Nutrition in horses encompasses the study of dietary requirements and feeding practices that support equine health, growth, and performance. It involves the analysis of nutrients such as carbohydrates, proteins, fats, vitamins, and minerals, and their roles in equine physiology. Proper nutrition is essential for maintaining optimal body condition, supporting metabolic processes, and preventing dietary-related disorders. Research in this field examines the nutritional needs of horses at different life stages and activity levels, as well as the effects of various feed types and supplements. This page compiles peer-reviewed research studies and scholarly articles that explore the composition, digestion, and impact of different dietary components on equine health and performance.
Ragnarsson S, Jansson A.The aim of the present study was to compare digestibility and metabolic response in Icelandic and Standardbred horses fed two grass haylages harvested at different stages of maturity. Six horses of each breed were used in a 24-day change-over design. A total collection of faeces was made on days 15-17 and 22-24. Blood samples were collected on day 24 of each period and analysed for total plasma protein (TPP), plasma urea, non-esterified fatty acids, cortisol and insulin concentration. There were no differences in digestibility coefficients of crude protein, neutral detergent fibre or energy be...
Earing JE, Cassill BD, Hayes SH, Vanzant ES, Lawrence LM.The objective of this study was to determine if in vitro methodologies developed for the Ankom Daisy(II) incubator could produce accurate estimates of in vivo equine DM digestibility (DMD) and NDF digestibility (NDFD) when equine feces were used as the inoculum source. Four mature geldings were utilized in a 4 × 4 Latin square design experiment with a 2 × 2 factorial arrangement of dietary treatments (timothy hay, alfalfa hay, timothy hay plus oats, and alfalfa hay plus oats), in which the geldings were individually housed and fed. During each 5-d total fecal collection period, feces were co...
Watts K.The sugar, starch, and fructan content (collectively referred to as nonstructural carbohydrates [NSC]) of pasture plants is dependent on the environmental conditions under which they have grown. Pasture that is stressed by cold, drought, or lack of nutrients can be 2 to 3 times higher in NSC than pasture that grows quickly in warm weather and is adequately watered and fertilized. Horses at risk for laminitis should have access to pasture limited or be removed completely when environmental conditions are conducive to high levels of NSC accumulation.
Geor RJ.Epidemiologic studies indicate that most laminitis cases occur in horses and ponies kept at pasture, hence the term 'pasture-associated laminitis'. Clinical cases of laminitis most often occur under conditions that favor accumulation of rapidly fermentable nonstructural carbohydrates (fructans, simple sugars, or starches) in pasture, and animals with an equine metabolic syndrome (EMS) phenotype (insulin resistance, abnormal insulin dynamics, +/- obesity) seem to be at highest risk for developing the condition. Although the mechanisms linking consumption of pasture forage with development of la...
van Doorn DA, Everts H, Wouterse H, Homan S, Beynen AC.This study addressed the question whether the concentration of phosphorus (P) in saliva of ponies is influenced by P intake. Six ponies were fed a diet high in P (HP treatment), providing 21 g P/day, and a diet low in P (LP treatment), supplying 7 g P/day. The two diets provided approximately 21 g calcium (Ca) and 6 g magnesium (Mg)/day. The experiment had an A-B-A design with treatment periods of 30 days. The ponies first received the HP diet (HP1), followed by the LP treatment and were then fed again the HP diet (HP2). Urinary P excretion was increased in both HP feeding periods and equalled...
Janis CM, Constable EC, Houpt KA, Streich WJ, Clauss M.It is often assumed that horses chew food more intensively during ingestion than cattle, which - as ruminants - complete part of the mastication during rumination. This has been proposed as a reason for more robust mandibles, larger masseter insertion areas and larger masseter muscles in horses as compared to cattle and other grazing ruminants. In this study, we evaluate results of comparative feeding trials with three horses (338-629 kg) and three cows (404-786 kg), on four different roughages. Ingestion time (s/g dry matter) and chewing intensity (chews/g dry matter) differed among animals w...
van den Boom R, Driessen F, Streumer SJ, Sloet van Oldruitenborgh-Oosterbaan MM.Insect bite hypersensitivity (IBH) is most often caused by Culicoides spp., although other insect species are also thought to play a role in causing this disease. The disease has been reported to occur in most countries, with a prevalence of up to 28% in some countries in some breeds. The only truly effective therapy currently available is to prevent horses from coming into contact with Culicoides midges, which can be achieved by stabling horses during certain times of the day or by covering them with insect blankets. The effect of a new dietary supplement containing vitamins, polypeptides, an...
