A treatise on the surgery of the alimentary canal : comprising the oesophagus, the stomach, the small and large intestines, and the rectum.

  • Maylard, Alfred Ernest.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the surgery of the alimentary canal : comprising the oesophagus, the stomach, the small and large intestines, and the rectum. 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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    the right side. Both inside and outside the gullet a little blood-stained fluid and clots were fomid, but no milk in the latter situation. The margin of the opening, which was circular, was smooth aboA^e and quite thin below, and in general suggested gastric solution of the part. (Stanley Boj'd, ' Trans. Path. Soc. Lond.' 1882, vol. xxxiii. p. 123.) Case VI.—RuiHure of the ceso2)hagus where the tvalls had become softened by gastric solution. E. B., a young woman aged 18, was admitted into University College Hospital under the care of Mr. Heath. She was in a state of great collapse, and died in ten or twelve hours. She was vomiting on admission, and every kind of stimulant or food given by the mouth returned unaltered before it could have reached the stomach. She complained of pain about the lower end of the sternum, but it was not severe. There was no dys- pnoea and no subcutaneous emphysema noticed. The patient passed water in the bed. At the post-mortem examination two or three ounces of bloody fluid which contained no food were found in the left pleura and seemed to have come from a rent in the left side of the oesophagus. The aperture was longitudinal, about two inches in length, and situated imme- diately above the cardia. The slitlike character of the aperture, and the existence of an uneven furrow between the longitudinal rugae and parallel with it, led to the belief that gastric solution had taken place at the seat of rupture. (Stanley Boyd, ' Trans. Path. Soc. Lond.' 1882, vol. xxxiii. p. 125.) In this case it was subsequently ascertained that the patient was suffering from Addison's disease, and that tlie vomiting with which she was troubled on admission was part of the symptoms of that disease. It had, however, proved the immediate cause of death, by leading to rupture of the oeso- phagus. The cases thus quoted will serve to illustrate the various forms in which rupture may occur. They may be divided into three classes : 1. Spontaneous rupture in a practically healthy canal. 2. Spontaneous rupture in a canal weakened either by ulceration or cicatrisation. 3. Spontaneous rupture in a canal which has undergone in parts gastric solution. (1) In the first class, that of rupture of a healthy canal, the rupture can only occur as the result of some violent effort to expel an impacted body. The patient makes every possible eifort to eject the body. The diaphragm is first fixed after an inspiration, and the lungs thus distended are made to e]idure