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AUTOPSY ON A CASE OF PROLONGED VOMITING.
456 the middle of the neck. The pharyngeal orifice became very slight effort. 3. The viscid mucus escaped through the funnel-shaped, and the posterior wall of the pharynx got tracheotomy tube. 4. The plug could be shaken out and gradually flattened out. There was no bronchial irritation cleaned. 5. Different notes could be produced by inserting of consequence. Twelve days after the operation a piece of plugs of different sizes, containing reeds of different length near
suspicious-looking pharyngeal mucous membrane was re- and breadth. moved by scissors. By the middle of December the wound Meantime the poor man began to show symptoms of had healed. Night attacks of fever and irritation of bowels serious lung disease. He suffered from evening pyrexia had occurred, but on the whole recovery had been satis- and nocturnal sweating, and gradually lost flesh and factory, and the patient’s condition never gave rise to strength. The discharge from the trachea became most much anxiety. His food and feeding were made the subject copious and purulent, and his appetite failed. He slowly of careful attention, and he began to improve in condition. wasted and sank of exhaustion on the 3rd of May, 1883, He could speak in a whisper when the hole in the front of five months and a half after the date of the operation.
his neck was closed by a bit of waterproof, or by the hollow On post-mortem examination both lungs were found of his own palm. He had been taught to keep the wound oedematous and infiltrated with miliary tubercles, some of clean and free of saliva and mucus with the aid of a small them caseating. There were two small vomicæ in the apex looking-glass. In the middle of January he was sufficiently well of the right lung, and the cavity of the left pleura contained to be able to appear at the Calcutta Medical Society. Shortly a pint of fluid, the result of recent subacute pleurisy. after this he was enabled to swallow by winding a narrow Traces of dysenteric ulcers were found in the colon. No caoutchouc bandage round his neck, so as to close and over- other disease of consequence existed, and there was no lap the wound. A tracheotomy tube was inserted in the sign of recurrence of the tumour. tracheal opening, for safety whenever he was fed either by Calcutta. bandage or tube. He could now consume pultaceous food, such as soft rice, with ease and manifest enjoyment. Mr. W. T. Woods, surgeon dentist of this city, after taking an AUTOPSY ON A CASE OF PROLONGED exact cast of the neck, contrived a vulcanite plug hollowed VOMITING. out posteriorly and secured in position by an elastic bandage, BY H. WHEATLEY HART, M.R.C.S.
following case, recently under the care of Mr. Wm. H. Rix, surgeon to the Tunbridge Wells Infirmary, will, I think, be read with interest. Mrs. E. J-, aged fifty-eight, had suffered more or less for twenty years from this distressing symptom, the characters of it being that frequently after food she suffered from a sense of pain and heaviness somewhat above the pit of the stomach, which continued until vomiting ensued. This, however, was not always so, as sometimes during a period of two or three days she would be tolerably free from both pain and sickness. On physical examination of both chest and abdomen, no signs had been discoverable; the THE
which also enabled him to swallow soft food without much difficulty. Liquids were apt to be squirted under the edges of both contrivances, and were more conveniently administered by tube. An attempt was now made to restore to the man the power of vocal articulation by means of an artificial larynx. A suitable harmonium reed was in the first instance let into the roof of a tracheotomy tube, which was secured in position by means of a vulcanite shield, closing up the aperture in the neck. It was found that a great effort was required to produce sound, and that the reed very soon got clogged and voiceless with mucus. A tracheotomy tube was next converted into a whistle, the pitch of which could be raised or lowered by attaching a shorter or longer blind tube to the end of the outer opening of the tube. The apparatus gave excellent sound when free, but when placed in position the chamber of the pharynx was too small to produce resonance, and it was dumb. A conical tube was next let into the roof of the tracheotomy tube, and a plug containing a tongueshaped reed in a boat-shaped case dropped into it. This answered perfectly, and the patient was exhibited at the April meeting of the Calcutta Medical Society, and his power of vocal speech fully demonstrated. The structure of the him to speak is clearly shown in The advantages of this apparatus, the perfecting of which was due to Mr. Wood’s ingenuity, perseverance, and mechanical skill, were found to be :—1. Great ease of insertion and removal. 2. Production of sound with
apparatus which enabled
the above
diagram.
