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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    On the fourth day, after an attack of coughing, the patient discharged a great quantity of pus through the wound. The flow continued for at least twenty-four hours; and, after this discharge, the patient began to recover. Before the wound had cicatrized, another abscess formed beyond the sterno- mastoid muscle just above the clavicle. This was opened on the 26th of March. The patient left the hospital perfectly well on the 9th of April following.* The third and only other instance in which this operation has been per- formed for the removal of foreign substances, is recorded by Mr. James M. Arnott, surgeon to the Middlesex Hospital, London, in the 18lh volume of the Medico-Chirurgical Transactions. The patient was a child only two years and a quarter old. The offending body, as in the two former cases, was a piece of bone. The operation was performed on the 21st of January, 1833, four weeks after the accident, and not until the respiratory organs had become seriously involved. The child bore the operation well; but the case resulted fatally, fifty-six hours afterwards, from inflammation of the lungs. The case which I have reported, then, should be looked upon as the fourth authentic instance in which cesophagotomy has been performed on the living subject; and as the only one in which it has been employed for the relief of stricture. The operative procedures of M. Begin, Mr. Arnott and myself, although essentially alike, differ in some important points from one another. The first of these surgeons, operating on the left side of the neck, carries his incisions from below upward. If the foreign body within the oesophagus causes any projection, and is within reach, he cuts directly upon it. “ But in a different case,” says he, “ the bistoury should be boldly plunged into the oesophagus parallel to its axis, at the middle of the wound, so as to lay it open to the extent of half an inch.t The incisions from below upward will enable the operator to use his left hand for dilating the wound and protecting the vessels and nerves on the side of the neck. These objects, however, can be quite as well effected by a curved spatula in the hands of an assistant. But as to plunging the bistoury boldly into the oesophagus, I must seriously protest against it. The yielding nature of this organ, even when its muscular fibres are put upon the stretch in deg- lutition, renders any attempt to incise it extremely difficult. It is readily fixed by passing a silver catheter or a firm gum-elastic tube into it. But a bold stroke of the knife, by transfixing the oesophagus, might readily endan- * Journal Universal et Hebdomadaire, vol. ii., April, 1833. t Dictionnaire de Mdd. et de Chirurg. Pract. Article, OEsophagotomie, vol. 12, p. 153:— “Si le corps etranger fcsait unc sailie appreciable sur quclque point, il faudrait inciser im- mediatement sur lui. Dans Ic cas contraire, !e bistouri doit eire hardiment plongc dans l’oesophage,” &,c.