DOI: 10.7925/drs1.ucdlib_280282
title: Stricture of the oesophagus

description: Watercolour medical illustration depicting stricture of the oesophagus. It has the alternative reference number 1354, 9 and P3A on the front. The Richmond Hospital Museum reference is B.b.21. The entry for this in P263/1 pg. 13 reads 'Stricture of the oesophagus. Aet 45. Dr Smith'. The typescript note on the back begins 'Mr R.W. Smith exhibited a specimen of stricture of the oesophagus'.
description: Scope and content: The full typescript note on the back reads 'Mr R.W. Smith exhibited a specimen of stricture of the oesophagus, taken from the body of a man aged 45, who during the present week had died under the care of Dr Kirkpatrick, in the hospital of the North Union Workhouse. He had been admitted into that institution about eight months ago, labouring under some of the symptoms of stricture of the oesophagus; he experienced difficulty in swallowing either solids or fluids, but was not emaciated, nor did he exhibit the aspect of malignant disease. After remaining in the workhouse for some time, he was discharged, but about four months ago he returned. The usual symptoms of stricture of the oesophagus were now well-marked. There was extreme difficulty in swallowing, the deglutition of fluids was peculiarly difficult and painful, and he was emaciated to the last degree. About two months after his second admission the symptoms of pulmonary consumption set in, and it was very remarkable that in proportion as these increased those of obstruction of the oesophagus diminished; and in fact, about a month before the patient's death he could swallow both solids and fluids without any difficulty, but not without pain. The post-mortem examination detected an example of stricture of the oesophagus, arising from a development of scrofulous tubercles between the mucous membrane and the muscular coat of the tube. In the situation which the stricture originally occupied, viz., about two and a half inches above the cardiac orifice of the stomach, an immense cavity was observed; the posterior wall of the oesophagus was wholly destroyed throughout an extent of at least three inches, and the back of the cavity alluded to was principally formed by the front of the thoracic aorta, and the condensed cellular structure of the mediastinum. This cavity communicated with the left lung, a little below its root, and the lower lobe of this organ presented a well-marked example of the third stage of pneumonia. Immediately above the cavity formed by the ulceration of the oesophagus, there existed beneath the mucous membrane of the tube a scrofulous tumour as large as a bean. Softened tubercles and cavities were found in the apex of each lung. Mr Smith observed that the case was interesting as affording an example of stricture of the oesophagus arising from the presence of scrofulous tumours beneath the mucous membrane, a cause of stricture in this situation by no means of frequent occurrence. The disappearance of the signs of obstruction for some months before the patient's death was an important feature of the case, and was to be ascribed to the softening and ulceration of the tumours. The practitioner should, therefore, bear in mind that the subsidence of the symptoms of stricture does not necessarily indicate that the disease is in process of cure; ignorance of this fact might induce him to prognosticate the recovery of the patient at the very time that the disease is rapidly advancing to a fatal termination. Mr Smith remarked, in conclusion, that this was the fourth example which he had seen, in which a communication had been established between a strictured oesophagus and the left lung'.
description: Numbering/sequence: Original reference number: 1354.
description: Date details: This illustration is undated, approximate dates are given based on dates for the entire collection.