TYMPANITES OF THE RUMEN Synonyms.Hoven, Bloating, Gaseous Indiges tion, Tympanitic Indigestion, Dew-blown, Fog-Sickness, etc.
Definition. Distension of the rumen by gases formed as a result of fermentation of the con tents of the organ.
General Remarks. Cases of tympanites may be looked upon as acute when the rumen is greatly distended and there is danger of suffoca tion, subacute when the swelling is easily com pressible and there is little evidence of uneasiness, and chronic when the tympanitic condition per sists for several weeks.
It may be either primary or secondary. Acute primary tympanites is almost invariably the result of acute indigestion set up by a gross dietetic error capable of upsetting apparently healthy animals, though the condition may be contributed to by an existing atonic state of the rumen walls. But though the latter may not be present as a predisposition it is soon produced by undue or prolonged inflation of the organ. The hoven that accompanies choking is a marked exception to the rule that acute tympany is primary in character and the result of indiges tion. But secondary forms of tympanites are seldom acute in character. Tympany of the rumen is perhaps the most common symptom of digestive disorders met with in cattle. All cases are more or less serious, the acute forms because of the imminent danger of suffocation, and the less acute or more chronic types because of the prolonged displacement of abdominal and thoracic organs to which they give rise, and the greater difficulty that is experienced in divining and removing the cause that has set up the condition. The displacing effect of marked tympany is a grave matter in animals advanced in pregnancy, in cases of hernia, or when old 'abscesses exist in connection with thoracic or abdominal organs or old adhesions confining quantities of peritoneal exudate which are liable to rupture under excessive strain. A certain amount of gas is normally present in the rumen of healthy animals, and is generated while the food is undergoing treatment in the organ, but the amount is limited, being governed by the eructations of it that occur during feeding and rumination, and when the animal is at rest. That considerable quantities of gas are so released is confirmed by the fact that obstruc tion of the gullet which prevents eructation immediately leads to gaseous distension of the rumen. But, within limits, the gas present in the rumen of healthy animals varies in quantity with the diet, and consists chiefly of carbonic acid, sulphuretted hydrogen, carburetted hydrogen, and a little nitrogen and oxygen swallowed from the atmosphere. The nature of the gases present in cases of tympany like wise depends on the quality of the food that is undergoing fermentation, but in most cases carbonic acid is in excess, and with it is a variable quantity of marsh gas, carbon mon oxide, hydrogen sulphide, oxygen, and nitrogen.
Tympanites.This dangerous condition is usually a sudden development due to an easily determined cause, but less acute forms occasion ally assume an acute character after a time and under certain conditions. Two varieties of tympanites are met with which differ according as the gas is free to be tapped or otherwise, viz.: (a) Cases in which the gas lies in bulk on the top of the ingesta, and is capable of quick extraction by trocar and cannula; and (b) Cases wherein the fermented gas exists in agitated and intimate mixture with the entire contents of the organ, akin to a boiling or effervescent mass in a cauldron, so that only a little bubbling of gas follows the use of the trocar, and little or no relief is afforded.
Causes. Obstruction of the gullet, as in cases of choking caused by a piece of turnip, mangold, or potato, etc. Here, as already stated, the gas is free to tap. Scarcely less sudden in their development are those cases of the second form caused by an immediate change of diet to luxuriant clover, wet with dew, and colloquially referred to as cases of dew-blown or fog-sickness. Many such cases occur every season when, through want of caution, the animals are put for the first time on the clover crop when its flowering heads are very wet.
