Part 15

TUMORS OF THE PHARYNX.

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

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

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

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

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

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

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

ESOPHAGITIS. INFLAMMATION OF THE GULLET.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SPASM OF THE ŒSOPHAGUS. ŒSOPHAGISMUS.

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

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

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

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