1600 ,,,,~.~~~~~~~~~~~~~~~~~~~Ju. A. M. A
1600 LYE PREPtR4TTIONS CLERF Jo.A.2i
3. The marke lipemia often present in diabete dis- low solid foods, and dysphagia for liquids. Five weeks
3. Th e marked lipemia often present in dabetes ds- before admission, the child drank from a pitcher standing
appeared rapidly under treatment. on a window-sill. The pitcher contained a solution of "Red
4. In one case of diabetic coma this treatment had a Seal Lye," which was being used to wash clothes. Roentgen
specific action, promptly restored the patient to con- ray examination by Dr. H. K. Pancoast showed marked con-
sciousness, and abolished glycosuria and hyperglycemla. striction of the esophagus. Esophagoscopy revealed active
5. The necessity of extrene cauition in the use of ulceration of the esophagus, beginning below the cricophar-
this prep>aration muat be ensphasized. yngcus. Retrograde dilation was carried out.
CASE 4.-A youth, aged 18, was referred, Sept. 7, 1921
by Dr. J. C. DaCosta, because of aphagia of six days'
duration. Ten years ago the patient swallowed some "Red
CICATRICIAL STIENOSIS OF THE ESOPHA- Seal Lye." When admitted, he was in a serious state of
GUS CAUSED BY COMMERCIAL LYE water hunger. Gastrostomy was done by Dr. T. A. Shallow
GUS CAUSED BY COMMERCIAL LYE under local anesthesia. Roentgen-ray examination by Dr.
PREPARATIONS * W. F. Manges showed a complete obstruction of the esoph-
agus. On esophagoscopy, a mucosal web stenosis of the
LOUIS H. CLERF, M.D. esophagus was found. This was ruptured by the tube, and
PHILADELPHIA subsequent roentgen-ray study showed a practically normal
esophagus. The patient was discharged well.
Sad cases of esophageal burns from swallowing CASE 5.-A girl, aged 4 years, was referred, Jan. 5,
caustic alkalis continue to be seen at the Bronchoscopic 1922, by Drs. Walter Lathrop and Ira Freyman, because of
Clinic, in various degrees of food and water starvation difficulty in swallowing. About three months before, the
from esophageal stenosis. During the last sixteen child drank from a glass which contained a solution of "Red
months, twenty cases were admittel, a brief synopsis Seal Lye." Severe burning of the mouth and pharynx
of which will be resulted, and she was
giyen. I! :~~~~~.IL : 1. : ;: :: ~~~~~ unable to swallow any
food for many days.
REPORT OF CASES s. L0 Later, liquids could be
taken only in small
CASE 1.-A boy, aged
quantities, and these
3c years, sent o l he
Di e r.t Lrt ce la yx H were often regurgi-
cliIni by ,,61 Lwec tated. On admission,
Lee, Aug. 26, 1921, w55 Ihe patient shswed con-
very ill, markedly ema-
siderable weight loss.
ciated, and could swal-
coisnrd,sud cold 5W5 Dr. W. F. Manges, by
low neitber fond nor
water; even saliva wasd l ed
regurgitated. He tion, found a marked
coughed almost con- sai 5 .
tinuously because of eophagus, which wal
the overflow of saliva e vwrified by esophagos-
cnto the larynx. Hic bI Wm copy. Gastrostomy was
weight was 16 pounds, performed by Dr. T. A.
14 ounces (about 7.7 Shallow, and later a
kg.). Almost eigrht e EN string was swallowed
months before admis nti anfsd retrograde dilation
sion, the child drank begun.
