A case of simple stenosis of the oesophagus, followed by epithelioma / by C. Hilton Fagge.

  • Fagge, Charles Hilton, 1838-1883.
Date:
[1892]
Catalogue details

Licence: Public Domain Mark

Credit: A case of simple stenosis of the oesophagus, followed by epithelioma / by C. Hilton Fagge. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    in the museum of Guy's Hospital. The following description is the result of a careful examination, but this was made after the parts had been macerated for some time in spirit. The upper part of the oesophagus is rather less than an inch in diameter. This calibre is maintained as the gullet descends, until a point about four and a half inches from the cardia. Here it becomes slightly dilated, its diameter reaching one and a half inch. About two inches lower it again becomes narrower, at first rapidly, afterwards more gradually, so that the shape of a funnel is pretty closely imitated. The narrowest part of all is at the termination of the oesophagus in the stomach. Here the calibre is so small that an ordinary lead pencil is firmly grasped by the gullet. At its widest part the walls of the oesophagus present a large irregular opening, two inches in length, which is evidently in part the result of ulceration, but which may also in part have been caused by injury during removal from the body. On one side the lung is adherent; there is also close to the outside of the gullet a lymphatic gland, which is the seat of epithelioma. The coats of the oesophagus are greatly thickened ; the longitudinal fibres are very distinct, and within these the transverse fibres are greatly hypertrophied. In the upper part of the tube the thickness of the coats is one fifteenth of an inch, just where the oesophagus opens into the stomach it reaches one fifth of an inch. In addition to my own somewhat cursory microscopical ex- amination, I have had the advantage of having the specimen carefully examined by my friend Mr. Howse, who has kindly supplied me with the following notes of the observations he made: « A section taken near the ragged opening previously described showed that the layers corresponding with the mucous membrane and muscular coats were very much thickened. Ex- amined under the microscope, there was a great increase of flattened epithelial elements in the former layer, and of short spindle-shaped cells in the latter. No very definite arrange- ment of the cells in the epithelial layer at this part could be made out. Indeed, many of them were considerably degene- rated, thus leading to the inference that they had been there for some time. A section, however, taken rather farther from the ragged orifice, where the thickening was not so great, showed