TYMPANITIC INDIGESTION IN THE RUMEN. BLOATING.
Definition. Susceptible Genera. Causes; gastric paresis, overloading, cold, fear, exhaustion, poisons, fermentescible food,—new grain, leguminosæ, frosted vegetables, ruminitis, foreign bodies in rumen, microbian ferments. Symptoms, abdominal, general. Gases formed under different aliments—carbon dioxide, marsh gas, hydrogen sulphide, nitrogen, oxygen. Lesions, rupture of rumen or diaphragm, compression or rupture of liver or spleen, petechiæ, congestion of lungs and right heart, of cutaneous and cerebral vessels. Prevention, avoid indigestible and fermentescible aliments, correct adynamic conditions, tonics, avoid injurious ferments, make alimentary transitions slowly. Treatment, exercise, bath or douche of cold water, rubbing and kneading, rope round abdomen spirally, gag in mouth, dragging on tongue, movement of a rope in fauces, probang, stimulants, antiseptics, alkalies, ammonia, oil of turpentine, oil of peppermint, alcohol, ether, pepper, ginger, soda, potash, lime, muriatic acid, carbolic acid, creosote, creoline, sulphites, kerosene, chloride of lime, chlorine, tar, common salt, hypochlorite of soda, magnesia, eserine, pilocarpin, barium chloride, colchicum, lard, trochar, Epsom salts, rumenotomy. Treatment of diseased gullet, mediastinal glands, stomach or intestines.
Definition. The condition is a combination of paresis of the rumen and gaseous fermentation of its contents. The initial step may be the paresis or in the more acute forms the fermentation.
Genera susceptible. While all ruminating animals are subject to this disorder, it is much more frequent in cattle and sheep than in goats.
Causes. It commences in paresis of the rumen in the weak, debilitated, convalescent or starved animals which are suddenly put on rich, and appetizing food. Hence it is common in animals that break into a cornbin, a store of potatoes, a field of growing corn or small grain, or that are turned out on green food in early spring. Cadeac maintains that paresis of the rumen is the essential cause in all cases, while the nature of the aliments ingested fills a secondary and comparatively insignificant rôle. According to this view the torpid stomach can neither relieve itself through regurgitation for rumination, nor expel through the œsophagus the constantly evolving gas which therefore distends the viscus to excess. In support of this view may be adduced the occurrence of tympany through fatigue, fear, cold, enlarged (tubercular) mediastinal glands pressing on the gullet and vagus, obstruction of the œsophagus by a solid body (choking), impaction of a morsel of solid food in the demicanal of the calf as noticed by Schauber, and the cessation of the normal vermicular movements of the rumen in connection with inflammation of its coats, or extensive inflammation elsewhere or finally of fever. Even in paralysis of the stomach by poisons like lead, tympany may be a result. Cadeac attributes tympany following the ingestion of green food wet with a shower, or drenched with dew, of frosted potatoes or turnips, or of iced water, to the paralyzing action of the cold on the rumen. This view is manifestly too extreme, as the bloating occurs often after a warm summer shower, or after the consumption of potatoes and other roots and tubers which have been spoiled by frost but which are no longer at a low temperature when consumed.
Tympany may also start from the ingestion of certain kinds of food which are in a very fermentescible condition. Green food, especially if the animal has been unaccustomed to it, is liable to act in this way. Clover and especially the white and red varieties, lucern (alfalfa), sainfoin, cowpea and other specially leafy plants, which harbor an unusual number of microbian ferments, and which contain in their substance a large amount of nitrogenous material favorable to the nourishment of such ferments are particularly dangerous in this respect. All of these are most dangerous when wet with dew or when drying after a slight shower, partly no doubt at times by reason of the chilling of the stomach, but mainly because the ferments have been stimulated into activity by the presence of abundance of moisture. Drenching and long continued rains are less dangerous in this respect than the slight showers and heavy dews, manifestly because the former wash off a large portion of the microbes, which under a slight wetting multiply more abundantly.
Frosted articles act in a similar way, partly when still cold by the chilling and paralyzing of the stomach, but cold or warm, by reason of the special tendency of all frozen vegetables to undergo rapid fermentation when thawed out. This is true of green food of all kinds when covered by hoarfrost, of turnips, beets, potatoes, carrots, apples, cabbage, etc., which have once been frozen, and of frosted turnips and potato tops, though, in the case of the latter agent, a narcotic principle is added.
In the case of Indian corn, the smaller cereal grains, and certain leguminous plants (vetches, tares, peas, beans) which have the seed fully formed but not yet quite hardened nor ripened, there is the double action of a paralyzing constituent and an aliment that is specially susceptible of fermentation.
