Esophageal Atresia goes back as far as the 1600’s

One has only to review case histories as recent as the past decade to find examples where identical symptoms were attributed to such conditions as prematurity, cerebral birth injury or pulmonary atelectasis (a condition in which the lungs of a fetus remain unexpanded at birth) and no thought was given to the possibility of esophageal obstruction.” So, many babies could have been born with esophageal atresia, but because the obvious defect was something else, an autopsy on the baby was not performed, and no one gave thought to esophageal atresia.During the second era, which spanned nearly 300 years (1670-1930’s), there were a number of references of esophageal atresia in the literature. As a parallel, one could say there was a “surgical era” which began in 1888 in which advances and interest in surgery were being made. The first documented case of esophageal atresia in Siamese ( conjoined) twin girls was written by William Durston in 1670, and the first account of esophageal atresia with a tracheo-esophageal fistula was written by Thomas Gibson in 1697. These are both classic contributions, although many would refer to Gibson’s account as the purest. The baby that Durston saw was a very unusual and rare case, being a Siamese twin. Gibson’s experience involved a distal (closer to the stomach) esophageal atresia, which is now considered the most common type.No references of esophageal atresia have been found during the 1700’s. However, another seemingly unrelated incident provided a solution which was later adapted to care for these babies. In 1793, John Hunter suggested providing a substitute for “deglutition”; paralysis of the muscles of deglutition (the act of swallowing), something that could happen to “normal” children as well as adults, in which they lose the motility of the esophagus. He says of a patient who acquired the disease of being unable to swallow, “It becomes our duty to put some artificial mode of conveying food into the stomach by which the patient may be kept alive while the disease continues.” Although John Hunter was not referring specifically to esophageal atresia, it is important to see that the method he suggested and ended up adopting, ultimately became a vital part of the treatment for esophageal atresia…tube feeding.More was written in the 1800’s usually of an esophageal atresia with a fistula connection to the trachea. It seems that more people were independently writing about these anomalies without ever realizing that anyone had seen it before.The first mention of VATER Association, as we know it today, was written by Thomas Hill in 1840 in the Boston Medical and Surgical Journal. “His patient, the newborn infant of Dr. and Mrs. Webster, also had rectal agenesis (failure of an organ or body part to develop or grow) with a recto-urinary fistula.” Hill is given credit for the first description of a combination of anomalies which has recently been encountered since and is presently referred as VATER or VACTERL Association. Hill’s clinical description says, “The infant had been noted to salivate excessively since birth, and with each feeding it would cough, become cyanotic (blue), and regurgitate all its food.” His diagnosis was ’spasmodic stricture’ of the oesophagus (British spelling), and he suggested a warm enema might relieve the spasm. When the nurse attempted to give the enema, she found not even a trace or mark of an anus. The baby died, and autopsy subsequently revealed esophageal atresia with a distal tracheo-esophageal fistula and an imperforate (without an opening) anus with a fistula to the bladder neck.