A manual of diseases of the throat and nose : including the pharynx, larynx, trachea, œsophagus, nose and naso-pharynx / by Morell Mackenzie.

  • Mackenzie, Morell, 1837-1892.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: A manual of diseases of the throat and nose : including the pharynx, larynx, trachea, œsophagus, nose and naso-pharynx / by Morell Mackenzie. Source: Wellcome Collection.

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    sound ” becomes audible. The phaiyngeal sound, which is due to the sudden jiassage of air and liquid into the pharyngeal cavity, is sometimes so loud, and so distinctly conveyed down the oesophagus, that it obscures the true I oesophageal sound. In tliese cases it is better to let the patient take a continuous draught of ■water, as by this means the intermingling of air and water is greatly diminished, and the true oesophageal sound may often be detected. The soimd which is heard conveys the idea of the rapid passing downwards of a “ small s])indle-shaped body of fluid con- sistence.” The sound is sharp and sudden, and ceases aln'uptly. Hamburger describes it as being suggestive of an egg-shaped body, about an inch in length, and half an inch in breadth, the small end of the. egg being above and the large end below. He is also of opinion that the shape of the morsel affords a strong indication as to the condition of the musciUar walls of the oesophagus, the lower end of the morsel or egg-shaped liody being blunted or truncated in ])roportion to the feeblene.ss of the muscular action. These, however, are retinements wliich it is difficult to arrive at. The principal points which have to be considered are— first, the character of the oesophageal sound ; and, secondly, the quickness of the act of deglutition. In some cases the sound is very feeble, and occasionally altogether absent; .sometimes, and this is often the case in organic strictures, a confused and continuous l)ubbling noise is heard, whicli lasts for several seconds ; sometimes a grating sound may be perceived at tlie same time. The (piickness of the act of <leglutition is also of some importance, and can be determined by placing the hand on tlie liyoid bone whilst the .stetho-scope is applied over the oesopliagus posteriorly ; as the })atient commences tr> swallow, the operator feels the hyoid lione rise, and can thus estimate the length of time which elapses before the morsel reaches that ])ortion of the a?so])hagus which is being auscultated. The rapidity of the act varies in different ])eople in a state of health, and it can always be made to take jdace (piite .slowly. This will be at once apparent on directing a healthy man to continue for a few minutes swallowing some rather difficult .substance, such as a mealy potato. Under ordinary circumstances the lapse of time between the entrance of the morsel into the gullet and its arrival opposite the .stethosco])c jilaced at the side of the eighth dorsal vertebra is .so short that it cannot be determined ; but after swallowing .several moutbfuls of