gas in saccharine media, and which readily kills rabbits and pigs with

pure cultures of the germ.

=Treatment.= Isolation, cleansing and disinfection. Locally antiseptics

and generally a febrifuge regimen will be advisable.”

PHARYNGEAL POLYPI.

The term “pharyngeal polypi” includes tumours of varying character,

which affect the polypus form, and occur with considerable frequency in

the bovine species. Many of these polypi are simply actinomycotic

growths springing from the pillars of the fauces, from the upper parts

of the palate or from its posterior surface. Less frequently they arise

from the lateral walls or the free surface of the hard palate.

=Symptoms.= The symptoms are so characteristic that the diagnosis rarely

presents much difficulty. They may shortly be described as indicative of

repeated obstruction in the pharyngeal, œsophageal or laryngeal region.

At the moment of deglutition, the polypus is thrust towards and

obstructs the œsophageal orifice.

Reflex stimuli are thus excited, which prevent deglutition; an attack of

coughing occurs, and food mixed with saliva is ejected from the mouth

and nostrils. The attack of coughing displaces the polypus either in a

forward or lateral direction, and swallowing then again becomes

possible, until by changing its position the growth produces fresh signs

of obstruction.

In other cases the polypus may only be of such small size as to impede

the food passing through the pharynx on its way into the œsophagus or to

cause difficulty in respiration by partially blocking the pharyngeal

portion of the nasal cavities. In such cases deglutition is only checked

and rendered slower.

Or again, the pedicle of the polypus may be sufficiently long to allow

the growth at certain moments to fall in front of the laryngeal opening.

Respiration is then painful, difficult and noisy. Unless the growth is

displaced during the subsequent attack of coughing, asphyxia may appear

imminent, or may even occur unless assistance is afforded.

Guided by these symptoms, the operator will explore the pharynx

manually, and thus discover the position and size of the tumour. Tumours

of the naso-pharynx produce very similar symptoms.

=The prognosis= is based on the information obtained by manually

exploring the pharynx. It is relatively favourable if the polypus has a

well-marked neck, but is very grave if the tumour is largely sessile and

cannot be removed.

=Treatment.= Medical treatment appears useless except in cases of polypi

due to the presence of actinomyces. The administration of iodine and

iodide of potassium, in large doses, may then lead to resorption; but

extirpation is often preferable.

In other cases extirpation is the only rational treatment. The operation

necessitates the performance of provisional tracheotomy in order to

avoid risk of asphyxia. The growth may be directly removed through the

buccal cavity without incision, provided that it prove possible to pass

the chain of an écraseur around the pedicle; or through the buccal

cavity, with incision, after vertically or obliquely dividing the soft

palate; or, lastly, through the larynx, after performing median

laryngotomy, thus obtaining access to the pharynx.

Only the first method of intervention is to be recommended; the last two

are more delicate. They necessitate after-treatment, and when the

patients are in a condition for slaughter it is frequently preferable to

send them to the butcher. The essential point is not to act without a

full knowledge of the causes.

CHAPTER III.

DISEASES OF THE ŒSOPHAGUS.

[Illustration: $1]

The œsophageal tube is of very simple anatomical construction, and

performs an equally simple physiological function; nevertheless, in the

ox it is liable to a large number of diseased conditions. These

conditions may affect only a circumscribed area of the mucous membrane

or the entire extent of the tube. Again, both the muscular and mucous

tissues may be affected, as in inflammation of the œsophagus accompanied

or followed by contraction, and in the formation of œsophageal abscesses

and tumours; or the muscular tissue alone may be affected, as in cases

of dilatation. Even where no lesion is apparent the normal rhythm of

deglutition may be interfered with, either by the presence of a foreign

body (obstruction) or by spasm of the muscular layers (œsophagismus) or

by compression due to tissues surrounding the œsophagus (false

contractions).

We shall successively study the different forms of œsophagitis,

contraction, and dilatation, together with their complications; then

obstructions, ruptures of the œsophagus, œsophagismus, and false

contractions.

ŒSOPHAGITIS.

Inflammation of the œsophagus may be due to many different causes, and

may occur in one of three different degrees of severity. It may be

either superficial, _i.e._, limited to the epithelial layer of the

mucous membrane; or deep, affecting the entire thickness of the mucous

membrane (epithelium, corium, and œsophageal glands); or, finally, it

may attack both the mucous and muscular layers. German authors recognise

various divisions, such as erythematous, catarrhal, follicular, and

phlegmonous œsophagitis. In reality these are not always different

forms, but simply successive stages in the evolution of a single morbid

condition. Here we shall only study the ordinary forms of œsophagitis,

leaving on one side those which occur symptomatically during

foot-and-mouth disease, cattle plague, gangrenous coryza, actinomycosis,

etc.

=Causation.= The causes of œsophagitis may be divided into three groups

of different character:—(_a_) Rough fodder (clover containing

wrestharrow, thistles, thorns, furze, or splinters of wood, etc.) must

be placed in the first rank, for its repeated action abrades and

irritates the mucous membrane to such an extent as finally to produce

inflammation. This inflammation usually remains superficial and of

moderate intensity; its occurrence can be anticipated during years of

scarcity, when the animals feed on rough and irritating material like

fern, broom, heather, furze, etc.