Inflammation of the rumen, already quoted as a cause, may be determined by hot as well as cold food, by irritant drugs and poisons, and by narcotico-irritant and other acrid plants in fodder or pasture. In the same way the inflammation caused by the introduction of foreign bodies into the rumen, such as nails, tacks, needles, pins, wires, knife blades, and masses of hair or wool may at times cause tympany.
The two main causative factors, of paresis of the rumen on the one side and of specially fermentescible food and a multiplicity of microbian ferments on the other, must be recognized as more or less operative in different cases, and in many instances their combined action must be admitted. The tympany is the symptom and culmination of a great variety of morbid causes and conditions, and its prevention and treatment must correspondingly vary.
Symptoms. The whole left side of the abdomen being occupied by the rumen, its distension leads to an uniform swelling of that side, differing from that caused by simple excess of solid ingesta in being more prominent high up between the last rib and the outer angle of the ilium, and in giving out in this region a clear tympanitic or drumlike resonance on percussion. It has also a tense resiliency, like that of a distended bladder, easily pressed inward by the finger but starting out to its rotundity the moment the pressure of the finger is withdrawn. The distension caused by overloading with solids bulges out lower down, is not resonant but dull or flat when percussed, and yields like a mass of dough when pressed retaining the indentation of the finger for some time. The swelling of tympany, when extreme, rises above the level of the outer angle of the ilium and even of the lumbar spines on the left side, and if no relief is obtained the right side may undergo a similar distension.
Auscultation detects an active crepitation over the whole region of the rumen, finer in some cases and coarser in others, according to the activity of evolution and the size of the bubbles of gas. The crepitation is especially coarse and loud in fermentation of green food, and of spoiled potatoes or other tubers or roots.
In all acute or severe cases, there is anorexia, suspension of rumination, and the normal movements of the compressed bowels seem to be largely impaired, though the anus is protruded and a little semi-liquid fæces or urine may be expelled at intervals. The breathing is accelerated, short, and labored. The nostrils are dilated, the nose extended, the face anxious, the eyes bloodshot and the back arched. Froth may accumulate around the lips, or the mouth may be held open with the tongue pendent. Sometimes a quantity of gas may suddenly escape with a loud noise, but without securing permanent relief. The heart beats are violent and accelerated, the pulse increasingly small and finally imperceptible, and the visible mucous membranes are congested and cyanotic. Pregnant females are very liable to abort.
When the right flank as well as the left rises to the level of the lumbar spines death is imminent, and this may take place as early as fifteen or thirty minutes after the apparent onset of the attack. Death may result from nervous shock, from suffocation, or from the absorption of deleterious gases, or from all of these combined.
In the less acute cases the animal may live several hours before the affection terminates in death or recovery. As a rule he stands as long as he can and finally drops suddenly, the fall often leading to rupture of the diaphragm or stomach, to protrusion of the rectum, or the discharge of ingesta by the mouth and nose.
In still slighter cases relief comes through vomiting or more commonly through frequent and abundant belching of gas, the swelling of the flanks subsides, rumbling of the bowels may again be heard, and usually there is a period of diarrhœa.
Gases present. When the rumen is punctured before or after death so as to give exit to the gas in a fine stream it proves usually more or less inflammable, the lighted jet burning with a bluish flame. The usual inflammable ingredients are carbon monoxide, hydrogen carbide (marsh gas) and hydrogen sulphide, yet the relative proportion of the gases varies greatly with the nature of the food and the amount of gas evolved, carbon dioxide being usually largely in excess. The following table serves to illustrate the variability:
| Gas. | Pflüger. | Gmelin, from clover | Lassaigne. | Lameyran and Fremy, from clover. | Vogel. | Raiset. |
|---|---|---|---|---|---|---|
| CO | 60–80 | 5 | 29 | 5 | 27 | 74.23 |
| CO | 28–40 | |||||
| CH | 15 | 6 | 15 | 48 | 23.46 | |
| HS | 80 | 80 | ||||
| O | 14.7 | |||||
| N | 50.3 | 25 | 2.22 |
The most elaborate observations on this subject are those made by Lungwitz on the different aliments kept in closed vessels at the body temperature, and on similar agents fed for days as an exclusive aliment to oxen provided with a fistula of the rumen for purposes of collection. He found carbon dioxide to be the predominating gas in all cases, but that it was especially so in extreme tympanies and varied much with the nature of the food. The following table gives results:
| Percentage of CO2. | |
|---|---|
| Buckwheat (Polygonum fagopyrum) | 80 |
| Alfalfa (Mendicago Sativa) | 70–80 |
| Clover (Trifolium pratense) | 70–80 |
| Meadow grass | 70–80 |
| Indian corn (Zea Maïs) | 70–80 |
| Spurry (Spergula arvensis) | 70–80 |
| Hay of alfalfa or clover | 70–80 |
| Oats with cut straw | 70–80 |
| Yellow Lupin (Lupinus luteus) | 60–70 |
| Vetch (Vicia sativa) | 60–70 |
| Oats cut green | 60–70 |
| Potato tops | 60–70 |
| Potatoes | 60–70 |
| Meadow hay | 60–70 |
| Leaves of beet | 50–60 |
| Leaves of radish | 50–60 |
| Cabbage | 40–50 |
The marsh gas varied from 16 to 39 per cent., being especially abundant in cases of abstinence. It should, therefore, be in large amount in the tympanies which accompany febrile and other chronic affections. Hydrogen sulphide was found only in traces, recognizable by blackening paper saturated with acetate of lead. Oxygen and nitrogen were in small amount and were attributed to air swallowed with the food. In the work of fermentation the oxygen may be entirely used up.
