For the purpose of this paper the data of about
five hundred X -ray examinations have been investigated,
but only those having a particular bearing on
the subject will be classified. In cases where no
direct confirmation is possible,the author has
adopted the following expedient.If the patient did not return to hospital following
a negative X -ray examination (or examinations)
this is considered as substantial proof that the
X -ray report was correct. In no case was oesophagoscopy
deemed necessary when the X -ray report was negative,
and in no such case was an oesophagoscopy performed subsequently. A few cases originally reported
as negative were re- examined,but in none was a foreign body found. The cases may be classified as
follows:-a) In 98 cases,the X -ray report was negative,
and no oesophagoscopy was performed.
b) In 63 cases,the X -ray report was positive,
but the location of the foreign body rendered interference
unnecessary.
c) In 15 cases,the X -ray report was positive,
and the foreign body was confirmed and removed by
oesophagoscopy.
d) In 5 cases,the X -ray report was positive,
but no foreign body was found on oesophagoscopic
examination.
e) In 3 cases,the X -ray report was positive,
and in addition a co- existent organic lesion was
reported. In these,both the foreign body and the
organic lesion were confirmed by oesophagoscopy.
Total number of cases investigated - 184It will be seen from these figures that a complete
X -ray examination as outlined in the foregoing,
performed with due care,gives extremely accurate
results. In only five cases was a needless oesophagoscopy
performed,thus erring on the side of safety,
from the patient's point of view. In no case did the
much more serious error occur of overlooking a foreign body when one was present. A closer analysis of
these five failures (from the oesophagoscopic standpoint)
emphasises the fact that a foreign body may
pass downwards in the interim between the X -ray examination
and the oesophagoscopy,and therefore the
interval should be as short as conveniently possible.
In four out of the five cases (Cases 30,31,33,and 34)
a foreign body was indisputably present at the time
of the X -ray examination,and though not found on
oesophagoscopy,confirmatory evidence in the form of
mucosal injuries was discovered in one of them. (Case
31). In the remaining case,the X -ray examination
raised the possibility of a mucosal injury,bút could
not completely exclude the presence of a foreign
body. As the other evidence was in favour of a foreign
body, an oesophagoscopy was performed but only
a mucosal tear was found,and this was confirmed by
subsequent X -ray examination. (Case 32). Taking these
explanations into account,thersfore,one may take it
that four out of five cases were correctly diagnosed
and that the fifth failed only in being unable to
exclude the presence of a foreign body in the mucosal
tear that was found as reported. This standard of
accuracy seems to the author to justify complete
reliance on the X -ray examination
