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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    sized stomach tube was now introduced through the wound; and a glass ot wine, and afterwards a full meal of boiled arrow-root, were administered. . The patient bore the operation with uncommon fortitude. After its com- pletion, lie informed me that the pain of the incisions was trifling to that produced by the fingers and the curved spatulas used in dilating the wound. After a few moments repose, the transverse portion of the external wound was drawn together by a single suture; the rest of the wound was allowed to remain open. The stomach tube was not removed from the oesophagus ; but its free extremity was secured to the side of the head, to prevent it from slipping inwards. On the following day the patient was free from fever, his pulse was less frequent than on the morning of the operation; his voice was slightly altered by the pressure of the tube or the tumefaction caused by the operation; but he had no difficulty of breathing. The saliva was issuing freely through the wound. No serious symptoms followed the operation. The tube was not disturbed until the end of the sixth day. It was then withdrawn, and another introduced through the left nostril. After this the wound was dressed with adhesive straps and compress, so as to favour cicatrization. The second tube, which was about an inch and an eighth in circum- ference, at first gave him some uneasiness, slightly affecting the left eye and causing some hemorrhage from the nose; but these unpleasant symp- toms subsided in a few days, after which the patient began to improve rapidly. This second tube was worn twenty-five days. Towards the close of this period it became rather offensive, and produced an unpleasant taste in the mouth. It was removed on the 15th of March, and a fresh instrument of the same size immediately introduced. The wound in the neck had now contracted to a mere line, and the fistulous opening into the oesophagus would scarcely admit a probe. The patient, of late, had been walking about the house, and, with the exception of one or two turns of indigestion from overloading his stomach, he had not had a bad symptom. He has not, however, gained much flesh; he is rather feeble, and his pulse ranges at 100. March 31 st. For some days past he has complained of soreness in the throat; he has raised much phlegm, and occasionally small streaks of blood; his respiration is somewhat oppressed, particularly at night. About a week since he had a slight swelling on the right side of the neck, which subsided under the application of a tobacco poultice. The present difficulty has not yielded either to this or to the use of anodynes. I was obliged to remove the tube from the nostril. It had been worn, since the last insertion, just sixteen days, and nearly seven weeks altogether. April 1st. The removal of the tube has not afforded much relief. The respiration is still embarrassed. He attempted to swallow some wine and water; but the effort brought on violent coughing, laboured breathing and other symptoms analogous to those of oedema of the glottis. The right side
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