Symptoms. Diagnosis. 233 



bloating, since belching is prevented. Bloating is frequently 

 the first sj^nptom in cattle (Johne) and is in certain cases, 

 as claimed by Hamoir, not due to an obstructing impediment 

 in the esophagus, but to pressure upon the pneumogastric 

 nerve by tuberculous mediastinal glands. (Gruetzner, however, 

 saw bloating of the stomach in rats only after severing the 

 cervical portion of the pneumogastric nerve ; cutting in a more 

 caudal region had no effect.) 



Some information as to the seat of a stenosis may be gained 

 from a careful observation of the animal during feeding; 

 energetic efforts at deglutition or a discharge of saliva mixed 

 with particles of food from the mouth or nose appears the 

 longer after swallowing of a morsel the nearer to the stomach 

 a stenosis is situated. The advance of the morsel may be con- 

 trolled by placing the hand upon the esophagus. The best re- 

 sults may be obtained by the use of the esophageal sound, but 

 the use of this instrument is not always without danger. A 

 sound of proper thickness, on being introduced into the esoph- 

 agus, meets the impediment and its seat can be ascertained 

 from the length of the part introduced. If now successively 

 smaller and smaller sounds are introduced, the thinnest one, 

 which finally passes into the stomach, gives the degree of the 

 stenosis. 



The introduction of the esophageal sound requires great care and some 

 practice; it can, however, be easily accomplished on all animals, particularly in 

 the horse in a standing position. The anterior end of the sound is moistened 

 with oil, glycerine, fat or vaseline, the head of the patient is elevated and so 

 stretched that it forms one line with the neck; the mouth is opened with a mouth 

 gag, or if nothing better is at hand with a piece of wood or cork placed Ijetween 

 the molars, the tongue is then depressed with the left hand which is introduced 

 into the mouth, then the sound is grasped with the right hand, like a penholder 

 with the anterior end somewhat raised, introduced into the mouth and pushed 

 carefully over the left hand into the esophagus until it meets an impediment. The 

 sound is then in place, held for a little while, is withdrawn somewhat, and again 

 pushed forward under even, very moderate pressure. Care must be taken not 

 to produce a perforation of the esophagus. If the sound again meets the impedi- 

 ment at the same place, a stenosis at this site may be diagnosticated. 



In ruminants the sound is to be intro<luced through the central opening of 

 a wooden crossbar used as a mouth gag (Fig. 3.3). (For the introduction of the 

 sound in horses see the chapter on acute dilatation of the stomach.) This procedure, 

 however, must never be instituted when there are signs pointing to acute inflamma- 

 tion of the esophagus. 



Diagnosis. Although the disease can usually be recognized 

 from the clinical symptoms, a definite diagnosis can only be 

 made after the use of the sound. It is also necessary to ascer- 

 tain the cause of the stenosis, and in this respect the clinical 

 history and contributory circumstances may give information. 

 Compression of the esophagus, due to tuberculous mediastinal 

 glands, may, according to Johne, be recognized without fail 

 when, aside from more or less definite symptoms of tuberculosis, 

 there is chronic bloating without disturbance of appetite, rumi- 

 nation and defecation. 



