STRICTURE OF THE (ESOPHAGUS, WITH THE LODGMENT IN IT OF A FOREIGN BODY. BY G. B. BALCH, M. D., YONKEES, N. Y. LREPRINTED FROM THE NEW YORK MEDICAL JOURNAL, MARCH,, 1875.] NEW YORK: IX APPLETON AND COMPANY, 54 9 & 551 BROADWAY. 1875. . uPULAR SCIENCE MONTHLY, {Established May, 1872,) Conducted by Prof. E. L. TO UMANS. The Popular Science Monthly was started to promote the diffusion of valuable sci- entific knowledge, in a readable and attractive form, among all classes of the community, and has thus far met a want supplied by no other periodical in the United States. The great feature of the magazine is, that its contents are not what science was ten or more years since, but what it is to-day, fresh from the study, the laboratory, and the experiment: clothed in the language of the authors, inventors, and scientists themselves, which comprise the leading minds of England, France, Germany, and the United States. 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STRICTURE OF THE (ESOPHAGUS, WITH THE LODGMENT IN IT OF A FOREIGN BODY. Me. F., aged twenty-seven years; strictly temperate; healthy and well nourished ; weight 184 pounds. About one o’clock, p, m., January 8, 1875, the patient ap- plied to me for professional advice, stating that while eating supper, about seven o’clock the previous evening, a piece of roast-beef had lodged in his throat, that it still remained there, and that he had not been able to swallow any thing since; not even a drop of water would pass the obstruction. His respiration and pulse were normal; felt no particular inconvenience, except from the inability to swallow his saliva. Fluids would enter the oesophagus as far as the stricture, and then return to the mouth. On attempting to pass the bougie, a slight stricture was encountered in the upper third of the oesophagus, which was readily passed. At the commencement of the lower third the bougie met an obstruction that it could not move or pass without the use of more force than was thought pr dent to use. History.—When about two and a half years of age he ac- cidentally swallowed some sulphuric acid. The effect upon his mouth and throat was terrible, and the destruction of his life would probably have resulted had he not had a full stom- ach at the time. The stomach was immediately emptied by vomiting. For a year following it was almost a constant 4 straggle for life, the difficulty of taking nourishment being so great. For about six years he could take nothing but liquids and semi-solid food. Since he has commenced the use of solid food, has had repeated attacks of obstruction of the oesophagus. The period of time the obstruction has remained has varied from a few minutes to fifty hours. About twelve years ago he had a severe choke from a piece of boiled corned-beef. Unsuccessful efforts were made both to push it down and pull it up; finally a prescription was given him containing muriatic acid for the purpose of di- gesting or dissolving the meat, and after several hours’ rest he attempted to swallow some water and it went down. The obstruction remained at this time thirty-six hours. For the past year or two he has considered himself entirely relieved, and has eaten everything he wished without trouble. At this time he was dining a little later than usual, and, being in some haste to keep an engagement, probably was not as careful to masticate his food as usual. Treatment.—After repeated trials to dislodge the obstruc- tion by mechanical means, and failing, the following prescrip- tion was given: ft. Acid, hydrochlor. dil. f‘3ij, pepsin. 3j, aqua pura q. s. ad. f § ij. Directions were given him to swal- low a teaspoonful repeatedly, so as to keep the beef moist ened by it, the object being to digest the meat. 10 p. m.—Ao change; the throat feels a little sore from the irritation caused by the attempts to pass the bougie, and efforts to swallow the medicine. Directed him to go to bed, and at one or two o’clock in the morning to attempt to swal- low some water ; if he then failed, to wait until daylight and repeat the trial. January 9ih, Ba. m.—Has just succeeded in swallowing, the obstruction having remained thirty-seven hours. Dur- ing the night he made several unsuccessful efforts to swal- low ; he then let it rest as directed for several hours, and then attempted to swallow some milk : two attempts were unsuc- cessful; a third with water succeeded. The throat remained sore for a few days, diet consisting of liquids and semi-solids, and then he resumed ordinary diet.. 5 Remarks.—In the American Journal of Medical Sciences, for April, 1871, Samuel Ashhnrst, M. D., reports a case of stricture in a child, aged four and a half years, that resulted fatally. A piece of ham lodging in the oesophagus near its entrance into the stomach, unsuccessful elforts were made to pass bougies. The stricture was caused by “ swallowing lye ” two years previous. The obstruction continued for seven days, when the child vomited some offensive, green' matter, and, as the child expressed herself, “ the lump had gone down.” The child continued to sink, and died nine hours after. The autopsy revealed some superficial ulcerations and a “ strong, fibrous stricture about one inch and three-fourths from the lower end of the oesophagus.” Mr. Jonathan Hutchinson, in the “ London Hospital Re- ports,” relates a case of cicatricial stricture with obstruction of the oesophagus very similar to Dr. Ashhurst’s, except that his case recovered after the dislodgment of the foreign body. Gastrotomy was thought of in both these cases, but not per- formed. Out of eighteen cases 1 where gastrotomy has been per- formed for stricture of the oesophagus, only two have been for cicatricial stricture. J. Cooper Foster’s2 case survived about four days ; Dr. Maury’s3 case twelve hours. Cicatricial strictures of the oesophagus are not of very un- frequent occurrence, and the most successful treatment thus far used has been dilatation. Dr. Morell Mackenzie4 has been very successful in the treatment of non-malignant or traumatic strictures by dilatation; his instrument is made similar to Holt’s dilator for urethral stricture. Mr. Durham 5 and Dr. Richardson advocate the same treatment. Dr. Richardson has invented a dilator which secures lateral dilatation by the use of air or frater. 1 Fifteen cases are reported and referred to by A. Jacobi, M. D., in a very able paper on “ Gastrotomy in Stricture of the (Esophagus,” Few York Medical Journal, yoI. xx., 1874. 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