(ESOPHAGUS. 



761 



being in great part or altogether deficient. In 

 some cases the pharynx does not terminate in 

 a cul-de-sac, but opens by a small orifice at 

 the side of the neck. Another congenital mal- 

 formation more rare than the last consists in 

 the division of a portion of the oesophagus into 

 two canals placed side by side. 



Acquired malformation. One of the most 

 common kinds of acquired malformation is 

 dilatation either general or partial. In the 

 Museum of King's College there is a remark- 

 able specimen of a dilated oesophagus. At each 

 extremity it is healthy and of the natural size ; 

 the intermediate part is enlarged to an extra- 

 ordinary degree of dilatation ; the lining mem- 

 brane is thickened and opaque, and has the 

 appearance of having partially yielded from 

 dilatation. The muscular fibres were of the 

 natural colour and thickness. The dysphagia 

 in this case was as great as in a case of stric- 

 ture.* Dilatation is a common consequence 

 of stricture. In such cases the dilatation 

 usually occupies the whole circumference of 

 the canal. In some rare cases dilatation occurs 

 in the form of a pouch projecting on one side 

 of the canal. Occasionally the mucous mem- 

 brane alone becomes pouched, protruding as a 

 hernia between the muscular fibres, but more 

 commonly the muscular coat also dilates and 

 expands over the pouch. Bleuland mentions 

 a case in which a large pouch containing ali- 

 mentary matters compressed the canal below 

 so as completely to close it, and to prevent the 

 passage of food into the stomach. These 

 pouches are most common at the upper ex- 

 tremity of the oesophagus, probably in con- 

 sequence of the sudden constriction which the 

 canal undergoes at this point, and partly too in 

 consequence of the muscular coat being thinner 

 here than in any other part.f 



Structnral changes. Among the most com- 

 mon are those which result from inflam- 

 mation, which however is seldom idiopathic, 

 but generally the consequence of swallowing 

 irritating substances, hot liquids, the strong 

 acids or alkalies. The effects in such cases 

 vary in degree from slight redness and soften- 

 ing of the mucous membrane, to ulceration 

 and sloughing of the whole circumference of 

 the tube. The Museum at King's College con- 

 tains a preparation of an oesophagus and of a 

 slough discharged from it, which was taken from 

 a young woman who had swallowed oil of vitriol. 

 A week afterwards she brought up a slough 

 having a tubular form, and consisting of the 

 whole lining membrane of the gullet. Some 

 of the muscular fibres were plainly visible on 

 the outside of the slough, in its recent state. J 

 Dr. Baillie gives a drawing of a fake mem- 

 brane lining the pharynx and oesophagus, taken 

 from a patient who had thrush. 



The. oesophagus is very frequently the seat of 

 stricture, the causes of which are various. Not 

 unfrequently it depends on the contraction of 

 a cicatrix after sloughing produced by the con- 



* This case has been fully described by Mr. Mayo 

 in the third volume of the Medical Gazette. 

 f Meckel, Manuel d'Anatomie. 

 | Dr. Watson's lectures, vol. ii. p. 332. 



tact of some irritating agent. The constriction 

 in these cases appears to go on continually in- 

 creasing. Sir C. Bell mentions a case in which 

 starvation was the consequence of stricture of 

 the oesophagus, twenty years after swallowing 

 a quantity of soap lees. Another common 

 cause of stricture is cancerous disease. This 

 is generally confined to the lower extremity, 

 but occasionally it pervades every part of the 

 oesophagus.* A more rare case of stricture is 

 described by Sir E. Home f IP. this case a 

 membranous partition extended across the canal; 

 in the centre of the partition was a narrow 

 passage ; the coats of the oesophagus surround- 

 ing the stricture were but slightly changed. 

 In cases of simple imflammatory stricture all 

 the coats of the oesophagus are thickened and 

 indurated at the seat of stricture, lymph is 

 effused between them, and the bloodvessels 

 are enlarged and distended. In consequence 

 of stricture the oesophagus above becomes 

 much dilated; sometimes ulceration and abscess 

 occur. Dr. Monro mentions a case in which 

 death occurred suddenly in consequence of 

 purulent matter escaping into the trachea. 



Morbid growths are occasionally found in 

 the oesophagus. Dr. Monroj describes the 

 dissection of a man aged 68, in whom the 

 oesophagus was dilated by a large fleshy excre- 

 scence or polypus. It was attached three 

 inches below the epiglottis and reached down 

 to the upper orifice of the stomach. Haller 

 gives an account of the dissection of a man, 

 in whom was found a polypus about seven 

 fingers' breadth long, and of the thickness of 

 a worm, which in its general appearance it 

 very much resembled ; it had a carneo-fibrous 

 appearance, a soft consistence, and a deep red 

 colour. Fttty and steatomatous tumours have 

 occasionally been found in the gullet. In 

 other cases a portion of the canal has been 

 found converted into bone, or cartilaginous 

 tumours have grown from it. 



An aneurism springing from the posterior 

 part of the arch of the aorta may compress 

 the oesophagus against the spine. The imme- 

 diate consequence is difficulty of swallowing 

 and other symptoms of stricture, and at length 

 in many cases ulceration and sloughing of the 

 oesophagus with escape of blood from the aneu- 

 rism either into the mouth or the stomach. 



BIBLIOGRAPHY. Meckel, Manuel d'Anatomie. 

 Cruveilhier, Anatomie Descriptive. Bleuland, De 

 sana et morbosa oesophagi structura. Todd and 

 Bowmun, Physiological Anatomy and Physiology 

 of Man. Miitier, Physiology, by Dr. IJaly. Monro, 

 Morbid Anatomy of the human gullet, stomach, 

 and intestines. Sir E. Home, Practical observa- 

 tions on strictures. Haller, Disputationes ad 

 morbos. 



(Geo. Johnson.) 



OLFACTORY NERVES. See NOSE and 

 SMELL. 



* Monro 's Morbid Anatomy of the Human Gul- 

 let, Stomach, and Intestines. 



f Practical Observations on Strictures, vol. ii. 

 p. 407, 3d ed. 



$ Op. cit. 



Disputationes ad Morb. torn. iii. p. 596. 



