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.

    22/610 (page 10)
    potato without drink, two or three second.s elap.se liefore the morsel arrives at the lower part of the cesoj>hagus. Regurgitation can also be perceived when fnjm any cause the food cannot descend into the stomach. The nio<le in which this takes place sometimes enables us to <lLstinguish between a spasmodic and an organic stricture ; for whilst in the latter case an appreciable time elapses Ijefore the food Ls forced upwards, in spasmodic stricture the regurgitation is instantaneous. According to Hamburger, when the oesojjha- gus is pressed upon by a tumoiu’ in the posterior medias- tinum, the sound may be heard more distinctly on the right side of the vertebrse than on the left. Sounding.—This method of exploration is carried out vdth the aid of bougias, and is employed for the purixtse of determining the calibre of the gullet. It should lie Imme in mind, however, that much harm is often done by the introduction of these instraments. They .should, therefore, never be used unless other means of investigation fail to give the desired information. Two kinds of Imugies are employed under dilferent circumstances, viz., those made of gum-elastic, and those in Avhich there is a slender whalelmne stem, terminating in an olive-shaped ivory knob. Ordinary- gum-elastic bougies ai'e cylindricaH in form throughout the greater part of their length, lint the distal end is more or less conical. From the experiments, however, already detailed (pages 3 and 4), as well as from the appearance in frozen sections,^ it is clear that the sectional outline of the gullet is oval or kidney-shaped, the diameter from siile to side being greater than from before backwards. I have, therefore, arrivetl at the conclusion that bougies somewhat flattened antero- posteriorly would most easily adajit themselves to the lumen of the tul)e through which they are meant to Iw passed, and this view has been confirmed by experience. Thirteen sizes are made, the measure of each one being based on the numlwr of millimetres in the transverse, he., their long diameter. The sizes are reckoned from Xo. 3 to Xo. l.o. Thus, Xo. 3 measures three millimcti-es from side to side, Xo. 4 four 1 III .some ciuse.s, liowevev, tapering and the .so-called “radish- .sha])(“(l ” in.stnunents may he nsefnl. The tapering hongie is small at the distal end, and gradually inorea.ses in .size for about three or four iuche.s till the maximum diameter is attained : and the radish- shaped instrument is slender at its further extremity, then becomes somewhat suddenly greatly enlarged, again returning to the smaller dimensions. - braune: Op. cit. pi. vii. viii. ix. x. and xi.