(_b_) Hot drinks, whether in the nature of beverages or medicinal

draughts, are a frequent cause of œsophagitis if administered by

careless or inexperienced persons. The mucous membrane is scalded over a

varying area and with different degrees of severity, or is destroyed by

the chemical action of such drugs as ammonia, dilute acids, iodine

solution, etc.

(_c_) Rough or clumsy manipulation in withdrawing or displacing foreign

bodies, or merely passing the probang, produces that variety of

œsophagitis termed traumatic. In clumsy hands œsophageal sounds or

catheters may abrade or even tear the mucous membrane and subjacent

tissues.

=Symptoms.= These vary to some extent, according to the intensity of the

inflammatory phenomena. If the lesions are superficial and only

implicate the epithelium, as in catarrhal œsophagitis, the symptoms

often pass unnoticed, and only produce difficulty in swallowing. When

inflammation has involved the entire thickness of the mucous membrane

the immediate consequence is loss of appetite due to pain during

swallowing. After the bolus of food has been masticated, and has passed

into the pharynx, the animal stretches out its head and neck and seems

to be making efforts to force it down the œsophageal canal. The progress

of the bolus is slow and clearly difficult.

In œsophagitis due to scalding the blisters are soon broken by the

passage of food, the corium is exposed, and the animal has equal

difficulty in swallowing either solids or liquids. The reflex action

provoked by the passage of the food over these lesions may be so violent

that the ingesta never arrive at the stomach, but are violently rejected

by a sudden and unexpected antiperistaltic contraction. Even saliva is

returned. Moreover, in these cases the history is generally clear, and

the animal is feverish or greatly depressed. These objective symptoms

are very significant, and when, in addition, an abnormal and exceptional

degree of sensibility is detected at some point by palpation, they

unmistakably indicate the existence of œsophagitis.

The irregularity in deglutition, and therefore also in rumination,

sometimes excites moderate tympanites without any very apparent cause.

Should the condition still appear doubtful the œsophageal sound may be

passed, but with great care. It generally aggravates the pain and

produces intense antiperistaltic movements, which the practitioner

should not attempt to overcome.

=Complications.= If œsophagitis is moderate, recovery is the rule. The

symptoms of pain gradually diminish.

When, on the contrary, inflammation is very intense, as in certain cases

of traumatic œsophagitis, the injured spot may become infected and

suppuration follow. The existing fever then persists or becomes more

marked; the animal is extremely depressed; respiration may be difficult

and accelerated, and appetite is entirely lost.

If the œsophageal abscess remains submucous the diagnosis is difficult,

but it is often problematical, even when the abscess develops in the

cervical region. The jugular furrow (usually on the left side) becomes

the seat of a severe diffuse inflammatory swelling, the course of which

clearly indicates the development of the symptoms. In exceptional cases

fluctuation may be detected.

If from the first the abscess develops around the œsophagus or in the

course of suppuration comes to occupy this position, swelling in the

jugular furrows is more apparent and easier to detect, and in this case

fluctuation may be localised. When the lesions are within the thorax no

tangible symptoms can be detected. Death may occur in a few days, when

an abscess in the lower cervical region breaks into the anterior

mediastinum, or when an abscess in the thoracic region opens into the

pleural cavity. In œsophagitis produced by scalding and from swallowing

hot or caustic liquids the mucous membrane, and sometimes the muscular

tissue, is destroyed, and ulcerations and cicatrices result, or the

œsophagus may even be perforated, with rapidly fatal results; even when

recovery occurs, cicatrices form and cause very grave contraction.

=Diagnosis.= The diagnosis is generally easy, provided that the symptoms

noted are methodically analysed and the history of the case is taken

into consideration.

=Prognosis= is favourable in ordinary cases. On the other hand, it may

be very grave when general symptoms become marked, when the vital

functions are disturbed and a deep-seated abscess appears to be forming.

=Lesions.= In the first degree the lesions are confined to inflammation

and desquamation of the epithelium; in the second, to inflammation of

the corium and of the mucous membrane; in the third, to infiltration of

the submucous layers and of the muscular and periœsophageal tissues.

Sloughing and perforation follow the administration of caustic liquids.

=Treatment.= As the direct application of medicines to the inflamed

mucous membrane can only be of a momentary character, treatment is

confined to administering emollient, anodyne, and slightly astringent

drinks, the action of which is assisted by feeding with milk,

farinaceous or mucilaginous foods. Under these circumstances recovery

occurs in ten to fifteen days. The application of stimulant or

blistering ointments along the jugular furrow may have a good effect.

When the general condition of the patient becomes aggravated, and the

formation of an abscess appears certain, it is best to recommend

slaughter. In the case of a submucous abscess the passage of the probang

may, however, predispose or cause the abscess to open into the

œsophagus, and thus lead rapidly to recovery, but this is exceptional.