Lesions. These are in the main the result of compression of the different organs, by the overdistended rumen. Rupture of the rumen is frequent. The abdominal organs are generally bloodless, the liver and spleen shrunken and pale, though sometimes the seat of congestion or even hemorrhage. Ecchymoses are common on the peritoneum. The right heart and lungs are gorged with black blood, clotted loosely, and reddening on exposure. The right auricle has been found ruptured. Pleura, pericardium and endocardium are ecchymotic. The capillary system of the skin, and of the brain and its membranes, is engorged, with, in some instances, serous extravasations.
Prevention. This would demand the avoidance or correction of all those conditions which contribute to tympany. In fevers and extensive inflammations, when rumination is suspended, the diet should be restricted in quantity and of materials that are easily digested (well boiled gruels, bran mashes, pulped roots, etc.,) and all bulky, fibrous and fermentescible articles must be proscribed. In weak conditions in which tympany supervenes on every meal, a careful diet may be supplemented by a course of tonics, carminatives and antiseptics such as fœungrec oxide of iron, hyposulphite of soda and common salt, equal parts, nux vomica 2 drs. to every 1 ℔. of the mixture. Dose 1 oz. daily in the food, or ½ oz. may be given with each meal.
Musty grain and fodder should be carefully avoided, also mowburnt hay, an excess of green food to which the stock is unaccustomed, clover after a moderate shower, or covered with dew or hoarfrost, frosted beet, turnip, or potato tops, frosted potatoes, turnips or apples, also ryegrass, millet, corn, vetches, peas with the seeds fairly matured but not yet fully hardened. When these conditions cannot be altogether avoided, the objectionable ration should be allowed only in small amount at one time and in the case of pasturage the stock should have a fair allowance of grain or other dry feed just before they are turned out. Another precaution is to keep the stock constantly in motion so that they can only take in slowly and in small quantity the wet or otherwise dangerous aliment.
When it becomes necessary to make an extreme transition from one ration to another, and especially from dry to green food, measures should be taken to make the change slowly, by giving the new food in small quantities at intervals, while the major portion of the diet remains as before, until the fæces indicate that the superadded aliment has passed through the alimentary canal. Another method is to mix the dry and green aliments with a daily increasing allowance of the latter. Some have avoided the morning dew and danger of fermentation by cutting the ration for each succeeding day the previous afternoon and keeping it in the interval under cover.
Treatment. Various simple mechanical resorts are often effective in dispelling the tympany. Walking the animal around will sometimes lead to relaxation of the tension of the walls of the demicanal and even to some restoration of the movements of the rumen with more or less free eructation of gas. The dashing of a bucket of cold water on the left side of the abdomen sometimes produces a similar result. Active rubbing or even kneading of the left flank will sometimes lead to free belching of gas. The same may be at times secured by winding a rope several times spirally round the belly and then twisting it tighter by the aid of a stick in one of its median turns.
A very simple and efficient resort is to place in the mouth a block of wood 2½ to 3 inches in diameter and secured by a rope carried from each end and tied behind the horns or ears. This expedient which is so effective in preventing or relieving dangerous tympany in choking appears to act by inducing movements of mastication, and sympathetic motions of the œsophagus, demicanal and rumen. It not only determines free discharge of gas by the mouth, but it absolutely prevents any accession of saliva or air to the stomach by rendering deglutition difficult or impossible. A similar effect can be obtained from forcible dragging on the tongue but it is difficult to keep this up so as to have the requisite lasting effect. Still another resort is to rouse eructation by the motions of a rope introduced into the fauces.
