116 
PATHOLOGY. 
treatment will be required if an inflammation take place 
5 n the part, after the obftruCting body is removed. A 
proper degree of agitation has fometimes fucceeded in 
removing the obftruCting body better than inftruments. 
Thus a blow on the back hath often forced up a fubftance 
that ftuck in the gullet or windpipe. Pins, which have 
lluck in the gullet, have been difcharged by riding on a 
liorfe or in a carriage. 
In the London Medical Obfervations and Inquiries, 
vol. iii. is an account of a finall fibre of a feather being 
fwallowed, and extradited by means of a probang with a 
thread or two palling from one end to the other, and 
faftened to the fponges which w'ere connected with each 
end of this inftrument. For fome more complicated 
methods of extracting thefe fubltances, fee the article 
Surgery. 
Independently of the caufes juft mentioned, Dr. 
Baillie has obferved, that the cefophagus is liable to ftric- 
ture, produced by the contraction of its mufcular fibres 
at fome particular part. This difeafe is mod common in 
women whofe conftitutions are delicate, and much fub- 
jeCt to nervous influence. When fuch a difeafe is exa¬ 
mined in the dead body, the cefophagus is found to be’ 
more or lefs contracted in fome part of it, and it feels 
harder than ufual, as all mufcles do in a contracted ftate. 
There is no appearance of difeafed ftruCture ufually com¬ 
bined with it; yet this contraction might lay the founda¬ 
tion of a permanent and even a fatal difeafe. The muf- 
cularfibres of the cefophagus might fo piefs on the inner 
membrane, as to excite inflammation in it, which might 
advance to fuppuration, and would molt probably termi¬ 
nate fatally. 
A very unufual ftriCture of the cefophagus has been 
noticed by the fame author. It confilted in its inner mem¬ 
brane being puckered together, foas to form a narrownefs 
of the canal at a particular part. The canal at that part 
was fo narrow, as hardly to allow a common garden-pea 
to pafs. There w'as no appearance, however, of difeafed 
ftruCture in the inner membrane which was fo contracted, 
and the mufcular part of the cefophagus furrounding it 
was perfectly found. This difeafe was very flow in its 
progrefs; for the perfon in whom it took place had been 
for many years affeCted with a difficulty of fwallowing, 
and could only fwallow fubftances of extremely finall fize. 
Thefe cafes have been much relieved by an attention to 
the ftate of the ftomach and inteftines, though not fo 
much fo as in the fpafmodic affeCtions we flrall have oc- 
cafion prefently to notice. But we (hall fubjoin a cafe 
wherein a cure was very happily performed by mechani¬ 
cal means. It was communicated by Dr. Stevenfon, of 
Kegworth, to the Medical and Phyfical Journal, vol. viii. 
“ Mrs. Wagdin, Trent Lock, Derbyfliire, the fubjeCt of 
the fubfequent communication, is forty years of age, of a 
thin fpare habit, and irritable temperament. She dates 
the origin of her complaints from a violent attack of 
cynanche maligna near twelve years ago, to the contagion 
of w'hich (lie was expofed alrnoft immediately after her 
recovery from a fevere parturition. The moll prominent 
features of her diforderfrom that period till the expiration 
of more than three years, were a flight though progreffive- 
ly-increafed difficulty of fwallowing, accompanied with 
fome degree of forenefs, and an augmentation of the 
lalival excretion. With a view' to the palliation of thefe 
fymptoms, (lie was directed to have occafional recourfe 
to aperients, leeches, blifters, and gargles. By this time, 
however, the difficulty of deglutition had become fo 
alarmingly exafperated, that (he was no longer capable 
of fwallowing folids, even of the magnitude of a pea. In 
this fituation (lie put herfelf under the direction of Dr. 
Smith, late of Nottingham, who prefcribed mercurials. 
