Notes on cases of tumour in the mediastinum / by E. Symes Thompson.

  • Symes-Thompson, Edmund, 1837-1906.
Date:
[1865]
Catalogue details

Licence: Public Domain Mark

Credit: Notes on cases of tumour in the mediastinum / by E. Symes Thompson. 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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    communicated by an ulcerated opening with the oesophagus. In this case the difficulty of breathing was so great, that tracheotomy was contemplated, and I urged immediate recourse to the operation ; but in the absence of the physician under whose care the patient had been admitted, tin’s was postponed, and death occurred in a paroxysm of dyspnoea. A similar case is recorded in the same volume of the “ Trans- actions,” in which life was prolonged and much suffering removed by this operation. About the same time another case fell under my notice, also in King’s College Hospital, of which I have preserved notes; and as this has never been published, I will give a few details :— Thos. Gale, rnt. forty-five, was admitted under the care of Dr. Budd, in December, 1858, with inability to swallow either solid or liquid food. The dysphagia had existed for twelve months; a probang had been occasionally passed and always met with an obstruction opposite the thryoid cartilage. At the time of admission the obstruction was almost complete, and the patient wasted rapidly from want of food, everything swallowed being coughed up or regurgitated a minute or two after it was taken. . After some persevering efforts, Mr. Fergusson succeeded in passing the tube of the stomach-pump beyond the constriction, but no food was injected as had been at first suggested. An - attempt was made to keep the patient alive by means of nutri- tive enemata, but without success, and the patient rapidly sank. At the post-mortem examination the bifurcation of the trachea j was found to be imbedded in a mass of hard cancerous material,i which involved also the arch of the aorta and the oesophagus,',] and was adherent behind to the pre-vertebral aponeurosis in front of the fifth and sixth cervical vertebrae. This carcinoma- tous tumour was of a roimded outline, but sent prolongations into the interspaces between the right and left bronchi, between the aorta and trachea, and between the trachea and oesophagus. The tumour was about three and a half inches in length, and j extended from the third ring of the trachea to an inch below the bifurcation. The apparent size of the mass was increased by numerous large bronchial glands filled with pigment. The free I surface of the tumour was smooth, but slightly nodulated. On I the left side a deep groove existed, formed by the transverse portion of the aortic arch. The tissue at the root of the lung was hard, white, and glistening. Opposite the cricoid cartilagE the oesophagus was found contracted so as scarcely to allow tint passage of the forefinger, and on a level with the filth trachea I ring it was constricted to the size of a crowquill. Below thn first constriction the mucous membrane was eroded, and the channel widened into a large, almost gangrenous cavity, coinnio) to the trachea and oesophagus. From this cavity the right am