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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    about indirectly by the disease of the oesophagus, should offer no objection to a repetition of the operation of oesophagotomy under similar circum- stances. The patient’s life was considerably prolonged by it. The super- vention of disease in t'lte bronchial passages, which was the immediate cause of death, should, as it appears to me, be looked upon as incidental, and not as a necessary consequence of the primary affection. And had this secondary affection not occurred, there is no reason to doubt that, so far as nutrition and digestion were involved, the patient’s life would have been preserved. The opening of the trachea, called for towards the close of the case, was the means of prolonging life only for a few days. In reference to the instruments employed for dilating the wound in the trachea, I am disposed to believe that the wire dilator, above delineated, or even the ring and lateral ligatures, may occasionally be found, as in this case, more convenient and useful than the canula of Casserius. On a former occasion I succeeded remarkably well in temporarily dilating the wound, by passing the lateral ligatures through the barrel of a quill, placed trans- versely across the neck, and tying their extremities together over this instru- ment. Any hollow tube, or a thin piece of wood, notched at either end and about three inches long, would answer a similar purpose. Many systematic and other surgical writers, since the commencement of the last century, have spoken of oesophagotomy as a feasible operation. But the instances hitherto published, or in which it is said to have been per- formed on the living subject, amount, at most, to only five. The first two of these, stated to have occurred more than a century ago, are, to say the least, of questionable authenticity; and all of them were for the removal of foreign bodies. The present, so far as I can discover, is the only instance in which this operation has been performed for supplying the stomach with food. The older surgeons were so apprehensive of danger, in attempting to reach the oesophagus by an incision, that in cases calling for this, they con- tented themselves with the use of probangs, flexible bougies, metallic sounds, blunt hooks, forceps and other similar instruments ; or, as a last expedient, where the foreign body in the gullet impeded respiration, they first opened the trachea, and afterwards attempted to disembarrass the oesophagus with the probang; or, failing in this, they allowed the foreign body to work its way outward, as it might, by ulceration. Nicholas Habicot, a surgeon of Hotel Dieu, about the beginning of the seventeenth century, was the first to open the trachea for this purpose. A youth about fourteen years of age was brought to him, who, in dread of being attacked by robbers, had swallowed nine gold pistoles enveloped in a piece of cloth. This package had lodged in the oesophagus, and was threatening suffocation by its pressure against the trachea. Habicot at once relieved the breathing, by opening the trachea and inserting a canula, and afterwards pushed the money onward into the stomach by means of a long leaden sound.* * Sprengel, tome <, p. 142. Hevirt, in Meinoircs de l'Acad. de Chirurg. tom. lre. Huti-