A moft fevere falivation was the confequence, under 
which ihe laboured for the protrafted (pace of three 
months. By this method the fymptoms were fo ccnfider- 
ably alleviated, that (lie was capable once more of fwal¬ 
lowing foft and well-comminuted folids. But, though 
thus refcued from her impending fate, the remedy was 
productive of effeCts no lefs formidable. I allude to ex- 
ceffive debility, frequent fyncope on the leaft motion, 
colliquative fweats, her fyftem being greatly emaciated, 
and a prey to hyfterical paroxyfms. By the aid of proper 
dietetical management, as the complaint it was vainly 
hoped was fubdued, her attendants flattered themfelves 
(lie might (till furvive even this fevere conteft. Alas! 
no fooner were her drooping fpirits reanimated by the 
fenfible acquifition of renovated vigour, than the fond 
expectations (he had cheriflied became deprefled by a 
vilible return of her former impediment to fwallowing. 
“ During the laft (even years, (he found herfelf reduced 
to the fad neceftity of fupporting a miferable exiftence 
by means of liquid aliment, fuch as foups, milk, &c. I 
faw her for the firft time in the beginning of OCtober, 
1801. She had then a dejeCted emaciated appearance, a 
quick pulfe and other heCtic fymptoms, and was harraffed 
by an alrnoft inceflant ptyalifm, more particularly urgent 
during the earlier part of the day, at which time (he 
was always hoarfe. The breathing was much incom¬ 
moded when (lie reclined on a fofa or bed, which con¬ 
curred with the other fymptoms in rendering her nights 
very reftiefs. Her bowels were habitually inactive. 
There was not any external tumefaCtion of the thyroid 
gland, nor could the obftruCted part be obferved by in- 
lpeCting the fauces. 
“ Dyfphagia, in this inveterate ftage, has I believe hi¬ 
therto alrnoft invariably bidden defiance to the beft-direCted 
medical expedients; and the Angularity of the cafe will, 
I truft, be deemed a fulficient apology for; the minutenefs 
of its defcription. I propofed to her, as a dernier refort, 
to have recourfe to mechanical dilatation, a practice none 
of the faculty had before even fuggefted. Senfible that, if 
not fpeedily relieved, (lie muft fall a victim to this relent- 
lefs difeafe, (lie agreed to fubmit implicitly to any plan 
from the adoption of which the fmalleft profpeCt offuccefs 
might rationally be anticipated. 
“ I firft cautioufly introduced a common bougie into 
the lower part of the pharynx. In this place, a powerful 
refiftance that occurred, and which occafioned my inftru¬ 
ment, on the application of fomewhat forcible preflure, 
to bend in various directions, feemed to confij-m my< 
theory of the nature of the difeafe. Thus foiled, I ven¬ 
tured to fubftitute a finall probang copioully charged with 
oil. It was not without fteady and continued efforts that 
this operation was made to dilate the ftriCture. After 
having overcome this obftacle, the inftrument defcended 
without much difficulty till it reached, I fuppofed, the 
lower portion of the celophagus near the cardia, when a 
fecond impediment announced the exiftence of another 
ftriCture. The fame meafures however at length availed 
in enabling the probang alfo to force a paflage through 
this contracted part, when it fuddeniy pafi’ed into the 
ftomach. The inftrument having been deliberately with¬ 
drawn, as foon as Mrs. W. had fomewhat recovered from 
the irritation and fatigue produced by this, I gave her 
fome gruel which ftood ready, in order that (he might af- 
certain, by fipping leifurely a fmall quantity, whether 
any benefit had accrued from the operation. Upon at¬ 
tempting to fwallow, (lie found the former impediment re¬ 
moved, and continued drinking till (lie had confumed at 
leaft half a pint of the liquid with the greateft facility as 
to the power of deglutition, though of courfe fome fore¬ 
nefs muft have exilted. Apprehending that the paflage 
would not, by the fmall inftrument employed, befufficiently 
dilated to admit of the ready ingurgitation of Folids, the 
operation was repeated with a larger inftrument three 
fucceflive times, a few days being fuffered to intervene 
between each, in order that the topical pain might be al¬ 
layed by the exhibition of oily linCtufes and aperients, 
and by fomentations. The fourth operation enabled her 
to fwallow folids without experiencing the fmalleft in¬ 
convenience, a faculty (lie (till continues to exercife in 
its fulleft extents 
“As 
4 