Kienzle E, Zeyner A.The development of a metabolizable energy (ME) system for horses is described. Predictive equations for gross energy and digestible energy (DE) are revisited. The relationship between feed protein content and renal energy losses and the relationship between feed fibre content and methane energy losses were analysed in a literature review to develop predictive equations for ME. In horses, renal energy losses are much higher than losses by methane energy. Renal energy losses were correlated more strictly to protein intake than to digestible protein intake. The reason probably is that per gram of...
Lorenzo JM, Fuciños C, Purriños L, Franco D.The effects of sex, slaughtered age (9 vs. 12 months) and livestock production system (freedom extensive system vs. semi extensive system) of "Galician Mountain" foals breed on the fatty acid composition were studied. The sex and slaughtered age of the animals had no statistical significance in the intramuscular fatty acids. Furthermore, the livestock production system showed differences in the fatty acid profiles from the Longissimus dorsi. The feeding system showed significant differences in PUFA content (P<0.001) higher in freedom extensive production system that semi extensive system, wher...
Beeler-Marfisi J, Gallastegui Menoyo A, Beck A, König J, Hewson J, Bienzle D.Gelatinous marrow transformation, or serous atrophy of bone marrow fat, has been noted in livestock, laboratory animals, and wildlife in association with an inadequate plane of nutrition, inanition, or intoxication. This is a report of gelatinous marrow transformation and hematopoietic marrow atrophy in a 5-year-old miniature horse stallion. The horse had oral malformations leading to poor food assimilation and emaciation. A bone marrow biopsy obtained to investigate persistent anemia and leukopenia showed hematopoietic atrophy and replacement of fat with a granular extracellular substance, wh...
Staniar WB, Bussard JR, Repard NM, Hall MH, Burk AO.The objective of this study was to evaluate nutrient composition, voluntary DMI, and apparent DM digestibility of teff hay cut at 3 different stages of maturity to evaluate its potential as a preserved forage for horses. Six mature Quarter Horse mares (12 +/- 3 yr; 553 +/- 39 kg of BW) were used in a replicated balanced Latin square design with 3 periods and 3 maturities of teff hay. Eragrostis tef ('Tiffany' teff) was planted in May and harvested at the boot, early-heading, or late-heading stage of maturity through the summer. Horses were acclimated to a mixture of maturities of teff hay for ...
Menzies-Gow NJ.Certain individual animals appear predisposed to recurrent pasture-associated laminitis, but the exact mechanisms underlying their predisposition remain a fundamental question in laminitis research. The risk of endocrinopathic laminitis can be reduced if steps are taken to improve insulin sensitivity and reduce inflammation using strategies based on exercise and diet. Exercise has been shown to reduce insulin resistance and suppress inflammation, and dietary manipulation can significantly affect insulin sensitivity.
Gere I, Dixon PM.Peripheral caries (PC) of equine teeth is a poorly described disorder that can cause serious clinical problems if it progresses. Objective: To assess the prevalence, sites and severity of PC in a population of Swedish horses. Methods: A post mortem study of 510 equine skulls was performed in 2 Swedish equine abattoirs. Results: PC only affected the cheek teeth (CT) and was present in 6.1% (31/510) of skulls. It affected mainly the peripheral cementum, and 87% of PC in the 29 affected mature horses occurred in the 3 caudal CT (Triadan 09-11). Concurrent infundibular caries involving most maxill...
Durham A.Although the treatment and management of laminitis in the horse requires a holistic and often multidisciplinary approach from the veterinarian, farrier, and nutritionist, this review focuses on pharmacologic interventions that might have prophylactic benefit, specifically in the horse with laminitis as a result of pituitary pars intermedia dysfunction and equine metabolic syndrome.
van Loon JP, van Oostrom H, Doornenbal A, Hellebrekers LJ.There is a need for objective evaluation and quantification of the efficacy of analgesic drugs and analgesic techniques in horses. Objective: To determine whether lumbosacral spinal cord somatosensory evoked potentials (SSEP) can be a useful and reliable tool to assess nociception in equines. Methods: SSEPs and electromyograms (EMG) from the epaxial muscles were recorded simultaneously, following electrical stimulation applied to the distal hindlimb in lightly anaesthetised Shetland ponies (n=7). In order to validate the model, the effect of increasing stimulus intensity was documented and the...
