_Lecturer on Laryngology in the University of
Maryland, Surgeon to the Presbyterian
Hospital, Baltimore._
The esophagoscope has passed the experimental stage in the diagnosis and
treatment of esophageal lesions. Its usefulness has been demonstrated so
often that it would seem superfluous to dilate upon its value. Its use,
however, is not as general as it should be. There are still those who
consider esophagoscopy unnecessary or impracticable. At the Presbyterian
Hospital we have had numerous instances of its practicability, and with
us it has become the routine practice to examine all patients
complaining of obscure esophageal symptoms. Dr. Chevalier Jackson
records the case of a patient whose only symptom was a lump on
swallowing. She appeared to be a neurasthenic, and his advice to have
the esophagus examined was ignored by the family physician. Two months
later, with the patient etherized for a radical antrum operation, he
passed the esophagoscope and found a malignant growth.
Three interesting cases have recently come under my observation, and
they illustrate so well the value of the esophagoscope I shall report
them somewhat in detail. The first patient was seen with Dr. E. B.
Freeman; she was 67 years old. The morning before she came to the
hospital, while eating ham, she swallowed a large piece that had not
been sufficiently masticated. It lodged in the introitus esophagi and
remained there. When she came to the hospital she had swallowed neither
solid nor liquid food for nearly thirty-six hours. A half hour before
examining the esophagus she was given a hypodermic of morphia and
atropia. With the patient in the sitting position the throat and upper
end of the esophagus were anesthetized with 10 per cent solution of
cocaine. Jackson's laryngeal speculum was introduced and the larynx
pulled forward. A large mass resembling somewhat an ulcerative
epithelioma was seen, and proved to be the piece of ham. Dr. Freeman and
I removed it piecemeal with Pfau's foreign body forceps. It required
about forty-five minutes to remove it entirely. The patient stood the
ordeal well, and was able to go home the same afternoon. For about a
week she had temperature, cough and expectoration, but ultimately made a
good recovery. In this case the esophagoscope probably saved the patient
an esophagotomy. The second patient was a female, thirty-three years
old, referred to me by Dr. J. F. Chisolm, of Savannah. While at an
oyster supper she attempted to swallow a large oyster, with the result
that she choked for a few seconds and then had a sense of fulness in the
region of the larynx. The next day she had some difficulty in
swallowing, so that she took only liquids. The second day afterward
swallowing was decidedly painful; she grew rapidly worse, until the
fourth day her condition was serious. She reached this city the morning
of the fifth day, with a temperature of 100 degrees and extreme
prostration. The examination of the esophagus was made under ether with
the head in the extended position. No foreign body was found, but the
upper end of the esophagus was red, swollen and edematous, and seemed to
be closed. The patient was given cold milk and ice bags to the throat.
For two days she suffered excruciating pain on swallowing, and it looked
as if we would have to resort to rectal feeding. The next day there was
slight amelioration of the pain, which gradually disappeared. In this
case the esophagoscope enabled us to see at once that a foreign body was
not present, and that the symptoms were due to a severe, acute
inflammation, probably caused by a piece of shell attached to the
oyster.
I was asked by Dr. A. M. Shipley to examine a patient who had been
referred to him for probable cancer of the stomach. The man was sixty
years old and had had some trouble in swallowing for about two months.
Attempts to pass the stomach tube were unsuccessful. The patient was
examined in the sitting position after cocaine anesthetization. No
difficulty was experienced in passing the esophagoscope. About three
inches below the cricoid cartilage the progress of the instrument was
arrested by a tumor partially closing the esophageal lumen. The
esophagoscope showed that the tumor was too low for removal. In this
case the patient can be dilated through the esophagoscope and made more
comfortable for the short time he has to live.