The “pointing” of the abscess and its opening towards the jugular furrow

may be followed by temporary improvement, but at a later stage is

followed by fistula formation, or by contraction of the œsophagus

itself. From an economic standpoint it is better to slaughter.

STRICTURE OF THE ŒSOPHAGUS.

Under normal conditions the cavity or lumen of the œsophageal tube is,

so to speak, imaginary: the walls of the tube lie flatly together, and

the mucous membrane is in folds. During the act of swallowing the tube

becomes dilated to a degree varying with the size of the bolus of food,

and again retracts as soon as deglutition is effected. Whenever the

dilatability of the tube is markedly diminished by changes in its walls,

and, in a much higher degree, when this dilatability has disappeared,

true stricture exists. In the former case small boluses of food and

liquids alone succeed in passing the stricture; in the latter, liquids

alone can pass.

=Causation.= Strictures are never primary. They result from intense

attacks of œsophagitis, ending in sclerosis of the mucous coat,

extensive ulceration consequent on scalding, or interstitial

inflammation affecting the muscular coats, which then become thickened

or sclerosed.

Internal injuries due to attempts to withdraw or propel foreign bodies

along the œsophagus may also cause strictures.

=Lesions.= In simple strictures the lesions are confined to the

development in the depths of the mucous membrane and in the muscular

layers of inflammatory tissue, which becomes denser with lapse of time.

This alters the character of the walls and the structure of the tissues,

and causes them to lose their elasticity. After extensive ulceration the

tissue of the cicatrix contracts and hardens to a very varying degree.

=Symptoms.= The apparent symptoms are very clearly marked; the appetite

is good, and the animal masticates as usual, but in the act of

deglutition is seen to extend the head on the neck, and to make efforts

to swallow, which prove unavailing when the contraction is too marked. A

reflex antiperistaltic movement often causes the substances ingested to

be at once rejected. These violent efforts, however, in time provoke

dilatation above the stricture. A quantity of food accumulates in this

dilatation, and the symptom so characteristic of œsophageal stricture

then appears—viz., regular regurgitation. The second constant symptom

associated with compression or obstruction of the œsophagus is

tympanites after feeding, however trifling may be the amount swallowed.

Rumination is suspended, and even eructation of gas is difficult.

Finally, the characteristic sign of stricture is noted on passing the

probang, which reveals the existence of the condition, indicates its

position, and suggests its degree of development.

[Illustration: $1]

=Diagnosis.= Strictures only develop progressively and slowly, a fact

which enables them to be differentiated from œsophagitis. It is more

difficult to differentiate them from dilatations, because the stricture

always ends by becoming complicated with dilatation; but this

distinction is of little practical importance, the consequences being

identical.

=Prognosis.= The prognosis is very grave, and there is no economic

reason for attempting treatment except in special cases; the indications

are in the direction of slaughter.

From the economic standpoint there is no treatment. Basing their actions

on human practice, the Germans have recommended progressive dilatation

of the lumen of the œsophagus by passing a series of catheters of

gradually increasing size. What, however, is justifiable in human

medicine, where the only object is to keep the patient alive at any

cost, may be highly objectionable in veterinary practice; and in the

present instance this is the case. Except in very rare instances, which

the practitioner alone can appreciate, dilatation is contra-indicated,

and the owner’s interest lies in slaughtering the animal before it has

lost much condition.

DILATATION OF THE ŒSOPHAGUS.

Dilatations are more frequent than strictures. Their mode of origin is

easily understood. When the muscular tissue has lost its tonicity and

contractile power at a given point, or when, as a consequence of any

form of inflammation, it has begun to undergo atrophy, the mucous

membrane becomes herniated, because its circumference is not supported

regularly during deglutition. The ectasia, which at first is of small

size, becomes more marked in consequence of the tendency that exists for

the food to accumulate in the dilated region. Dilatation is thus set up.

[Illustration: $1]

Localised attacks of œsophagitis, accidental injuries and fissuring of

the œsophageal muscular tissue, produced by clumsy efforts to displace

foreign bodies with the probang, are the principal causes of dilatation.

When the probang is imprudently or clumsily manipulated, it may press

excessively at any point where the œsophagus makes a slight bend, and

thus split the contracted muscular coat without injuring the lax mucous

membrane.

Œsophageal contractions, as we have seen, may form the point of origin

of dilatations, but in this case the dilatations are more regular in

form, and affect the entire circumference of the tube. The muscular

tissue is still everywhere normal, and becomes dilated in consequence of

equally-applied eccentric pressure.

=Symptoms.= When the dilatation develops slowly and progressively, as a

consequence of muscular atrophy, the symptoms remain unnoticed for a

long time, and the owner only begins to be anxious when the animal loses

condition, or when the driver or cowman detects masses of half-chewed

food mixed with the saliva in the manger.

Certain signs are pathognomonic; others may be regarded as of secondary

importance. By carefully watching an animal which is feeding the

following symptoms may be noted: As a general rule hunger is very

marked, and the animal chews its food and swallows the first few

mouthfuls in a perfectly normal way. Three, five, eight, or even ten

mouthfuls may be swallowed; then the animal suddenly stops, appears a

little anxious, extends its head and neck, an antiperistaltic

contraction occurs, and one or two masses of food are rejected and fall

into the manger. The discomfort being thus momentarily relieved, the

animal, which is dying of hunger, although faced with food which it is

unable to swallow, returns to its meal, swallows one, two, or three

boluses of food, regurgitation again occurs, and the whole process is

repeated.

