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

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.

138/784 page 84

$8h Gen. III. Spec. I. D. Con- stricta. Symptoms ef scirrhus. Stricture sometimes indurated and bony, Remote causes. often rejected almost as soon as the effort is made to swallow it. Dysphagy, arising from scirrhus of the cesophagus, is attended with symptoms very similar to those of stricture. Pain, and inability to swallow solids, are the early symptoms. After a time the passage of fluids is arrested; they remain for a short time in the canal, and, distending it, create a sense of suffocation. At length, they are partly rejected by an inverted action of the cesophagus through the nose and mouth, and the rest passes down with a gurgling noise.* By careful and experienced observers, however, some circumstances have been noticed by which a scirrhus. of the cesophagus is more particularly characterised. The patient is conscious of a dull pain and oppressive tightness, not only when he attempts to swallow, but at other times; and, if credit can be given to Wichmann, who first made this remark, the disagreeable sensation and the difficulty of swallowing cease in a great measure when the patient lies down upon his back. In addition to these particulars, Richerand’s observation merits attention, namely, that a bougie is generally more easy of introduction, than in cases of stricture. The disease is reported to be sometimes met with in very young subjects as well as others, Percival having observed it in a child only thirteen years of age, and Wichmann in three children under eight. A question, however, here presents itself, namely, whether these were examples of true scirrhous disease of the csophagus, or only scrofulous swellings of the lymphatic glands, which are well known to be particularly common in young subjects ? ] : Where osthexia, or an ossific diathesis, is present, the stricture sometimes assumes a bony hardness; and Metzger gives a pitiable case of this kind, in which the passage was so narrow, that the unhappy patient perished altogether of hunger t! At times, indeed, the cesophagus has become entirely imperforate, either from the case.[ Examples of the latter have occasionally followed small- pox(, or strumous indurations.|| In a few instances half the length of the cesophagus has been One patient thus afflicted died of marasmus in the seventh month from the commencement of the disease, and i the prime of his life. The tumour reached from the middle of the canal to the cardia, and so thoroughly blocked it up that a probe was with difficulty passed into the stomach on examining the part after death.q An analogous case is recorded by Sir C. Bell.** Of stricture of the cesophagus, it is often difficult to trace the remote causes. A neglected catarrh; common sore throat, small- pox ; syphilis; a highly nervous or spasmodic diathesis; the smoke of tobacco++ ; the use of the datura stramoniumtt; the abuse of * See Monro’s Morbid Anatomy of the Human Gullet, &c. p. 326. + Advers. Med., vol. i. p. 175. + Cent. ii. Obs. 46. \l Mauchart, Diss. de Struma Cisophagi, hujusque Coalitu, &c. Tubing. 1742. q Edinb. Med. Essays, vol. ii. art. xxiv. ** Surgical Obs., p. 79. TT Eph, Nat. Cur., Dec, m1 Ann i, obs. 79. #f Ibid., Ann., iis obs 68. a s$