Diseases of the digestive system / an authorized translation from "Die Deutsch Klinik" under the general editorial supervision of Julius L. Salinger.

  • Billings, Frank, 1854-1932.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Diseases of the digestive system / an authorized translation from "Die Deutsch Klinik" under the general editorial supervision of Julius L. Salinger. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    immediately, and we may sometimes succeed in cases where we have pre- viously failed. For this purpose I employ spiral bougies (see above) or English bougies with a solid metallic guiding staff. For dilatation of esophageal stenosis, still other instriiments have been employed. Senator was the first to introduce laminaria tents of varying thickness into the carcinomatous stricture to attain a dilatation by their gradual swelling. The laminaria tent was fastened by a screw to a thin, flexible bougie. I have entirely abandoned this method in the treatment of carcinoma; but the idea may be well utilized in the dilatation of other strictures if the laminaria tents armed with a silk thread under the direc- tion of the eye and by the aid of the esophagoscope are introduced into the narrow passage, and are permitted to remain from three to ten hours, perhaps even longer, and the tents are then drawn up by the silk threads. Dilatation may thus be promoted with extraordinary rapidity. We may soon convince ourselves that there is no danger in this process, and in des- perate cases I have obtained from it excellent results (see below). To produce a slow and careful dilatation, Schreiber advises a dilator consisting of an ordinary, thin, non-fenestrated stomach-tube, at the esophageal end of which a rubber tube 2 to 3 cm. in length is attached, which again terminates in a smooth firm point. At the opposite end of the sound there is a metallic attachment which is connected with a suitable syringe having a capacity of from 10 to 30 c.c. The sound is introduced through the narrow passage, water being injected into the sound so that the rubber piece fills and expands. The tense, elastic balloon we now attempt to withdraw through the narrow passage. This, in fact, is ex- tremely difficult, but with great care quite decided pressure is exerted upon the internal walls of the stenosed area. This process I very rarel}' employ in carcinomatous strictures, as they are generally too unyielding to respond to the pressure. But the method is well adapted to soft, recent, cicatricial tissue, and to overcoming spastically stenosed areas. [Professor B. W. Sippy, of Chicago, has invented an instrument for the dilatation of spasmodic and other strictures of the esophagus, especially cardiospasm (see Fig. 1). The instrument is especially applicable in hypertrophic stenosis of the cardia due to long standing cardiospasm. It has been successfully employed in several patients. In two patients under my charge the result was notable. In one, a woman with long standing cardiospasm and apparent hypertrophy of the circular fibers due to the spasm of the cardia, and with considerable dilatation of the esophagus, three applications of the instrument resulted in complete relief. Other methods failed after a trial of several months. The instrument is applicable in cases of organic stricture, but should then be used with extreme caution.—Ed.] In conclusion I must mention the treatment with a permancni cannula which was so strongly advised in foreign countries, was tested by Loyden and Rcnvers, and has been of late especially praised by Curschmann. The