117 
PATHOLOGY. 
tc As a further teftimony of the efficacy of mechanical 
means in the radical cure of this tremendous difeaie, 
permit me (hortly to add, that the only daughter of the 
above-mentioned lady, aged twelve years, had from her 
earlieft infancy, indeed from her birth, laboured under 
Dyfphagia conftriCta. Her conftitution partakes much 
of the nervous irritability of her mother. The want of 
fubftantial food (for her exiftence had been fupported 
by the fuCtion of liquid aliment alone) tended obvioufiy 
to retard the phyfical evolution of her fyftem. The 
complete fuccefs which had crowned my efforts in the cafe 
of Mrs. W. naturally created an anxious wilh in the pa¬ 
rents to have the fame means reforted to in the prefent 
inftance ; of the abi'olute neceffity of which my intelli¬ 
gent little patient was fully fatisfied, and readily con¬ 
tented to undergo the operation, from the.fanguine ex¬ 
pectation of deriving equal benefit. It is with fentiments 
of the greateft fatisfaClion I am authorifed to (late, that 
the expedient has proved altogether falutary and effica¬ 
cious. The texture of her body, which previous to the 
operation had ever been extremely delicate, has acquired a 
wonderful degree of renovated vigour; and her fpirits, 
formerly fubjeCl to great depreffion, have obtained fuch a 
healthy flow, that ihe can now engage in juvenile amufe- 
ments with the greateft cheerfulnefs and vivacity.” 
2. Dyfphagia atonica, or the difficulty of fwallowing 
from debility of the mufcles concerned in that aCf, is 
perhaps chiefly diftinguifhed from the other fpecies of 
this genus by the circumftances, that the obftruCtion 
f'eems continual, thus different from the fpafmodic ; and 
that folids are more eafily fwallowed than liquids, which 
does not obtain in the firlt fpecies noticed. It is often 
fympathetic of a morbidly-diftended ftate of the mufcu- 
lar coat of the llomach, dependent on the interrup¬ 
tion of nervous influence. If even idiopathic, it ftiould 
be combated by gentle ftimulants, among which bitters 
perhaps hold the inoft favoured rank. The moft inte- 
refting cafe in illuftration of this difeafe with which u'e 
are acquainted, was publifhed in the 3d volume of the 
Medical Obfervations. The part was preferved in Dr. 
Hunter’s collection. The pharynx was, in the cafe in 
queftion, dilated at its lower extremity, into a pouch of 
confiderable fize, which palled behind the cefophagus. 
This pouch began to be formed in confequence of a 
cherry-ftone having relied there forfome time, which had 
made a kind of bed for itfelf. It remained in that fitu- 
ation for three days, and then was brought up by a vio¬ 
lent fit of coughing. A part of the food always refted 
afterwards in the cavity made by the cherry-ftone, by 
which it was gradually enlarged. At length, in the 
courfe of about five years, the cavity was enlarged into 
a bag of a confiderable fize, fufficient to contain feveral 
ounces of fluid. This bag paffed down a good way be¬ 
hind the cefophagus, and the cefophagus neceffarily ac¬ 
quired a valvular communication with it. In proportion 
as the bag enlarged, this valvular communication would 
become more and more complete, till at length every 
kind of food muft have refted in the bag, and could not 
, pafs into the cefophagus. In this way the perfon was de- 
llroyed. The lower end of the pharynx is, perhaps, the 
only part of the canal where fuch an accident could hap¬ 
pen. The pharynx is not contracted gradually, fo as to 
lofe itfelf infenfibly in the cefophagus, but contrails itfelf 
rather fuddenly at the lower end. Hence a little recefs 
is formed, in which an extraneous body may occafionally 
reft. This is neceffarily at the pofterior part, fo that, if 
the recefs lhould be enlarged into a cavity, it muft pafs 
behind the cefophagus. 
Blifters have been found of ufe in the paralytic ftate of 
the mufcular fibres of the cefophagus; and electricity has 
been found fuccefsful, with the occaflonal ftimulus of 
the probang. The latter means we ffiould ftrongly recom¬ 
mend. 
