Treatment
Categories: ESOPHAGOSCOPY FOR FOREIGN BODYSources: A Manual Of Peroral Endoscopy And Laryngeal Surgery
It is a mistake to try to force a foreign body into the
stomach with the stomach tube or bougie. Sounding the esophagus with
bougies to determine the level of the obstruction, or to palpate the
nature of the foreign body, is unnecessary and dangerous.
Esophagoscopy should not be done without a previous roentgenographic
and fluoroscopic examination of the chest and esophagus, except for
urgent reasons. The level of the
the foreign body, can thus be decided. Blind instrumentation is
dangerous, and in view of the safety and success of esophagoscopy,
reprehensible.
If for any reason removal should be delayed, bismuth sub-nitrate,
gramme 0.6, should be given dry on the tongue every four hours. It
will adhere to the denuded surfaces. The addition of calomel, gramme
0.003, for a few doses will increase the antiseptic action. Should
swallowing be painful, gramme 0.2 of orthoform or anesthesin will be
helpful. Emetics are inefficient and dangerous. Holding the patient up
by the heels is rarely, if ever, successful if the foreign body is in
the esophagus. In the reported cases the intruder was probably in the
pharynx.
External esophagotomy for the removal of foreign bodies is
unjustifiable until esophagoscopy has failed in the hands of at least
two skillful esophagoscopists. It has been the observation in the
Bronchoscopic Clinic that every foreign body that has gone down
through the mouth into the esophagus can be brought back the same way,
unless it has already perforated the esophageal wall, in which event
it is no longer a case of foreign body in the esophagus. The mortality
of external esophagotomy for foreign bodies is from twenty to
forty-two per cent, while that of esophagoscopy is less than two per
cent, if the foreign body has not already set up a serious
complication before the esophagoscopy. Furthermore, external
esophagotomy can be successful only with objects lodged
in the cervical esophagus and, moreover, it has happened that after
the esophagus has been opened, the foreign body could not be found
because of dislodgement and passage downward during the relaxation of
the general anesthesia. Should this occur during esophagoscopy, the
foreign body can be followed with the esophagoscope, and even if it is
not overtaken and removed, no risk has been incurred.
Esophagoscopy is the one method of removal worthy of serious
consideration. Should it repeatedly fail in the hands of two skillful
endoscopists, which will be very rarely, if ever, then external
operation is to be considered in cervically lodged foreign bodies.
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The Woman At The Next Desk
IT may be the woman sewing in the next chair; it may be the woman standing next at the same counter; it may be the woman next at a working table, or it may be the woman at the next desk. Whichever one it is, many a working woman has her li... Theory Of Man
Let the question now be raised--What is man? The answer will have much to do with the remedial system which I aim to teach. For this reason it is thus early introduced. My answer to the above question is as follows: Man is a threefold being, comp... There Is Neither A Specific Nor A Prophylactic To Be Relied On
All these different methods and remedies, and many others, have been and are still used with more or less effect. But where there are three physicians to recommend one of them, there will always be four to contradict them. They may all do some good ... Thuya
is a specific when locally used for _Sycosis_, also for fungoid cancerous tumors. I have cured well-marked cases of _Fungus Haematodes_ with the tinct. Thuya applied to the surface of the tumor. The _Thuja Cerate_ is a valuable application for mal... Tissue Forceps
With the forceps illustrated in Fig. 28 specimens of tissue may be removed for biopsy from the lower air and food passages with ease and certainty. They have a cross in the outer blade which holds the specimen removed. The action is very delicate, t... To Mothers
MOST mothers know that it is better for the baby to put him into his crib and let him go quietly to sleep by himself, than to rock him to sleep or put him to sleep in his mother's arms. Most mothers know also the difficulty of getting the... To Prevent Bilious Fever Or Ague
