This patient was attended by Dr. Watson and myself. But the means which we tried to enable her to retain her food, and to support her expiring strength, had scarcely a temporary effect. She died on the 2d Dec. sixteen days after her admission. The body was carefully examined, at the expressed wish of her relatives.
The unusual appearances found in the abdomen were—1. the smallness of the first part of the duodenum, which was but half the ordinary size of the ileum; 2. the capaciousness and fulness of the gall bladder,—from which, however, on compressing it, the bile flowed readily into the intestine; 3. a contraction of the middle of the stomach of the length of two inches, for which extent the peritoneal coat was thickened and opaque, and the inner membranes folded in deep longitudinal rugæ, the mucous surface of which was partially suffused with circular spots of red. The breadth of the contracted part of the stomach, as it lay collapsed, was an inch and a half.
But it was in the chest that the most remarkable circumstance presented itself. The œsophagus gradually enlarged from the pharynx, which was perhaps rather narrower than usual, to an extraordinary degree of dilatation; the greatest breadth which it attained was situated about four inches above the cardia: the tube then contracted more abruptly, so as to render the termination of the œsophagus, like its commencement, of nearly the usual dimensions. The structure likewise of the cardiac extremity for about an inch, and of the pharyngeal end for about half an inch, was healthy. The intermediate part presented, when inverted, the following curious appearance:—The inner membrane was thickened and opaque, and had the appearance of having partially yielded from dilatation; at the upper part the furrows or thinner parts of the membrane followed in some degree a longitudinal direction; at the lower part the surface was pitted with shallow depressions of various figures. I have represented in the adjoined sketches these appearances, which on the middle of the œsophagus passed from one into the other; at the furrows or depressions the membrane seemed of the natural thickness and colour; the intermediate raised and thickened part was opaque and whitish. The muscular fibres of the œsophagus were of the natural colour and thickness.
I remain, Mr. Editor,
Your obedient servant,
Herbert Mayo.
19, George-street, Hanover-square,
Dec. 6, 1828.