120 
EVACUATING THE GUTTURAL POUCHES. 
opening must be made in Yiborg’s triangle. For this purpose Dieterich 
employs a curved trochar. But it is more easily managed with a blunt 
seton needle passed outwards from the guttural pouch towards this 
triangle, the incision being made according to Yiborg’s directions. This 
method no doubt deserves preference; it lessens the danger of injuring 
large vessels or nerves, and gives a large opening, allowing easy exit of 
secretions, and insuring complete evacuation of the sac. Where, on 
account of much distension of the sac, there is difficulty in finding the 
blood-vessels, a blunt seton needle is inserted at the point of division of 
the vessels. Following Dieterich’s directions, Moller succeeded in passing 
the entire hand into the guttural pouch, and examining from this point 
the Eustachian tube. After-treatment consists in flushing out the sac 
with disinfectants, astringents, and other therapeutic agents. Too much 
fluid must be avoided, as it may enter the pharynx, trachea, or lungs 
by way of the Eustachian tube. Degive lost a horse in this way from a 
solution of potash entering the lungs and producing pneumonia. 
On 11th of March, 1886, an aged grey working-mare, showing no constitutional 
symptoms, was sent into hospital on account of swollen throat. The head was 
held extended, and side movements avoided. A thick yellowish-white frothy 
uid ian from the nose, and was increased and became purulent on depression 
ot the head. A snoring inspiratory sound could be heard when the horse was 
resting, which, on the slightest excitement or movement, became audible also 
m expiration. Deglutition visibly caused difficulty ; part of the water taken 
flowed back through the nostril. A swelling existed in the parotid region 
most marked on the right side, where it was pear-shaped, the smaller end 
iymg at the base of the ear, the lower border overpassing the anterior edge 
ot the neck by about 2 inches, and extending over the trachea. The swelling 
was 14 inches long and Hi 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 4f inches and greatest breadth 6 inches. The skin on both 
sides of the neck showed traces of the application of irritants. Distinct 
fluctuation cpuld be detected, percussion produced in the lower sections of the 
right side a hollow note, which was distinctly tympanitic in the upper part. 
he percussion sound on the left side was everywhere resonant. Movement 
of the head and rapid pressure on the swelling produced on both sides a 
distinct splashing sound The cicatrix of a tracheotomy wound was visible 
m 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 bv 
Dieterich s method, with the modification that the incision was made with a 
seton need e The great swelling and displacement of the organs rendered 
F im Possible to discover the point of division of the arteries. Immediately on 
incision a quantity of unpleasantly smelling gases was discharged. After 
making an opening m Yiborg’s triangle, about five pints of turbid fluid con¬ 
taining white lumps, flowed out. The cavity was washed, and a thick drai’nage- 
tube inserted. When the horse got up, the swelling had disappeared on both 
sides, the bieathmg was regular, and food could be taken without difficulty. 
lorn March 13th the guttural pouch was washed out once daily, either with 
7 Per cent - solution of tannic acid or of permanganate of potash. The running 
lorn tie nose decreased greatly, though a muco-purulent discharge continued 
