gunther's catheter in chronic catarrh of guttural pouches. 367 



Diagnosis may be confirmed by the use of Gunther's catheter. After 

 a little practice it can even be inserted whilst the animal is standing. 



Prognosis is, as a rule, unfavourable. The condition is 

 not usually recognised until the mucous membrane of 

 the sac has undergone considerable anatomical change, 

 and when its walls have become concentrically thickened 

 cure is impossible. 



Appropriate treatment is sometimes followed by 

 recovery. Although Gunther describes one case, spon- 

 taneous recovery seldom occurs. 



Treatment. Vapour baths, so frequently recommended , 

 are, as Haubner has pointed out, quite worthless. Their 

 reputation is due to error in diagnosis. Recovery is only 

 obtained by complete removal of the contents of the 

 pouch, and by direct treatment of its lining membrane. 

 Entrance to the pouch may be obtained either through 

 the Eustachian tube or by an operative wound. The 

 first method is rarely successful, for it does not remove 

 such solids as chondroids, nor provide sufficient exit 

 even for fluid contents. Gunther's catheter is therefore 

 of little value in treatment though it is sometimes used 

 for diagnostic purposes. 



It consists of a brass tube about 20 inches in length ; 

 one end is closed, but is provided with two lateral openings, 

 and is somewhat curved. The other end is also slightly 

 bent, possesses a long opening to take the so-called index, 

 and receives the screw of an iron handle. The index consists 

 of a spring, about 8 inches long, and serves to fix the distance 

 of the Eustachian tube from the entrance to the nostril. 

 By marking with the spring the distance of the temporal 

 can thus, which lies at an equal distance from the entrance 

 to the nostril, one knows, on introducing the instrument, 

 when the upper end has attained the Eustachian tube. To 

 use the catheter the patient's head must be moderately 

 extended. After applying the twitch and fixing the spring, 

 the tube is passed, the bent end directed towards the palate, 

 into the lower meatus of the nostril, until the index shows 

 that the end of the instrument has attained the entrance 

 of the Eustachian tube. A quarter turn is then made with 

 the handle of the instrument, so that the point is directed 

 to the side, and the handle of the catheter pressed towards 

 the septum nasi, probing movements being made, until the FlG - 332 - 

 sound passes into the guttural pouch. Unopposed progress Gunther's 

 of the instrument, without back pressure, shows that it has catheter, 

 entered the pouch. The handle is now removed, and the contents of 

 the sac allowed to flow through the tube. In a similar manner fluids 



