CHRONIC TYMPANITES. 197 



Diagnosis. In the present state of our knowledge regarding diges- 

 tion 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 tym- 

 panites 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 disturb- 

 ance. 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 over- 

 looked, 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 hydro- 

 chloric 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 sub- 

 mucous 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 pre- 

 cisely 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 diar- 

 rhoea, without manifest constipation (motor dyspepsia), and without any 

 other apparent organic disturbance, drugs calculated to stimulate peri- 

 stalsis of the rumen seem indicated. The most promising comprise 



