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of swallowing in these cases is due not so much to the stenosis of the carcinoma but to a spasm, the result of the irritation following the attempt to swallow solid food. In many cases the spasm can be prevented by a very simple method and the patient can then swallow with relative facility. The procedure is as follows:
A lavation of the cesophagus is first made with a soft rubber stomach tube inserted to the place of stricture, with not more than 150 grams of water in order to prevent an eventual dilatation of the oesophagus as in most cases the cesophagus is the seat of a more or less pronounced catarrh produced by the stagnation of the food. Then 50 grams of olive oil are poured in and the tube withdrawn during the act of pouring, in order to spread symmetrically the oil over the mucous membrane of the esophagus. In cases of especially severe pain, a four per cent. solution of eucain acts extremely well instead of oil. After two or three minutes the patient can cautiously eat solid food and this food passes down without much difficulty. This method of treatment can be repeated several times a day and always with good effect.
The value of this method consists:
First, it has a great moral effect on the patients. As they are able to eat solid food several times a day, they become hopeful and are no longer terrorized by the thought of carcinoma.
Secondly, the cachexia may be held in check by the increased amounts of food, which is ingested.
The third advantage is, that the duration of time before the gastrostomia can be prolonged. The gastrostomia, however must always remain the ultimum refugium.
With our material it was impossible to determine if the length of life can be protracted by this method. Six patients have been treated in this manner and the following histories illustrate the effect of this treatment.
1. April 4, 1899, G. M., 63 years old, workman, until October, 1898, always enjoyed good health. He ate during this period all kinds of food, but was forced to swallow a mouthful of water after every particle. Since the beginning of this year solid food cannot be swallowed, but only liquid.
The patient has lost thirty pounds in four months. a great eater and always ate very hastily. He thinks that he may have burnt his esophagus by a hot drink.
Status præsens: Markedly cachectic; heart and lungs normal; abdomen strikingly retracted; the urine contains a small quantity of albumen, but no sugar. The patient can barely swallow water, while wheat bread is immediately regurgitated with choking. The soft rubber stomach tube meets with an invincible resistance thirty-seven c.m. distant from the teeth. One finds by the esophagoscope at the same distance a very strong pulsating tumor which is irregular and hyperæmic.
Therapy: After lavation of the cesophagus by which a great deal of mucus is washed out, fifty grams of olive oil are poured in the manner described. The patient is then able to swallow wheat bread with meat without much trouble. The treatment was continued for two months, in which time he lost only three pounds. He swallowed liquid food and after every oil injection, solid food. Unfortunately the patient passed from our observation after this time.
2. July 19, 1899, Bernard B., 50 years old, farmer. In February of this year, difficulty in swallowing began and gradually increased until now he vomits all solid food.
Status præsens: Strikingly cachectic; the tube meets with an obstruction in the region of the bifurcation; lavation of the cesophagus brings out residual milk, raspberries and wheat bread. After an injection of fifty grams of oil he is able half an hour later to swallow wheat bread and eggs.
July 20. Repetition of the procedure. The patient describes himself as "new born."
July 22. The state of health is subjectively excellent. He returns to his native village and is ordered to continue the lavations at home.
July 28. The patient writes that he is very well contented with the state of his health. He is able to swallow coffee, milk, cakes and pork with caution.
The histories of other cases could be added, but they are practically the same. The success of the treatment is in most cases quickly evident and the method may be employed in all cases of carcinoma esophagi.
ARTERIAL TENSION IN CHILDHOOD.
By HENRY L. K. SHAW, M. D.,
The subject of arterial blood pressure in children is one which has not received the amount of attention it deserves.
The reason for this lies partly in the extreme difficulty of determining it in the small rapid pulse of young children. Most of the clinical instruments designed to measure the pulse tension are too complicated and too difficult of applica
tion upon children whose restlessness and uneasiness are so well known to workers in this branch of medicine. Of its importance there can be no doubt, although very little reference is made to the blood pressure in most text books on children's diseases. Baginsky calls attention to the role it plays and says that the determination of the pulse tension is
as important in the pathology of childhood as it is during
A series of experiments were undertaken in the Anna Kinderspital in Graz, Austria, to determine the amount of the blood pressure in health and disease. The Gärtner Tonometer was employed and found to be admirably suited to this purpose. This instrument consists of a small pneumatic ring
connected by rubber tubing with a mercury manometer and rubber ball, the whole being air tight. Pressure on the ball forces air into the pneumatic ring and mercury bulb and the amount is accurately recorded by the manometer. The ring is placed over a phalanx of a finger which has been made
anæmic and a force is exerted on the rubber ball enough to create a pressure in the ring sufficient to compromise the digital arteries. This force is slowly reduced until the pressure exerted by the ring upon the arteries is the same as that of the blood stream upon the ring. The instant this occurs the finger will become hyperæmic and the amount of pressure recorded by the manometer is the same as the arterial tension. The chief advantages of this method lie in the ease and rapidity of application and in the use of the sense of sight in making the determination.
Over four hundred measurements were taken on forty-five children ranging in age from three months to twelve years.
From these experiments it was found that in normal conditions the blood pressure was sufficient to raise the column of mercury from 90 to 110 m. m. Gumprecht* found that with the Riva Rocci sphygomanometer the arterial tension in children was nearly constant at 100 m. m. The age of the child appeared to have very little influence on the amount of
A very small pneumatic ring was employed and slipped over the first phalanx of the thumb or the second phalanx of the middle finger according to the size of the child. The first trial was often unreliable owing to psychical disturbances, fear, suspicion, etc., but when the children found that no pain attended the proceeding they welcomed the experiment as some new kind of game. For an accurate determination it is necessary to have the finger tip perfectly anæmic. This is accomplished by slipping a very small rubber band over the finger tip and rolling it down the finger as far as the joint. In small children it is better to do this before placing the pneumatic ring in position. When the hand is cold it is impossible to obtain a correct reading owing to vaso-motor disturbances. Placing the hand in warm water for a few minutes will easily overcome this difficulty. The pressure in the pneumatic ring was slowly reduced until the finger tip became distinctly pink. This color deepens and in a few seconds becomes an intense red so that there can be no mistake when the right point is reached. Variations in the arterial tension taken on the same patient were frequently observed but were slight and never exceeded ten millimeters. In eleven cases the pressure in the right hand