GASTRIC TYMPANY 63 



But why the stomach symptoms ? They are there in 

 alarming abundance, and the practitioner feels bound to 

 treat them. 



The third and fourth visits find the same symptoms 

 present, but the animal visibly weaker. Twenty-four to 

 forty-eight hours sees the end. 



While writing this I have a case in my mind which 

 ran an exactly similar course to the one described above. 

 It was treated for gastric tympany, and its real nature 

 unsuspected until the expiration of twelve to twenty-four 

 hours. It was then apparent that some serious condition 

 was impeding the egress of food from the duodenal end 

 of the stomach, and the possibility of the presence of 

 twist was suggested to the owner. It was even ventured 

 to locate the seat of twist as the duodenum. The end 

 of the second day saw the death of the animal, and 

 a post-mortem examination cleared things up satisfac- 

 torily. 



The double colon was twisted two or three times upon 

 itself in the position of the sternal and diaphragmatic 

 flexures, thus completely shutting off the second and 

 third portions of the bowel from the first and fourth. 



In that portion of the bowel immediately anterior to 

 the twist was a huge mass of accumulated ingesta. This 

 was lying in close apposition with and pressing on the 

 stomach, accounting to some extent, no doubt, for the 

 preponderance of stomach symptoms that presented so 

 perplexing a part of the history of the case. 



It will be seen from this that the utmost care is 

 necessary when giving a diagnosis of, or foretelling the 

 issue of, a case of tympanitic stomach. In the majority 

 of cases the symptoms I have described will lead the 

 practitioner to a correct estimate of his patient's con- 

 dition. He should never forget, however, the possibility 



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