If the animals are very hungry they very soon fill their paunch with the quickly grown, cold, wet, and succulent herbage, and without having to exercise their limbs very much. The quickly swallowed mass of food to which they have not been accustomed chills and renders anaemic and passive the walls of the rumen so that the organ fails to perform its functions and rapid fermenta tion ensues. Danger is most pronounced if there has been frost in the early morning and the temperature of the bedewed herbage is very low—when wet with rain only the crop is not quite so dangerous. Besides the red and white clovers, which are specially indicted because of the water-carrying capacity of their large flowering heads, the other leguminous plants, peas, vetches, beans, tares, etc., when consumed in a wet condition, are more apt than ordinary grasses to produce gaseous indigestion, since they are more susceptible to fermentation. It is in a less degree, therefore, that tympany is liable to follow on a sudden transition from winter food or from poor to abundant pastures, but susceptible animals are victimized if put out in the early morning when the grass is covered with hoar frost. In fact it is at all fillies risky to put animals too suddenly on green food of any kind to which they have not been accus tomed for a time. Fermenting, half-withered grass which has been cut and left in a heap is readily eaten by many cattle, often with bad results. The consumption of frozen roots or cabbage, etc., in quantity is often followed by tympany—their chilling effect leading to ener vation of the rumen. Potatoes are unsafe if given in too great quantity, and the use of a small ration of diseased potatoes has frequently been disastrous, Other foodstuffs demanding caution in their use include bean straw, turnip tops, and any kind of food that has begun to ferment. Many plants or shrubs, e.g. meadow saffron, hemlock, deadly nightshade, ranun culus, rhododendron, yew, etc., which are more or less poisonous are readily eaten by cattle, and set up hoven, but this in great measure occurs as a sequel to the inflammation caused by their irritant action on the digestive mucosa. Again, any factor capable of shocking the system, paralysing digestion, and interfering with the act of rumination may lead to tympany, e.g. chill from prolonged exposure to storms or biting winds, violent exercise after feeding, drinking of large quantities of ice-cold water, etc. Foreign bodies in the rumen and reticulum act in a similar way, e.g. balls of hair or wool, pieces of wood, leather or bone, wires, needles, nails, or foetal membranes which have been swallowed, etc. But while food liable to speedy fermentation because of its quality and condi tion must be considered the chief factor in producing acute gaseous indigestion, it must be borne in mind that susceptible animals, and especially such as are predisposed by an atonic state of the digestive organs, from whatever cause arising, are more readily victimized than their healthy neighbours, and in them, even, minor dietetic errors lead to hoven.
Symptoms. The appearance of the objective signs of acute tympany is in many cases a speedily progressive matter, and if the animal be on wet clover it may continue to feed until signs of discomfort or actual pain are evident. The upper left side of the abdomen becomes ballooned, the measurement of its circumference being vastly increased. The swelling is at first softly, but soon becomes tensely, elastic and resonant like a drum, and the freer the gas the more drum-like is the sound produced by percussion. On the other hand the rumen, distended with solid or semi-fluid food only, presents its chief swelling lower down than the upper left flank if unassociated with tympany. If the ear, placed over the tympanitic paunch, detects no crepita tion sounds but only occasional rumbling noises, we may conclude that the gas present is free to tap as in cases of choking, and not in intimate mixture with the food. But if active crepitation sounds are heard they betoken the existence in the stomach of a bubbling effervescent mass, and the practitioner need not expect to give much relief by any small puncture of the rumen. When the tympanitic state is sufficiently ad vanced the patient becomes uneasy, respiration is accelerated, laboured, and shallow, and as the pain increases the animal moves backward and forward, stamps and kicks at the abdomen, crouches and endeavours to lie down, but if it goes off its feet in a vain effort to seek relief from pain it is soon up again because of the difficulty experienced in continuing respiration. The tail is lashed about, the back is arched, and at irregular intervals semi-fluid excreta and quantities of urine are voided. After a time the dejecta may contain mucus or blood. The animal champs the jaws and salivates or gapes with the tongue hanging out. It grunts and moans with abrupt sounds, the action of the heart is violent and palpitating, and the pulse frequent, small, and later on almost impercep tible. The circulation is evidently greatly dis turbed by the forward pressure of the swollen organ, there is engorgement of the superficial veins of the neck, and the visible mucous membranes are deeply congested or cyanosed. The nose is poked out, and in some cases gases are belched up or actual vomiting may occur. Such symptoms according to their degree are salutary, but they are not very common, and to yield marked relief they require frequent repeti tion. As the case advances the swelling becomes as high as the spine, the eyes are bloodshot and protruding, and the suffocating animal staggers on its feet and falls asphyxiated. If the victim of acute tympany be relieved by operation or otherwise, untoward sequel may present them selves in the course of a day or two as a result of the pressure exerted and the excitement caused by the distended paunch, e.g. pregnant animals may abort, peritonitis may arise as a result of the bursting of an existing abscess, or the rending of old adhesions, or the passage of a foreign body into the chest may be precipitated, setting up a traumatism of the heart, lungs, or pleurm. Some difference of opinion exists as to the immediate cause of death, but, while it may be conceded that some neurotic animals die suddenly as if from nervous shock or cardiac interference, we entertain no doubt, and the cyanotic condition of the majority of cases before death is proof, that death results from carbonic - acid poisoning. Absorption of the deleterious gases contained in the rumen, which consist chiefly of carbonic acid, proceeds during the progress of the case, and the poisoned state of the blood is soon augmented and rendered insupportable by the gradual failure of respira tion. Death occurs in some cases of acute hoven within half an hour if the animals are not relieved by suitable treatment. When the fer mentation is less active the animals live for an hour or two before suffocation occurs, but the period of time that elapses is controlled in some degree by the presence or absence of eructations of gas from the paunch.