of a solution of "Ster- e Fig. . m-Six of tihe twenty chidren admitted to the Bronchoscopic Clinic during CASE 6.-A man, aged
the last sixteen monthes suffering with stricture of CSe soephagu teds stsig
re~~~~~~~~~~~~~~~~~trorae esophagusfomy stigwaslaredtrug,nrowetpitbingintelwrhrdweeteewa
ling Lye,' found among caustic alkalis put up in packages for household use. In order, from l eft to right, ce 53, came the clini,
Unfortunately~~~~~~~~~~~~~~~~~~~5,th chlcotactdmeals tompicthed byling.Eohospic,buiaewsntttd
ot h e r articles i n a prepr ations accidentally swallowed were: Red eal Lye, Red Devil Lye, Kleanall, March 3 192 ecause
Steriig Lye, Babbitt's Lye and Red Seal Lye. The photograph was taken Marcheo
~sm ~okehouse . There month s fteh adxiss, h th e children were much improsved by treatment. Most Of difficulty in swallow-
was immediate dys- of them were in a pitiable state of emaciation when admitted. ig. About irty-oue
ph a g i a, w h i c h i n- years before, he had
creased, and emaciation became extreme. Gastrostomy was drunk of a bottle containing a solution of home-made lye,
done two months after the accident. On admission, Dr. F. F. mistaking it for a cough mixture. There was severe burning
Borzell, by roentgen-ray examination, found a complete atresia of the mouth and throat, and difficulty in swallowing solid
of the middle third of the esophagus. Esophagoscopy showed foods was noticed. For thirty years he had eaten only liquid
absolute atresia of the esophagus. Communication was even- d smislid fod. Roengn-ray study by Dr. W. F.
ray exainatio, Dr. W F. Mages fond shem eisi nual oswllowan foods. OnRoentgen-ray stuy b D. W F
tually established by perforation by combined peroral and Manges revealed an irregular lumen of the esophagus, the
retrograde esop hag oscopy. A stri ng was carried br thnrrwest point bing in the lowsr third, where here ws
~~~~~~~~~~~~~~~nroetupitbeing ins the lower third, ofhthe theraccesohgs Folwan soh
and retrograde dilation performed, using the Tucker bougie. cunsiderable cunsîriction. Esuphagoscupy vsrified these find-
Unfortunately, the child contractd measles, complicatd by lg. Esophagoscd pi bouginage wa s instiuted.
a severe bronchopneumonia, which terminated fatally. CASE 7.-A girl, agsd 10 yesrs, wss referred, March
by D. MatinJ Farel becu ef * b-lty t l- CASE 7.--A girl, aged 10 years, was referred, March
CASE 2.-A man, aged 39, was sent to the clinie because ut 9, 1922, by Drs. Ayer sud Buif, because ut aphagis. About
s o In 1 l swa 2, 1922, by Drs. Aye and Buffl, because of apaina.bilitytswlo
dysphagia for o solid foods. At the age of 18 mon e drak twenty-to month befor admission, the patient drankfu
from a pitcher containing a lye solution used in making soft a solution ut "Rsd Seal Lys." Severe burus ut the muuth
suap. This lye wss put up lu s lin container; the sud throat, with dysphagia, resulted. During October, 1921,
brand was not remembered. He was very ill for about
braud wes nul Frsmsmbrd He wasS sev vsry i for hadbout aphagia resulted, and gastrostomy was performed. On admis-
sion, the patient was fairly well nourished, underdeveloped
able to eat only soft foods and liquids. On rosulgen- sud unable lu swallow auy foud. On rusutgeu-ray examina-
ray examination, Dr. W. F. Manges fuud Ibres defluite lion, Dr. W. F. Manges fuud practically complete obstruc-
strictures of the esophagus. Esupbagoscupy rsvealsd Ihe lion ut the esophagus. Esophsguscopy revealed a stenusis
uppermost stricture. Esophagoscopic bouginage was insti-
uppermusi striclure. Ecopbagoscopic bougluage waonsîl- utof the upper part of the thoracic esophagus. Following esoph-
CASE 3.-A boy, agsd 6 years, was rsfarred, Sept. 7, 1921, copic bouginage, retrograde dilation was started.
by Dr. Martin J. Farrell, because of inability tl îwal- CASE 8.-A boy, sgsd 5 years, was rlfsrred, March
27, 1922, by Dr. J. J. Reilly, because of inability to swallow
FFrom the Bronchoscopic Clinic, Jefferson Hospital. solids and frequent regurgitation of liquids. About four