FOREIGN BODY IN THE NOSE.
Professor Gamgee records the destruction of an animal for glanders in which the cause of the discharge was afterwards found to be a physic ball coughed up into the posterior part of the nose and firmly impacted there.
COLLECTIONS OF PUS IN THE GUTTURAL POUCHES.
Structure, position and opening of pouches, inflamed by extension. Symptoms, discharge intermittent with pendent head, swallowing, pasturing, cough, roaring, dyspnœa, inhalation of food, parotid swelling, glandular enlargement. Nature of contents. Treatment, pasturage, blister, tonics, irrigation, puncture, injection.
Though this is commonly a result of severe sore throat or strangles, yet as it causes a chronic discharge from the nose liable to be confounded with those properly due to diseases of the nasal chamber, it is noticed in this place.
The guttural pouches are two mucous sacs peculiar to solid footed animals. They lie side by side above the throat, and in direct contact with the lower surface of the superior bones of the head and the first bone of the neck. They are properly speaking dilatations of the Eustachian tubes which in all animals establish a communication between the pharynx and the middle ear. The opening into the pharynx is at the anterior extremity of the pouch and close to the posterior opening of the nostril, hence the discharge takes place chiefly or exclusively when the head is lowered, since gravitation then favors the escape of the fluid.
Frequently implicated in severe sore-throat the walls of the guttural pouches pour out pus as readily as other mucous membranes in a state of inflammation. As the escape of this product is hindered alike by the narrowness of the orifice and, in the elevated position of the head, by gravitation, it frequently becomes imprisoned and inspissated and proves a permanent source of irritation and discharge. In the early stages the contents are glairy with whitish or yellowish clots; later they are creamy, caseous or even cretaceous. The mucosa, at first red, congested and tumefied, becomes in chronic cases, hard, thick, puckered and adherent to adjacent structures. It sometimes ulcerates and the contents escape in mass, through the pharynx and nose, or externally behind the angle of the lower jaw. In the last case water swallowed may escape through the opening. More commonly the pus remains pent up, and thickens, and may dry and roll into round or oval pellets from the movements of deglutition. The discharge may be arrested for weeks or months when such masses block the outlet.
Symptoms. The nasal discharge is intermittent or irregular, being often partially or wholly suppressed by keeping the head elevated, and reappearing or becoming profuse when it is lowered. Feeding from the ground, nibbling roots, or pasturing increases the discharge, as the dependent position of the outlet, the jerking and shaking of the head and the movements of deglutition all favor its exit. Swelling of the parotidean region, a flatness instead of resonance on percussion, and the flattening and discharge and sometimes gurgling by manipulation are characteristic. There is cough, roaring during active exertion, sometimes dyspnœa, and, in bad cases, food may be drawn into the bronchia with serious and even fatal results. When the orifice is blocked and the pouch filled with gas the elastic swelling and resilience are characteristic, and pressure may flatten it with a gurgling sound. These symptoms serve to differentiate it from peripharyngeal abscess. The submaxillary lymphatic glands are usually swollen but less than in glanders and not so hard.
Treatment. In mild and recent cases in which the contents of the pouch have not yet become thick and dry, a cure may be effected; in winter by feeding the animal from the ground and largely with roots; and in summer, by turning out to grass. In either case the matter is allowed to escape almost as soon as formed and the irritated membrane tends to resume its healthy functions. This result will be favored by giving a course of tonics as recommended in simple ozœna, and the application of a mild blister to the throat.
Should this fail an operation must be resorted to. Günther, of Hanover, uses an instrument in the form of a tube a yard long, half an inch in diameter, slightly curved for two inches at one end which is blind, and having an orifice on one side close to this extremity. This tube having been introduced through the chamber of the nose on the affected side and its curved end having been carried into the narrow opening of the Eustachian pouch, tepid water is pumped in and the pouch thoroughly cleaned out. Astringent solutions are then employed. The introduction of the tube is, however, a very difficult operation and one quite impossible to any one who has not the most accurate knowledge of the parts in question.