Diagnosis. The condition is easily recognized by the presence of a quickly-developed, resonant swelling in the superior aspect of the left flank. As already stated, the swelling seen in impaction of the rumen with food only is lower down and non-resonant. The diagnosis of the cause is also an easy matter in most cases of acute hoven, though this cannot be said of the less acute or chronic forms.
Prognosis. Acute tympany is always serious, but much depends on promptitude in treat ment. If several cases occur simultaneously in a clover field the practitioner must act quickly and adopt heroic measures if the lives of the animals are to be saved. If marked eructation of gas is established the patient may gradually recover without being operated on. The recovery of some animals that have been punctured is more or less protracted owing to the occurrence of untoward sequelse. In all cases the value of the animals is considerably reduced.
Prevention. All conditions known to set up tympany are to be avoided. The common causes of choking, which is always accompanied by tympanites, are well known and are to a great extent capable of elimination. The dangerous cases met with in fields of clover emphasize the need for certain precautions in utilizing this useful aftermath crop. To begin with, the animals should not be put out on growing clover when they are hungry, or in the early morning when it is cold and soaked with dew, and they should be kept under observa tion during the short hour that they are allowed on the crop for the first day or two. The risk is greatly minimized if they are fed before being put out, and this should be done preferably in the afternoon or at least when the herbage is quite dry. After these preliminary precautions the animals get accustomed to the change of diet and are soon able to consume the crop even on a wet day without bad result, though it can never be considered safe to allow them on growing clover in the early morning when it is soaked with moisture or covered with hoar frost. The use of frozen roots or cabbages is to be avoided, as their consumption in quantity sets up indigestion that is often accompanied by tympanites. When frozen they should be kept in the byre for twelve hours before being offered to the herd. Roots that have become decomposed owing to bad storage are capable of upsetting digestion and causing acute haven in some animals; nevertheless, it is remarkable that most cattle readily eat, and with impunity, large quantities of the repulsive-looking, soft, and evil-smelling turnips that are to be seen on many farms in the early springtime. This great wastage would not arise if all roots were stored in a dry condition in suitable weather, and the pits or heaps properly covered to pre vent the penetration of frost. Owing to the evil effects of drinking quantities of very cold water by housed animals the temperature of the water so used should be raised, in frosty weather, by the addition of a reasonable amount of warm water. If the cattle be turned out to water at a pond or running stream they drink less greedily than in the cow-shed, and the exercise they get lessens the risk of danger. The prunings of yew trees and other poisonous shrubs should be burned, and if dangerous trees or shrubs are within reach of grazing animals they should be suitably fenced off. The larger animals often fall victims when the fence is too low and the smaller ones escape. At all times when a radical change of food is intended, and especially from indoor rations to green food of any kind, this should be made gradually, giving at first only a small amount and daily increasing the proportion of the new diet. If cut green food is to be used it should be secured when dry and kept dry, and given to the cattle while it is still fresh. Animals suffering from febrile complaints which prejudice digestion and cause suspension of rumination cannot safely be fed on food-stuffs liable to ferment in the rumen, and should receive only easily-digested food such as bran and linseed mashes, pulped or boiled roots, cooked gruels, and a little good hay. And because acute tympany is often so quickly fatal that death may occur before pro fessional assistance can be got, cattle-owners should possess, and know how to use in an emergency, a suitable trocar and cannula for puncturing the swollen paunch, as well as a sharp knife for enlarging the opening if necessary. The practitioner when he does arrive can very often make good the recovery of an animal with an ugly gaping hole in its flank by means of which the amateur managed to relieve the suffocating patient.
