Licence: Public Domain Mark
Credit: The diseases of the stomach / by Dr. C.A. Ewald. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![In introdiwing flexible tubes, it is superfluous, as Oser showed, to apply oil, vaseline, or glycerin to tlie outside of the instrument. It need only be dipped in warm water, as the abundant secretion of saliva by the patient will lubricate it sufficiently. Let the patient [who is seated in a chair with his head thrown back a little] open his mouth, push the tube on to the posterior wall of the pharynx (the tube is sufficiently rigid to permit this), and then ask the patient to swallow ; the tube is grasped by the muscles of deglutition and passes without any difficulty into the upper end of the oesophagus, its passage through the introitus oesophagi being distinctly felt; then, by gently pushing the tube, it speedily reaches the stomach. At times a slight resistance is felt at the cardia, frequently not. By this method we avoid the manipulations in the patient's mouth, which are unpleasant both to the latter and to the physician. The procedure is much simplified, and the unpleasantness and excite- ment are so much lessened that, among the many thousand patients examined by me, I can scarcely recall a case in which I was unable to introduce the tube, provided, of course, that I had the patient's co-operation. With a little patience on the one hand, and deter- mination on the other, we may succeed even in nervous and anxious subjects. The patients' conduct during this procedure has afforded me an excellent test of the strength of their nerves, and, as the an- cients expressed it, of their sanguine and lymphatic temperaments. In very sensitive persons, the local sensation may be entirely abol- ished by painting the posterior pharyngeal wall with .a 10 to 20 per cent cocaine solution a few minutes before introducing the tube. I have hardly ever found this necessary, and furthermore avoid it wherever it is possible, on account of some patients' idio- syncrasy toward the drug. But, even without its use, I may safely assert that this procedure is much less distressing to the patient than a laryngoscopic examination without cocaine, as the latter at first sets up a much greater irritation. Under certain conditions it may be impossible to pass a soft instrument through the oesophagus, even though it be free from obstruction; then there is also the active resistance of the insane, etc. ; finally, we may encounter mechanical obstructions, such as unusual narrowing of the entrance of the oesophagus, due to bony](https://iiif.wellcomecollection.org/image/b21223026_0024.jp2/full/800%2C/0/default.jpg)
