44 



DISEASES OF THE DIGESTIVE APPARATUS. 



become of a pasty consistence, and undergoes a cheesy or creta- 

 ceous change; frequently the discharge will diminish, and the 

 functional disturbance become much reduced, sometimes even 

 entirely disappearing. 



Patholog-ical anatomy. The alterations consist of a con- 

 gestive tumefaction and hypersecretion of the mucous membrane; 

 in the pouch is found a purulent, glairy matter, holding in sus- 

 pension whitish or yellowish-white firm clots. When the disease 

 is old the mucous membrane is pale, wrinkled, rugous, much 

 hardened, and sclerotic, often adhering to the neighboring tissues 

 through induration of the connective tissue which unites it to these 

 organs; the numerous small lymphatic ganglions of the region 

 are hard and tumefied ; pus contained in the pouch is consistent 

 and adheres to the mucous membrane, sometimes it forms veri- 

 table concretions (Barthélémy, U. Leblanc, Goubaux). 



Diagnosis. When there is purulent collection of the pouches,, 

 it is indicated by a unilateral or a bilateral discharge, of a clotty 

 character, free from odor or nearly so, and intermittent, appearing 

 during mastication or the deglutition of solids and especially of 

 liquids, by an engorgement of the lymphatic ganglions, and a 

 tumefaction of the parotid region, which makes its diagnosis 

 especially easy. It can only be mistaken for collection of the 

 sinus. In troublesome cases, analysis of the symptoms will always 

 allow us to distinguish these two affections. In collection of the 

 sinus the discharge is particularly abundant during exercise ; it is 

 curdled like collection of the guttural pouches, but it exhales gen- 

 erally an offensive odor. Percussion of the sinus produces pain, 

 and this, and the bulging of the bones forming the external wall of 

 the sinus, are characteristic symptoms of the seat of the disease. 



Prognosis. Collection of the guttural pouches is a serious affec- 

 tion. It never heals spontaneously, and the deep location of the 

 affected organ renders it almost insusceptible to means likely ta 

 check phlegmasia of the mucous membranes. We have seen that 

 it may cause death by asphyxia, or gangrenous pneumonia. The 

 necessity of having recourse to an operation in order to obtain a 

 cure is not without serious dangers, and is another circumstance 

 aggravating the prognosis. 



In fact, the only efficient treatment is the puncture of the diseased 

 guttural pouch. It should be made through the parotid, or by 

 practising classical hyo-vertebrotomy. Catheterization of the 



