CHAPTER V.. Acute Inflammation of the Gastric Compartments.

ACUTE INFLAMMATION OF THE GASTRIC COMPARTMENTS.

RUMENITIS—RETICULITIS—GASTRITIS.

=Causation.= Acute primary inflammation of the first gastric reservoirs, viz., the rumen and reticulum, is not common. It sometimes accompanies such infectious disorders as foot-and-mouth disease, gangrenous coryza, etc., but then constitutes an added phenomenon which should be studied along with the original disease itself. Rumenitis or reticulitis may however follow the ingestion of irritant foods or plants, of very hot liquids, and more frequently still of unskilfully compounded medicines. In such cases the mucous membrane is directly attacked, and pathological congestion, infiltration, and desquamation may follow, or even vesicles and ulcerations may rapidly be formed.

=Symptoms.= Inflammation of the rumen or reticulum is announced by loss of appetite, suspension of rumination or of regular peristalsis, slight tympanites, and particularly by excessive sensitiveness to palpation. This sensitiveness is general, but is more specially marked in the left lower third of the abdominal cavity, and in the retro-ensiform region which corresponds to the position of the reticulum. Moderate fever is present.

These symptoms, which indicate the gravity and intensity of the inflammation, may persist, become aggravated, provoke vomiting from the rumen, and leave as a legacy motor dyspepsia, or even more serious consequences. On the other hand, they may progressively diminish and disappear for good.

=Lesions.= The lesions comprise hyperæmia of the walls of the rumen and of the mucous membrane, extensive local exfoliation of epithelium, and sometimes true ulceration of the mucous membrane.

=Diagnosis.= The diagnosis is based on the exceptional sensitiveness of the gastric compartments on palpation, and also on the history, provided reliable information can be obtained.

=Prognosis.= The prognosis should be reserved, because it is never possible to foretell whether acute lesions may not give place to chronic disease, which, though apparently unimportant, may terminate in grave consequences.

=Treatment.= Owing to their local action demulcent drinks and teas are indicated. Cooked food is useful, because it makes little demand on the digestive powers; steamed hay and farinaceous substances are given, both on account of their nutritious qualities and of the slight local irritation they cause when swallowed.

Lukewarm drinks and saline laxatives, such as the sulphate of soda, and carbonate of soda or Carlsbad salt in small doses of 1½ to 2 ounces, seem most useful in combatting the reflex atony of the digestive compartments.

=Inflammation of the omasum=, like that of the rumen and reticulum, occurs as a secondary phenomenon in conditions like rinderpest, Texas fever, foot-and-mouth disease, anthrax, and gangrenous coryza (malignant catarrh); but primary inflammation is much rarer even than that of the rumen and of the reticulum.

This is accounted for by the deep position of the omasum, which is thus sheltered from external violence, early contact with irritant foods and from the effect of chills, etc. It can only become inflamed by the prolonged action of irritant food and drink, which have already produced lesions in the rumen and reticulum; or as a consequence of the prolonged stagnation of dry food in cases where animals have been deprived of water.

Under these conditions inflammation of the omasum develops slowly, and from the clinical point of view is identical with what was formerly known as obstruction of the omasum. Obstruction or impaction is probably much rarer than has been stated, in so far at least as it constitutes a primary condition, for in the great majority of cases it is consecutive to impaction, inflammation of the rumen, or inflammation of the abomasum. Obstruction of the omasum, which was formerly invoked in all doubtful and ill-defined cases of digestive disturbance, seldom occurs as an isolated disease.

It has been suggested that the omasum, being supplied with nerves solely by the sympathetic system, and provided with a relatively weak muscular coat, was more susceptible than the other reservoirs to the reaction of abdominal reflexes, and therefore more subject to inflammation, indigestion and obstruction. We do not hold that view, because, as a result of its general situation and the position of its orifices of communication, this compartment is easily able to expel its contents so long as they are liquid. Its function appears chiefly to be to complete the trituration of food after rumination.

We do not consider that inflammation of the omasum never occurs, for we are well aware of the contrary, and that the inflammation assumes a subacute course and is accompanied by stasis of the semi-digested food between the mucous leaves which partly fill the cavity. We simply wish to emphasise the view that the condition is not a primary and isolated inflammation.

=Symptoms.= The symptoms are always vague and very difficult clearly to define.

