to advert to the obstructions of the œsophagus: no cases of stricture of the rectum are noticed in our reports. The four cases of dysphagia that came under my own care, were all, probably, instances of the scirrhous stricture of the œsophagus; some of them were proved to be so by dissection; and the probability of the cancerous nature of these affections, is certainly increased by the fact that, during the same period of three years, I met with one case of scirrhous cardia, and four of scirrhous pylorus, among the same patients, 1096 in number. This makes the proportions of scirrhous affections of the œsophagus and stomach 1 in 120 nearly. If we reckon the whole cases of dysphagia recorded, as of a scirrhous character, and reckon only three of the cancerous cases included in the report from 1823 to 1833, as having their site in the stomach, (there are only three so named in the report of the physicians, although, possibly, others also included under the general name cancer may have had their site in the same part) we have no less than 33 cases of scirrhous affections of the œsophagus during the seventeen years, being 1 in 231 of the whole medical cases.
It is singular that dysphagia should be regarded, by the old practitioners of the district, as a disease of comparatively recent origin. The three oldest surgeons had each met with a few cases (all fatal) within the last ten years, and they did not remember to have met with any previously. May this fact, for I believe it to be such, be accounted for by the greater prevalence of dyspepsia, consequent on the distress and poverty produced by an increased population
