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.

    8/10 (page 6)
    die third of oesophagus. (Richardson, Lajicet, 1873, ii. p. 596.) Case XII.—Male, 54. Carcinomatous j/rzr- tU7'e opposite third or fourth dorsal vertebra, determined by oesophageal auscultation. (Morell Mackenzie, Lancet, 1874, i. p. 754.) It is impossible to estimate the influence exerted by the thoracic narrowing of the oesophagus upon the cases just selected. It is well, however, to bear in mind the re- lationship. The following cases, while not in all instances directly associated with the left bronchus, were at least limited by this structure above, and it is probable, since from the post-mortem appearances the le- sions were of long standing, that the first deposition was at the region of the bron- chus, the lower portion of the gullet being involved subsequently. This is, I think, a •rational supposition, conceding the tend- ency of cancerous and other growths to extend in the direction of least resistance. Case I.—Female, aged 37. Cancerous dis- ease at lower part of middle third of oesophagus, three inches from cardiac end, opening into second right intercostal artery. (Bristowe, Trans. Path. Soc. Bond., 1857, viii. p. 211.) Case II.—Female, 25. (Esophagus f7-om bifurcation to one inch above diaphragni the seat of simple ulceration, with contraction. Ulceration into pericardium where that mem- brane is reflected from pulmonary vessels to the left auricle. (J. W. Trotter, Trans. Path. Soc. Bond., viii. p. 317.) Case III.—CFsophagus impet-vious toivards iotver third, opening into bronchus. (Nun- neley, Trans. Path. Soc. Bond., 1862, xiii. p. 74.) This case might be included in preceding group.) Case IV.—Disease five inches fi-ojn the stomach, extendmg do'wnward two inches. (Page, Lancet, 1863, ii. p. 248.) Case V.—tEsophagus involved three inches above cardiac orifice, opening into right side of the descending portion of aorta. (W. H. Flower, Med.-Chir. Trans., xxxvi. p. 353 ) Case VI.—Disease e.xtended from bifurca- tion to %vithin two inches of cardiac end. (Sedg- wick, Trans. Path. Soc. Bond., viii. p. 48.) Case VII.—Male, 62. Cancerous disease behind left bronchus, opening into descending aorta below, and involving the lung of the leVt side. Stomach and duodenum contained clot. (Wilks, Med. Times afid Gaz., 1861, vi. p. 36.) Case VIII.—Cancerous disease involving oesophagus from bifurration of trachea to the stomach. (Rees, Lancet, ii. p. 284.) Case IX.—Cancerous disease beginning at bifurcation and opening theiice into pericar- diuni. [G. W. W. Firth, Lancet, 1859, P- 284.) Case X.—Male, 18 years. Small perfo- rating ulcer of oesophagus one-quarter of an inch below bifurcation, penetrating into peri- cardium. (J. Forsyth Meigs, Ani. fotent. Med. Sci., 1875, 69, N. S., 87.) The following eight cases were limited to the oesophagus at its lower portion, viz., between the left bronchus and cardiac end. In five of them the cardiac orifice was directly involved. Case I.—Disease in the form of epithelial cancer mvolved cardiac orifice. (Bennett’s Practice, p. 340.) Case II.—Male, 56. .Scirrhous tumor at car- diac orifice exte^idingup three ijiches. (Beared, Trans. Path. Soc. Bond., vii. p. 95.) Case III.—Male, 70. Mass of cancerous disease extended upiuard from cardiac orifice three mehes. (Graham, Ibid., vii. p. 128.) Case IV.—Male, 49. Ruphme of oesophagus one inch long immediately above the diaphragm. (J. Griffin, La?icet, 1869, ii. p. 336.) Case V.—Male, 64. Cancerous stricture near cardiac orifice of the stomach and oppo- site to the third dorsal vertebra. No ulceration. Case U/—Male, 72. Ulcer two itiches loftg situated above the cardiac orifice. (Bennett’s Practice, p. 424.) Case VII.—Male, 54. Constriction otie and a half inches above the cardiac orifice. (Mur- chison, Trans. Path. Soc. Bond., xv. p. 183. Case VIII.—Patient 80 years of age. Ulcer about one inch above diaphragm, measuring three inches in vertical diameter. {Mem.—This will bring it to about lower border of left bron- chus.) (C. Heath, Trans. Path. Soc. Bond., ix. p. 211.) In addition to the influence, fixed and probable, which the left bronchus exerts in locating oesophageal disease, a number of incidental lesions are recognized whicli appear to be limited by this' important structure. An analysis of the cases already quoted will have suggested this truth. To illustrate it further, I give several examples under the following heading. Limitation of morbid action and lesion by the left bronchus, viz.: Case I.—Male, 47. A sti'icture opposite the bifurcation of the trachea, associated with en- gorgements of the lymphatic glands in the same neighborhood, caused dilatation of the oesophagus both above and below the seat of disease. The stomach was enormously dis- tended, reaching below the umbilicus. (Bewis, Med. Times and Gaz., 1861, p. 332.) Case II.—A stricture adherent to the bron- chial lymphatic ,fiands caused dilatation from two inches below rima glottidis to beginning of lower third of (esophagus. (Barker, Trans. Path. Soc. Bond., x. p. 141.) Case III.—An aneurism of the aorta below the origin of the great vessels {Mem., between