THE (ESOPHAGUS. 1609 



The deafness often associated with hypertrophied tonsils is the result of adenoid 

 growth in and about the Eustachian tube. The intervention of the soft palate pre- 

 vents direct pressure by the enlarged tonsil upon that canal. Reflex spasmodic 

 cough may follow irritation of the glosso-pharyngeal filaments by inspissated secre- 

 tion within the follicles ; fetid breath often results from the decomposition of such 

 secretion ; epithelial necrosis and denudation render such tonsils a common seat of 

 entrance of various infections, as the tuberculous — emphasized by the frequency 

 with which the cervical glands just mentioned are the first to enlarge in tuberculous 

 adenitis of the neck — or those streptococcic or staphylococcic varieties in which 

 acute arthritis (including many cases of so-called "inflammatory rheumatism") or 

 endocarditis may follow a trifling "sore throat." 



THE CESOPHAGUS. 



The oesophagus or gullet is a musculo-membranous tube, about 25 cm. (10 in.) 

 in length, connecting the pharynx and the stomach. It begins at the lower border of 

 the cricoid cartilage near the disk between the sixth and seventh cervical vertebrae, 

 about 15 cm. from the incisor teeth, and ends below the diaphragm, opposite the tenth 

 (sometimes the eleventh) thoracic vertebra. The entrance into the stomach is marked 

 by a groove on the left of the gullet, best seen when the organs are inflated. There 

 is no line of separation on the right when the parts are unopened. The form and 

 calibre of the oesophagus are very variable and uncertain. Longitudinal folds are 

 sometimes found, especially in the upper part, which give the cavity a star-shaped 

 appearance on transverse section. Often the front wall lies in contact with the back 

 one ; at the lower part, however, there may be a permanent cavity. Constrictions 

 have been described very variously. Probably the most marked occurs at the very 

 beginning, with a diameter of perhaps only 14 mm. There is usually one at the 

 passage through the diaphragm, often one at the point where the arch of the aorta 

 crosses the gullet, and another where the latter goes behind the origin of the left 

 bronchus. Mehnert ^ has described thirteen places, at any one of which there may be 

 a constriction. They correspond to the points of entrance of the arteries, and, accord- 

 ing to him, have a metameric significance. Occasionally the oesophagus is much 

 dilated, the diameter exceeding 3 cm. It is probably constricted in life. After 

 passing through the diaphragm it presents a funnel-like expansion. 



Course and Relations. — Throughout its course the gullet is surrounded by 

 much areolar tissue and frequently sends fibres from its muscular coat to neighbor- 

 ing parts. While following the general direction of the vertebral column, although 

 not closely, below the bifurcation of the trachea the gullet lies i or 2 cm. in front 

 of the spine. Directly after its beginning it inclines to the left, so that soon it pro- 

 jects by one-half beyond the left border of the trachea. We have seen, in a child, 

 the two tubes lie side by side. Just above the bifurcation of the trachea the oesophagus 

 meets the arch of the aorta, which, so to speak, pushes it to the right ; it lies, how- 

 ever, always behind the beginning of the left bronchus, while to a less degree, or even 

 not at all, it is in relation to the right one. Owing to the influence of the aorta, the 

 gullet passes farther to the right; but, leaving the spine, it lies behind the pericardium 

 in a plane somewhat anterior to that of the aorta, and near the diaphragm sweeps in 

 front of the aorta to the left of the median line, passes into the abdomen near the 

 lower border of the tenth thoracic vertebra, and, running very obliquely, presently 

 ends in the stomach. Hardly more than i cm. , which lies behind the left lobe of the 

 liver and in front of the left pillar of the diaphragm, can be said to be subdiaphrag- 

 matic, when examined from without. The line of separation between the oesophagus 

 and the stomach, however, is very clear on the inner surface, owing to the sudden 

 change in the nature of the epithelial lining. There is often a fold on the left of the 

 end of the gullet, usually at the upper and back part, from 2-5 mm. broad, ^ which, 

 perhaps, acts as a valve against regurgitation. The subdiaphragmatic part is about 

 3 cm. long. Sometimes the longitudinal folds of the gullet seem to project into the 

 stomach, but usually it ends in a gradual expansion. 



1 Verhandlung. der Anat. Gesellschaft, 1898. 



^ Berry and Crawford : Journal of Anatomy and Physiology, vol. xxxiv., 1900. 



