EVACUATING THE GUTTURAL POUCHES. 371 



An aged grey working-mare was sent into hospital on account of swollen 

 throat. The head was held extended, and side movements avoided. A thick 

 yellowish-white frothy fluid ran from the nose, and was increased and became 

 purulent on depression of the head. A snoring inspiratory sound could be 

 heard when the horse was resting, which, on the slightest excitement or 

 movement, became audible also in expiration. Deglutition caused difficulty ; 

 part of the water taken returned through the nostrils. A swelling 

 existed in the parotid region, most marked on the right side, where it was 

 pear-shaped, the smaller end lying at the base of the ear, the lower border 

 overpassing the anterior edge of the neck by about 2 inches, and extending 

 over the trachea. The swelling was 14 inches long and 11^ inches broad 

 at its greatest breadth. On the left side it presented a rounder form, 

 was of less size and less sharply defined. Its length was 4| inches and 

 greatest breadtb 6 inches. The skin on both sides of the neck showed 

 traces of the application of irritants. Distinct fluctuation could be detected, 

 percussion produced in the lower sections of the right side a hollow note, 

 which was distinctly tympanitic in the upper part. The percussion sound 

 on the left side was everywhere resonant. Movement of the head and 

 pressure on the swelling produced on both sides a distinct splashing 

 sound. The cicatrix of a tracheotomy wound was visible in the middle 

 of the neck. The larynx seemed to have retained its normal position, 

 though the trachea was bent at a point below the swelling. No doubt 

 could exist as to the diagnosis, and operation was decided on by Dieterich's 

 method, with the modification that the incision was made with a seton 

 needle. The great swelling and displacement of the organs rendered it 

 impossible to discover the point of division of the arteries. Immediately 

 on incision a quantity of unpleasantly smelling gas was discharged. 

 After making an opening in Viborg's triangle, about five pints of turbid 

 fluid, containing white lumps, flowed out. The cavity was washed, and 

 a thick drainage-tube inserted. When the horse got up, the swelling had 

 disappeared on both sides, the breathing was regular, and food could be 

 taken without difficulty. From the second day following operation the 

 guttural pouch was washed out once daily, with either 3 per cent, solution of 

 tannic acid or 1 per cent, permanganate of potash. The running from the nose 

 decreased greatly, though a muco-purulent discharge continued to flow from 

 the lower operation wound. The condition now remained at a standstill 

 for a long time, and a lotion of acetate of aluminum was used foi rinsing 

 the guttural pouch. The wound closed after removal of the drainage-tube, 

 but had to be re-opened because the sac had again filled. Washings with 

 permanganate, acetate of aluminum and 1 per thousand of corrosive subli- 

 mate were without success. The discharge continued, though in smaller 

 quantities. On June 9th, 88 days after the first operation, the patient 

 was cast, and the operation wound so enlarged that the hand could be 

 passed into the pouch and the fingers introduced into the Eustachian 

 tube. The finger of the left hand, introduced from the mouth, could also 

 be passed into the Eustachian tube, so that both hands met here. The 

 tube appeared widely dilated ; but it was further laid open with a guarded 

 tenotome, in accordance with Bassi and Niebuhr's suggestions. The sac 

 continued to be washed out, and from time to time painted throughout 

 with a 1 per 1000 solution of sublimate. But this treatment remained 

 unsuccessful. No marked contraction occurred in the mucous membrane, 

 and the pouch preserved its abnormal size. When it was seen on June 