3. Dyfphagia globofa, the globus hyftericus of Darwin, 
and the nervous quinfey of Heberden, is a difficulty of 
fwallowing from wind in the ftomach, fpafmodically com- 
preffed into the feeling of a ball afcending into the cefo¬ 
phagus, and producing a fenfe of ftrangulation. Irrita¬ 
tion of the nerves appears to be always conceded with 
it. This may be produced, in its firft origin, by the 
many and various caufes acting on the nervous extremi¬ 
ties. In the womb and the alimentary canal, the rnajo- 
rity of thefe caufes are applied ; while in many inftances 
the brain itfelf is primarily and immediately aCted on by 
mental emotion, and propagates through the nervous 
fyftem its difturbed ftate. According, then, to the ftruc- 
ture from the difeafed aCtion of which this phenomenon 
is derived, it is accompanied by the fymptoms peculiar to 
diforders of that ftruCture. Hence the variety of appear¬ 
ances conneCted with this difeafe bid defiance to arrange¬ 
ment, and finuilate, in their proteiform and varying cha¬ 
racter, many of the moft ferious maladies ; and hence our 
plan of cure muft vary according as the ftomach, the 
brain, or the uterine fyftem, is primarily affeCted. 
As far, however, as regards the globus hyftericus itfelf, 
we cannot confider it as any thing but a fymptom of the 
irritation before delcribed. We give oumolologift’s own 
reafon for inferting it, which it will be feen does not at 
all impugn our opinion. He fays; “This (Dyfphagia 
globofa) is by no means a mere fymptom of hyfteria, as 
is often fuppofed ; for it as frequently occurs under the 
influence of various paffions, as grief, fear, and anger; 
and is a frequent attendant upon the hypochondriacal 
diathefis. It is, however, for the moft part, a fympathetic 
affeCtion, concatenating with the ftate of the ftomach.” 
In fpeaking of Dyfpepfia and Hylteria, we (hall detail this 
fubjeft in full: for the prefent we may remark, that, for 
the removal of the mere fymptom, ftimulants of the fto¬ 
mach are the moft appropriate palliatives. 
4. Dyfphagia uvulofa, or fwallowing impeded by elon¬ 
gation of the uvula. This may arife from Ample relax¬ 
ation, from inflammation, or ulceration. It is attended 
with uneafinefs and difficulty in fwallowing, cough,,nau- 
fea, commonly a continual fpitting, (ometimes a difficulty 
of breathing, and a Hammering or faulty articulation. 
There are two varieties, differing as they arife from in¬ 
flammation or from relaxation. In the firft, the uvula is 
fwelled, hot, acutely painful, of a red or livid colour, and 
falls down in an altered form. Sometimes fuppuration 
comes on, and the difficulty both of fwallowing and 
breathing is more confiderable than in the fubfequent va¬ 
riety. When this complaint is very violent, there is ap¬ 
parent danger of ftrangulation. It is cured by bleeding 
and purging ; gargling with fubaftringent liquids, and 
fometimes lcarification. In the feconcl variety, the uvula, 
preferving its natural colour, is relaxed, elongated, pale, 
or cedematous. 
It is remarkable that, on fome occafions, the irritation 
arifing from this elongation of the uvula is only felt when 
the mucous membrane of the ftomach and fauces is in an 
irritable ftate. A medical man applied to an eminent 
leCturer on furgery for the purpofe of having a portion of 
the uvula taken off. The leCturer, who had on (ome 
former cafe remarked the faCt juft noticed, eluded the 
performance of the operation for fome days, and during 
that time directed opening medicines, &c. to be taken ; the 
confequence of which was, that the patient felt in a little 
while no inconvenience from his elongated uvula, al¬ 
though on examination no diminution of its fize was ap¬ 
parent. The treatment of the relaxed uvula confifts in 
the ufe of (limulating and aftringent gargles, and trie 
correction of morbid Hates of the mucous membrane of 
the alimentary canal. When thefe meafures are unfuc- 
cefsful, the extirpation of a portion of the uvula is advif- 
able ; for which, fee Surgery. - 
5. Dyfphagia linguofa, fwallowing obftruCted or trou- 
blefome from magnitude or protrulion of the tongue. 
This fpecies has two varieties : a, exertoria ; ( 3 , ranula. 
In a. exertoria, the tongue is protruded, often with 
enlargement of its fubftance. As an idiopathic and du¬ 
rable 