Post - mortem Lesions. — The carcase is enor mously rotund even at first, but soon becomes more so unless the gastric contents force an exit by the gullet and nostrils. Rupture of the rumen is only occasionally seen, but the lesion is usually a post-mortem one. Rupture of the diaphragm may be present and it some times occurs prior to death. Rupture of the right auricle of the heart has also been recorded. The abdominal organs are usually pale and more or less bloodless owing to the pressure that has been put upon them, but haemorrhages are sometimes to be seen. The walls of old adhesions that enclosed pockets of peritoneal exudate are often burst and their contents scattered. The capillaries of the skin and remote organs are engorged, the usual appear ances set up by death from asphyxiation are present as well as ecchymosis, and it may be extravasations on the chief serous membranes. In females advanced in pregnancy there is often evidence that the uterine contents have suffered. The condition of the ingesta in the rumen varies in different cases.
Treatment. When tympany has just set in, the patient should be forcibly exercised and the swelling should be rubbed and kneaded with both hands to try and establish eructation from the stomach. This may also be assisted by placing a piece of wood or an ordinary wooden gag in and athwart the mouth, secured on each side by a strap or piece of rope to the horn. This should be done at once, too, in all cases of choking if a probang is not at hand or if its use has proved ineffectual and likely to be dangerous if persisted in, and before resorting to puncture of the rumen. Cold water ablutions are . also recommended as a stimulus to the belching up of gas. There are not many cases of acute primary tympanites in which the passage of the hollow probang taps successfully the imprisoned gas, nevertheless it should be tried if the state of the patient permits, for though it fails to take off the gas its use is some times followed by eructations that afford some relief. Sometimes actual and salutary vomi tion occurs when the tube is withdrawn, and this in some cases has been so forcible that death has occurred from drowning, some of the un controlled and barmy semi-fluid ingesta having found its way into the trachea. In other cases bronchopneumonia has been set up by strayed material, in too small quantity to cause sudden death by drowning. When the animal is rest less and nervous the passage of the probang is not an easy matter, but it should be done with as little disturbance to the animal as possible. While an assistant steadies the head by the horns and so elevates the mouth, the practitioner separates the jaws with one hand and with the other passes the oil-smeared pro bang as speedily as possible down the gullet. If gas emerges freely through the tube, the latter should be kept in position until the swelling has gone down. Thereafter, in order to prevent further fermentation and collection of gas in the rumen, stimulants and chemical antidotes, as recommended in the treatment of chronic tympany, should be administered. If necessary the tube may be passed a second time, when it is again likely to afford relief. But if only a little bubbling of gas and fluid takes place through the tube when it is in position, the indication is that the ingesta is in a barmy condition and that even the use of the trocar and cannula will be ineffectual. In all urgent cases that have defied the above measures, and before resorting to rumenotomy, as well as in cases of choking by an awkward and dangerous obstruction, relief must be tried by puncture of the rumen. Sometimes the instant use of the trocar is called for as soon as the animal is seen. The puncture should be made at the height of the swelling at a point on the left side at equal distances from the last rib, the transverse process of the vertebrae, and the point of the haunch-bone. The operator stands on the left side of the animal with his back to its head, and with the right hand plunges the instru ment into the stomach and withdraws the trocar. The instrument should be from 6 to 7 inches long, oval in shape, and about ft inch broad. If gas emerges freely, steady pressure should be exerted on the cannula, especially if it be a short one, for the emptying stomach regains its tone and, beginning to squirm, tilts the cannula to such an extent that they may lose connection and render necessary a second puncture of the stomach wall. Stock-owners who summon courage to puncture the swollen stomach usually operate with any pointed knife that is at hand, and very often the hole made is too small to act efficiently, and it occasionally happens that some of the gas finds its way into the meshes of the loose tissue between the"fell and the flesh,"producing an extensive sub cutaneous emphysema that persists for many days. When a simple puncture of the rumen does not succeed and the case is urgent, rumeno tomy must be performed. (See p. 1025.) Chronic Tympanites. In chronic tympany the swollen state of the paunch is more or less per sistent. It may be permanent or intermittent. When intermittent it is usually most pronounced shortly after the animal has swallowed its meal ration, and in some cases the swelling begins to subside when the patients have begun to eat hay or straw, the deglutition of the balls of roughly-masticated food seeming to favour the upward escape of accumulated gas.
