116 
CHRONIC CATARRH OF THE GUTTURAL POUCHES. 
when the head was lowered. Occasionally the swelling of one side is 
also appreciable on the other, and may give the impression that both 
pouches are diseased. The greater the swelling, the more marked its 
fluctuating character. Entrance of air or gases into the diseased pouch 
causes a churning sound when the horse moves its head, and percussion 
reveals pretty clearly the division between fluid and gases. Should the 
horse eat from the ground, or be ridden or driven, a portion of the contents 
of the sac is discharged, and the swelling visibly diminishes. 
(3) Severe distension compresses the larynx, trachea, and pharynx, 
and produces difficulty in breathing and swallowing. Inspiration soon 
begins to produce a rough sound, and at a later stage expiration becomes 
loud. The seeming contradiction between clinical observations and the 
experiments of Gunther, in which filling the sac with a mass of plaster 
of paris produced no difficulty in breathing, is explained by the fact that 
the dyspnoea is not produced by the filling of the sac, but by its distension 
and pressing on the larynx and trachea. Filling the pouch with large 
quantities of fluid or gases is usually accompanied by dyspnoea, whilst 
filling with hard materials, such as chondroids, produces no such result. 
Experiment confirms this statement, which also agrees with most of the 
cases reported. 
_ ( 4 ) I n severe distension the animal holds the head towards the sound 
side—a condition particularly pronounced when the horse is ridden. 
Gunther’s catheter for the guttural pouch gives absolute information 
as to the presence of the disease. 
The disease is sometimes mistaken for swelling of the parotid or 
subpai otideal lymph glands, in which the swelling is, however, less sharply 
defined. Ulcerative processes in the pharynx produce similar discharges. 
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. Ihe condition is not usually recog¬ 
nised until the mucous membrane of the sac has undergone considerable 
anatomical changes, and its walls have become concentrically thickened, 
when cure is impossible. 
Appropriate treatment is sometimes followed by recovery. Although 
Gunther describes one case, spontaneous 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 either be obtained 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 tube or catheter is therefore of 