Inflammation of the omasum is indicated by relative loss of appetite, marked thirst, general atony, and diffuse and vague sensitiveness in the inferior half of the right hypochondrium (zone of the asternal ribs). There are no pathognomonic symptoms.

Obstruction has also been described as accompanied by loss of appetite, constipation, the passage of black, coated, fœtid and sometimes blood-streaked fæces, symptoms of chronic tympanites with fœtid eructations and sometimes vomiting. These sometimes accompany hydrochloric acid dyspepsia, a form of chronic gastritis, and, from our standpoint, the stagnation of food in the omasum is only secondary. We therefore interpret the facts in quite a different manner, and believe that only by a rational and physiological interpretation of the symptoms observed can one diagnose the condition.

=Diagnosis.= The diagnosis of inflammation of the omasum can only be made by a process of exclusion; and although we are admittedly dealing with a condition secondary to disturbance of the rumen and reticulum, or on the other hand consecutive to inflammatory states or to modifications in the secretion of the abomasum (dyspepsia), the diagnosis does not present insuperable difficulties.

=The prognosis= is only grave when the primary acute or chronic conditions of the other gastric compartments are serious.

=The lesions= comprise abnormal vascularity of the mucous membrane and desquamation, and even gangrene, of the leaves. The partially digested food is not passed on, becomes dry and hard, and in time aggravates the local condition.

=The treatment= does not essentially differ from that of other gastric inflammations. The object to be attained is to evacuate as completely as possible, not only the omasum, but all the gastric reservoirs, for which purpose one may freely administer demulcent drinks—linseed gruel, bran mashes and lukewarm liquids containing laxatives. At first such alkaloids as arecolin and pilocarpine may be subcutaneously injected to ensure energetic and speedy evacuation.

Later on slightly stimulant aromatic infusions, like infusions of sage, peppermint, hyssop, thyme, etc., stimulate the functions of the stomach and hasten the return of normal conditions.

ACUTE GASTRITIS.

The term “acute gastritis,” sometimes “gastro-enteritis,” is used in bovine pathology to indicate inflammation of the abomasum. If this inflammation is confined to the superficial epithelial layers it is defined as superficial catarrh of the abomasum; if, on the contrary, it extends to the deep epithelium of the gastric glands and to the mucous corium, it is termed deep-seated gastritis.

Clinically it is impossible to make these distinctions. We simply recognise degrees of gravity, and only in this way can one diagnose acute gastritis, phlegmonous gastritis, ulcerative gastritis, etc.

=Causation.= The abomasum frequently becomes inflamed as a consequence of irritant foods, apart altogether from lesions of the rumen or reticulum, the mucous membrane lining the abomasum being so much more delicate than that of either of the two first compartments.

Irritant plants, parasites, acid drinks, very cold water, certain acid or toxic industrial residues like mouldy brewers’ grains, fermented vegetable pulp, decomposed beet, etc., and mouldy or spoilt forage of any kind may all produce acute gastritis.

Intense feeding—i.e., feeding with farinaceous materials, with large quantities of beans, roots, peas, given regularly—may also cause gastritis by overtaxing the functions of the organ. Frozen or fermented roots and sudden changes in feeding produce similar results. Chills have also been blamed, but it is probable that they only act as favouring causes.

=Symptoms.= It is necessary to consider these very carefully in order to arrive at a correct diagnosis.

Inflammation of the abomasum is attended with moderate fever, diminution in appetite, irregularity in rumination and some tension of the rumen, without, however, true tympanites.

At first the bowels are constipated, but in time fœtid diarrhœa sets in. Examination of the digestive apparatus on the left side and in the right posterior abdominal region reveals nothing abnormal, but pressure over the lower portion of the abdomen and along the cartilages of the right hypochondriac region produces, on the contrary, well-marked pain. This region corresponds to the position of the abomasum.

The conjunctiva appears reddish yellow, as in most visceral inflammations.

Some authors have described attacks of extreme excitement, but these are no more pathognomonic than is grinding of the teeth, which is a constant symptom, or the metallic sound noted on auscultation of the rumen. This sound occurs in all cases of inertia of the rumen, and indicates distension and emptiness of the viscus (acute peritonitis, chronic adhesive peritonitis, inflammation of the reticulum as a consequence of the presence of foreign bodies).

Dull colic and groaning are not uncommon. Finally, Thierry and others have all mentioned an alliaceous smell of the eructations as pathognomonic.

