Transcriber's Note:
The cover image was created by the transcriber and is placed in the public domain.
| Vol. V | BALTIMORE, MD., MAY 15, 1909 | No. 3 |
The esophagoscope has passed the experimentalstage in the diagnosis and treatment of esophageallesions. Its usefulness has been demonstratedso often that it would seem superfluousto dilate upon its value. Its use, however, is notas general as it should be. There are still thosewho consider esophagoscopy unnecessary or impracticable.At the Presbyterian Hospital wehave had numerous instances of its practicability,and with us it has become the routine practice toexamine all patients complaining of obscureesophageal symptoms. Dr. Chevalier Jackson recordsthe case of a patient whose only symptomwas a lump on swallowing. She appeared to bea neurasthenic, and his advice to have the esophagusexamined was ignored by the family physician.Two months later, with the patient etherizedfor a radical antrum operation, he passedthe esophagoscope and found a malignantgrowth.
Three interesting cases have recently comeunder my observation, and they illustrate so wellthe value of the esophagoscope I shall report themsomewhat in detail. The first patient was seenwith Dr. E. B. Freeman; she was 67 years old.The morning before she came to the hospital,while eating ham, she swallowed a large piecethat had not been sufficiently masticated. Itlodged in the introitus esophagi and remainedthere. When she came to the hospital she hadswallowed neither solid nor liquid food for nearlythirty-six hours. A half hour before examiningthe esophagus she was given a hypodermic ofmorphia and atropia. With the patient in the sittingposition the throat and upper end of theesophagus were anesthetized with 10 per centsolution of cocaine. Jackson's laryngeal speculumwas introduced and the larynx pulled forward.43A large mass resembling somewhat an ulcerativeepithelioma was seen, and proved to bethe piece of ham. Dr. Freeman and I removed itpiecemeal with Pfau's foreign body forceps. Itrequired about forty-five minutes to remove itentirely. The patient stood the ordeal well, andwas able to go home the same afternoon. Forabout a week she had temperature, cough andexpectoration, but ultimately made a good recovery.In this case the esophagoscope probablysaved the patient an esophagotomy. The secondpatient was a female, thirty-three years old, referredto me by Dr. J. F. Chisolm, of Savannah.While at an oyster supper s