urine contained no albumen, and the normal functions, except those of taking food and digestion, had been carried on well. The patient died on July 29th from gradually increasing anaemia and inanition. At the post-mortem the pleurse were found firmly adherent throughout, but the lungs presented no signs of pressure ; the pericardium was also intimately adherent where it met the chest-wall, and also to the whole of the surface of the heart ; the left ventricle and aorta were considerably dilated ; there were several bronchial glands much enlarged, and in a condition of calcareous degeneration. The mucous membrane of the stomach was fairly normal, with the exception of an area of undue vascularity along the lesser curvature ; the organ itself was somewhat shrunken, while the cardiac orifice was excessively contracted, only just admitting the little finger, and that with difficulty; there was, however, no thickened or indurated tissue around the contraction. The oesophagus was enormously dilated above this point of stricture, containing a large quantity of grumous It occupied a position to the right of the vertebral column, lying in the hollows formed by the angle of the ribs. At the spot vhere the dilated oesophagus came in contact with the diaphragm it was bent on itself nearly in the form of a right angie, forming a curve as it passed from the right side of the chest to the opening in the diaphragm on the further side of the mesial line. removing the organ its shape was found to have a remarkable resemblance to an ordinary stomach; it had a gross cubical capacity of twenty-five fluid ounces, and the muscular tissue was found to be very much hypertrophied. The kidneys were slightly granular, but the other organs fairly normal. The point of interest ia that such a partial stricture should have caused so enormous a dilatation above it, and the strong probability is that it was due to the adhesions, existing in the thorax, undergoing gradual contraction, and so causing a deviation of the oesophagus from the direct line at its passage through the diaphragm, and thus was produced a dragging on this structure against the tendinous fibres of the diaphragm, converting a canal, the comfortable patency of which is so necessary to health, into a condition of obliquity and stenosis, varying according to the movements of the diaphragm and the contents of the thoracic cavity. Tunbridge Wells.
fluid.
On
suspicious-looking pharyngeal mucous membrane was re- and breadth. moved by scissors. By the middle of December the wound Meantime the poor man began to show symptoms of had healed. Night attacks of fever and irritation of bowels serious lung disease. He suffered from evening pyrexia had occurred, but on the whole recovery had been satis- and nocturnal sweating, and gradually lost flesh and factory, and the patient’s condition never gave rise to strength. The discharge from the trachea became most much anxiety. His food and feeding were made the subject copious and purulent, and his appetite failed. He slowly of careful attention, and he began to improve in condition. wasted and sank of exhaustion on the 3rd of May, 1883, He could speak in a whisper when the hole in the front of five months and a half after the date of the operation.
his neck was closed by a bit of waterproof, or by the hollow On post-mortem examination both lungs were found of his own palm. He had been taught to keep the wound oedematous and infiltrated with miliary tubercles, some of clean and free of saliva and mucus with the aid of a small them caseating. There were two small vomicæ in the apex looking-glass. In the middle of January he was sufficiently well of the right lung, and the cavity of the left pleura contained to be able to appear at the Calcutta Medical Society. Shortly a pint of fluid, the result of recent subacute pleurisy. after this he was enabled to swallow by winding a narrow Traces of dysenteric ulcers were found in the colon. No caoutchouc bandage round his neck, so as to close and over- other disease of consequence existed, and there was no lap the wound. A tracheotomy tube was inserted in the sign of recurrence of the tumour. tracheal opening, for safety whenever he was fed either by Calcutta. bandage or tube. He could now consume pultaceous food, such as soft rice, with ease and manifest enjoyment. Mr. W. T. Woods, surgeon dentist of this city, after taking an AUTOPSY ON A CASE OF PROLONGED exact cast of the neck, contrived a vulcanite plug hollowed VOMITING. out posteriorly and secured in position by an elastic bandage, BY H. WHEATLEY HART, M.R.C.S.
