115 
PATHOLOGY. 
cording to the nature of the gaftric difturbance. This 
affeClion is alfo occafionally fympathetic, as in dentition 
fometimes occurs, and as a f'equel or crifis to various 
other afteCtions. 
2. Ptyalifraus c'nronicus. When, from the caufes we 
have detailed, an excited ftate of the falivary glands has 
continued long, a chronic inflammation is fet up, and al¬ 
tered and vitiated Hates of the fecretion take place. 
This naturally induces much derangement of the procefs 
of digeftion, and hence demands more particular atten¬ 
tion. In addition to the conftitutional remedies required 
in the acute ftage of ptyalifm, we are now called upon to 
adopt the application of topical remedies, for the purpofe 
of altering the aCtion of the fecernents. Of thefe, acid 
and aftringent gargles are the moft ufeful. Blifters be¬ 
hind the ears have alfo been found efficacious. Dr. 
Robertfon has detailed, in the LondonMedical andPhyflcal 
Journal, vol. xxxiii. fome cafes fuccefsfully treated by 
the oxyde of bifmuth. In the London Medical Tran- 
faCtions, vol. ii. a curious cafe is mentioned, in which a 
very long-continued and troublefome ptyalifm was cured 
by chewing dry bread and fwallovving it. 
3. Ptyalifmus iners, drivelling or Havering. This 
confifts in an involuntary and diftreffing flow of faliva 
from fiuggiffinefs of deglutition or other caufes, without 
increafed Jecretion. It has three varieties : cc, infantilis ; 
£, fenilis; 7, moriae. 
This affection is diftinguiffied from the other fpecies of 
ptyalifm by the circumftance, that, while in the former 
increafed fecretion (arifing either from an excitement or 
dilated Hate of the fecreting veflels) is prefent, in this 
the redundancy of fluid owes its exiftence to diminijhed 
ahjbrption, and to the want of that almoft continual deglu¬ 
tition by which this fecretion is removed from the mouth. 
The lecond variety is particularly attendant on para¬ 
lytic patients. This circumftance is probably connected 
with the ftate of the brain ; an idea which obtains con¬ 
firmation from the contemplation of the third variety, 
with which debility of underftanding is thus curioufly 
connected. To trace the relation which exifts between 
thefe ftates would form a fubjeCl of much intereft and 
difficulty. As it does not appear however, that, in the 
prefent ftate of our knowledge, this affeCtion is under 
the control of the medical art, we (hall wave all further 
difcuffion of the lubjeCt. 
Genus III. jfivfphagia, [from bad or imperfeCt, and 
Qccyu, to eat orlw’allow.] Pain or obftruCtion in fwallow- 
ing. This genus includes five fpecies. 
1. Dyfphagia conltriCta, or difficulty of fwallowing from 
permanent diminution of the calibre of the cefophagus. 
This affeCtion arifes from a thickened ftate of the mucous 
membrane, from induration of the fame, from its acqui¬ 
ring a cartilaginous ftrudlure, from offiflcations, excref- 
cences, fcirrhous or calculous concretions, See. It may 
be produced likewife by tumors prefling on the canal, 
when thefe arife from neighbouring parts. Ulcers like¬ 
wife, or other folutions of continuity, by deftroying the 
play of the circular fibres, prevent or impede deglutition. 
Among other caufes, Dr. Parr, in his Medical DiCiion- 
ary, mentions the concretion of mucus, and fupports it 
by the teftimony of Hoffman. We need fcarcely obferve, 
that, from the nature of the cefophageal ftrudlure, this 
circumftance cannot occur, unlefs indeed the natural le- 
cretions are very much altered ; an alteration which 
would impiy previous difeafed action for a long period, 
and hence is unlikely to be removed by diluents and ni¬ 
trous powders, as the above-mentioned author has re¬ 
commended. The cafe in queftion was probably one of 
the kind deferibed by Dr. Baillie in his work on Morbid 
Anatomy, in which coagulated lymph was found in great 
quantity. The obftruCtion of fwallowing is moft fre¬ 
quently caufed by mechanical injury, as pins ,or other 
iubftances accidentally introduced. 