Acute gastritis develops regularly in ten to fifteen days, after which the symptoms diminish and disappear, giving place to normal health. In grave cases, despite proper treatment, acute gastritis more frequently ends in a chronic condition, finally leading to gastric atrophy, and the insufficient secretion of hydrochloric acid, with all the consequences of these conditions. The glands of the stomach degenerate; the secretion becomes abnormal and dyspepsia is set up.

=Diagnosis.= The diagnosis is rather difficult, for the condition is very apt to be confused with primary dyspepsia, or with inflammation of the gastric compartments. It might also be mistaken for acute enteritis of the first part of the small intestine; but as gastritis is very often complicated with duodenitis, such a mistake is without serious consequences.

=Prognosis.= The prognosis is grave, not because death is a frequent termination, but because the disease very often leads to chronic incurable lesions.

=The lesions= consist of congestion of the vascular network of the mucous and sub-epithelial coats, serous infiltration of the corium and submucous connective layers, desquamation, and later in excessive proliferation of the epithelium.

When the inflammation is deep seated the epithelium of the gastric glands becomes swollen and cloudy, and undergoes a kind of atrophic degeneration. In very grave cases, petechiæ, superficial capillary hæmorrhages, and slight ulceration may be noted. The mucous folds are always thickened and infiltrated.

=Treatment.= In cases of gastritis or acute gastro-duodenitis moderate bleeding (three to four quarts) and local stimulation were formerly recommended. This practice certainly has its advantages, provided it is not pushed to excess. Sinapisms give good results, but as they must be left in position for a considerable time, it is often better to apply vesicants over the lower right hypochondriac region. At first purgatives are useful, because they unload the digestive tract, arrest the organic fermentation which results from stagnation in the movement of food along the alimentary tract, and diminish the tendency to intoxications or infections.

At a later stage small doses of laxatives and bicarbonate of soda should be given daily, the diet being of an emollient character, and consisting of milk, starchy or farinaceous foods, and small quantities of good hay.

Linseed, bran, cooked grain, decoctions of pellitory, barley and various cereals may also be administered with advantage.

CATARRHAL GASTRITIS IN SWINE.

=Definition.= Inflammation of the gastric mucosa, with muco-purulent discharge.

=The causes= comprise irritants, fermented or putrid swill, decomposed food, excess of brine, alkalies (washings from table dishes, hotels, etc.), gastric parasites.

The condition occurs also in hog cholera, swine plague, rouget, etc.

The chief =symptoms= are: Inappetence, vomiting, uneasiness, colic, constipation or diarrhœa, fever, stiffness, tense and tender abdomen, arched back, frequent grunting, limpness of the tail. Sudden vomiting may bring about a rapid recovery.

=Treatment= calls for a complete change of food, which may include freshly cooked roots, linseed or meal, butter milk, boiled milk, etc.

As an emetic 30 grains of ipecacuanha may be given. Constipation can be relieved by a dose of calomel or jalap. If diarrhœa is persistent small doses of grey powder should be given, and to combat the irritation of the gastric mucous membrane bismuth subnitrate is also useful.

The piggery should be cleansed and disinfected, and the litter frequently changed.

ULCERATIVE GASTRITIS.

Ulcerative gastritis (ulcer of the abomasum) is recognised after death, but hitherto it has been impossible to so clearly identify the symptoms as to permit of diagnosis during the animal’s life. It has been found after death in adults and in calves (Ostertag).

=Causation and Pathogeny.= The cause of gastric ulceration is decidedly obscure, though we know that certain forms occur during infectious diseases like cattle plague, foot-and-mouth disease, gangrenous coryza, and as a consequence of certain direct local infections; other forms result from the administration of drugs; and finally some are of secretory origin.

In human medicine at the present day there is a tendency to refer the development of round ulcer and ulcerative gastritis to the secretion of an excess of hydrochloric acid. Probably the same cause may be at work in domestic animals, but the proof has not yet been given.

With regard to the pathogeny, the theories of embolism or of thrombosis of capillary vessels find favour with few authorities at the present day. Yet these explanations are logical enough, for if we prevent physiological irrigation of any given part, it is possible to conceive that ulcer formation may follow from auto-digestion, i.e., from the simple action of the gastric juice on a surface which is no longer protected.