following case, recently under the care of Mr. Wm. H. Rix, surgeon to the Tunbridge Wells Infirmary, will, I think, be read with interest. Mrs. E. J-, aged fifty-eight, had suffered more or less for twenty years from this distressing symptom, the characters of it being that frequently after food she suffered from a sense of pain and heaviness somewhat above the pit of the stomach, which continued until vomiting ensued. This, however, was not always so, as sometimes during a period of two or three days she would be tolerably free from both pain and sickness. On physical examination of both chest and abdomen, no signs had been discoverable; the THE
which also enabled him to swallow soft food without much difficulty. Liquids were apt to be squirted under the edges of both contrivances, and were more conveniently administered by tube. An attempt was now made to restore to the man the power of vocal articulation by means of an artificial larynx. A suitable harmonium reed was in the first instance let into the roof of a tracheotomy tube, which was secured in position by means of a vulcanite shield, closing up the aperture in the neck. It was found that a great effort was required to produce sound, and that the reed very soon got clogged and voiceless with mucus. A tracheotomy tube was next converted into a whistle, the pitch of which could be raised or lowered by attaching a shorter or longer blind tube to the end of the outer opening of the tube. The apparatus gave excellent sound when free, but when placed in position the chamber of the pharynx was too small to produce resonance, and it was dumb. A conical tube was next let into the roof of the tracheotomy tube, and a plug containing a tongueshaped reed in a boat-shaped case dropped into it. This answered perfectly, and the patient was exhibited at the April meeting of the Calcutta Medical Society, and his power of vocal speech fully demonstrated. The structure of the him to speak is clearly shown in The advantages of this apparatus, the perfecting of which was due to Mr. Wood’s ingenuity, perseverance, and mechanical skill, were found to be :—1. Great ease of insertion and removal. 2. Production of sound with
apparatus which enabled
the above
diagram.
urine contained no albumen, and the normal functions, except those of taking food and digestion, had been carried on well. The patient died on July 29th from gradually increasing anaemia and inanition. At the post-mortem the pleurse were found firmly adherent throughout, but the lungs presented no signs of pressure ; the pericardium was also intimately adherent where it met the chest-wall, and also to the whole of the surface of the heart ; the left ventricle and aorta were considerably dilated ; there were several bronchial glands much enlarged, and in a condition of calcareous degeneration. The mucous membrane of the stomach was fairly normal, with the exception of an area of undue vascularity along the lesser curvature ; the organ itself was somewhat shrunken, while the cardiac orifice was excessively contracted, only just admitting the little finger, and that with difficulty; there was, however, no thickened or indurated tissue around the contraction. The oesophagus was enormously dilated above this point of stricture, containing a large quantity of grumous It occupied a position to the right of the vertebral column, lying in the hollows formed by the angle of the ribs. At the spot vhere the dilated oesophagus came in contact with the diaphragm it was bent on itself nearly in the form of a right angie, forming a curve as it passed from the right side of the chest to the opening in the diaphragm on the further side of the mesial line. removing the organ its shape was found to have a remarkable resemblance to an ordinary stomach; it had a gross cubical capacity of twenty-five fluid ounces, and the muscular tissue was found to be very much hypertrophied. The kidneys were slightly granular, but the other organs fairly normal. The point of interest ia that such a partial stricture should have caused so enormous a dilatation above it, and the strong probability is that it was due to the adhesions, existing in the thorax, undergoing gradual contraction, and so causing a deviation of the oesophagus from the direct line at its passage through the diaphragm, and thus was produced a dragging on this structure against the tendinous fibres of the diaphragm, converting a canal, the comfortable patency of which is so necessary to health, into a condition of obliquity and stenosis, varying according to the movements of the diaphragm and the contents of the thoracic cavity. Tunbridge Wells.
fluid.
On