Familial Short Œsophagus

Towards the end of 1934 Miss M., a trained nurse aged 53 years, was referred to me for investigation. She gave a history that ever since she started her nursing training she had suffered from bouts of pain, but at first the periods of freedom from pain had lasted as long as six months. The bouts became gradually more frequent, and after a year of rather severe trouble she consulted her doctor. Cholecystography and opaque meal examinations were carried out, with negative results, but during the examination I found a lump in the pelvis which turned out to be a fibroid tumour, and hysterectomy was carried out. The patient was fitter while resting after the operation, but the bouts of pain returned, and a second cholecystography was later carried out which also was negative. Towards the end of 1937 she was seen in consultation by Professor Ryle, who asked me if I would carry out another examination of the œsophagus and stomach, with special reference to the possibility of the presence of a paraœsophageal hernia. Routine examination in the erect, prone, and supine positions, including obliques, failed to show any abnormality, and so the double filling method was tried. After drinking 5 or 6 oz. of opaque fluid the patient was placed in the supine position and rotated to the left. The foot of the couch was then raised about 18 in., and the patient was given a further supply of opaque fluid in a baby's bottle.