The theory of microbic origin has been advanced; but although it may be accepted in relation to the intestine, where the most varied organisms abound, it is scarcely so applicable to the stomach, in which acidity is always very marked and must exercise a very energetic antiseptic action. In sucking calves, however, this theory appears the most plausible.

It is quite certain that ulceration may result from the unwise use of drugs, like tartar emetic or arsenious acid, especially if these be administered for long periods; but such ulceration always occurs at the same points, viz., at the deepest portion of the rumen, reticulum, or abomasum.

On the other hand, ulceration due to secretory disturbance occurs at different points, and the figure opposite shows that the mucous folds themselves may be injured and perforated.

=Lesions.= Ulceration of the abomasum varies in severity. The case referred to showed excavated ulcers from the site of which a portion or the whole of the epithelium and glandular layer had been shed; true round ulcers, which had destroyed the entire depth of the mucous membrane and had produced chronic inflammation and sclerosis of the muscular layer; and finally perforations resembling cleanly punched-out holes.

=The Symptoms= are those of a mild form of ordinary acute gastritis, without marked fever, and without special injection of the conjunctiva. The appetite is diminished and irregular, but more as a consequence of excessive reflex sensibility of the injured organ than from absence of hunger. This excessive reflex sensibility of the abomasum causes relative or absolute gastric intolerance, so that only a small amount of the food ingested passes towards the intestine.

Absolute intolerance on the part of the abomasum may even occur, as in a case described by Moussu in 1895, which produced a very special form of impaction of the rumen, absolutely different from primary impaction.

Intolerance of the abomasum for food already ingested and ruminated may extend to the omasum. Peristalsis of the rumen then ceases, and slight tympanites occurs. The most characteristic condition is the existence of obstinate constipation. If ulceration takes place without producing any important vascular lesion, which, however, is rare, the fæces are hard and coated, but without other peculiarity; if, however (and this appears to be the rule), local hæmorrhage occurs, the extravasated blood is modified by the gastric and intestinal juices, and the fæces appear of a black, tarry colour. This coloration is very significant, and differs from that produced by the bile. It occurs only in gastric hæmorrhage, and at intervals.

=Diagnosis.= The diagnosis of gastric ulcer is difficult, and can only be arrived at with confidence when the above-mentioned coloration of the fæces can be detected.

=Prognosis.= From an economic standpoint the prognosis is grave. The patient may recover; the ulcers may heal, but cicatrisation is always prolonged, and as, on the other hand, the glandular apparatus of the abomasum is generally more or less injured, complete recovery is impossible.

=Treatment= should be directed towards checking hæmorrhage, diminishing intolerance to food, and assisting the healing of the lesions. These objects are facilitated by prolonged complete rest in the stable, by injecting ergotine, or, ·7 per cent. saline solution, at the time when the hæmorrhage occurs, and, if possible, by placing the animals on milk diet or on emollient food, like gruels, emollient infusions, barley, milk, cooked roots, etc.

Stimulation over the region of the abomasum is also of value. At a later stage, when the acute symptoms have diminished, Carlsbad salts, in doses of 1 to 2 ounces per day, can be given. Bicarbonate of soda is also of considerable value.

CHRONIC TYMPANITES.

Chronic Indigestion—Obstruction of the Abomasum—Chronic Gastritis—Dyspepsia.

Among pathological conditions of the stomach in ruminants a certain number are clinically marked by one constant symptom, viz., chronic tympanites, a fact which was formerly recognised as indicative of chronic indigestion.

It is evident that such titles have only the significance accorded them, and the term chronic indigestion used only to mean that gastric digestion was badly performed, and that the condition was more or less permanent. It being granted, on the other hand, that the term indigestion is used to characterise temporary conditions during which digestion is suspended, and produces immediate disturbance, it would appear that the term gastric dyspepsia is more exact and more in conformity with the present state of our knowledge of general physiology. In studying this question it is clear a number of facts still require explanation, for, as has been previously indicated, we know almost nothing concerning the variations in the chemical phenomena of gastric digestion under different morbid conditions; nevertheless, the dominant fact, the imperfect or irregular digestion, is easily appreciable. Future discoveries will no doubt enable us more exactly to differentiate several dyspeptic conditions due to chemical or mechanical causes and with or without anatomical lesions. At present it is sufficient to indicate the limits of inquiry.

