The localization of diseased action in the oesophagus / by Harrison Allen.

  • Allen, Harrison, 1841-1897.
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: The localization of diseased action in the oesophagus / by Harrison Allen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    eign bodies in the oesophagus are mostly j arrested at its origin behind the cricoid | cartilage, or at its lower end, just above j the diaphragm, the two narrowest por- | tions of the tube, and anything that can be swallowed may be so impacted.” Erichsen states that “if a foreign body go beyond the cricoid cartilage it usually be- comes arrested near the termination of the oesophagus.” From among ten cases of foreign bodies, which I have collected, three were situated behind the cricoid, four just above the left bronchus, two near the cardiac end, and one between the cricoid and left bronchus. I will briefly relate these cases, omitting mention of the cricoid variety. Case /.—Male, aged 30, in taking a drink of water swallowed an artificial front tooth, with gold plate, which measured one and a quarter inches in length and five-eighths of , an inch in height. A probang was passed * eleven inches before touching it. It was re- moved by silver wire loops secured to the end of the probang. (John Dearden, Lancet, 1869, Oct. 16, p. 540.) Case II.—Male, aged 21. Swallowed a half-crown piece. At the end of a month hemorrhage occurred from the mouth. Sud- den death. Stomach distended with coagu- lated blood, and intestine, as far as descend- ing colon, contained blood, more or less changed. An ulce7-ation %uas fo7cnd afte?- death at the comnie7icenicnt of the tJi07'acic portio7i of the ao7'ta. Case ///.—Male, adult. An impacted fish- bone caused death on the tenth day. An ulcer was found on the right side of the oesophagus, perforating the walls 07i the level of the fourth do7'sal vertebra and communi- cating with the aorta. A similar ulceration had excited thickening around and obstruc- tion of the right azygos vein. (Ramskill, La7tcet, May 13, 1871.) Case IV.—A child, aged 5 years, swallowed a halfpenny. The coin was pushed violently | downwards into the stomach. Death from enteritis. The coin was not found at the autopsy. The totuer tJiird of oesophagus m- fla7/icd. (Jas. Nicholls, St. George’s Hosp. Rep., iv., 1869, 219.) In Case I. the probang must have reached a point just above the left bronchus. An examination made upon a dead body lying upon a table has shown me that the left bronchus is reached by a jtrobang at the distance of ten and a half inches from the teeth. It is in every way probable that in the living subject, in the erect position, a half-inch might be naturally added to this measurement; to say nothing of the indi- vidual variations in length of the parts traversed by the probang. In Case II. the term “ commencement of the thoracic por- tion of the aorta,” when paraphrased (as I have ventured to do) as follows, “ at a point opposite the third dorsal vertebra,” w'ill bring the point of obstruction just above the left bronchus,—the latter structure answering at its origin to the fourth dorsal vertebra. The impaction from a body the size of a half-crown piece would be evident as it approached the bronchus, rather than be detected lying directly behind it. In like manner, in Case III., the phrase “on the level of the fourth dorsal vertebra” brings the point of obstruction to the re- gion of tlie left bronchus. In Case IV. the coin had most probably been lodged at the bronchus, and the track of inflam- mation at the lower third of the oesophagus answers to the extent of bruising incurred in the violent passage of the coin and the probang. The two cases of cardiac obstruction are as follows : Case I.—Male, 56 years old, in whom a piece of bone \\7\.ii perfo7-ated the right side of the aesophagits a halfi7ich above the dia- phragm, and wounded the superior vena cava. Death at end of sixth day. Stomach and right pleural cavity filled with coagula. (E. Cocster, Bert. Klhi. JVoche7isc/i7'7fi, Oct. 24, 1870.) Case II.—Adult male, in whom a fish-bone ha.(l pe7forated the cardiac e7id of the oesopha- gus, perforating the stomach and diaphragm, and penetrating the posterior wall of the heart, making a jagged wound immediately in the middle of the ventricular septum, and open- ing the right coronary artery and vein. [La/i- cet, i860, ii. p. 186.) It will be at once seen that in both these instances the lesion was occasioned by the sharp, needle-like bone. It is by no means probable that a coin-like, much less a globose, substance would have been so ar- rested. A striking contrast exists between that portion of the oesophagus above and that belotv the left bronchus. The upper portion is relatively firmly held between the respiratory passages and the vertebral column, and is subject to no variable de- viation from its normal line. But that portion below the bronchus must be re- laxed in the marked ascent of the dia- phragm accompanying gastric repletion,-—• a feature somewhat roughly imitated in the subject when the sternum is removed and the diaphragm .sags slightly upward.