What is going on under these circumstances is easy to explain.

At the commencement of the meal the dilatation is usually empty, or

nearly empty. A mouthful of food is swallowed. It descends the œsophagus

until it arrives at the diverticulum, into which it partially or wholly

passes, the peristaltic wave of contraction ceasing at this point. The

second mouthful follows with the same result, then a third, a fourth,

etc. The diverticulum soon becomes filled to repletion, and no more food

can enter it. The food therefore accumulates in the upper portion of the

œsophageal tube until the latter becomes nearly filled; but as this

tube, provided its innervation is intact, is intolerant of the presence

of any foreign body, and as efforts to swallow prove fruitless, a sudden

antiperistaltic wave of contraction occurs, with the result that all the

material contained in the tube above the dilatation is ejected into the

mouth, whence it falls into the manger. The same result follows any

further attempts to swallow during a particular feeding time. From this

it will be seen that the animal can ingest at a given time only as much

as the dilatation will contain.

In the intervals between meal times and under the action of the saliva

and warmth, the food collected in the dilatation becomes softened,

breaks down, and slowly moves onward towards the rumen. When the next

feeding time arrives the dilatation is almost empty, and the same set of

symptoms recurs.

If, instead of forage, the animal begins by taking gruel or very fluid

material, deglutition appears normal, or at least fairly easy; but if

drinking is deferred until after taking hard food, it becomes almost

impossible, because the passage is obstructed. These symptoms are, so to

speak, pathognomonic. Under any circumstances they are so significant

that error in diagnosis is unlikely.

By careful examination œsophageal regurgitation can very easily be

distinguished from true vomiting; the character of the rejected material

shows that it has not come from the stomach, while the boluses of food

preserve their cylindrical form, and are still saturated with saliva.

Some secondary signs also deserve to be mentioned, such as the animal’s

anxiety and restlessness whilst its neighbours are feeding, the

existence of trifling and intermittent tympanites due to suppressed

eructation, suppression or irregularity of rumination, constipation,

etc. At a later stage there is rapid wasting and disordered appetite,

and finally the patients die slowly of hunger, whatever efforts are made

to feed them.

When the seat of dilatation is in the cervical portion of the œsophagus,

there are other symptoms which leave no doubt as to the condition. When

empty the pouch cannot be detected; but during a meal the accumulation

of food causes it to assume the appearance of a doughy, diffuse,

indolent swelling, which alters the outline of the jugular furrow,

yields to pressure, and sometimes produces respiratory disturbance by

pressing on the trachea, the pneumo-gastric and inferior laryngeal

nerves, etc.

When the dilatation is intra-thoracic and the above-described symptoms

have been observed, the dilated spot can only be detected and localised

by using the probang. The greatest possible prudence, however, is

required in manipulating the instrument, in order to avoid rupturing the

thin walls of the dilated portion.

=The diagnosis= is not always easy; when food is regurgitated, and one

finds by auscultation that the sound usually produced by the passage of

solids or liquids into the rumen is absent, there need be no hesitation

in diagnosing either a dilatation or a stricture. The clinical

consequences being the same, the possible error would be of little

importance.

=Prognosis.= The animal’s life is rarely in immediate danger, but from

the economic point of view the prognosis is extremely grave, and it is

in the owner’s interest to slaughter the animal as soon as possible in

order to avoid loss. Even in cases of dilatation in the cervical region,

surgical interference is not advisable.

=Treatment.= As foreshadowed by what has been said, there is no rational

economic treatment. When the dilatation is in the cervical region, one

might in exceptional cases attempt to restore the regular calibre of the

œsophagus by removing an elliptical portion of mucous membrane, and

bringing the muscular tissue together with sutures; that is to say, when

the rupture or fissuring of the muscular coat has been accidental. But

as one is usually unable to remove the primary cause, to which the

change in the muscular tissue is essentially due, the dilatation would

recur without the operation having conferred any benefit.

When an exact diagnosis has been made, the only useful indication is to

confine the animal to very fluid food, which will not obstruct the

œsophagus. Ordinary forage should be withheld.

ŒSOPHAGEAL OBSTRUCTIONS.

In this chapter we shall only consider such obstructions as occur in

consequence of the animal having attempted to swallow without

sufficiently chewing objects which become arrested in the œsophagus.

Obstruction is termed “total” or “partial,” according as the obstructing

body fills the entire calibre of the œsophagus at the point of

obstruction, or only occupies a part of the space. Partial obstructions

produced by beet and turnip tops, etc., are usually but momentary;

liquids and saliva are still able to pass between the obstruction and

the walls of the tube, and as soon as the arrested food becomes a little

softened it is displaced and the œsophagus again becomes patent.