=Causation.= The symptom of chronic tympanites accompanies a great number of very different conditions—some due to disease of the digestive tract itself, others to general diseases or lesions of neighbouring parts. In the latter cases the tympanites is only indicative of secondary dyspepsia; in the former, on the other hand, the dyspepsia is primary.

Secondary dyspepsia occurs very commonly during tuberculosis, diseases of the liver, subacute or chronic peritonitis, gestation, lesions of the mediastinum, etc., etc.

=(a) Secretory or Chemical Dyspepsia.= In primary dyspepsia it is impossible to discover any lesion sufficient to explain the disturbance. Chronic tympanites, for instance, follows prolonged consumption of rough or bad food (in years when forage has been scarce or winter food has been lacking), and too short a supply of water for weeks in succession. It also occurs as a consequence of acute inflammation of one or other of the gastric compartments—rumenitis, reticulitis, gastritis. Sometimes it assumes an insidious, slow, progressive form, without any apparent cause whatever.

In these various conditions, the mucous membrane of the gastric compartments suffers from the deferred results of the bad feeding or want of water. Its secretory powers and anatomical structure becoming modified, it is no longer able regularly to elaborate the juices necessary for digestion, and chronic indigestion, imperfect digestion, or dyspepsia result. Similar results follow acute inflammation of the omasum, reticulum, or rumen. Integral repair becomes impossible. Anatomical injury is done, disturbance of secretion follows, and dyspepsia is a necessary consequence.

=(b) Motor Dyspepsia.= Finally, it would appear that general bad health, abstinence and exhausting work, may produce a form of dyspepsia, unconnected with secretory disturbance, but resulting from mechanical disturbance due to general enfeeblement and to atony of the muscular walls of the gastric compartments. The rumen ceases to perform its work of mixing the food, the reticulum also acts badly, and the abomasum receives imperfectly prepared material. The result is what might be described as motor dyspepsia, in opposition to those forms which are of chemical origin.

The condition may vary in degree, peristalsis being diminished (one contraction every two or three minutes instead of two per minute), or being simply intermittent and occurring only for a few hours during the day, or finally being altogether suppressed. Suppression is never absolute, but atony may be so marked that the mixing of the food is very imperfectly performed.

=Symptoms.= The most constant symptom present in all dyspeptic conditions is chronic tympanites, indicated by a certain degree of tension or by permanent dilatation of the rumen.

Rumination is impeded and irregular, the distended rumen loses its power of contraction, and no longer causes eructation nor passes gas into the intestine. It becomes progressively inert, whether the inertia be primary and occur suddenly, as a result of some particular condition of the sympathetic system (motor dyspepsia), or secondary and of slow development in consequence of disturbance in the gastric secretions and of abnormal organic fermentation (secretory dyspepsia).

This symptom of tympanites is always accompanied by irregularity, diminution, and frequently also by depravity of appetite.

Wasting occurs, but to a very varying degree, according to the nature of the primary condition and the method of feeding.

These general symptoms are accompanied either by constipation or by diarrhœa; and as stagnation of food leads to fermentation, which always forms products differing from those of normal digestion—toxic materials in fact—a chronic auto-intoxication results, which in its turn, if not remedied, becomes a cause of irritation, and aggravates the bad general condition.

In many cases fever is absent, except during the final complications, in animals in the last stages of wasting; but some signs always exist on which the diagnosis may be founded.

The most frequent clinical type of these dyspeptic conditions is motor dyspepsia, consisting in relative atony of the rumen without disturbance in the secretion of the gastric mucous membranes. Luckily, this is the most easily curable form, and is only marked by distension, dulness and constipation.

Dyspeptic diseases of secretory origin are little understood. Their essential causes have been badly described, and their clinical symptoms are ill-recognised.

We cannot prove whether the forms said to be due in man to excess of hydrochloric acid and insufficiency of hydrochloric acid really occur or are well defined in domestic animals: nor are we better informed as to the exact part played by the organic acid of fermentation (lactic, butyric, acetic acid, etc.); but the most complete investigations which have yet been made justify our supposing there is some parallel.

Moussu described primary ulcerative gastritis in 1895; and as this form is almost certainly associated with excess of pepsin, the occurrence of an excess of hydrochloric acid also seems possible, the more so as the symptoms noted resemble the general symptoms of that condition—preservation of appetite and of the motor power of the rumen, accumulation of food in the rumen as a consequence of reflex intolerance of the abomasum, constipation, and vomiting.

