Dysphagia

“ If treatment by bougies be attempted in dysphagia arising from such a cause, the practitioner not being aware of the nature of the disease, the fatal issue will be fearfully hastened—a very unpleasant consequence of any practice. ”

“ Symptoms.—Dysphagia, regurgitation, distress after eating, and loss of weight, vary with the degree of the stenosis. The intermittency of the symptoms is sometimes confusing, for the lodgment of relatively large particles of food often simulates a spasmodic stenosis, and in fact there is often an element of spasm which holds the foreign body in the strictured area until it relaxes. Static esophagitis results in a swelling of the esophageal walls and a narrowing of the lumen, so that swallowing is more or less troublesome until the esophagitis subsides. ”

“ DIAGNOSIS.—The diagnosis of organic stricture of the oesophagus rarely presents difficulty. Dysphagia, spasm, and regurgitation are quite characteristic of stricture. When the constriction is high up, the vomiting or regurgitation of food may closely follow its deglutition; when low down, this act may be delayed ten or fifteen minutes, in some cases for hours. Alkaline reaction of the vomited matters is indicative of their having failed to reach the stomach. The presence of blood-cells, pus-cells, and cancer-cells indicates ulceration, suppuration, and malignant disease, respectively. ”

“ Thus, secretion, which in most cases is very slight, glassy grayish, and viscid, is occasionally very abundant, yellowish, or darkish, or more rarely still mixed with streaks of blood and in clumps, though not sticky or dried into scabs, and is sometimes so fetid that the patient's breath is exceedingly malodorous. Cough, which in most cases is either absent or comparatively trifling, barking, or hacking, occasionally is the most troublesome of all the symptoms. Dysphagia is sometimes present even in simple or mild cases. ”

“ Dysphagia after recent diphtheria should suggest paralysis of the esophagus. The larynx, lips, tongue, and pharynx also, are usually paralyzed in esophageal paralysis of bulbar origin. The absence of the cricopharyngeal resistance to the esophagoscope passed without anesthesia, general or local, is diagnostic.
Treatment.—The internist and neurologist should govern the basic treatment. Nutrition can be maintained by feeding with the stomach-tube, which meets no resistance to its passage. Should this be contraindicated by ulceration of the esophagus, gastrostomy should be done. ”

“ When all cases of persistent dysphagia, however slight, are endoscopically studied, precancerous lesions may be discovered and treated, and the limited malignancy of the early stages may be afforded surgical treatment while yet there is hope of complete removal. ”

“ When the ary-epiglottic folds are the seat of the oedema, the patient experiences either suddenly or gradually a difficulty of inspiration, while the expiration may be at first unimpaired, and with increasing sensation of constriction of the throat or of the presence of a foreign body, hoarseness, and stridor, but often without dysphagia, the most threatening paroxysms of suffocation supervene. ”

“ Thirst is seldom absent in fever. It is also usually present in the state of collapse, as from cholera, pernicious intermittent, or the shock of severe (especially railroad) injuries.
Dysphagia or difficulty of swallowing may result from simple debility, as in the moribund state; inflammation of the fauces, tonsils, or pharynx; stricture of the oesophagus; obstruction by a foreign body or by a cancerous or aneurismal tumor; retro-pharyngeal abscess; paralysis of the muscles of the throat, such as sometimes follows diphtheria. ”

“ Soreness of the throat is present in some, but not in all of these examples of dysphagia, being most marked in the inflammatory condition of pharyngitis, tonsillitis, scarlet fever, and diphtheria. Ulceration of the throat should always be carefully looked for, and if present investigated to ascertain whether it is simple, diphtheritic, or syphilitic. We must be careful not to mistake a mere local accumulation of mucus, or aphthous vesicle, or the curd-like formation of thrush or muguet, either for ulceration or pseudo-membranous deposit. ”

“ CHAPTER XXVII—MALIGNANT DISEASE OF THE ESOPHAGUS Cancer of the esophagus is a more prevalent disease than is commonly thought. In the male it usually develops during the fourth and fifth decades of life. There is in some cases the history of years of more or less habitual consumption of strong alcoholic liquors. In the female the condition often occurs at an earlier age than in the male, and tends to run a more protracted course, preceeded in some cases by years of precancerous dysphagia. ”

“ People who dine at uncertain hours, and eat one meal too quickly on the last, must expect the stomach to retaliate in the long run. A very fruitful cause of dyspepsia is imperfect mastication. We remember one old gentleman who used always to warn young people on this point by saying: "Remember you have no teeth in your stomach." Nervous people nearly always eat fast, and as nearly always are the victims of nervous irritability, produced by dyspepsia....To sit much in a stooping posture interferes with the stomach's action. ”

“ Of the causes which concern the organism, nervous influences come first. Bad news may take away all power of digestion and even provoke vomiting, and any worry or mental trouble tends to bring on this condition. General weakness and atony of the body affects the stomach in like degree, and, if the muscles of the abdominal wall be much wasted, they become too weak to support the abdominal viscera in place. Hence results a general tendency for these organs to fall, giving rise to a condition of visceroptosis, of which an obstinate dyspepsia is a very marked feature. ”

“ The symptoms of dyspepsia, even when due to a like cause, are so numerous and diversified in different individuals that probably no description could exactly represent them as they occur in any given case. All that can be here attempted is to mention some of the more prominent morbid phenomena usually present in greater or less degree.
Very briefly, a furred tongue, foul breath, disturbance of appetite, nausea and vomiting, oppression in the chest, pain, flatulence and distension, acidity, pyrosis and constipation or diarrhoea are a few of the commonest symptoms. ”