Waller AP, Lindinger MI.Carbohydrate (CHO) stored in the form of skeletal muscle glycogen is the main energy source for glycolytic and oxidative ATP production during vigorous exercise in mammals. In man, horse and dog both short-term high intensity and prolonged submaximal exercise deplete muscle glycogen. In horses, however, muscle glycogen synthesis is 2-3-fold slower than in man and rat, even when a diet high in soluble CHO is fed. There appear to be significant differences in CHO and glycogen metabolism between horses and other mammals, and it is becoming increasingly clear that many conclusions drawn from human...
Petersson KH, Burr DB, Gomez-Chiarri M, Petersson-Wolfe CS.Horses have an increased susceptibility to infection because of a decline in immune function with advancing age. Vitamin E has been found to play a key role in normal immune system function. The purpose of the study was to examine the effect of vitamin E supplementation on immune function and response to vaccination in older horses. Predominantly older horses (18.9 +/- 1.3 yr, range 7 to 26 yr; 523 +/- 38 kg of BW) were supplemented orally once daily for 16 wk with either all-rac-alpha-tocopheryl acetate (15 IU/kg of BW; n = 8) or a placebo (n = 8). One horse from each group was removed from t...
Vecchi I, Sabbioni A, Bigliardi E, Morini G, Ferrari L, Di Ciommo F, Superchi P, Parmigiani E.Standardbred maiden mares are generally stressed and in poor physical condition because of their incorrect management at the end of their racing careers. The purpose of this study was to identify an objective assessment that, similar to body condition score (BCS) determination, is easy to measure and able to confirm or improve fattening status assessment, as well as to ascertain whether a relationship with reproduction efficiency exists in subjects destined for a first-time insemination program. The authors assessed 29 Standardbred maiden mares (7 +/- 2 years old) during the breeding season. O...
Bertelsmann H, Keppler S, Höltershinken M, Bollwein H, Behne D, Alber D, Bukalis G, Kyriakopoulos A, Sieme H.The essential trace element selenium is indispensable for male fertility in mammals. Until now, little data existed regarding the relationship between selenium and sperm quality in the stallion. Selenium, or selenium-dependent glutathione peroxidase activity, was determined in red blood cells, semen, seminal plasma and spermatozoa, and the percentages of spermatozoa with progressive motility (PMS), intact membranes (PMI), altered (positive) acrosomal status (PAS) and detectable DNA damage, determined by the sperm chromatin structure assay, were evaluated in 41 healthy stallions (three samples ...
Trombetta MF, Accorsi PA, Falaschini A.When the mare's estrous cycle resumes in winter, the β-carotene content of hay is depleted. Sixty Italian trotter mares were randomly assigned to a Control or a Treated Group. Treated Group received 1g/d synthetic β-carotene for 15 days from parturition. Blood samples collected at parturition and on days 5, 10 and 15 after partum were analysed for β-carotene, vitamins A, progesterone, 17 β-estradiol, the energy parameters (glucose, cholesterol, NEFA), the protein profile (total protein, albumin, urea) and LDH. Some changes in these measures were attributable to treatment, which significant...
Hunter JO.Irritable bowel syndrome (IBS) in man is not a single entity but has several causes. One of the most common forms has similarities with colic and laminitis in horses. Undigested food residues may pass from the small intestine into the colon where bacterial fermentation produces chemicals that lead to disease. In horses the consequences may be disastrous, but in healthy humans such malabsorption may not be harmful. After events such as bacterial gastroenteritis or antibiotic treatment, an imbalance of the colonic microflora with overgrowth of facultative anaerobes may arise, leading to malferme...
Willing B, Vörös A, Roos S, Jones C, Jansson A, Lindberg JE.Diets rich in readily fermentable carbohydrates, fed traditionally to meet the increased energy requirements of the performance horse, are associated with a number of gastrointestinal disorders that involve disturbances in the intestinal microbiota, however, these changes are poorly understood. Objective: With the long-term objective of improving intestinal health and to increase understanding of the relationship between diet and microbiota, the effect of feeding Standardbred horses a high-energy forage-only (F) diet was studied compared to a more traditional forage-concentrate (C) diet on fae...
