After this confession of the extremely small amount of experience in this class of disease possessed by the subscriber, I will proceed to pass comment upon Dr. Woodvine’s paper, with its new ideas and novel methods.
The division of the subject into three classes of constriction is a very natural one, and simplifies the handling of the subject. In the first class, viz., spasmodic constriction, we have almost invariably to deal with a so-called nervous individual. I doubt whether, in many cases, any organic cause for the constrictive spasms can be demonstrated; that is, any actual disease at the seat of the nerve centres from whence co-ordinate motion is controlled.
I am equally unable to demonstrate the absence of such organic lesion, but I believe functional conditions, as, for instance, nerve anaemia, if I may call it so, might easily be a causative factor, as also might its opposite, viz., congestion of the central nerve seat or along its track. Except in the more aggravated cases, where absolute starvation or at least decided emaciation is progressing, I am inclined to be content with the Homoeopathic remedy as I can find it indicated, abetted, perhaps, by the faradic current of electricity applied at intervals. f the cause is central, or at least away from the actual seat of constriction, it appears fair to suppose that remedies might prove more efficacious than local dilatation.
In the use of the improved comes or olive-shaped bougies described by Dr. Woodvine, I should dread very much the possibility of a severe constriction occurring after its passage; and this being then above the butt of the bougie, would make it extremely difficult of removal, perhaps even causing a separation of the whalebone screw-thread, leaving our bougie to deep down to the stomach beyond our reach. This may be an unnecessarily suspected bugaboo, but it would present itself more in such cases then where a fixed organic stricture occurs. There, care should be taken to avoid passing a come too large to readily return. In the spasmodic case this cannot be done, as the extent of the sudden constriction cannot be anticipated.
The treatment by means of bougies is, of course, the rational treatment for organic constriction, especially when nutrition is gravely interfered with.
I contended that in such cases none but an experienced hand should officiate, especially in the inflammatory or malignant cases, owing to the case with which serious damage may be done, aggravating the patient’s discomfort and often shortening his life.
The novel method of applying locally the suitable remedy, as well as for inserting solid food balls by means of the so-called “introducer,” is quite interesting, and I believe in the suitable cases will prove of great value. The instrument, from its description, seems a very ingenious one, and well adapted for its designed use.
In many cases, though I feel we can more readily and with more comfort to our patient apply our local remedy in liquid form, though of course in small quantities, where the constriction is high up in the oesophagus, I doubt whether the suppository would be any better borne than the liquid remedy; and when lower down I am more decidedly inclined to doubt it-of course admitting that the suppository is capable of holding the remedy in contact for a much longer period, if that should be a desideratum.
The most valuable feature of the instrument, to my mind, is the possibility, with it, of depositing solidified masses of meat, etc., beyond the point of construction, then fulfilling the requirements for free nourishment.
The author of this paper admits that he has used his introducer for applying suppositories, etc., to a limited extent only, owing to the fact that suitable cases occur but seldom in a single practice; therefore, much may yet be learned by trial and experimentation with this new method of treating this troublesome and distressing condition. To my mind, there is much that is practical and feasible, in the method and instrument designed, therefore, as described in the paper.
