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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    lie had once had an obstinate sore on his chin, which gave rise to this opinion. At my first visit, I put him on the use of hydriodate of potassa, grs. v. in solution, three times a day. I directed a blister to be applied on each side of the neck; and as he could swallow only fluids, advised a diet of milk. The blisters were kept open about ten days; and in the mean time I frequently attempted to get an cesophagus bougie beyond the stricture, intro- ducing it sometimes through the mouth, sometimes through the nostrils; sometimes passing a large hollow instrument down to the obstruction, and leaving it there for an hour together; or passing a smaller instrument through the larger one; but all without success. At times the instrument appeared to clear the stricture and pass onwards; but, on withdrawing it, I invariably found that this apparent success depended on a doubling of the extremity of the bougie. Failing with simple bougies and catheters, on the 27th of January I passed an armed bougie, through a hollow catheter, down to the stricture, and allowed a piece of lunar caustic, about the size of a pin’s head, to melt at the seat of obstruction. This caused some soreness, but did no good. The caustic application was repeated on the day following. It appeared rather to aggravate than to relieve the difficulty. With a view to an operation for getting into the oesophagus, beyond the stricture, I now requested a consultation. The patient was accordingly seen, first, by Dr. Stevens, then by Drs. Rodgers, Hoffman and Post; all of whom expressed their conviction as to the necessity of the measure, the obstruction being now so great that the patient was unable to say whether any portion of his fluid food actually passed into the stomach or not. On the 2d of February, wishing to delay the operation until the arrival of his friends from the country, he was obliged to resort to nutritive injections. For the ten succeeding days, these were statedly administered through a long gum-elastic tube passed into the colon. They consisted of beef tea, broth containing boiled flour, boiled starch and arrow-root, boiled eggs, and such other articles as could be administered. The injections had a marked effect in recruiting his strength and in assuaging the sense of hunger. They increased the volume of the pulse and the fulness of the capillary vessels. But at times they excited tormina; and, occasionally, they purged him, especially when they chanced to be too highly seasoned with salt. Feb. 12th. The patient had all the morning been suffering from tormina; his pulse was feeble, ranging at 120; but he was otherwise in a favourable condition. I commenced the operation about one o’clock, P. M., assisted by Drs. Stevens, Rodgers, Hoffman, Post and Buck, in the presence of several of my own students, and a few of the friends of the patient. Having previously placed him on a cot near a window, with his back well supported by pillows, and his head thrown gently backwards, I commenced the first incision on the left side of the neck, midway between the os hyoides and