Gastal MO, Gastal EL, Beg MA, Ginther OJ.The objective of this study was to evaluate the effect of short-term feed restriction on characteristics of the preovulatory follicle and on concentrations of systemic hormones (leptin, follicle-stimulating hormone [FSH], luteinizing hormone [LH]) and follicular fluid hormones and growth factors (leptin, estradiol, inhibin-A, activin-A, free insulin-like growth factor-1 [IGF1], insulin-like growth factor binding protein 2 [IGFBP2], vascular endothelial growth factor [VEGF]). Mares were submitted to a short-term (48 h) feed restriction when the expected ovulatory follicle was > or =27 mm (Hour ...
Aytekin I, Onmaz AC, Aypak SU, Gunes V, Kucuk O.The aim of this study was to compare hematological, some biochemical parameters, and serum trace element concentrations in horses with or without pica. Fifteen horses with pica (group I) and another 15 healthy horses without pica (group II) were used. The hematological parameters were not changed between the two groups. In group I, hemoglobin values were lower than those of group II. However, the difference in hemoglobin values between the two groups was not significant (P > 0.05). Serum iron and copper concentrations and the copper/zinc ratio were lower in group I than those of group I...
Borgia LA, Valberg SJ, McCue ME, Pagan JD, Roe CR.To evaluate effects of fats with odd and even numbers of carbon atoms on muscle metabolism in exercising horses with polysaccharide storage myopathy (PSSM). Methods: 8 horses with PSSM (6 females and 2 males; mean +/- SD age, 6.3 +/- 3.9 years). Methods: Isocaloric diets (grain, triheptanoin, corn oil, and high-fat, low-starch [HFLS] feed) were fed for 3 weeks each; horses performed daily treadmill exercise. Grain was fed to establish an exercise target, and HFLS feed was fed as a negative control diet. Daily plasma samples were obtained. For each diet, a 15-minute exercise test was performed,...
Chaucheyras-Durand F, Durand H.The use of probiotics for farm animals has increased considerably over the last 15 years. Probiotics are defined as live microorganisms which can confer a health benefit for the host when administered in appropriate and regular quantities. Once ingested, the probiotic microorganisms can modulate the balance and activities of the gastrointestinal microbiota, whose role is fundamental to gut homeostasis. It has been demonstrated that numerous factors, such as dietary and management constraints, can strongly affect the structure and activities of the gut microbial communities, leading to impaired...
Viljoen A, Saulez MN, Donnellan CM, Bester L, Gummow B.Medical records of equine after-hours admissions from 1998 to 2007 are reviewed. Data extracted from the medical records included signalment, reason for admission, pre-admission treatment, clinical presentation, procedures performed, final diagnoses, complications occurring in hospital, length of stay and outcome. Eight hundred and twenty after-hours admissions were available of which 75% were classified as emergencies. Most horses originated from Gauteng province (82%), with Thoroughbred, Arabian, and Warmbloods representing 46%, 10% and 7% of horses. Horses had a median age of 7 years and we...
Madej JP, Nowacki W, Boratyński J, Borkowski J, Włodarczyk-Szydłowska A, Musiał E.Vitamin D-binding protein (DBP) participates in the actin scavenger system, it is a carrier of vitamin D and its derivatives, it manifests the capacity to bind mainly monounsaturated and saturated fatty acids, it binds to the surface of several cells and enhances chemotactic activity of C5a of the complement. The present study was aimed at answering the question whether serum DBP level in mares is related to levels of this protein in colostrum and in serum of its progeny. For this purpose, sera from 77 mares, colostra from 72 mares and sera from 69 Thoroughbred foals were collected. Mother's a...
Van Duijkeren E, Kessels BG, Sloet van Oldruitenborgh-Oosterbaan MM, Breukink HJ, Vulto AG, van Miert AS.Binding of antibiotics to food has received little attention in equine medicine, although such binding could potentially reduce the bioavailability and clinical efficacy. In the present study, binding of trimethoprim (TMP) and sulphachlorpyridazine (SCP) to hay, grass silage and concentrate was investigated in vitro in buffer at pH 6.8 at different concentrations. The binding of TMP and SCP to caecal contents was also studied. In addition, the degradation of TMP and SCP by the caecal microflora was investigated by incubating sterilized and non-sterilized caecal contents for 3 h at 37 degrees C...
