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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    In this position the lower portion of the oesophagus is free from any pressure what- ever, and to any other foreign body, save that of the character described in the cases, is not liable to present resistance. The remaining instance of foreign bodies involves the ascending aorta. Case /.—Male, 22, after illness of six days, occasioned by the swallowing of a bone, died suddenly from hemorrhage. The qff'cnding body had perforated the anterior wall of the a’sophagns and the ascending portion of the aorta owQ and a quarter inches below the origin of the innominate artery. This point, in the language of the recorder, answered to the centre of the middle third of the oesophagus. (Farquharson, Trans. Path. Soc. bond., 1868, 219.) In this case it is likely that the oltstruc- tion tvas primarily occasioned by the left bronchus, since the middle third of the oesophagus would nearly correspond to it.* Nine cases have been collected of cri- coid disease, as follows: Case /.—rMale, aged 50. Constriction below base of cricoid. From this to the bronchus the oesophagus was dilated. (N. Ward, Trans. Path. Soc. bond., i. p. 247.) Case II.—Female, aged 53. Q'.sophagus ad- herent to vertebral column one and a half inches opposite and below the cricoid cartilage. The oesophagus much thickened and con- tracted. The constriction extending down- wards two inches. A cancerous tumor lay between the oesophagus and trachea opposite the stricture. (E. Andrews, Ibid., xii. p. too.) Case III.—Alale, 44. Upper three inches of a'sophagus involved in cancerous tumor ul- cerating into left subclavian artery. (Dick- inson, Ibid., xii. p. 108.) Case IV.—Female, 40. Tight stricture at upper part of (esophagus'' opening info tra- chea. (C. Heath, Ibiel., x. p. 130.) Case V.—Female, 24. Trachea and aw///- agus excessively diseased nearly as far as bifurcation of trachea. An oval ulceration ex- isted between the trachea and oesophagus. (Wilkes, Ibid., vi. p. 179.) Case VI.—Stricture, four inches below the cricoid cartilage, extending to the bifurcation of the trachea. (Knight, Dost. Med. andSurg. fournal, N. S., vol, vi. p. 348.) Case r//.—Female, aged 53. (Esophagus constricted, adherent to vertebree below the cri- coid cartilage. Carcinomatous tumor in tra- chea, growing from posterior wall. Disease * I he space between the cricoid region and the left bronchus embraces ihe beginning of the thoracic portion and is the lo- cality of greatest normal constriction. Vet I have secured but one example of lodgment of a foreign body therein. The diminished calibre of the canal at tlii.s point is caused by increased development of muscular fibre, and would not of necessity interfere with distention. cancerous. (Gibbs, Diseases of Throat, 2d ed., p. 392.) Case H///.—Male, aged 65. Constriction two inches from upper e.xtreinity ; an ulcer one inch long extending all round the tube. On the right side the ulcer communicated with the cavity between the oesophagus and innominate artery. The right subclavian artery, one and a half inches from origin, showed a circum- scribed opening into the above-mentioned cavity. Disease cancerous. (Balding, Trans. Path. Soc. bond., ix. p. 194.) Case IX.—Female, aged 35. Cancerous stricture at cricoid, extending upward to behind thyroid cartilage. (Holmes, Lancet, 1876, ii. p. 824.) The following twelve cases of obstruc- tion were located at the point where the left bronchus crosses the oesophagus : Case I.—Female, adult. Cancerous ulcer situated opposite the bifurcation of trachea. (Wilks, Trans. Path. Soc. bond., xii. p. loi.) Case II.—Female, adult. Oesophagus im- pervious towards lower third. Just above be- ginning of constriction, free opening into bronchus. (Nunneley, Trans. Path. Soc. bond., xiii. p. 74.) Case III.—Male, 51. (Esophagus three inches from upper extremity involved by epi- thelial cancer, communicating with trachea just above bifurcation. Hemorrhage from first intercostal of right side. (Sydney Jones, Ibid., iv. p. 202.) Case IV.—Male, 45. Two inches of oesoph- agus upward from bifurcation of bronchi in- volved. Communication with trachea just above bifurcation. (Budd, Ibid.,\. 145.) Case V.—Male, 50. Stricture on level of bifurcation extending down two inches. (Shil- litoe. Ibid., xiii. p. 72.) Case VI—Boy, 10 years. Qisophagus di- lated opposite bifurcation, %uhere longitudinal ulcer one and a half inches long CQ>m\\\\\x(\c.-N.^dL with an enlarged, suppurating bronchial gland filling up the interval between the bronchi. (O. Ward, Ibid., ii. p. 208.) Case VII.—Stricture about the middle of oesophagus circumscribed, without involve- ment of any of the neighboring parts. Asso- ciated with cancerous polypus near cricoid. (Cooper Forster, Lancet, 1863, ii. p. 247.) Case VIII.—Disease situated in oesophagus at “ root of the lung. (Bennett’s Practice of Medicine, p. 424.) Case IX.—Male, 44. Cancerous stricture opposite bifurcation of trachea, into which it perforated. (Partridge, Med. Times and Gaz., 1866, p. 338.) Case X.—Male, 61. Non-malignant ulcer- ation five inches from upper end (if a’sophagus, just beneath the arch of the aorta, cominuni- cating with right bronchus. (Partridge, Trans. Path. Soc. bond., 1857, p. 191.) Case XL—Carcinomatous stricture at mid-