=Causation.= The circumstances under which this accident occurs are

extremely easy to understand. Obstructions are produced by apples,

potatoes, turnips, carrots, cabbage-stalks, beetroots, etc., which,

whether sliced or not, are swallowed gluttonously. Not having been

sufficiently comminuted, and being of larger size than the œsophagus can

readily accommodate, they become arrested at some point between the

commencement of the œsophagus or a few inches behind the pharynx, or

just in front of the point of entry of the gullet into the stomach. The

latter is the commonest position, though not infrequently the

obstruction occurs in the intra-thoracic portion.

It may occur in the stable, but is commoner in animals which, having

broken loose, have entered orchards, gardens or potato or turnip fields

and attempted to swallow apples, cabbages, potatoes, etc., found there.

In sheep, obstruction of the œsophagus is due to similar causes, but in

their case the above-mentioned objects are replaced by small wild

apples, turnip shells, Jerusalem artichokes, horse-chestnuts, carrots,

etc.

The symptoms may be divided into general and local.

=General symptoms.= As soon as the foreign body becomes fixed in

position, the animal begins to make exceptional efforts to swallow. The

head is extended on the neck, and the œsophagus and the muscles

surrounding the trachea are violently contracted. These efforts proving

fruitless, feeding is necessarily stopped, and the animal at once

appears slightly anxious.

Very soon afterwards salivation sets in, saliva being continuously

secreted. If the obstruction is total, the saliva cannot be swallowed,

and is either returned in quantities by antiperistaltic movements or

escapes in frothy filaments from the mouth.

Tympanites is not long in appearing. It is progressive, and results both

from arrest of eructation and from continued fermentation in the rumen.

It may eventually come to a standstill, or may continue and threaten to

produce asphyxia.

=Local symptoms.= The local symptoms are difficult to appreciate, except

in cases of cervical obstruction. Sometimes the foreign body produces a

local swelling, which changes the outline of the jugular furrow, most

frequently on the left side. In many cases it can only be detected by

manipulating the parts between the trachea and the lower surface of the

cervical vertebræ. When the obstruction is within the thorax, the

probang alone can detect its position.

=Diagnosis.= The diagnosis is usually easy. The history and the observed

symptoms are often very clear, and the suddenness with which the

obstruction has made its appearance prevent the condition from being

confused with dilatation or stricture.

=The prognosis= is very variable. It is often easy to remove the

obstacle; in other cases intervention is difficult, and death may occur

rapidly.

=Treatment= is confined to one essential point—removal of the

obstruction. The chief difficulty lies in choosing the mode of

intervention. Moreover, success depends on several factors, which, in

the order of their importance, are as follows: the size of the

obstructing body; the time which has elapsed since the accident

occurred; the bodily condition of the animal—_i.e._, whether it be fat

or thin—and the extent to which tympanites has developed.

The first thing to do (and in favourable cases all that is required) is

to puncture the rumen and leave the canula for some time in position.

The onward progress of the foreign body, especially when the obstruction

is in the intra-thoracic portion of the tube, is often impeded by the

tympanites, which tends to thrust the object towards the pharynx, or at

least to fix it in position. In consequence of a sudden change in the

conditions of pressure the foreign body may move and pass into the

rumen; all danger is then at an end.

Even though the obstruction does not immediately cease, puncture of the

rumen, by removing the danger of asphyxia, allows one at least to wait

for several hours, sometimes until next day, during which time the

object may pass into the rumen without further extraneous assistance.

The other methods may be grouped into four series:

I. =External taxis.= This is directed towards loosening the foreign body

and thrusting it towards the pharynx and buccal cavity. It can only be

used against obstructions in the cervical region. Two methods, although

very ancient, are still practised.

(_a_) The first is carried out in the following way: the animal is fixed

to a post or tree so that it cannot struggle, its head being drawn up as

high as possible. The operator stands on the left side, with his back

turned towards the patient’s head, his left hand is pressed into the

right jugular furrow, his right hand is placed on the left jugular

furrow immediately below the foreign body. By using the fingers the

foreign body is moved, and is progressively thrust towards the pharynx,

in spite of the animal’s efforts to swallow. In carrying out this

manipulation it is absolutely indispensable not to let slip the

obstructing body for a single instant, otherwise the peristaltic action

will immediately return it to its former place. When it has been raised

as far as the pharynx, an assistant passes his hand into the back of the

mouth, as indicated in a former chapter, seizes the object and withdraws

it; or, instead, the assistant takes over the operator’s duties, while

the latter himself extracts the foreign body.

(_b_) In the second method the animal is fixed in a different position,

the head being held about 10 to 12 inches from the ground, with the neck

lowered and inclined towards the earth. As in this position the

œsophagus is longitudinally relaxed, and can be dilated to its fullest

extent transversely, the difficulty of displacing the obstacle should be

very much less. In this case the operator always stands on the left side

of the neck, but with his back towards the animal’s body. The right arm

is passed around the neck and the right hand pressed into the right

jugular furrow, the left hand being similarly engaged in the left

jugular furrow. The method of employing the fingers is identical, or

instead of the fingers the thumbs may be used.

