Copy 1, Volume 1

The study of medicine. Improved from the author's manuscripts, and by reference to the latest advances in physiology, pathology, and practice / [John Mason Good].

  • John Mason Good
Date:
1834
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Licence: Public Domain Mark

Credit: The study of medicine. Improved from the author's manuscripts, and by reference to the latest advances in physiology, pathology, and practice / [John Mason Good]. Source: Wellcome Collection.

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    used to suffer as much from flatulence as from dysphagy, and, in Ge. III. consequence of the entrance of bougies into the opening of the sac, it _Srzc: I. was difficult to pass them.* Pouches of this description are some- z nape times the result of abscesses, which burst into the pharynx. An °“™ instance, in which there were two large sacs reaching from the pharynx along the sides of the cesophagus and trachea, and betwixt the former and the vertebrz of the neck, was seen by Sir €. Bell. The mechanical operation of these pouches, and their valvular communications with the pharynx, by which the food that insinuated itself into them was confined there, occasioned the patient’s death from irritation and inanition.+ Cases of dysphagy, attended with the formation of the above kind of sacs, have been pronounced inevitably mortal.t This melancholy prognosis, it is to be presumed, would be fully warranted where the sac was the consequence of a scirrhous disease of the cesophagus; yet if Dr. Odier has taken a correct view of a case Singular that occurred at Geneva, an example, in which the cesophagus was case ter- in a scirrhous state, and there was a large prominent pouch on each minating side of the neck, yielded to medical treatment.] The food which fvourably. the patient, a young nobleman, took, commonly remained in these sacs an hour or two, and was then thrown up. Hemlock pills were prescribed, and a bandage applied to the protuberance. As soon as the pills were rejected, which, like the food, they were sure to be in an hour or two, their place was supplied by others, so as to let the hemlock constantly act on the seat of the disease. The patient soon experienced relief, and was gradually cured; the pouches disappeared; the aliments descended into the stomach; and the cesophagus recovered its former calibre. § [In stricture from chronic thickening of the mucous membrane, the Symptoms patient feels, instead of actual pain, a sort of pressure or tightness, of stricture. either in the course of the intestinal canal, or about the shoulders. He points out the exact part of the cesophagus in which the obstruc- tion is situated; and the lower this point is, the greater reason has the practitioner to suspect a thickened state of the coats of the canal. The unpleasant sensations sometimes extend to the cardiac orifice of the stomach; but they are only felt when the patient makes attempts to swallow. In the early stage, the food does not return into the mouth till long after a meal, sometimes not till four or five hours afterwards. As the disease makes progress, however, the return is quicker, and the quantity of aliment brought up again larger. * Sir C, Bell, Surgical Obs., p. 64. * tT Surg. Obs., p. 71. With the assistance of Mr. Broxholm, of Sunbury, the editor removed from the late Mr. Champion, of Halliford, a tumour that was situ- ated just below the occiput. Its consistence was that of cartilage, and its size that ofalarge orange. It had been growing many years. The reason which induced the patient at length to submit to an operation, was a serious difficulty of deglu- tition, which, he supposed, might depend upon the irritation of the tumour. After the removal of the swelling, the wound healed up very well, but no amendment took place in the power of swallowing, and the patient, who could hardly take any nourishment, for two or three weeks, died in a very emaciated state, about two months after the removal of the tumour. On dissection, a thickening of the parietes of the oesophagus was detected, attended with a very close stricture, and a.pouch above it, containing some orange pips. ¢ Jourdan, in Dict. des Sciences Méd., tom. x. p. 439. § Edinb. Med. Convers., vol. iii. p. 193. G2
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