Copetti MV, Santurio JM, Boeck AA, Silva RB, Bergermaier LA, Lubeck I, Leal AB, Leal AT, Alves SH, Ferreiro L.This article reports an outbreak of intoxication of female horses with Claviceps purpurea in southern Brazil. The outbreak affected twelve pregnant mares which were fed with black oat (Avena strigosa) during the pre-delivery period. Underdevelopment of the mammary gland in the pre-delivery period resulting in post-delivery agalactia was the most pronounced finding. These mares delivered weak and unviable foals, which showed no suckling reflex and died within a few hours of birth. Laboratory analysis of oat samples fed to the animals resulted in the identification of Claviceps purpurea scleroti...
Watts K.The sugar, starch, and fructan content (collectively referred to as nonstructural carbohydrates [NSC]) of pasture plants is dependent on the environmental conditions under which they have grown. Pasture that is stressed by cold, drought, or lack of nutrients can be 2 to 3 times higher in NSC than pasture that grows quickly in warm weather and is adequately watered and fertilized. Horses at risk for laminitis should have access to pasture limited or be removed completely when environmental conditions are conducive to high levels of NSC accumulation.
Glunk EC, Hathaway MR, Grev AM, Lamprecht ED, Maher MC, Martinson KL.Modern horse management systems tend to limit a horse's opportunity to forage, rely on meal feeding, and may contribute to the increase in equine obesity. The use of slow-feed hay nets represents an opportunity to extend foraging time while feeding a restricted diet. The objectives of this study were to determine if limit feeding combined with a slow-feed hay net would affect morphometric measurements and postprandial metabolite and hormone patterns in overweight adult horses. Eight adult Quarter horses (BW 563 kg ± 4.6 kg; BCS 7.2 ± 0.3) were used in a randomized complete block design, with...
We compared the composition and content of fatty acids (FAs) in the liver, muscles, and subcutaneous fat of Yakut horses inhabiting extreme environment in the Cryolithozone. Essential linoleic and alpha-linolenic acids, supplied to horses with their food, were accumulated in different tissues. Linoleic acid was accumulated in the liver but alpha-linolenic acid was accumulated in muscle and subcutaneous fat. Such a distribution indicates different roles of these fatty acids in the metabolism of horses. Yakut horse meat is a valuable dietary product owing to its fatty acid composition and conten...
Walthall JC, McKenzie RA.Horses grazing manily Cenchrus ciliaris and/or Panicum maximum var. trichoglume pastures on over 30 properties in southern central Queensland developed lesions of osteodystrophia fibrosa. Horses on individual properties in coastal Queensland grazing Setaria anceps, Brachiaria mutica or Pennisetum clandestinum also developed the disease. Ill-thrift, lameness, and fibrous swellings of nasal bones, maxillae and mandibles were observed. Calcium and phosphorus levels of pasture were normal but all the above pasture species contained oxalates which were suspected of causing the disease.
Argo CM.Leisure animals now comprise the majority of working horses in industrialized nations; a shift that has decreased workloads yet improved veterinary care and lifetime health. Although many horses now progress well into their 20s without any requirement for dietary modification, age-related changes are insidious, and older animals benefit from regular veterinary monitoring to identify, address, and ameliorate the inevitable onset of age-related "disease." Basal metabolic rate decreases with age; older animals expend less energy on controlled exercise, and there can be an increased propensity tow...
Hinton M.The literature published over the last 150 years provides confusing and often conflicting advice on the ideal way to water horses. Many of the problems associated with watering appear to be caused by either mismanagement or ignorance. An obvious way to prevent trouble is to provide adequate water at all times when a horse is at rest and to allow sufficient opportunity to drink while working.
Aboling S, Scharmann F, Bunzel D.Poisoning with L. in horses contradicts the hypothesis of coexistence between plants and vertebrate herbivores being mediated through antipastoral traits as toxins. However, incidental observations showed that horses evaded seedlings with primary leaves. The objective of the present cross-discipline study was (i) to analyse whether developmental stages of L. differed as to phenolics hypothesised as antipastoral traits, and (ii) to observe systematically the selection behaviour of pastured horses towards seedlings. Methods: Phenolic profiles of five developmental stages from fruits to seedl...