[Illustration: $1]

When the obstructing object has been lifted as far as the pharynx it has

a tendency to fall out of the mouth, and if it fail to do so it can be

fixed in position and removed as in the preceding case.

II. =Extraction.= These methods are applicable to cases where the

foreign body has become fixed in the cervical region, but more

especially to obstructions in the intra-thoracic part of the œsophagus.

In the majority of cases they are dangerous, and may lead to pinching,

rupture, or perforation of the œsophageal mucous membrane. They should

therefore be regarded as exceptional measures. Theoretically, the

instruments described are perfect, but practically they do not secure

the results anticipated, because one can never prevent displacement,

wrinkling, and involution of the œsophageal mucous membrane.

The forceps probang has the drawback of seldom grasping smooth foreign

bodies with sufficient firmness to permit of their extraction.

The corkscrew sound exposes one to the great danger of completely

piercing the œsophagus, because it has to be managed blindly, and

because one never knows at what depth the corkscrew portion should be

protruded in order to obtain a proper hold of a foreign body.

III. =Passage of the probang.= When taxis fails or is inapplicable, we

are forced to attempt thrusting the foreign body onwards. The method is

much safer than the preceding, but, nevertheless, demands great tact,

prudence, and gentleness. Suitable œsophageal sounds are made with

cupped extremities, though in cases of emergency an instrument can often

be successfully improvised from a cane, whip handle, or flexible stick,

about 4½ to 5 feet in length, securely wrapped at one end with cloth or

tow and freely coated with some greasy material such as lard, vaseline,

or oil.

The end of the sound having arrived in contact with the obstacle, the

operator exercises moderate but permanent pressure. The obstacle may not

move immediately, because of spasm of the œsophagus, which grasps it. It

is therefore necessary to wait and to take advantage of a moment when

the resistance is less, and even then the obstacle may not move.

Rough manipulation with improvised sounds may tear, fissure, or

perforate the muscular and mucous coats, producing the gravest

consequences.

IV. =Crushing.= The crushing of an obstruction in the cervical region

was long ago suggested, and is still greatly commended by empirics and

farriers. It is performed by means of a little mallet and a piece of

board. The method is barbarous, and exposes the animal to such grave

complications as crushing of the œsophageal walls, followed by necrosis,

laceration of the connective tissue, and interstitial hæmorrhage,

injuries of the superficial or deep-seated jugulars, of the carotid

artery, pneumo-gastric nerve, etc. It should never be practised, even

although attempts have been made to improve it by replacing the mallet

and board by specially formed forceps intended for crushing potatoes or

roots. Only in the rare cases where one is certain that the foreign body

consists of a very ripe fruit could crushing be justified, and in this

case there is no need to have recourse to special instruments, for the

hands alone suffice.

=Injection of alkaloids.= The practitioner occasionally finds himself in

the embarrassing position of having vainly tried all the above methods.

Before adopting the last resource, viz., œsophagotomy, it is then worth

while to test the action of certain alkaloids, injected subcutaneously,

after having punctured the rumen.

We know that pilocarpine and eserine stimulate secretion and the action

of the bowels. Injected under the skin they cause frequent swallowing

efforts, and intense peristalsis extending throughout the length of the

digestive tract. Doses of 1½ to 2 grains of pilocarpine and 1 to 1½

grains of eserine, according to the size of the animal, sometimes

produce excellent results, and rapidly remove obstructions.

Apomorphine, the effects of which are, so to speak, inverse, because

they tend to produce anti-peristalsis and vomiting, may be tried in

doses of 2 or 3 grains.

=Œsophagotomy.= The last resource is œsophagotomy, which, however, is

only applicable in cases of obstruction of the cervical portion of the

œsophagus. It should be performed as described in the section hereafter

on operative manipulation. (See also Möller and Dollar’s “Regional

Surgery,” p. 166.)

The point selected is necessarily governed by the position of the

obstacle. There is no need to enter into full details. We may remark

that it is not always necessary to perform the complete operation, and

the third and fourth stages can sometimes be avoided by substituting for

them attempts to break down the foreign body by submucous manipulation.

The œsophagus, having been exposed and isolated, is punctured with a

straight tenotome immediately below the obstacle. A curved tenotome is

then introduced, and the root, potato, or fruit divided. As a rule, a

little pressure from the outside then causes one or other of the

fragments to move onwards and deglutition becomes normal.

Attempts have also been made to divide the obstructing body directly

without previous incision and without isolating the œsophagus. It is

much more difficult, for the least movement of the patient changes the

relationships of the superposed layers and introduces obstacles to the

manipulation of the blunt-pointed tenotome which is employed. More

success often attends attempts to puncture the object with a fine

trocar.

RUPTURES AND PERFORATIONS OF THE ŒSOPHAGUS.

=Causation.= Wounds of the œsophagus caused by external violence are

rare, or at least secondary; lacerations produced from within, on the

contrary, as a result of clumsy manipulation are relatively frequent.

They may extend throughout the length of the tube, but in a far greater

number of cases are found near the entrance to the stomach at the point

where the œsophagus turns towards the left.

