A manual of diseases of the throat and nose : including the pharynx, larynx, trachea, œsophagus, nose and naso-pharynx / by Morell Mackenzie.

Mackenzie, Morell, 1837-1892.

Date:: 1884

Credit: A manual of diseases of the throat and nose : including the pharynx, larynx, trachea, œsophagus, nose and naso-pharynx / by Morell Mackenzie. Source: Wellcome Collection.

48/610 (page 36)

$young children. In most of tliese there wa.s circuniscritx'il pneumonia, wliilst in 2 there Wiis enteritis, and in 2 cAo/em infantum. In some of Hillard’s ca.ses, however, it wouhl appear that the morbid changes had actually commence^l before birth. The exciting cau.se of the complaint stx'ins to be sore nij)ples or a defective quality of milk on the j>art of the mother or nurse, or improper food. The principal mpnptum of oesoidiageal inflammation in iliildren is an unwillingness to suck. When the child, however, can be induced to take the breast it leaves ofl‘ sucking after a second or two and commences crying. Most of the milk is immediately returned, (piite unchanged, a very small quantity probably reaching the stomach. Gentle pressure on the lower part of the trachea will, as Hillard* lias pointed out, often make the child cry. The duu/noms of this affection is very difficult. If occur- ring at the time of birth, it may be confoundeil with a cnngeuital malformation of the oesophagus. In the latter case, however, all the milk is rejected, and panixysms of suffocation are brought on by attempts to swallow. (>n tlie other hand, in the affection now under consideration, altliough the child cries after trying to suck, a small quantity of nutriment is retained. The path()lo(/ical changes vary in different cases. Some- times the whole lining membrane is inflamed, whilst occa- sionally the hyperremia affects only a limited surface. Ecchy- motic patches are often present. Sometimes the inflammation goes on to ulceration. The ulcers vary in form and size. Thus, in one. of Hillard’s - cases the upjier jiart of the oesophagus \vas highly injected, and there were two .shar]dy-cut ulcers of oblong shape, each measuring about four lines in its longest diameter. In amifher of Hillard’s^ cases the whole of the u|i])cr third of the gvdlet showed erosions of the ejnthelium, wliilst in a third instance jKirtions of the ejiithelial layer were expectorated as broad yellowish shreds ; on jio.d-moiicvt examination tlie mucons membrane exhibited large ])atches of a bright red cok)ur, which ap])cared to corresjxmd with tin* inend)ranous material ('Xpectorated during life. I leers, when piH'sent, generally ali’ect only a limited jxirtion of the oeso- phagus—the ujiper or lower ]>art—and, according to Steffen,'* their number is in inverse projawtion to their size. It not, unfre(incntly hapixms that the inflammatory process is ^ Op. cit. ]>. ‘290. ‘2/6. , » Ibid. p. ‘279. ^ Loc. cit.$