The passing of a hollow probang into the rumen is very effective as it not only secures a channel for the immediate escape of the gas, but it also stimulates the demicanal and rumen to a continuous eructation and consequent relief. Friedberger and Fröhner advise driving the animals into a bath of cold water.
Of medicinal agents applicable to gastric tympany the best are stimulants, antiseptics and chemical antidotes. Among stimulants the alkaline preparations of ammonia hold a very high place. These, however, act not as stimulants alone, but also as antacids and indirectly as antidotes since the alkaline reaction checks the acid fermentation which determines the evolution of the gas. They also unite with and condense the carbon dioxide. Three ounces of the aromatic spirits of ammonia, one ounce of the crystalline sesquicarbonate, or half an ounce of the strong aqua ammonia may be given to an ox, in not less than a quart of cold water. Next to this is the oil of turpentine 2 oz., to be given in oil, milk, or yolk of egg. But this too is an antiferment. The same remark applies to oil of peppermint (½ oz.), the carminative seeds and their oils, and the stronger alcoholic drinks (1 quart). Sulphuric or nitrous ether (2 oz.) may be given in place. Pepper and ginger are more purely stimulant and less antiseptic. Other alkalies—carbonate of potash or soda, or lime water may be given freely.
Among agents that act more exclusively as antiseptics may be named: muriatic acid 1 to 1½ drs. largely diluted in water; carbolic acid, creosote or creolin, 4 drs. largely diluted; sulphite, hyposulphite or bisulphite of soda 1 oz.; kerosene oil ½ pint; chloride of lime 4 drs.; chlorine water 1 pint; wood tar 2 oz. The latter agent is a common domestic remedy in some places being given wrapped in a cabbage leaf, and causing the flank to flatten down in a very few minutes as if by magic. The extraordinarily rapid action of various antiseptics is the most conclusive answer to the claim that the disorder is a pure paresis of the walls of the rumen. The affection is far more commonly and fundamentally an active fermentation, and is best checked by a powerful antiferment. Even chloride of sodium (½ lb.) and above all hypochlorite of soda or lime (½ oz.) may be given with advantage in many cases.
Among agents which condense the gasses may be named ammonia, calcined magnesia, and milk of lime for carbon dioxide, and chlorine water for hydrogen.
Among agents used to rouse the torpid rumen and alimentary canal are eserine (ox 3 grs., sheep ½ gr. subcutem), pilocarpin (ox 2 grs., sheep ⅕ gr.), barium chloride (ox 15 grs., sheep 3 to 4 grs.), tincture of colchicum (ox 3 to 4 drs.). Trasbot mentions lard or butter (ox 4 oz., sheep ½ oz.), as in common use in France.
In the most urgent cases, however, relief must be obtained by puncture of the rumen, as a moment’s delay may mean death. The seat for such puncture is on the left side, at a point equidistant from the outer angle of the ilium, the last rib and the transverse processes of the lumbar vertebræ. Any part of the left flank might be adopted to enter the rumen, but, if too low down, the instrument might plunge into solid ingesta, which would hinder the exit of gas, and would endanger the escape of irritant liquids into the peritoneal cavity. In an extra high puncture there is less danger, though a traumatism of the spleen is possible under certain conditions. The best instrument for the purpose is a trochar and cannula of six inches long and ⅓ to ½ inch in diameter. (For sheep ¼ inch is ample.) This instrument, held like a dagger, may be plunged at one blow through the walls of the abdomen and rumen until stopped by the shield on the cannula. The trochar is now withdrawn and the gas escapes with a prolonged hiss. If the urgency of the case will permit, the skin may be first incised with a lancet or pen knife, and the point of the instrument having been placed on the abdominal muscles, it is driven home by a blow of the opposite palm. In the absence of the trochar the puncture may be successfully made with a pocket knife or a pair of scissors, which should be kept in the wound to maintain the orifice in the rumen in apposition with that in the abdominal wall, until a metal tube or quill can be introduced and held in the orifices.
When the gas has escaped by this channel its further formation can be checked by pouring one of the antiferments through the cannula into the rumen.
When the formation of an excess of gas has ceased, and the resumption of easy eructation bespeaks the absence of further danger, the cannula may be withdrawn and the wound covered with tar or collodion.
When the persistent formation of gas indicates the need of expulsion of offensive fermentescible matters, a full dose of salts may be administered. If the presence of firmly impacted masses can be detected, they may sometimes be broken up by a stout steel rod passed through the cannula. If the solid masses prove to be hair or woolen balls, rumenotomy is the only feasible means of getting rid of them.
In chronic tympany caused by structural diseases of the œsophagus, mediastinal glands, stomach or intestines, permanent relief can only be obtained by measures which will remove these respective causes.