In addition to these two morbid conditions, a third occurs with some frequency. It is characterised by chronic tympanites, alimentary diarrhœa (the food being badly digested), and progressive wasting. This condition seems due to an insufficiency of hydrochloric acid, brought about by chronic gastritis, the epithelial cells of the mucous membrane appearing incapable of producing sufficient hydrochloric acid for digestion.

=Diagnosis.= In the present state of our knowledge regarding digestion in ruminants the precise diagnosis of these pathological conditions must always remain difficult; but it is indisputable that with the above grouping of symptoms we are more likely to succeed than by confining ourselves to the diagnosis formerly common, viz., that of chronic tympanites or chronic indigestion.

The difference between primary and secondary dyspepsia should always be borne in mind, and careful examination will often reveal the special condition which has served as the point of departure for gastric disturbance. Thus generalised tuberculosis, or tuberculosis of the liver or mediastinum, should always be sought for, and the possible existence of such conditions of the liver as echinococcosis, cancer of the bile ducts, tumours, etc., and diseases of the kidneys should be borne in mind. The influence of gestation, which so frequently causes gastric disturbance complicated with albuminuria, should never be overlooked, and in these secondary forms of dyspepsia the determining cause, and not the objective symptoms should receive chief attention.

=Prognosis.= The prognosis of secondary forms of dyspepsia varies with the gravity of the primary disease. The prognosis of primary dyspeptic conditions varies greatly, and that state in which hydrochloric acid is too sparingly secreted is certainly the gravest.

=Lesions.= The lesions have not been carefully studied, but it is probable that in many cases they might afford a key to the symptoms noted. Like all mucous lesions, they are difficult to demonstrate histologically. Infiltration and thickening of the mucous corium and submucous layers have been described. Such lesions indicate nothing; but in some cases new growths have been found in the gastric compartments or contractions about the pyloric orifice, the essential importance of which cannot be doubted.

=Treatment.= If our knowledge is still insufficient to enable us precisely to diagnose what we have termed “gastric dyspepsia,” or what is still currently described as “chronic dyspepsia,” the difficulty is even greater when attempting to lay down lines of treatment, because of the lack of known facts and the want of a base for reasoning. Thus we find, without being able to explain why, that some prescribe tartar emetic, others rapid and energetic purgatives, others, again, laxatives; whilst German authors, apparently without any justification, recommend oil of turpentine. It seems to us, however, that one might do better than this and attempt to lay down some rational indications for treatment.

(a) In cases characterised only by chronic tympanites, without diarrhœa, without manifest constipation (motor dyspepsia), and without any other apparent organic disturbance, drugs calculated to stimulate peristalsis of the rumen seem indicated. The most promising comprise ipecacuanha in doses of 1 to 2 drams per day, tincture of nux vomica in similar doses, powdered nux vomica in doses of 45 to 75 grains, and laxatives like Carlsbad salts in doses of 8 to 10 drams.

Little by little peristalsis returns, becomes regular, and the chronic tympanites disappears for good. This is frequently the case during gestation, when the condition simply consists in motor dyspepsia without anæmia.

(b) If, on the contrary, chronic tympanites is accompanied by constipation, and the fæces are hard or, as is usually the case, covered with mucus, suggesting the probability of excess of hydrochloric acid, salines are indicated—not to the point of producing purgation, which would not lead to any lasting improvement, but still as laxatives, continued daily for ten, fifteen, or twenty days, or, if necessary, even longer.

Carlsbad salts in doses of 8 to 10 drams, or one-ounce doses of sulphate of sodium associated with 2½ drams of bicarbonate of potash after each meal, are to be recommended in preference to bicarbonate of soda alone, because they act on the secretions, on the muscular system, and also on the liver.

(c) Finally, when chronic tympanites is accompanied by diarrhœa, a condition which usually indicates insufficient secretion of hydrochloric acid, the administration of that acid tends to arrest or check organic fermentation and to facilitate digestion in the abomasum by supplementing the diminished physiological secretion. The dosage is an important point. At first small quantities should be given, 2½ drams per day, divided into two doses and freely diluted in the drinking water; but this amount may, if necessary, afterwards be doubled or trebled. The drinking water is not rendered irritant by these doses, for it is admitted, and Moussu has confirmed the fact by analysis, that the quantity of HCl in the gastric juice may rise as high as ·2 to ·3 per cent. Chloride of sodium, the excito-secretory action of which on the gastric mucous membrane is well known, may be given for long periods in doses of 1 to 1½ ounces per day.