Cause8. Many cases of chronic hoven are secondary in character, being dependent on remote causes. Others are primary and due to existing disorder or disease of the organs of digestion. On the other hand, subacute cases are intermediate in character between acute and chronic, are commonly the result of faults in dieting, etc., and are more amenable to treat ment, their etiology being more easy to decide. To determine the cause of chronic tympany is often a difficult matter, since it is so often a condition secondary to chronic disease of other important organs and structures, e.g. the liver, peritoneum, uterus, etc. It is commonly seen in tubercular animals and in badly-nourished pregnant cows. Acute and subacute cases if improperly treated readily acquire a chronic character owing to the stony of the stomach walls which results when recovery is protracted. Moreover, oft-repeated fermentation gives rise to catarrh of the gastric mucosa, and this per petuates gaseous indigestion. Tympany is therefore a common accompaniment of rumen itis, reticulitis, due to foreign bodies, and gastritis, caused by improper food or poisonous leaves or twigs, or chemical poisons, or the over-use of purgative medicines, and it is often present in cases of peritonitis and ascites. Many of the most persistent cases are dependent on condi tions that cause partial stenosis of the gullet, inhibiting the physiological eructations of gas from the stomach, e.g. enlarged mediastinal glands, suprasternal abscesses caused by the passage of foreign bodies from the reticulum, en largement of the liver due to abscess formation or invasion by multilocular cysts of echino cocci, etc., any of which may exercise pressure on the oesophagus. Again, foreign bodies of large size in the rumen prejudice its functions, and if situated near to the oesophageal groove interfere with eructation. Accumulation of sand in the stomach is also a potent cause, and arises when animals are fed on meals that are impure through admixture with sand derived from the grinding of dirty cereals. The heavy material loads the stomach and paralyses its motor power. The latter also arises when an animal is enfeebled from such causes as lack of or abstinence from food, improper food, exhaus tion, wasting diseases, septicaemia of uterine origin, etc., and tympany soon appears when the functions of the rumen are badly performed or cease altogether. In young animals hair balls in the rumen cause tympany.
Symptoms. The hoven condition of the stomach in chronic is less severe than in acute cases, and the other signs of disturbance are correspondingly less marked. The swelling is at first intermittent to some extent and may be almost absent for a period before each meal. It is usually aggravated after feeding, and eventually, if the cause is not removed, the swelling persists though its tenseness is subject to variation. Palpation shows that in all cases the gas is free to tap. Rumination is irregular or suppressed, and it is only when the swelling falls a little that any attempt is made to chew the cud. Appetite is irregular, sometimes depraved, and often in abeyance, the bowels are lazy and the dejecta glazed, hut diarrhoea may be seen during a period of increased hoven. Respiration is thoracic and shallow, and a grunt of oppression is occasionally heard. Loss of condition is fairly rapid, especially if fever or diarrhoea be present. Tympanites in cattle is never relieved by the passage of flatus per rectum.
Diagnosis. This presents no difficulty, and only a novice could mistake chronic tympany for impaction of the rumen or dropsy of the abdomen or uterus. As in acute eases, the swelling is marked on the left side and situated high up where the flank is normally hollow, it is resilient to pressure, percussion gives a drum like sound and yields no wave movement such as that seen when a dropsical abdomen is sharply struck. The swelling seen in hernia of the rumen is too low down to be mistaken for tympanites.
Prognosis is always grave.
Post-mortem Lesions. Increased capacity of the rumen is evident though the ingesta may be under normal in bulk. The lining membrane is in a catarrhal state and lesions may be present in the bowels, the carcase is anaemic and often greatly emaciated, and there is little fat to be seen. When the ease has been due to some diseased condition involving the gullet, this is usually very apparent in the shape of enlarged glands, a tumour or abscess, etc.