From whichever of thefe numerous caufes impeded 
Vol. XIX. No. 1291. 
deglutition may arife, the removal of the caufe itfelf will 
be the firft indication of cure. Hence, in all cafes where 
tumors in or around the pharynx exift, the removal or 
diminution of thofe morbid accumulations rnuft be at¬ 
tempted. This is, however, no very eafy talk, becaufe, 
in the firft place, the kind of tumor or excrefcence is 
feldom to be diferiminated when in the canal; and thofe 
which arife externally, as bronchocele, &c. are often dif¬ 
ficult of cure. In thefe cafes, while we ufe every en¬ 
deavour to remove the difeafe according to particular in¬ 
dication, the patient mult be fupported with nourifhing 
clyfters or with liquid aliment palled into the ftomach by 
means of a flexible tube. By this contrivance, according 
to the teftimony of Dr. Good, a lady was fupported for 
twenty years. 
Difficult as tumors of the cefophagus are to remove, w’e 
ffiould not negleCt every probable means of relief; for 
fometimes the breaking of an abfeefs and the difeharge 
of its contents has been of great fervice. In the Hiftory 
of the Royal Medical Society in Paris for the year 1776, 
we are told, that a young lady, aged fixteen years, after 
being troubled for about three months with a fpafmodic 
cough, began to have a difficulty of fwallowing, which 
increafed fo fall, that after a very fliort time ffie was in¬ 
capable of taking any nourifhment by the mouth, fo that, 
for the fpace of three months, life was fupported folely 
by clyfters. Mercurial and other frictions were employed 
without effeCt. At length M. Macquart, reflecting on 
the cafe, and conjecturing that an eneyfted tumourexifted 
in the cefophagus, and that it might probably be now in 
a ftate of fuppuration, he refolved to adminifter fome 
fubftance, which, by its weight, might occafion a rup¬ 
ture of the fac. For this purpofe he preferibed an ounce 
of crude mercury, mixed with the yolk of eggs, to be 
fwallowed every three hours. This remedy was taken, 
and the patient, foon after flie had fwallowed the fecond 
dofe, brought up a confiderable quantity of pus. From 
this moment ffie was able to fwallow broth, and by pro¬ 
per care recovered. An emetic, in cafes when complete 
itoppage does not happen, might be preferibed with equal 
advantage. According to Dr. Parr, when fcrofulous in¬ 
durations happen about the cefophagus, the ungt. hy- 
drargyri, rubbed on the neck over the induration, or 
fmall dofes of calomel, have often been of Angular effi¬ 
cacy, efpecially if ufed early after the attack of the dif- 
order. If the cafe is of more confiderable duration, he 
thinks the mercurials ffiould be given, fo as to excite 
and fupport a moderate ptyalifm for fome time. 
Many are the contrivances for removing foreign bodies 
flicking in the paflage to the ftomach ; but it would often 
be better to leave the cafe to nature, than to irritate fo 
tender a part, which muft be the effeCt of fuch attempts. 
If the fubftance'can be reached with the fingers, or with 
the forceps, the extraction is eafy. When pins, fiffi- 
bones, or fimilar bodies, flick acrofs the gullet, fome re¬ 
commend a wire with its end turned up like a hook, to 
be pafled below thefe bodies, and then turned fo as to 
bring them up. Pins, and other (harp bodies, when 
they have ftuck. in the throat, have been returned by 
fwallowinga piece of tough meat tied to a ftrong thread, 
and then pulled up again. If the detained body may 
more fafely be pulhed down, the probang is a ufeful in- 
ftrument. It hath frequently happened, that, though 
indigeftible bodies have been fwallowed, no inconveni¬ 
ence hath arifen from them. (See Lond. Med. Tranf. vol. 
iii. and Med. Mufeum, vol. ii.) If the bodies cannot be 
eafily moved up or down, endeavours Ihould not be con¬ 
tinued long, left inflammation come on. If the patient 
can fwallow, a large draught of water may be taken, a 
pradfice the more neceflary if the fubftance wedged in 
poflefs any great degree of folubility; or, if he cannot 
fwallow, an affiftant may injeCt fome fluid into the gullet, 
W'hich will fometimes loofen the impacted body. When 
thefe endeavours fail, the patient muft be treated as if 
labouring under an inflammatory difeafe; and the fame 
H h treatment 