In these various chemico-pathological states the food should receive the closest attention. The forage, which should be good, may be supplemented by the addition of cooked roots, demulcent drinks, and, if possible, milk.

GASTRIC DISTURBANCE DUE TO FOREIGN BODIES.

These morbid conditions are extremely complex, but the facts that they are due only to one cause, and that they possess certain symptoms in common, permit of a certain grouping. It would obviously be illogical to speak of traumatic indigestion of the rumen, reticulum, and abomasum, as has been done in more than one book on this subject; for the gastric disturbances described below should be considered as complications, and not as diseases.

=Causation.= In young animals foreign bodies may be composed of hairs, wool, bristles, cotton, and clover hairs.

Hair balls are common in the rumen, and are sometimes met with in the fourth stomach. They cause irritation, indigestion, sometimes pyloric obstruction, dilatation, and eventually death.

Wool balls in lambs, bristle balls in young pigs, cause much gastric irritation. Cotton balls occur in lambs fed on cotton-seed cake; the fibre constitutes a foreign body. The hairs of clover leaves may form a ball in the abomasum of lambs.

Under the influence of depraved appetite animals of the bovine species consume, apart from their regular food, the most varying substances, such as linen, fragments of wood, nails, stones, gravel, sand, etc. Moreover, forage, even when of good quality, often contains foreign bodies like nails and pins (when the fields are near factories), sewing or knitting needles (when the animals are looked after by women), fragments of iron wire derived from bales of compressed forage, etc., etc. The ingestion of such objects is followed by various consequences, which may be studied in three divisions, in the first of which the foreign object is soft in character, in the second is blunt at one extremity and pointed at the other, and in the third is pointed at both ends.

(1.) =Soft objects.= The movements of the rumen, the warmth and the action of the digestive fluids, may cause soft objects to be broken up; the disturbance they produce is then insignificant.

Of such substances, however, some are quite incapable of digestion (clothing, sacks, linen, etc.), and may produce obstructions; others are both indigestible and heavy (gravel and sand), and may fall into the depressions of the compartments, where they remain, or, if passed into the reticulum, may become arrested in the deepest lying part. They then produce atony of the muscular coats, slowing of peristaltic movements, diminution in the frequency of eructation, and, as an additional consequence, chronic tympanites, sometimes visible at the flank.

=The symptoms= are vague and common to a number of the digestive diseases already described. The animals masticate without having anything in the mouth; rumination becomes irregular or is altogether suppressed, but this is not characteristic, being a symptom common to many visceral diseases.

Later, as a result of auto-infection, diarrhœa sets in; under the influence of abnormal fermentation in the gastric compartments the eructations become fœtid; the animals fall into a condition of marasmus. Death usually results after a varying time—when large quantities of foreign substances have been ingested, in twenty to thirty days.

=The diagnosis= chiefly rests on the history, and can only be of a confident character when one knows what quantity and what kind of foreign body has been swallowed.

=The prognosis= is grave, because the animal usually dies of progressive exhaustion.

=Treatment.= There is only one rational form of treatment—viz., gastrotomy, followed by examination of the rumen and reticulum and removal of the foreign body. Before undertaking operation the surgeon should be fully informed as to the cause and the probable results to be expected.

(2.) =Foreign bodies with one pointed extremity.= These usually consist of large-headed nails, or fragments of iron wire rolled up at one end, which have been swallowed during primary mastication along with forage.

When ingested, they may become implanted at any point in the gastric apparatus without necessarily penetrating deeply. When fixed across the division of the reticulum, they cause slowing of its physiological action. Should they penetrate the wall either of the reticulum or of the rumen, they may attack on the right the liver, or on the left the diaphragm or spleen, producing suppurating hepatitis, splenitis, or respiratory disturbance. The hypochondriac region then appears sensitive. The muscular portion of the diaphragm is partly paralysed, and costal respiration set up, while frequent coughing of reflex origin is provoked by irritation of the pneumo-gastric and diaphragmatic nerves, and may give rise to suspicion of some thoracic disease, from which, however, it is distinguished by the absence of discharge, expectoration, and pulmonary symptoms.

Finally, if implanted in the lower wall or sides of the rumen or reticulum, foreign bodies may carry with them infectious agents and set up localised or generalised peritonitis.

