The practice of surgery / by James Gregory Mumford.

  • Mumford, James Gregory, 1863-1914.
Date:
1914
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery / by James Gregory Mumford. Source: Wellcome Collection.

    133/1062 (page 127)
    INFLAMMATIONS OF THE ESOPHAGUS Inflammations of the esophagus occur at times and may interest the surgeon. They may assume various forms, such as acute or chronic catarrhs, and necrotic or diphtheric inflammations. These inflamma¬ tions may be ascertained by the use of the esophagoscope. Treat¬ ment is rather uncertain. If the disease is mild, relief and cure follow the administration of a cool liquid diet and the use of general tonics. If the disease is more severe, it may be necessary to make local applica¬ tions with such solutions as silver nitrate (1:4000) or a 5 or 10 per cent, solution of argyrol. Ulcers of the esophagus occur also—gangrenous ulcers caused by pressure from within or from without; syphilitic ulcers in the upper portion; rarely tuberculous ulcers; and actinomycosis of the esophagus has been described. It appears also that peptic ulcer of the esophagus1 may be found as well as the curiously uncommon typhoid ulcer. All these latter lesions are curiosities of surgery. They can be ascertained by the use of the esophagoscope, and by the recognition of associated general disease, while their treatment, with the exception of that for actinomycosis, must be along general systemic lines. The Stomach The stomach has become an organ of supreme interest to surgeons in these days. Within the past twelve years the literature of gastric surgery has grown to enormous dimensions; and advances in accuracy of diagnosis, in confidence of treatment, and in operative technic have been in proportion. We have seen how the appendix with its various manifestations of disease dwarfs the importance of most other ab¬ dominal organs, and how its disturbances have a special bearing on digestive disorders. In like manner the stomach, ulcerated, catarrhal, or the seat of malignant disease, looms up as an organ continually sub¬ ject to surgical observation and treatment. Gastric surgery is more than thirty years old, but for the first fif¬ teen years its progress was halting and unsatisfactory. So long ago as 1880 von Mikulicz sutured a perforation on the lesser curvature of the stomach, but the patient died, and in the year previous Pean at¬ tempted a pylorectomy,—unsuccessfully,—to be followed by Rydygier in 1880. Billroth improved the operation and saved his first patient in 1881, while Rydygier excised successfully an ulcer in 1881, and in the same year Wolfler performed the first gastro-enterostomy. Up to that time, and until much later, indeed, lesions of the stomach were regarded as belonging to the domain of the internist acting alone, but of recent years we have come to see that many disorders of diges¬ tion are due to anatomic changes which disturb the stomach’s mechan¬ ism and demand mechanical interference for their relief. For instance, 1 Peptic ulcer of the esophagus is well recognized and may lead to stricture. Considerable literature on this subject is summed up by AVilder Tileston, Peptic l leer of the Esophagus, Amer. Jour. Med. Sci., August, 1906.