Take _Podophyllin_, _Baptisia_ and _Gelseminum_ 1st in rotation, one dose at night, and if symptoms of fever, as headache and loss of appetite, or bad taste in the mouth in the morning appear, take a dose three times a day, and refrain entirely from... To Prevent Cholera
_Camphor_ (_pellets medicated_ with the pure tincture) _Veratrum_ 3d, and _Arsenicum_ 3d, should be taken in rotation--a dose morning, noon and night, in the order named; so as to take a dose of each every twenty-four hours. If any sense of weakness... To Prevent Colds
Keep the _arms_, _hands_ and _chest_ well clothed and warm. _Affecting_ the _head_ as _catarrh_, or the pelvic regions keep the _feet and ankles warm and dry_. Affecting joints and muscles as Rheumatism--protect the _Spine_ (back) from colds and cur... To Prevent Diarrhoea
Where it is prevailing as an _epidemic_, _Ipecac_ at night, and _Veratrum_ in the morning will often _suffice_. For _teething children_ give _Ipecac_ and _Chamomilla_ in the same manner. ... To Prevent Dysentery
In hot weather when bilious diseases prevail, use _Mercurius_ 3d, _Podophyllin_ 2d, and _Leptandrin_ 1st in rotation, giving one dose a day. In the winter, or when _Typhoid fevers_ prevail, use _Mercurius_ and _Rhus_ tox. alternately a dose every... To Prevent Itch
A dose of _Sulphur_, or rubbing a little flour of sulphur on the hands, will generally suffice. ... To Prevent Scarlet Fever
Give Belladonna at the 3d attenuation, three to six pellets, according to the age of the child, every morning, during the prevalence of the epidemic. This is for the common or mild form of the disease. If the prevailing epidemic is of the _malignant... To Prevent Small-pox
Use _Macrotin_ 1st night and morning, and if nursing or exposed frequently, use it every four hours. ... To Prevent Typhoid Fever
When exposed, as in nursing the sick, take _Baptisia_ 2d, and _Macrotin_ 2d, a dose three times a day. ... To Prevent Yellow Fever
Take _Aconite_, _Belladonna_ and _Macrotin_, 1st in rotation one dose a day. If there is any headache, or pains occur in other parts of the body, or a languid feeling, take a dose twice or three times a day in rotation. ... Tobacco
In spite of the fact that a large number of men today do not smoke, more and more frequently every clinician has a patient who smokes too much. The accuracy with which he investigates these cases depends somewhat on his personal use of tobacco, and ... Tobacco
Smoking, a Senseless Habit. Smoking is the curious act of drawing smoke into the mouth and puffing it out again. Why this custom should have become so widespread is even a greater puzzle than is the drinking of alcohol. In civilized countries at lea... Tolerance
WHEN we are tolerant as a matter of course, the nervous system is relieved of almost the worst form of persistent irritation it could have. The freedom of tolerance can only be appreciated by those who have known the suffering of intolerance and ... Toothache
It is difficult to determine the cause of toothache, and more difficult to select the remedy. It often depends upon decay of the tooth, and exposure of the nerve to air, and contact with food or drinks, or even saliva, which irritate and produce pai... Torpid Liver
Take A D or B D current, full medium force. Treat with N. P. over the liver, at the right side, immediately below the short ribs, and thence backward and a little upward, as far as to the spine, holding P. P. on the left side, close under the ribs, ... Torpid Reaction Asthenic
The more violent the contagious poison, and the weaker the organic power, the less decidedly and the less successfully will the organism combat against the poison, and the more inroad will the latter make upon the system, affecting vital organs and ... Towards The End Of The Period Of Efflorescence When The Rash
declines, fades, disappears, and the skin begins to peal off, an ablution in the morning of cool water, with which some vinegar _may_ be mixed, and a pack and bath in the afternoon, are quite sufficient, except the throat continue troublesome, when a ... Toxic Disturbances And Heart Rate
Under this head it is not proposed to consider disturbances of the heart due to infections, to cardiac disease, or to localized or general acute or chronic disease, but to discuss disturbances due to the absorption of irritants froth the intestine... Tracheobronchial Diphtheria