=Early diagnosis= is a matter of great difficulty, as it can only rest on the diaphragmatic disturbance or on the symptoms of peritonitis.

=Lesions.= Small-sized sharp bodies cause lesions of trifling extent, which in most cases are only indicated by retardation of movement of the gastric compartments, between which and the diaphragm, and between the diaphragm and the posterior portions of the lung, various adhesions are set up. In such cases the peripheral inflammation ends by producing a fibrous sleeve, which prevents the pleural cavity becoming infected. Other cases show patches of adhesive peritonitis or signs of generalised peritonitis, the real cause of which often evades discovery during life.

=Treatment.= Gastrotomy is the sole means of effecting a cure, but we are forced to admit that it only gives good results when the operator knows what he is trying to find. Without this information he acts in the dark, is obliged to abandon himself to chance, and although luck sometimes favours him, it more often leaves him in the lurch.

(3.) =Foreign bodies pointed at both ends.= Bodies like needles, pins, straight fragments of iron wire, knitting needles and broken hairpins, become implanted in the gastric walls and travel in the most diverse directions, in obedience to the varied movements of the organ injured. They produce results similar to those just described. Most frequently they fall into the lower part of the gastric compartments, pass near the ensiform cartilage, between the pleura and the triangularis sterni into the thickness of this muscle, or into the mediastinum, and there produce either an abscess in the region of the ensiform cartilage, an abscess of the thoracic wall, or a collection of pus in the subpericardial or subpleural region (pseudo-pericarditis). They may even reach the pericardium, causing pericarditis, and sometimes, when adhesions are set up between the heart and pericardial sac, carditis.

By deviating to the right or left, the foreign body may produce pleurisy or even pneumonia. If it moves towards the right, it involves the liver and produces suppurative hepatitis; if to the left, suppurative splenitis. Travelling in a downward direction, it encounters the abdominal wall, and after producing an abscess may be eliminated; passing backwards, it falls into the peritoneum, and may lead to peritonitis. In those exceptional cases in which foreign bodies reach the abomasum they generally become implanted towards the greater curvature, producing in the abdominal wall an abscess which breaks externally, and through which the foreign body is discharged; gastric fistula is then a common sequel.

=The symptoms= vary, according to the complications. The earliest comprise digestive disturbance, which coincides with the passage of the sharp object through the rumen or reticulum, and depends on whether such passage produces local peritonitis and pain, rendering movement of these compartments impossible. Later, when the diaphragm has been penetrated, respiratory disturbance occurs, and is succeeded by apparent improvement, which in its turn may be followed by the occurrence of pericarditis, pleurisy, or abscess formation.

In other cases where suppurative hepatitis or splenitis, or even peritonitis may be present, the symptoms are extremely vague and very difficult to refer to their real cause.

=Diagnosis= is difficult, unless the owner is able to supply exact information that at some previous time the animal had swallowed such and such an object.

=The prognosis= is grave, though cases occur where a foreign body is tolerated, and may for a long time be retained without producing accidents.

=Treatment.= Gastrotomy should not be performed unless the operator is possessed of very precise information. In such case the rumen and reticulum should be emptied and the foreign body sought for and removed.

When the symptoms strongly point to the presence of a foreign body exploratory gastrotomy may be performed, but the operator will do well to employ the operation only as a last resort.

Many complications, like septic peritonitis, hepatitis, and splenitis, are practically hopeless; but others show a tendency to recovery. This is the case when abscesses form in the thoracic or abdominal wall, or beneath the pleura or pericardium. The entire difficulty consists in diagnosis, for when once this is clearly defined intervention is fully justified. As, however, the surgical measures vary in every case, the exact course to be adopted must be left to the initiative of the surgeon.

TUMOURS OF THE GASTRIC COMPARTMENTS.

=Papillomata= result from hypertrophy of normal papillæ; they resemble those of the pharynx and œsophagus. The growth may attain the size of a fist. It often resembles a cauliflower in appearance. When very large, such growths may cause obstruction. A very striking illustration of a papilloma of the mucous membrane is given on p. 180 of Möller and Dollar’s “Regional Surgery.”

=Sarcoma= has been noted by Paule, Kitt, and Schütz as forming in the subserous tissue of the omasum, and later bulging out as a wounded swelling of irregular size.

=Actinomycosis of the abomasum= has been reported by Professor Axe.