Waller AP, Pearson W, Lindinger MI.Standardbred and Thoroughbred racehorses around the world are tested for performance enhancing substances. Among these are blood alkalising substances that raise plasma pH and total carbon dioxide (TCO(2)) concentration. However, many horses have an elevated TCO(2) due to dietary, environmental and health concerns without having been administered an alkalising substance. Objective: The purposes of this study were to determine the acid-base profile of a cross section of Standardbred horses in racing/race training in Ontario and the main independent variables that contributed to acid-base state....
Matsui T, Murakami Y, Yano H, Fujikawa H, Osawa T, Asai Y.This experiment was conducted to study phytate degradation and the effect of dietary phytate level on phosphorus absorption in the gastrointestinal tract of horses. Six Thoroughbred horses were fed diets containing low-phytate diet or high-phytate diet for 5 days. The diets were supplemented with Cr2O3 as an unabsorbable marker. The horses were killed 3 h after the last feeding and digesta in some segments of the intestine were collected. In both dietary groups, the daily passage of phytate phosphorus was decreased in the upper small intestine and in the lower large intestine. The daily passag...
The type of diet that a horse consumes is one of the most important factors determining the mineral profile and tensile strength of its hooves, so the quality and nutritional value of the supplied feed are fundamental to achieving satisfactory hoof quality. The objective of this study was to compare the differences in the mineral concentrations of sodium (Na), potassium (K), magnesium (Mg), zinc (Zn), and Iron (Fe) between two diets, namely silage and a commercial concentrate, using atomic absorption spectrometry and to determine which led to higher increases in the hoof tensile strength of ho...
McIlwraith CW, James LF.Five of 26 pregnant mares observed ingesting locoweed (Astragalus mollisimus) subsequently aborted and another 10 produced foals with various limb deformities. Seven of the foals had deformities of a flexion-extension type and 3 had angular deformities. Four foals were normal. The limb deformities either resolved spontaneously (5 cases) or were treated successfully (in 4 of the other 5 cases). The problems of abortion and limb deformities were attributed to locoweed ingestion on the basis of the mares having eaten the plants, and the similarity of the syndrome to that previously reported in sh...
Elghandour MMMY, Maggiolino A, García EIC, Sánchez-Aparicio P, De Palo P, Ponce-Covarrubias JL, Pliego AB, Salem AZM.This review examines the available data regarding the positive effects of microencapsulated essential oils (EOs) on the nutrition, metabolism, and possibly the methane emission of horses. A literature review was conducted on the effect of microencapsulated (EOs) on the health of horses. The information comprises articles published in recent years in indexed journals. The results indicate that mixtures of microencapsulated EOs may be beneficial to equine health due to their antimicrobial and antioxidant activity, as well as their effects on enteric methane production, nutrient absorption, and i...
Blakley BR, Bell RJ.The purpose of the study was to determine normal baseline levels of vitamin A and vitamin E in clinically normal horses under typical field conditions in Saskatchewan and Alberta. Heparinized blood samples were collected from approximately 400 clinically healthy horses selected from 24 locations in Alberta and Saskatchewan during a two-year period. For each horse, historical information including feed type, vitamin supplementation, time of year, sex, and age were recorded. From each blood sample, the plasma vitamin A (all-transretinol) and vitamin E (alpha-tocopherol) levels were measured usin...
Jansen WL, van der Kuilen J, Geelen SN, Beynen AC.The hypothesis tested was that the intake of extra fat at the expense of an isoenergetic amount of nonstructural carbohydrates reduces fibre utilisation in horses. In a crossover trial with feeding periods of 42 days each, 6 mature trotting horses (age 4-12 years, bodyweight 340-476 kg) were given either a control or test diet. The test concentrate was formulated to contain 37% of net energy in the form of soybean oil. The control concentrate contained an isoenergetic amount of corn starch plus glucose. The concentrates were fed in combination with the same amount of hay so that the control an...
Knottenbelt DC, Harrison LJ, Peacock PJ.Three foals under four weeks old and two under six months old with a history of oesophageal obstruction, had oesophageal strictures of different characters in the rostral cervical oesophagus. One case, which was complicated by severe inhalation pneumonia, was euthanased without any treatment and in another initial treatment by bougienage under general anaesthesia was attempted without success. The four surviving cases were provided with progressively firmer and coarser food, starting with liquid only, over a period of three to four weeks. The treatment is recommended in the early stages of str...