Practical observations on organic obstructions of the oesophagus : preceded by a case which called for oesophagotomy and subsequent opening of the trachea / by John Watson.

  • Watson, John, 1807-1863.
Date:
[1844]
Catalogue details

Licence: Public Domain Mark

Credit: Practical observations on organic obstructions of the oesophagus : preceded by a case which called for oesophagotomy and subsequent opening of the trachea / by John Watson. 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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    but this weakness was not of long continuance. There was never any torsion or lateral inclination of the neck in consequence of the division oi the muscle. It may here be asked, were there no symptoms before death indicating the existence of the perforations between the trachea and oesophagus? I he first appearance that led to a suspicion of the sort, was the passage of air into and out of the artificial opening in the neck, which was noticed for eight or ten days before the operation of tracheotomy. This appearance was not constant, but was observed for a few minutes after every removal of the oesophagus tube. The next circumstance, leading to the same sus- picion, I noticed, for the first time, a day or two only before death. A few drops of prepared arrow-root, after 1 had administered a bowlful of this through the oesophagus tube, were seen within the trachea, immediately behind the opening made by the operation of tracheotomy. The accompanying plates will probably convey a more accurate idea of the pathological condition of the upper part of the trachea and oesophagus, than can be given by mere verbal description. The foregoing case, in reference as much to its pathological character as to the measures instituted for its relief, is one of unusual importance. The tubercular deposits in the submucous cellular tissue around the upper part of the oesophagus, were unquestionably the starting point of disorder. They probably existed there long before the first serious manifestations of disease, and may have given rise to the “narrow swallow” with which the patient had always been affected. The extension of irritation from these to the tissues in their neighbourhood, probably induced the cough which had troubled him for a few weeks prior to the first symptoms of stricture. But up to the period of opening into the oesophagus, the disease, I am disposed to believe, had not progressed to ulceration, at least to any extent; for when opened, so far as I could see, the inner surface of the oesophagus was smooth and of its natural colour. Above the opening the finger could detect some irregularity; but there had been no discharge of blood or of purulent matter from this surface. Below the cut the tissues were also smooth, though somewhat rigid and resisting to the first introduction of the tube. This rigidity was very circumscribed, easily overcome and never subsequently observed. Whether the long continuance of the tube in the oesophagus had much to do in favouring the spread of ulceration or not, is difficult to determine. I am disposed to think it had no marked effect in this way. The ulcer did not extend beyond the range of the tubercular deposits, although the tube reached much farther down, and was as likely to affect the mucous mem- brane at its lower as at its upper portion. Be this as it may, I would not, in a similar case, recommend the constant continuance of the tube in the passage. The recorded cases of foreign bodies lodged in the oesophagus