“ Any accidental impurity of the atmosphere tends to disturb the balance of health. Oxygenation of blood is the object of respiration; and its replenishment is the object of digestion. On the other hand, the digestive secretions, as well as the nervous energy by which they are governed, depend for their perfection upon the perfect state of the blood. For this reason ill-ventilated workshops and crowded sleeping-rooms among the poor, and the overheated and impure atmosphere of assemblies and public places of amusement among the better classes, are constantly acting causes of dyspepsia. ”

“ This faculty is liable to take on a diseased action, and crave a much greater amount of food than nature requires, and hence is the great cause of dyspepsia. Its diseased action may be known by a craving, hankering, gone sensation before eating; by heart-burn, pain in the stomach, belching of wind, a dull, heavy, or painful sensation in the head, and a desire to be always nibbling at something; lives to eat, instead of eating to live, and should at once be erased by omitting one meal daily, and, in its stead, drinking abundantly of cold water. ”

“ Dyspepsia is commonly due to loading the stomach at too frequent intervals; but on the other hand, it not infrequently leads to the taking of insufficient food, because of the discomfort produced. The result of this is that a chronic starvation results, with impaired vital powers. Dyspeptic patients should abstain from pastry and from tea and coffee, except in small quantities. Alcohol in any form, as a rule, does harm. Not uncommonly mastication is imperfectly performed, and a good dentist may cure the indigestion which has resisted all other treatment. ”

“ 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. ”

“ Dyspeptic disturbances are rarely absent during the climacteric period. Most often we see disordered appetite, sluggish digestion, pyrosis, eructation, at times nausea and retching, and actual vomiting of a watery or bilious fluid. Occasionally, an abnormal sensation of hunger follows each meal, associated, however, with a feeling of distension of the stomach. A very distressing symptom is an excessive formation of gas within the intestine. At times such meteorism is extreme, and it then gives rise to very severe abdominal pain. ”

“ By inverting this motion of the stomach and bowels, an effect which may be produced by certain stimulating medicines, for instance, ipecacuanha, as well as by a local irritation of the fauces, it will be easily understood, that either nausea or vomiting will be the natural consequence, according to the different degrees of the stimulus applied.
The viscera of the abdomen are, in common with other parts of the body, liable to a variety of disorders; the most formidable of which, are those arising from inflammation. ”

“ Under the head of the relation of food to the organs may be placed the effects of insufficient mastication. It is a fruitful source of dyspepsia, and is more frequently caused by haste or carelessness, than inevitable from the want of teeth. The great prevalence of dyspepsia in the United States has been attributed to the rapid and characteristic manner in which meals are there dispatched. In some employments the insufficient time allowed for meals is, for the same reason, a cause of disturbed digestion, and too often gives rise to permanent disease. ”

“ But whatever you eat, give your digestion a fair chance.”
“You can digest anything if you use Thingumbob Pills,” observed Mr. Clyde sardonically. “The newspapers say so.”
“That’s the kind of doctrine that makes dyspeptics,” returned Dr. Strong. “The American stomach is the worst-abused organ in creation. Saliva is the true digestive. If people would take time to chew properly, half the dyspepsia-pill fakers would go out of business. If they’d take time to exercise properly, the other half would disappear.” ”

“ The rich properties of the blood are fearfully decreased.
Symptoms.—Stomach and bowels, dyspepsia, nausea and vomiting, or constipation, may precede other symptoms or they may last throughout the case. The onset is gradual and unknown, with gradually increasing weary feeling, paleness and some difficulty in breathing and palpitation of the heart on exertion. There is paleness of the skin and the mucous membranes, the lips look pale, no color. The paleness becomes extreme, the skin often having a lemon yellow tint. The muscles are flabby; the ankles are swollen, you can see the arteries beat. ”

“ Symptoms.—Acrid soapy taste in mouth, burning in throat and gullet, acute pain at pit of stomach, vomiting of bloody or brown mucus, colicky pains, bloody stools, surface cold, pulse weak. These preparations are not volatile, so that there is not much fear of lung trouble. In chronic cases death occurs from stricture of the œsophagus causing starvation.
Post-Mortem Appearances.—Soapy feeling, softening, inflammation, and corrosion of mucous membrane of mouth, pharynx, œsophagus, stomach, and intestines. Inflammation may have extended to larynx. ”

“ Symptoms.—Persons suffering from chronic dyspepsia complain of a bad taste in the mouth, dry throat, nausea, and a feeling of great weight in the stomach for an hour or two after each meal.
Frequently there is no appetite whatever, or it may be even more ravenous than natural because of the irritation and inflammation in the stomach. When the latter is the case, food does not satisfy, and it becomes necessary to eat every two or three hours in order to quiet the gnawing and empty feeling in the stomach. The chronic dyspeptic suffers greatly from nervousness and depression of spirits ”

“ EXCITING CAUSES.—The immediate causes of dyspepsia are such as act more directly on the stomach. They embrace all causes which produce conditions of gastric catarrh, such as excess in eating and drinking, imperfect mastication and insalivation, the use of indigestible or unwholesome food and of alcohol, the imperfect arrangement of meals, over-drugging, etc.
Of exciting causes, errors of diet are amongst the most constantly operative, and of these errors excess of food is doubtless the most common. ”

“ The action of the heart and capillaries is hurried during the papular and vesicular stages; but becomes more equable while maturation is going on. During the former period, the loaded and not unfrequently furred tongue evidences disordered stomach, the cravings of which are for cold drinks. The somewhat laborious respiration may, in some cases, depend on the swelling and soreness of the fauces and pharynx; in others, on the eruption extending along the lining membrane of the larynx; whilst in others, it may be caused by bronchial engorgement. ”