Urgent dyspnea in diphtheria when no membrane and but slight lessening of the laryngeal airway is seen, calls for bronchoscopy. Many lives have been saved by the bronchoscopic removal of membrane obstructing the trachea or bronchi. In the early sta... Tracheotomy
Indications.--Tracheotomy is indicated in dyspnea of laryngotracheal origin. The cardinal signs of this form of dyspnea are: 1. Indrawing at the suprasternal notch. 2. Indrawing around the clavicles. 3. Indrawing of the intercostal spaces. ... Training For Motion
"IN every new movement, in every unknown attitude needed in difficult exercises, the nerve centres have to exercise a kind of selection of the muscles, bringing into action those which favor the movement, and suppressing those which oppose i... Training For Rest
BUT how shall we gain a natural repose? It is absurd to emphasize the need without giving the remedy. "I should be so glad to relax, but I do not know how," is the sincere lament of many a nervously strained being. There is a regular trai... Trauma
The chief traumatic factors in chronic laryngeal stenosis are: (a) prolonged presence of a foreign body in the larynx (b) unskilled attempts at intubation and the wearing of poorly fitting intubation tubes; (c) a faulty tracheotomy; (d) a badly fitt... Treating With Electrolytic Currents
For decomposing and carrying off unnatural growths, as fistula, ficus, glandular enlargements and other tumors, it is often best to dilute the electrolytic quality of the galvanic current A B with one or both of the Faradaic currents, as by taking A... Treatment
In this rapid high tension age the physician should be as energetic in teaching prevention of arterial hypertension as he is in preventing contagion. As infectious diseases are reduced in frequency, more patients live to die of diseases later in lif... Treatment
If pneumonia or gonorrhea is supposed to be the cause of the endocarditis, injections of stock vaccines should perhaps be used. If the form of sepsis is not determinable, streptococcic or staphylococcic vaccines might be administered. It is still a ... Treatment
The treatment of a suspected coronary sclerosis is the same as that of general arteriosclerosis--primarily the elimination of anything which tends to cause high tension or to produce chronic endarteritis. When either general or local arteriosclerosi... Treatment
The present 100 per cent mortality in cancer of the esophagus will be lowered and a certain percentage of surgical cures will be obtained when patients with esophageal symptoms are given the benefit of early esophagoscopic study. The relief or circu... Treatment
Pedunculated malignant growths are readily removed with snare or punch forceps. Cure has resulted in one case of the author following bronchoscopic removal of an endothelioma from the bronchus; and a limited carcinoma of the bronchus has been report... Treatment
Acute esophagitis calls for rest in bed, sterile liquid food, and the administration of bismuth powder mentioned in the paragraph on contraindications. An ice bag applied to the neck may afford some relief. The mouth should be hourly cleansed with t... Treatment
It is a mistake to try to force a foreign body into the stomach with the stomach tube or bougie. Sounding the esophagus with bougies to determine the level of the obstruction, or to palpate the nature of the foreign body, is unnecessary and dangerou... Treatment
Bronchoscopy should be done in all cases of chronic pulmonary abscess and bronchiectasis even though radiographic study reveals no shadow of foreign body. The patient by assuming a posture with the head lowered is urged to expel spontaneously all th... Treatment Of Acute And Subacute Inflammation And Ulceration Of The Esophagus
Bismuth subnitrate in doses of about one gramme, given dry on the tongue and swallowed without water, has a local antiseptic and protective action. Its antiseptic power may be enhanced by the addition of calomel to the powder, in such amount as may ... Treatment Of Affections Of The Nervous Centres
In affections of the nervous centres, the _brain_, the _cerebellum_, and the _spine_ (see 17-19), the danger which threatens the patient's life is principally averted by the sitz-bath. The nervous system needs support, and the circulation must be re... Treatment Of Broken Compensation
