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BIOLOGY LIBRARY

CONTENTS VOLUME VI

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PAGE

OCTOBER, 1913. NUMBER 4

NOVEMBER, 1913. NUMBER 5

UNIV. OF

American Journal of Diseases
Diseases of Children

VOL. 6

JULY, 1913

No. 1

THREE TYPES OF OCCLUSION OF THE ESOPHAGUS IN EARLY LIFE*

THOMAS MORGAN ROTCH, M.D.

BOSTON

The following cases of occlusion of the esophagus of non-traumatic origin have been under my care in the wards of the Children's Hospital. The rather unusual occurrence of the condition in my experience and the importance of recognizing which type we are dealing with, on account of prognosis and treatment, are my reasons for reporting them. Considering the rarity of the condition it is to be noted as a coincidence that during Dr. Morse's service, preceding mine, three cases of esophageal narrowing entered the same wards and have been reported by him.

CASE 1.-The first case is that of a boy 25 months old. The labor was normal and the infant was normally developed. He was fed on breast milk for the first seventeen months. From birth he had always vomited, from four to six times daily. The vomiting had always occurred during the feedings and was never forcible. The child gagged or coughed a little and a considerable amount of the feeding would come out of his mouth. Sometimes he vomited just as he began his feeding and the amount then was a great deal more than he had just swallowed. The vomitus consisted of unchanged milk, not curdled or sour, and had no regular relation to the feedings. Sometimes he would retain several feedings and then vomit during the next two or three. He not only vomited breast milk but modifications of cow's milk. He seemed to be always hungry and had to be fed at least twelve times a day. It was found that he vomited less if he had only three ounces given at a feeding. He had always been constipated and he soon became a pale, thin baby.

Physical examination, beginning with the mouth and throat, was negative except for the heart, which was found to be decidedly dislocated to the right, and there was a blowing, systolic murmur, loudest at the base and transmitted to the left axilla. There was no systolic retraction. The urine was normal. Listening with a stethoscope over the epigastrium, when the child was swallowing, a slight splashing sound was heard fifteen to twenty seconds after the mouthful of milk had been swallowed. The sound was like that of a metallic trickling as though the milk came into the stomach by drops. The usual time for liquid to pass into the stomach at this age is five seconds.

A bismuth meal was given and a Roentgen examination immediately made. This showed a narrowing of the lower third of the esophagus extending not quite to the cardia. The esophagus was shown to be a little to the right of the median line and there appeared to be pericardial and mediastinal adhesions. The esophagoscope showed a stricture of the esophagus about 17 cm. from the incisor

*Read at the meeting of the American Pediatric Society, Washington, D. C., May, 1913.

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