The passage of the œsophageal sound or probang is apt to exaggerate this

curvature, and if pushed violently the instrument may produce first a

flexure, then a partial rupture or even a perforation of the tube.

In other cases a rough, irregular, infected foreign body may when

swallowed penetrate the wall and cause inflammation, necrosis and

perforation of the œsophagus.

=The symptoms= are always very grave, and of rapid development. They

consist in local œdematous swelling, sero-sanguineous infiltration at

the entrance to the chest, in the pretracheal region and along the

jugular furrows.

The pneumo-gastric and inferior laryngeal nerves being compressed,

dyspnœa results. If the œsophagus is perforated in the thoracic cavity

septic pleurisy at once sets in.

=Diagnosis.= The diagnosis is easy, provided the history point to

perforation of the œsophagus.

=The prognosis= is fatal whenever the perforation is within the thorax.

It is sometimes possible to intervene in cases of perforation in the

cervical region, but from the economic standpoint such intervention is

of little value.

CHAPTER IV.

DEPRAVED APPETITE—PICA—THE LICKING HABIT.

Depraved appetite, causing animals to swallow bodies which cannot

properly be described as food, is frequent. The condition is commonest

in adult animals of the bovine species, in calves and in lambs. The

consequences are sometimes very serious, so that although depraved

appetite does not represent a well-defined morbid entity, it is

important to be in a position to remedy it.

Depraved appetite does not appear under the same conditions in young and

in old animals. In adults it often results from faulty feeding, or from

some wasting disease which develops insidiously, or remains

unrecognised; in young animals it is the result of insufficient

nourishment.

Roloff & Röll hold that pica is the first symptom of osteomalacia (which

see).

DEPRAVED APPETITE IN THE OX.

=Causation.= In the bovine species depraved appetite occurs in adult,

debilitated animals, which are often, though not always, suffering from

some well-marked digestive disturbance.

The frequency of this symptom, and the peculiarities in its occurrence,

have caused it to be referred to a large number of different causes,

among which may be mentioned bad hygiene, chronic gastro-enteritis,

tuberculosis, osseous cachexia, pasteurellosis, gestation, etc.

It is very certain that the peculiarity in the appetite is, above all,

the result of incomplete and irrational alimentation. The animal has

certain special requirements, to meet which the food must be of suitable

composition. If these alimentary and digestive conditions are not

fulfilled, depraved appetite may occur, even in animals which appear

well nourished. Certain authors refer the appearance of this condition

to want of certain soda salts in the daily ration, and, in support of

this opinion, they point to the frequency of the disease in mountainous

regions where the geological formation is chiefly granite, as in the

Black Forest. Alluvial soils are supposed not to produce it. It

certainly seems more common on soils lacking in certain constituents or

exhausted by repeatedly growing certain crops. Nevertheless, in France

it might be urged that pica occurs equally on all kinds of soil, and a

German author, Lemke, ascribes this perversion of nutrition to the want

of phosphorus. Haubner and Siedamgrotsky attribute it to a nervous

disorder. All causes which exhaust the organism, especially all chronic

diseases of digestive origin, may induce aberration of appetite.

Permanent stabling, confinement, absence of sunlight, want of exercise

and pure air contribute to the general debility which predisposes to

attack. Dry seasons, by reducing the supply of food, have a similar

effect.

In tuberculosis and in pasteurellosis, it is the general organic decline

which produces these puzzling changes in appetite. Similarly the

influence of gestation depends on the superadded demands on the organism

caused by the development of the fœtus.

=Symptoms.= The symptoms may be divided into two phases.

In the first phase, the animals still preserve their appetite, but

whenever they have an opportunity they eat earth, sand, manure, litter

saturated with urine, plaster, etc. They lick the walls, the boarding,

the mangers and the trees, and they chew and swallow linen spread out to

dry.

This phase may continue for a very long time, three to four months or

more, provided no acute complication results from the eating of such

foreign material. There is no fever, but the appetite, although well

preserved, is often capricious, and the ordinary food is eaten slowly.

In the second phase, which frequently marks the development of

complications produced by the passage, contact, or prolonged sojourn of

various materials in the digestive tract, fever appears, little marked

as a rule, but continuous in character.

The appetite is diminished. The animal wastes; the secretion of milk

diminishes, and signs of chronic gastro-enteritis may be noted. The

perversion of appetite still continues; rags, decomposing or filthy

materials, pieces of old shoes, etc., are eaten, and it is not

surprising that such substances should have an unfavourable effect on

the mucous membrane of the digestive tract.

The wasting process slowly leads to marked emaciation, and after an

interval of from six months to a year, or even two years, the patients

die in a state of complete exhaustion. The lesions found on post-mortem

examination are those of various diseases capable of producing depraved

appetite or simply lesions of chronic gastro-enteritis.

=Diagnosis.= The diagnosis presents no difficulty. The important point

is to discover whether or not there exists some previously unrecognised

primary disease.

=Prognosis.= The prognosis of this condition is grave, because depraved

appetite is frequently only a symptom of some incurable disorder, or

because the changes in the digestive mucous membrane are already too far

advanced to permit of much improvement.