The consideration of this subject will include the following topics: A. Hygiene. B. Diet. C. Elimination. D. Physical measures. E. Medication. 1. Cardiac Tonics: Digiralis, strophanthus, caffein, strychnin. 2. Cardiac Stimulants: Ca... Treatment Of Cicatricial Stenosis
A careful direct endoscopic examination is essential before deciding on the method of treatment for each particular case. Granulations should be removed. Intubated cases are usually best treated by tracheotomy and extubation before further endoscop... Treatment Of Compression Stenoses Of The Trachea
If the thymus be at fault, rapid amelioration of symptoms follows roentgenray or radium therapy. Tracheotomy and the insertion of the long cane-shaped cannula (Fig. 104) past the compressed area is required in the cases caused by conditions less am... Treatment Of Endocarditis
As mild endocarditis rarely occurs primarily but is almost always secondary to some acute disease, its immediate treatment is only a slight modification of that of the disease which is causing it. A complication which is so frequent should always be... Treatment Of Other Eruptive Fevers
The treatment as prescribed for scarlatina in this pamphlet, is applicable also for other eruptive fevers, such as small-pox, varioloids, chicken-pocks, measles, miliaria, urticaria, zoster, rubeola, erysipelas, erythema, &c., its principal feature ... Treatment Of Pseudo-anginas
The treatment of these pseudo-angibas depends, of course, on the diagnosis of the cause, and the cause should be eliminated or modified. If the heart shows real disturbance from this reflex cause, the treatment aimed toward it depends on whether the... Treatment Of Scarlatina Anginosa Or Sore-throat Scarlet-fever
In _scarlatina anginosa_, or _sore-throat scarlet-fever_, which is the most common form of the disease (1-7) we have to discriminate, whether 1) the _reaction is mild_, the heat of the body not being much above 100 deg. Fahr. and the pulse full, b... Treatment Of Scarlatina Simplex Or Simple Scarlet-fever
_Scarlatina simplex_, or _simple scarlet-fever_ (9), without inflammation of the throat, is generally so mild in its course, that it requires little or no treatment. However, I would not have parents look upon it as "scarcely a disease," as neglect ... Treatment Of The Mild Or Erethic Form Of Scarlatina Anginosa
The _mild_ or _erethic form_ of scarlatina anginosa requires about the same treatment as scarlatina simplex. I would, however, for the sake of safety, advise a pack and bath per day, through the whole course of the disease, in the afternoon, when th... Treatment Of The Violent Or Sthenic Form Of Scarlatina Anginosa
The _violent_, or _sthenic form_ of scarlatina anginosa becomes dangerous only through the excess of reaction, when the heat is extreme (upwards of 105 deg. Fahrenheit, sometimes 112 to 114), the pulse can scarcely be counted, as it hammers away ful... Tricuspid Insufficiency
This rarely, if ever, occurs alone; it is generally a sequence of other valvular defects, and represents an overworked, dilated right ventricle. It may, however, occur from lesions of the lungs which impede the blood flow through them. Such are fibr... Tricuspid Stenosis Tricuspid Obstruction
This is rare and probably always congenital, and is supposed to be due to an inflammation of the endocardium during intra-uterine life. In early childhood it is possible that it may be associated with left-side endocarditis. A special treatment o... Trismus Lockjaw
For traumatic trismus, use the B D current, of vigorous force. Let the wound be kept open and clear, except that soothing emollients may be applied. Place N. P. at the coccyx, or near it on the spine; and then treat, by firm but momentary touches of... Troubles Of The Nervous System
The Nervous System is not easily Damaged. The nervous system is subject to a good many more diseases than are either the muscles or the bones; but, considering how complex it is, it is not nearly so easily damaged or thrown out of balance as we usua... Tuberculosis
In the non-cicatricial forms, galvanocaustic puncture applied through the direct laryngoscope will usually reduce the infiltrations sufficiently to provide a free airway. Should the pulmonary and laryngeal tuberculosis be fortunately cured, leaving,... Tuberculosis Of The Esophagus
Esophageal tuberculosis is not commonly met, but is probably not infrequently associated with the dysphagia of tuberculous laryngitis. It may rarely occur as a primary infection, but usually the esophagus is involved in an extension from a tuberculo... Tuberculosis Of The Tracheobronchial Tree