Treatment. During the treatment of chronic tympanites the food allowed should be easy of digestion—bran mashes, boiled roots, demulcent drinks, and a little good hay or straw. If the case is well established before advice is sought, great care should be exercised to determine the cause, if possible, and treatment should be directed towards its removal, and even when this is deemed practicable, it must be remembered that the lost tone is not easily restored to an organ that has been subjected to continued dis tension. If there be evidence of generalized tuberculosis or persistent stenosis of the gullet, the animal should be slaughtered. Medicinal treatment in suitable cases is most likely to be successful in the early stages, but as the most potent drugs for the dissipation of tympany render the flesh unfit for food, medicinal measures should only be attempted when it is not intended, at any stage, to salve the carcase. The agents likely to prove useful comprise antiseptics, stimulants, and purgatives, and per haps gas absorbents. Sodium hyposulphite in 2-ounce doses dissolved in a pint of water may he given two or three times a day, or sodium bicarbonate in similar doses. A favourite drench is 2 ounces of oil of ,turpentine in a pint of raw linseed oil with 15 to 20 minims of oil of peppermint, and this may be given once or twice on the first day, subsequent doses of turpentine being given once a day in milk in stead of oil. Formalin in doses of two drachms well diluted with cold water may be given twice a day. Dilute hydrochloric acid is useful com bined with bitters and nerve stimulants, such as gentian and nux vomica, to stimulate the mucous, salivary, and alkaline secretions and control fermentation. Chinosol, creolin, lysol, izal, and kerol are also worthy of trial. But no treatment is likely to be of permanent value that does not include the use of moderate saline purgatives, such as the sulphate of soda or magnesia or common salt, in doses of a half to one pound according to the size of the animal. The purgative dose should be combined with ginger and some treacle, and followed by 1-ounce doses of carbonate of ammonia given in a quart of cold water at intervals of four hours for three times. When mild purgation has been set up, the animal may be put on the hydrochloric acid, gentian, and nux vomica mixture or the following: 4 Pulv. pot. nit. 5ij. Pulv. nue. vom. 3ij. Pulv. zingib. 3iv. Pulv. gentian. 3iv.
M. ft. pule. Sig. One to be given twice daily in a bottle of ale or gruel.
If drenching is to be avoided the following electuary is a useful substitute: c Sod. chlor. Pulv. nuc. vom.
Pulv. zingib. as 3j. Pulv. gentian. Theriac. q.s.
M. ft. Electuar. Sig. The whole to be smeared on back of tongue twice or thrice daily.
The electuary should be made up in bulk of several doses. When animals are dangerous to drench, easy purgation may be induced by placing in the mouth with a wooden spatula a mixture of common salt and treacle of proper consistence and, taking advantage of the thirst induced, to give repeated 4-ounce doses of salt in drinking water, the doses to be reduced or withheld according to results. Large doses of tincture of ginger have been highly recom mended, and these may with advantage be con tinued with tincture of nux vomica and dilute hydrochloric acid. Electricity applied over the gastric region is advised by some authors, as well as the use of eserine, veratrine, apomor phine, tartar emetic, and barium chloride. A sinapism over the region of the stomach is of distinct service in some cases. But the adop tion of mechanical means to get rid of the gas must not be too long delayed or the walls of the viscus will lose tone to a serious degree. The swelling should be vigorously rubbed and forcibly palpated, and, if eructation of gas is not thus set up, the probang should be passed, and if successful this may be repeated as often as necessary. Puncture of the rumen secures the desired result at once in chronic tympany, and the cannula should be left in position for two or three days, during which time suitable medicinal treatment is carried out. After the removal of the instrument the orifice is soon sealed up, but if the digestive functions are not restored the tympany returns, the animal sickens anew, and the trocar has to be used again. The cannula is liable to dislodgement, and if too often reinserted a localized peritonitis is set up and the likelihood of a satisfactory recovery is remote. In such cases, instead of repeated use of the trocar and cannula, a modified rumenotomy should be performed to provide an effective means of escape for all gases of fermentation and afford an opportunity for the manual exploration of the interior of the stomach, the removal of foreign bodies that may be present, and the breaking up and removal, if necessary, of masses of agglutinated indigestible food.