=The lesions= comprise: general emaciation, presence of a yellow serum

in the fatty tissue, muscles pale and flabby, catarrh of the mucous

membrane of the stomach and bowel. The blood seems less in quantity and

coagulates feebly or not at all.

=Treatment.= The treatment should be directed against the primary cause,

if such exists (osseous cachexia, pasteurellosis, gestation, etc.).

In other cases a change in management and in feeding, and the

administration of food rich in mineral salts like chlorides, carbonates,

and phosphates of lime, soda or potash, produces the best possible

results. The leguminous foods, sainfoin, clover and lucern, are to be

recommended. The animal, if formerly stabled, should be turned out and

its living conditions entirely altered.

It is often useful to place a block of rock-salt in the manger; when

hyperacidity of the stomach is suspected lime water, chalk, or magnesia

should be given. Where digestion is weak or slow HCl, pepsin and

vegetable bitters are indicated. Nevertheless, one sees cases which

refuse to yield to any of the ordinary methods. In treating these, Lemke

has recommended the subcutaneous injection of chloride of apomorphine, a

drug which may be regarded as a true specific. The doses vary between 1½

and 3 grains, and an injection is given once a week for three weeks in

succession. After this the tendency to pica is said to disappear and the

general condition to improve. The treatment must be repeated every three

months in countries where depraved appetite appears general and

permanent.

It is difficult to understand by what mechanism this drug produces the

effects attributed to it, but those who have employed it speak very

highly of its action.

We may add that in addition to the different modes of treatment, it is

not infrequently necessary to hastily perform gastrotomy in order to

avoid fatal consequences, which would otherwise follow indulgence in

this habit. When an animal has swallowed a considerable quantity of

linen, for example (and Moussu has seen cases in which many pounds

weight had been devoured), immediate intervention is required to avoid

intestinal obstruction. Furthermore, when the history is quite clear

gastrotomy allows the entire mass of foreign bodies, ingested at

different times, to be removed.

DEPRAVED APPETITE IN CALVES AND LAMBS.

=Causation.= Depraved appetite is commonest in calves and lambs when the

animals are insufficiently nourished, or when the mothers are suffering

from chronic debilitating diseases and are therefore yielding milk poor

in fat and in mineral constituents. In a few rare cases it is impossible

to discover what causes the young animals to devour these foreign

materials. Even fully-grown sheep, when shut up together in winter,

acquire the habit of chewing each other’s wool, sometimes to the extent

of virtually depilating their fellows and accumulating wool balls in

their stomachs.

=Symptoms.= Calves have a tendency to lick themselves or their

neighbours, and thus little by little collect a varying quantity of hair

which they swallow. When this habit of licking is little marked the

quantity of hair ingested may not be dangerous; but in the contrary case

the hair (which cannot be digested) accumulates and is permanently

retained in the abomasum. It soon becomes converted into masses,

cemented together with mucus, and forms round balls, to which the name

of œgagrophiles has been given. If these œgagrophiles, or hair balls,

are of small size, they prove of trifling importance; but too frequently

they attain considerable dimensions and obstruct the pylorus or the

intestine. The young calves then refuse all nourishment, and die in

twenty-four to forty-eight hours in a state of complete exhaustion or

after a series of epileptiform attacks.

In lambs the complications due to depraved appetite develop in a similar

way, but the wool swallowed is obtained from the mothers. The lambs

first suck the locks of wool, then tear them off and swallow them. So

long as these peculiarities of appetite are little marked no bad results

follow; but if the shepherd is careless, and fails to note the condition

of his young flock sufficiently early, accidents occur.

The wool is not so easily converted into balls as is hair, but it soon

accumulates in the pyloric region or in the intestine, and forms

obstructing masses. The little patients lose appetite and lie down in

corners, where they are found dead after twenty-four to forty-eight

hours. The masses of wool or of hair are rarely passed with the

excrement; more frequently they are vomited, but this again is

exceptional; usually they become arrested at the entrance to the

pylorus. The lambs show colic, tympanites of the abomasum, and attempts

at vomiting, though unfortunately these are often overlooked. The

quantity of wool found in the abomasum and intestine on post-mortem

examination may be considerable, in relation to the size of the

digestive compartments. Death results from intestinal obstruction,

exactly as in the case of calves.

These aberrations of appetite in lambs have been considered as due to

the want of sufficient mineral salts in the mother’s milk; and it has

been stated that the lambs practise this habit because of the laxative

result of the fat contained in the wool swallowed. The explanation seems

very logical, though it is by no means perfectly proved. It is certain

that this habit becomes particularly common after years in which forage

has been scarce and among flocks in bad bodily condition. The force of

example also plays a certain part, and animals probably imitate one

another, and so acquire the disease. This explains the importance of

early segregation.

=Diagnosis.= The diagnosis of depraved appetite, pica, or the licking

habit presents no difficulty; but it can only be arrived at by the

cowman or shepherd, for the symptoms can only be detected by continued

watching.

The diagnosis of pyloric or intestinal obstruction is very difficult in

the absence of information. It becomes easy after the first post-mortem

examination has been made.