The bronchoscopic study of tuberculosis is very interesting, but only a few cases justify bronchoscopy. The subglottic infiltrations from extensions of laryngeal disease are usually of edematous appearance, though they are much more firm than in or... Tucker Forceps
Gabriel Tucker modified the regular side-curved forceps by adding a lip (Fig. 21) to the left hand side of both upper and lower jaws. This prevents the shaft of a tack, nail, or pin, from springing out of the grasp of the jaws, and is so efficient t... Typhoid Fever
Ulcerative lesions in the larynx during typhoid fever are almost always the result of mixed infection, though thrombosis of a small vessel, with subsequent necrosis is also seen. If the ulceration reaches the cartilage, cicatricial stenosis is almo... Typhoid Fever
This is a dangerous, and with the ordinary allopathic treatment, a very fatal disease. It generally comes on insidiously, the patient feeling a dull head ache, more or less pain in his joints, back and shoulders, with loss of appetite, restless and ... Ulceration Of The Esophagus
Superficial erosions of the esophagus are by no means an uncommon accompaniment of the stagnation of food and secretions. From the irritation they produce, spastic stenosis may occur, thus constituting a vicious circle; the spasm of the esophagus in... Ulcers Case Xxi
Mrs. Butcher, aged 52, has two ulcers a little above the outer ankle, one the size of half-a-crown, the other, of a shilling, of four months duration, which are now in a healing state by the application of cerate and poultice; the healing process is... Ulcers Case Xxii
J. Copeland, blacksmith, aged 38, came to me with many deep ulcerations, from the size of a horse bean to that of a pea, attended with great pain, heat, itching and excoriations of the surrounding skin, obliging him to rest at different times, for s... Ulcers Case Xxiii
Mr. Marshall, aged 60, had a troublesome ulcer under the outer ankle, of an oblong form and of the size of sixpence. He has been long subject to ulcers of the legs, and he had a similar ulcer to the present one in the same situation, some years ago,... Ulcers Case Xxiv
The following case must not be regarded as altogether trifling. For such sores are very apt to spread and to remain long very troublesome. An old gentleman came to me with an oblong ulcer on the shin about an inch in length; it was very painful a... Ulcers Case Xxix
The peculiarity of the present case arose from neglect in evacuating the fluid effused under the eschar the day succeeding its formation, the consequence of which was that the edges of the eschar became raised all round, without however being entire... Ulcers Case Xxv
The following case illustrates the superior efficacy of the lunar caustic over the ordinary modes of treatment in some ulcers of the legs, and will, I trust, be found particularly interesting. Mr. G.B. aged 60, a very tall and stout person, had tw... Ulcers Case Xxvi
The following case occurred in the person of a lady with varicose veins and far advanced in pregnancy. Its speedy cure by the caustic was, therefore, the more remarkable, and saved her much trouble and suffering. Mrs. C. aged 40, had two small ir... Ulcers Case Xxvii
Mrs. Wakefield, aged 36, had an extensive ulceration with excoriation on the upper part of the right breast, of two months continuance; it had been greatly aggravated by improper treatment. I applied the lunar caustic over the whole ulcerated and ex... Ulcers Case Xxviii
Mrs. U. aged 60, has been subject to ulcerated legs for several years. She has one ulcer on the outer ankle of the size of a shilling, and another behind it of the size of a horse-bean; they have been extremely troublesome and under surgical treatme... Ulcers Case Xxx
C. Cocking, aged 17, has an ulcer of the size of half-a-crown on the inner part of the knee, occasioned by an accident. He had been a month under surgical care in the country when he applied to me, but the ulcer continued without disposition to heal... Ulcers Case Xxxi
Mr. S. aged 30, had a sore two inches in length in the groin, the remains of a phagedenic ulcer. It had remained stationary a whole fortnight under the ordinary treatment by bandage. I applied the lunar caustic to form an eschar and then the gold-be...